I feel that these cases may have been prevented had there been, within the Nursing Facilities Policy, a requirement of McGregor PACE nursing staff to assess the skin of all participants within 24 hours of being transferred to, or being discharged from an acute care/or skilled nursing facility, as well as daily while in a facility. Pressure ulcers are among the most common conditions encountered in patients’ acutely hospitalized or requiring long-term institutional care (Berlowitz, 2013, para. 5). In older adults pressure ulcers have numerous detrimental ramifications, including pain, decreased quality of life, longer hospital stays, infection, and risk of death ...view middle of the document...
Even though I am not considered elderly, I fully believe that all patients require a complete physical, mental, social and emotional assessment for the best chance at recuperation and recovery. The skin is the largest organ of the body; it deserves a plethora of attention and care. Patient-centered and quality care are the future of nursing. Nurses must open their eyes and collaborate with multiple disciplines to prevent undue harm to every single patient.
Ethical Principle or Theory
In considering how difficult life can become just through the normal aging process alone, the last setback an older adult wants to encounter is a preventable pressure ulcer. This is why the ethical principle emerging from the above stated discussion is that of beneficence. Beneficence is action that is done for the benefit of others. Beneficent actions can be taken to help prevent or remove harms or to simply improve the situation of others (Pantilat, 2008, para. 1). Providing proper and timely skin assessments, as well as wound evaluation across all health care settings is invaluable as a benevolent action of a skilled nurse. Not only does it allow for the most optimal patient outcomes, it minimizes the cost of additional care needs.
Policy Brief/Community Organization Plan
One must also consider beneficence in evaluating the hierarchical approach to policy making. In a top-down approach the good of the stakeholders is not always taken into consideration. The original Nursing Facilities Policy at McGregor PACE is a prime example of a top-down policy implementation. The Chief Executive Officer and upper level management staff wrote the policy many years ago, and it has been over three years since it has been reviewed. The recent Level Two incidents involving preventable pressure ulcers, begs the question as to whether the new policy should be written from a bottom-up approach instead. Considering McGregor PACE holds one of its core values as improving the quality of life for older adults (McGregor PACE, n.d., p. 1), it would only make sense to involve all stakeholders in policy-making working from the participants upward.
Utilizing a bottom-up approach would allow the interdisciplinary team consisting of health professionals, managers, and participants to work towards a common goal of creating an evidence-based policy regarding skin assessments of those participants being admitted to or discharged from an acute care/or nursing facility. The bottom-up advantage would also recognize that individuals at subordinate levels are likely to play an active part in implementation and may have some discretion to reshape objectives of the policy and change the way it is implemented (Powell, Davies, Bannister, & Macrea, 2009, para. 4). The success of this policy change would lie predominantly within the hands of the nurses, with the most important stakeholders being the PACE participants.
According to the Agency for Healthcare Quality and Research (AHRQ), the...