The aim of the Healthcare Quality Strategy (HQS) is to deliver excellent healthcare to the citizens of Scotland and brand NHS Scotland as a world leading care provider (Scottish Government, 2010). An improvement intervention examined in the HQS is the prevention of pressure ulcers (PUs). