Pressure ulcer (PU) is currently a significant health problem that affects society and is associated with increased rates of morbidity as well as rising expenditures for the healthcare sphere. The social costs of PU for individuals include pain, decreased mobility, and isolation from the community. In addition, the financial costs of treating the condition are escalating and being measured in billions of US dollars per year. In the United States alone, the incremental hospital costs per patient of treating hospital-acquired pressure injuries are estimated at around US$10,708 and can exceed US$26.8 billion at the national level (Labeau et al., 2020). However, such estimations do not include the additional expenses that patients or the health care sphere encounter once patients are transferred home or if they undergo treatment in a home health setting under the supervision of nurses.
Due to the understaffing and overloading problems that the current sphere of healthcare faces during the COVID-19 pandemic, more patients will be treated within home health settings to increase the number of available beds at hospitals (World Health Organization, 2020). Therefore, nurses must be well-trained inappropriate efforts aimed at preventing pressure injuries, including PUs within the home health setting. Since there has been a lack of attention given to the problem within the defined context, the current proposal has the potential of solving the problem within the shortest timeframe possible. This paper aims to formulate a PICOT question concerning the improvement of treatment and prevention of pressure ulcers among patients who receive care at home.
Statement of the Problem
A pressure ulcer is a common healthcare issue that represents a significant burden for patients while the costs of both prevention and treatment of the problem. At any point in time, around 10% of hospital patients and 5% of community nursing patients are suffering from pressure ulcers (European Wound Management Association, 2019). The prevalence of the condition rates in high-risk institutions can range from 8.8% to 53.2%, with the incidence rate varying from 7% to 71.6% around Europe, the US, and Canada (European Wound Management Association, 2019). Therefore, the problem can vary in scope and impact, and the implications of the high ulcer rates reduce care effectiveness as well as patient outcomes.
Clinical practice guidelines formulated to increase pressure ulcer prevention efforts have been targeting mainly inpatient settings, and there is currently insufficient evidence as to how the guidelines are being adapted to in-home health care use (Bergquist-Beringer & Daley, 2011). In addition, the influence of educational programs and interventions aimed at managing and avoiding pressure ulcers within home health settings has not been studied sufficiently. It is important to compare the implementation of educational efforts aimed at reducing pressure ulcers with no such efforts implemented altogether. The objective of a learning intervention is to lower the rates of pressure ulcers within sixteen weeks with the focus on the home health setting, which has been largely understudied.
In-home health nurses does the implementation of an educational program aimed at preventing pressure ulcers, compared to the rate of pressure ulcers before and after the educational program, reduce the incidence of pressure ulcers within 16 weeks.
Population of Interest
Home health nurses represent the population of interest in the formulated PICOT question that targets PU prevention. Home health nurses provide multi-dimensional home-based care to patients of all ages. The services that they offer are cost-efficient in terms of delivering quality care while also adding to the convenience of being treated at home. Home health nurses develop care plans for achieving goals that are based on the diagnoses of their clients, including preventive, therapeutic, and rehabilitative measures (DeVliegher et al., 2015). Therefore, nurses in a home care context must be well-equipped with information on how to manage such complex issues as PUs.
Intervention of Interest
An educational intervention targeting PUs within the home health setting is an integral part of the condition’s prevention and management. The intervention can include information on the risk factors and the pathophysiology of PU development, possible limitations and potential tools of risk assessment, the measures of skin assessment, the selection of appropriate medical treatment, as well as the definition of roles.
Comparison of Interest
The comparison of interest pertains to the need to juxtapose the rates of pressure ulcers without the intervention (or before the intervention) and with the intervention (or after its implementation). The rates of PUs in home health settings will be compared to determine whether the intervention is effective enough and can continue being carried out in the future. If there is a decrease in the rates of PUs among patients, the health of which is managed in a home setting, the intervention will be considered effective.
Outcome of Interest
The outcome of interest within the defined PICOT question is concerned with the need to reach a significant reduction of pressure ulcer rates in a home health setting over sixteen weeks. It is recommended that home health nurses regularly monitor the outcome, which is represented by pressure ulcer incidence and prevalence rates, at least one or two processes of care, such as skin or diet assessment, as well as the aspects of care that support the best delivery of services. Importantly, nurses should pay attention to whether the rates of PUs are low or improving to ensure that the condition’s management and prevention are effective. Any data collected during the implementation can make a case for the use of an educational intervention.
In conclusion, it is important to note that pressure ulcers present a challenge in care delivery and disease prevention within the context of a home health setting. The condition is complex to address because of the wide range of factors involved in its development and treatment. The formulated PICOT question aims to determine the effectiveness of an educational intervention to prevent pressure ulcers among home health patients within sixteen weeks as compared to not implementing the program. It is expected that an educational intervention will give home health nurses multi-faceted information on how PU should be prevented as well as how it can be managed in the specific outpatient setting. The PICOT question is of particular relevance because the home health setting has been widely overlooked within PU prevention guidelines and recommendations. In addition, the healthcare system is currently overloaded by the need for inpatient care for patients infected with COVID-19 who require emergency care. Therefore, the prevalence of home health care may increase in the nearest future, which makes the current PICOT question highly relevant in the modern context.
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