ReflectiveImprovementPlanforPressureInjury

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Reflective practice is a learning method through critical reflection on everyday experiences and decisions. It is a way for nurses to make sense of their practice and gain a new perspective on their experiences. It helps nurses to reflect on their practice not only in terms of technical competence but also in terms of the ethical and moral dimensions of care. Reflective practice is a process of actively and skillfully analyzing experiences and exploring the implications of thoseexperiences for clinical practice and professional development. This process enables the nurse to use personal experiences to enhance knowledge and improve practice (Koshy et al., 2017). Gibb's reflective cycle is a model of structured reflection first developedbypsychologistandeducatorGrahamGibbsin1988.Themodelisusedtoanalyze experiences and facilitate learning. It comprises six stages: a situation description, feelings, evaluation, analysis, conclusion, and action plan (Wain, 2017).

The Gibbs reflective cycle in nursing is a useful tool to help nurses to reflect on and learn from their experiences. It can be used to understand how one responds to different situations and identify areas for improvement. By using this cycle, nurses can identify strengths, weaknesses, and areas for further development. This can assist with providing better care and achieving better outcomes (Wain, 2017). This essay aims to reflect upon an issue of pressure injury and its prevention and management that needs improvement in acute care settings. Simultaneously, provide in-service education to nurses in ICU to improve the better outcome of managing patients with pressure injuries.

While working at xx hospital as a charge nurse in the intensive care unit, I noticed that the number of pressure injury cases had been increasing daily as per the data collected from the medical record section. A study conducted by Cox et al. suggests that patients

admitted to critical care units are four times more prone to developing more severe pressure injuries (Stages 3, 4, deep tissue pressure injuries [DTPI], and unstageable), compared to other units in hospital settings (Cox et al., 2022). To find out the exact reason behind the increasing number of pressure injuries, I conducted a study among ICU nurses providing a questionnaire about pressure injury and its prevention and management. After the study, I identified that staff needed to gain better knowledge about preventing and managing pressure injuries and implementing strategies that required improvement in my specialty area.

When I learned about the problem of pressure sores in the intensive care unit, I felt disappointed as this issue is a significant problem which can lead to severe injury. I also felt frustrated that more initiatives had not been taken to address the problem. At the same time, I felt a sense of responsibility to improve the prevention and management of pressure sores. I understood the potential consequences of not acting and must look for ways to improve the situation.

Pressureinjuriesareacommonandexpensivehealthcareproblemwithimplications for patient morbidity, mortality, and hospital costs (Rodgers et al., 2021). The good thing about this situation was that increased pressureinjury cases increased awareness within the ICU. The increase in pressure injury cases allowed staff to reassess current prevention protocols,updatepolicies,andreinforcebestpractices.Oneofthebestwaystomitigatethe consequences of pressure injuries is increased awareness of how to prevent them effectively(Awoke et al., 2022). With an increase in pressure injury cases comes greater attention to the issue and, in turn, more education to front-line staff, increasing their knowledge on prevention methods. Additionally, higher numbers of pressure injury cases

have provided a platform for research and collaboration. With the increased incidence of pressure injuries, further research into the area will be ushered in, leading to greater insight into how we can effectively reduce the risk of pressure injuries.

The rise in pressure injury cases also had the downside of causing an increased economic burden on the healthcare system. This was due to the prolonged hospital stays, multiple operations, and additional manpower and resources needed to treat the injuries. This caused a strain on healthcare budgets and potentially limited access to resources and services (Mortada et al., 2020). Furthermore, there was an increased risk of morbidity and mortality for those who had suffered pressure injuries. This was due to the increased risk of infection, impaired wound healing, and, in extreme cases, amputations, sepsis, or even death (Li et al., 2020).

I observed that standard prevention protocols could have been implemented and emphasized to hospital staff to reduce pressure injuries in the ICU and limit further morbidity and mortality in patients. Periodic patient repositioning, proper use of pressure redistribution support surfaces, correct nutrition and hydration methods, and meticulous skin care could have been prescribed and followed. Moreover, In-service education could have been provided to the nurses in ICU.

Pressure injuries, otherwise known as decubitus ulcers or pressure ulcers, are injuries to the skin and underlying tissue that occur due to prolonged or persistent pressure on the skin. These ulcers are most common among people with disabilities, patients who use wheelchairs, elderly individuals, and those with poor nutrition or other chronic health conditions. Pressure sores are typically located on the bony areas of the body, such as the hips, elbows, ankles, tailbone, and heels. They are caused by the skin and soft tissue being deprived of proper blood circulation for prolonged periods, which can lead to tissue death and the formation of painful open wounds (Zaidi SRH, 2022). A study conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia states that patients staying in an intensive care unit have a significantly higher chance of getting pressure ulcers than any other healthcare facility, including long-term care homes, emergency hospitals, home based services, and rehabilitation centers(Mortada et al., 2020). According to Cox et al., patients who are critically ill have an increased susceptibility to developing pressure injuries (PIs) due to the complexity of their medical condition and the use of numerous advanced treatments.

