Nutritional Interventions in the Prevention and Management of Pressure Injuries in Long-Term Care NUR4036

1. Introduction

Bedsores also referred to as pressure injuries or pressure ulcers, pose a considerable threat to patients well-being and are an important issue in extended care facilities (Hajhosseini et al., 2020). These injuries result from pressure exerted on the skin and adjacent tissues causing damage to the tissues and eliciting a lot of pain, infection, and poor quality of life in the affected individuals. Pressure injuries are impaired, crushed, or otherwise damaged tissues usually from prolonged pressure in different locations (Gefen et al., 2021). These injuries are actions that occur over bony projections such as the spine, heels, and elbows, and are common in the elderly many of whom are confined to their wheelchairs in long-term care facilities. Pressure injuries are now categorized into stages where stage one is non-blanchable erythema while stage four is referred to as full-thickness tissue loss (De Oliveira et al., 2017).

Pressure injury care consists of tactical and medical intercessions targeting the wound and the patients treatment for pain management, and surgery (Hajhosseini et al., 2020). However, nutritional status is one of the important components that influences the prevention of injuries and their recovery (Munoz, 2020). Adequate nutrition aids the skins barrier functioning, promotes wound healing, and influences the clients clinical condition. Thus, the effects of malnutrition include poor skin health, reduced ability to heal wounds, as well as vulnerability to infections (Munoz, 2020). The purpose of this paper is to establish knowledge of how nutritional interventions can affect pressure injury treatment and residents quality of life in long-term acute care (LTAC). Based on this, a research question has been formulated- "How do nutritional interventions impact pressure injuries and overall well-being in patients residing in long-term care facilities?"

2. Discrete Population and Interventions

Population: Patients seen in long-term care facilities who are bed-bound or chair-bound, have medical complications such as diabetes, or are in a weakened state often due to their advanced age.

Issue: Pressure ulcers and their effects on different aspects of patients health and well-being.

Intervention: Nutritional interventions, including:

High Protein Diets: To enhance wound healing and maintain skin integrity.

Micronutrient Supplementation: To supply food containing such necessities as vitamins and minerals for skin health and healing of the skin.

Specialized Enteral Nutrition: Optimized diets to address the modern patients at risk requirements.

Comparison: Oswestry Disability Index (ODI) questionnaire and assessment of quality of life compare different types of nutritional interventions to decrease the prevalence and severity of pressure injury as well as to enhance the patients quality of life.

Outcomes:

Incidence and Severity of Pressure Injuries: Pain felt during pressure injuries and the duration and severity of pressure injuries before and after nutritional interventions.
Rate of Wound Healing: Duration that it takes for pressure injuries to heal.
Quality of Life and Overall Well-Being: Data based on self-recalled life satisfaction and functional status of the patient.
Nutritional Status Indicators: Other indices like serum albumin, BMI, etc.

3. Article Selection Criteria

Inclusion Criteria:

Publication Date: Identification of the articles within the selected journals in the last ten years to keep the research findings as updated as possible.
Population Focus: The paper reviewed in this context included studies that involved elderly patients in long-term care facilities.
Intervention Type: The research focuses on the assessment of nutritional interventions that are preventive or therapeutic for pressure injuries.
Outcome Measures: Studies that describe pressure injury prevalence, risk distribution, and wound healing, as well as the patients quality of life.

Exclusion Criteria:

Language: Articles that are not written in English language.
Setting: Established on samples of patients outside the hospitals.
Relevance: Nomination of studies that are not based on nutrition for pressure ulcer prevention or treatment.
Year of publication: Abstracts of published research papers that appeared before year 2013 were not considered for this study.

4. Approach to Literature Review

To assess the impact of nutritional interventions on patients general health and the prevention of pressure ulcers in long-term care facilities, a systematic review approach was used. This approach was carefully planned so that the evidence is current, balanced, and carried out in a way that can be repeated. Below, the approach is elaborated into detailed stages:

Initial Screening

Database Search: Database search has been done with the help of predefined keywords connected to the nutritional interventions and pressure injuries in the chosen databases (PubMed, CINAHL, The Cochrane Library).
Search terms used included:
"Nutritional interventions"
"Pressure injuries"
"Long-term care"
"Elderly patients"
"Wound healing"
"High-protein diets"
"Micronutrient supplementation"
"Specialized enteral nutrition"

Title and Abstract Review: The suitability of the articles is determined from the titles and abstracts of the articles that were retrieved. Key factors considered include:

Elderly patients with LTAC needs.