Diabetes mellitus, cardiovascular disease, hypotension, ventilator usage, and the use of vasopressor drugs can all contribute to conditions that reduce oxygenation and circulation, leading to the development of PIs (Cox et al., 2022).

Moreover, research conducted in 10 hospitals in the Wollega zone, Ethiopia, showed that nurses' lack of knowledge about pressure ulcer prevention is one of the main reasons for the increasing number of pressure injuries in hospitals, especially in ICUs (Ebi et al., 2019). Nurses' knowledge is vital in preventing pressure ulcers in the intensive care unit (ICU). ICU staff are responsible for assessing a patient's risk of developing pressure ulcers, providing regular skin inspections and preventative care measures, and promptly recognising and treating existing wounds. Without adequate knowledge, staff may not recognise a patient's risk of developing a pressure ulcer or be unable to provide the necessary preventive care needed to reduce the risk. This increases the likelihood of a pressure ulcer developing, which can cause severe and long-term health consequences for the patient. Other factors that can contribute to inadequate staff knowledge are limited time and resources, lack of attention to detail correct repositioning protocols), and inadequate training (Etafa et al., 2018). All of these can lead to undesirable outcomes, such as increased risk for developing pressure ulcers in the ICU.

Furthermore, healthcare organizations may also play a role in developing Pressure Sores (PI) due to lack of subject matter expertise, heavy workload, and inadequate staffing being a barrier to providing proper care. This lack of expertise and necessary resources can lead to inadequate assessment of a patient's condition, insufficient monitoring, and inadequate risk assessment(Awoke et al., 2022). A study conducted among 240 staff nurses who are working in intensive care units and specialty areas in Wolaita Sodo University Teaching and Referral Hospital showed that nurses' workload and lack of resources also cause pressure injuries in hospitals(Awoke et al., 2022). Furthermore, the lack of necessary staffing can cause strain on remaining healthcare practitioners, leading to missed signs of developing ulcers and the neglect of preventive care practices that could help stop their development. All these factors can worsen PI and put the patient's health at an even greater risk.

To protect against the development of pressure injuries, a comprehensive strategy which combines repositioning, heel elevation, multiple layers of bed linens, nutritional support, and moisture management is necessary. A survey was conducted to evaluate the implementation of pressure injury (PI) prevention strategies in critical care settings in the United States showed that repositioning is a crucial intervention in pressure injury

prevention. It involves changing the position of a person in bed to ensure that pressure is evenly distributed over the contact surface. It should be done every two hours for people at, high risk of developing a pressure injury and every three hours for those at low risk (Edsberg et al., 2022).

In addition to this, elevating the heels helps to redistribute pressure away from vulnerable areas of the body. Using multiple layers of bed linens to distribute weight across the contact surface is essential. This includes a mattress overlay, mattress protector, and top sheet.Itisessentialtoensurethatalllayersremaindryandclean.Nutritionalsupportisvital in preventing pressure injuries. Proper nutrition helps to keep the skin healthy, decrease pressure, and maintain hydration. Keeping the skin dry is another crucial step in preventing pressure injuries. This includes changing bed linens as soon as they become wet or soiled, using absorbent bags or other protective items, and thoroughly drying the skin after bathing orwashing. Additionally, use amoisturizer to keep the skin hydrated (Edsberg et al., 2022).

Moreover, a study conducted in a public hospital in Singapore among 24 nurses suggests that in-service education and training are vital for nursing staff to ensure the PI strategies are carried out correctly and consistently (Teo et al., 2019). Additionally Implementing pressure injury assessing tools like the Braden scale helps prevent pressure injuries in the intensive care unit. The Braden Scale is a clinical tool healthcare professionals use to measure a patient's risk of developing pressure ulcers. The scale assigns each patient a numeric score from a range of 1 (the highest risk) to 23 (the lowest risk) based on six categories: sensory perception, moisture, activity, mobility, nutrition, and friction and shear. The Braden Scale is one of the most used screening tools for predicting pressure ulcer risk and can be used to individualize care plans for those at risk. This could include repositioning the patient, providing support surfaces, and providing external aids such as cushions or forks. The Braden Scale is a valuable tool for healthcare professionals in preventing pressure injuries and providing quality care. (Huang et al., 2021).

Iunderstoodthatitisessentialtoidentifyandaddressriskfactorsassociatedwiththe development of pressure sores to reduce morbidity and mortality associated with the condition. This can be done by implementing effective preventive strategies within medical facilities, including pressure relief techniques, proper nutrition, and regular wound care and assessment of patients. Additionally, education across healthcare teams is vital to ensure all staff know the risk factors and effective preventive strategies.

As an ICU nurse, pressure injuries are something that I have been concerned about in the course of my work. Over the years, I have seen an increase in the number of pressuren injuries that our nurses have to contend with, and it is essential to create an improvement plan to tackle the underlying issues that can lead to these injuries.

There are a few steps that can be taken to implement an improvement plan for the treatment of pressure injuries among ICU nurses. Firstly, I believe that it is important to understand the factors that can cause pressure injuries, such as poor bed mobility, poor hygiene, friction, and immobility. By thoroughly understanding the causes of pressure injuries, we can ensure that nurses are better equipped to prevent them from occurring. I will conduct in service education among ICU nurses. This education programme will help nurses to know more about pressure injury risk factors, prevention strategies, and identification methods through online and in-person training, including didactic lectures, small group discussions, and hands-on demonstrations. I will use computer-based technology or physical simulations of patient scenarios to gain experience in recognizing early signs and symptoms of pressure injury development and practice preventive strategies. Furthermore, additional resources, such as posters and pamphlets, will be available in care units . So that staff can keep themselves informed about the latest developments in pressure sore prevention.

To evaluate the effectiveness of this in-service education plan, I will measure the number of correctly identified pressure injuries in my unit before and after the in-service education programme is implemented. Also, I will conduct surveys by using questionnaires and pressure sore assessment tools to measure nurses' understanding of pressure injury risk factors, prevention strategies, and identification methods. Surveys will be conducted before and after the in-service educational programme to assess the programme's impact. Finally, I will measure patient outcomes related to pressure injuries, such as the number of new pressure injury cases or the number of pressure injuries resolved after implementing the in- service education programme.

In addition to educating staff about the causes of pressure injuries, it is crucial to ensure that nurses are aware of the most effective treatments that can be used to manage them. Implementing appropriate equipment, such as pressure relieving mattresses or cushions, can reduce the occurrence of any pressure injuries that may be sustained. To assess the effectiveness of this plan, it is important to monitor the number and severity of any pressure injuries sustained by patients over time. This should include data analysis regarding the number of pressure injuries acquired the period of time taken for pressure injuries toheal, and any instances of recurrence or worsening of existing injuries. Additionally, feedback from nurses and other healthcare staff on the quality and quantity of effects their use of pressure-relieving devices can offer can help indicate the overall efficacy of the plan.

In addition, I will notify the health care organizations about the nurses workload and lack of resources to improve the outcome of pressure injuries and I will explain them the importance of hiring care giver personnel to provide quality care to the patient.

I will provide evidence-based care to prevent and manage pressure injuries. To ensure quality patient care, I will develop strategies for a systematic organisation-wide approach which incorporates standardised risk assessment tools into regular practice. When pressure injuries are identified, I will make sure that best practice guidelines are followed, and resources are available for their effective management. I will also establish robust audit and data collection systems to evaluate current practices and identify areas for improvement.

Moreover, I will conduct a systematic review of patient clinical records in order to evaluate the frequency and accuracy of documented skin assessments. This audit will also aim to determine the proportion of assessments which are compliant with relevant policies, procedures and protocols. Furthermore, I will be implementing a comprehensive wound managementsystemwhichoutlinesthevariousprotocolsandprocessesforadequatepatient care once a pressure injury has been identified. This system will include the assessment, treatment, monitoring and documentation of any pressure injuries.

Finally, I will engage patients and carers in the development of management plans to provide them with an opportunity to inform the workforce about factors specific to them that may have an impact on the effectiveness of the plan. Furthermore, I will document their involvement in the plan. Additionally, I will provide space for patient feedback as part of the improvement process, in addition to monitoring the completion rate and surveying patient and carer experiences in regard to pressure injury management.

In conclusion, Gibbs Reflective Cycle is a practical tool that can be used in a clinical setting to help practitioners reflect on their experiences and identify areas for improvement. Pressure injuries are a serious problem in intensive care unit and can lead to severe injury and even death. It is essential to identify and address risk factors associated with the development of pressure sores to reduce the prevalence of the condition. Through improving education and training chances, implementing regular monitoring, incorporating risk assessments, and using the most suitable pressure relieving devices for the patient, healthcare providers can dramatically reduce the occurrence of pressure sores in acute care settings as well as improve clinical outcomes and enhance patient safety. Implementing a reflective improvement plan for pressure injuries would provide nurses with the necessary knowledge and resources to accurately diagnose and prevent these lesions. It would also provide healthcare institutions with a more organized and effective approach to reducing the occurrence of pressure injuries, while ensuring that patient satisfaction is improved. Therefore, it is believed that the proposed reflective improvement plan could have a positive impact on the management of pressure injuries amongst bedridden patients.

References

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