Centrality on nutritional interventions and their effect on pressure injuries.

Data Extraction

The phase of data extraction requires the identification of the required data extracted from the included studies and arranged in a standardized manner to enable comparisons to be made.
Study Design and Methodology: Details on the conduct of the study such as the type of study; experimental or observational, and details of data collection and analysis.
Sample Size and Characteristics: All information concerning the study participants such as the total number, their characteristic features such as age and gender, and whether there were any specific criteria for selecting or eliminating some participants.
Intervention Details: Details concerning the actual nutrients that were targeted during the study like the type of diet or supplements that were given in the study and the amounts and the time lengths that these were given.
Outcome Measures: The impact and accuracy of the outcomes reported (e.g., pressure injuries rate, quality of life, nutritional status) is evaluated. Only articles that have passed the quality and relevance test are taken to the review. This phase of the review process helps to filter out studies that have unsuitable or weak methodologies and/or that present unrelated findings.

Data Synthesis

The synthesis phase includes integrating and analyzing the results obtained within the included studies to assess the overall efficacy of the investigated nutritional interventions. This process includes:
A variety of study designs, including qualitative and quantitative studies, randomized controlled trials, cohort studies, and observational studies, are analyzed. Each design provides insights into how different nutritional interventions impact pressure injury outcomes and overall well-being. Key outcomes such as the rate of pressure injuries, nutritional status improvements, and quality of life enhancements are evaluated. The synthesis identifies consistent trends and discrepancies across studies.

Assessment of Research and Quality Improvement

To evaluate the quality of included studies, the following standards were used:
Critical Appraisal Skills Programme (CASP) Checklists: CASP checklists are relevant for evaluating the methodological characteristics of different sorts of studies, including RCTs and other types of cohort experiments (Critical Appraisal Skills Programme, 2020).

5. Results & Findings

The initial systematic search identified 423 citations after the removal of duplicates. After screening titles and abstracts, 223 articles remained. After a full-text examination, 41 studies were included. Based on inclusion and exclusion criteria, 12 studies were included. Finally, after CASP analysis, a total of 4 studies were included in this systematic review including: Navarro and Brody (2023), Munoz et al. (2020), Gielen et al. (2021), Chew et al. (2021). The findings of the selected studies are:

Effectiveness of Nutritional Interventions

High-Protein Diets: Higher levels of protein emphasize the decreased risk of pressure injuries. It was also indicated by Navarro and Brody (2023) that elderly patients taking a high-protein diet had fewer cases of pressure injuries compared to those taking a standard diet. The increase in the quantity of protein ensures the growth of new tissues and maintains skin strength to prevent pressure injuries.

Micronutrient Supplementation: Thus, vitamins A, C, and zinc are critical in the wound healing process due to their micromineral nutrient properties. Munoz et al. (2020) also noted that patients who received micronutrient supplements showed better results on the two parameters than the rest of the patients. It means that on top of two fundamental aspects, collagen synthesis, and the immune system, all the listed nutrients are required to provide effective wound healing.

Impact on Overall Well-Being

Quality of Life: Therefore, the quality of life of neurological patients is greatly enhanced when there is improved nutritional care. Gielen et al. (2021) established that increased nutritional status outcomes were associated with enhanced quality of life and function among the patient population. Thus, nutritional interventions are important not only in the effective prevention and management of pressure injuries but also in improving the clients health status and satisfaction.
Functional Outcomes: This study and other studies that have been done show that nutritional interventions are effective in functional improvement, which is measured in the form of mobility, and care dependency among others. According to Chew et al. (2021), there was enhanced mobility among the target patients and decreased care requirements arising from nutritional interventions. In addition to the restoration of structures, this improvement in the functional status adds to the general health and ability to perform daily activities.

6.Conclusion

Nutritional support is a relevant strategy when it comes to addressing the prevention of pressure ulcers in long-term care settings. Optimally meeting the patients nutritional requirements may help the caregivers promote efficacious wound healing, ameliorate the living standards of the patients, and consequently decrease expenses linked to the formation of pressure injuries. Due to the systematic review approach, it is possible to conduct a comprehensive, stringent, and structured analysis of the available literature source on the topic of the given nutritional interventions and related consequences, such as pressure injuries and changes in general quality of life.

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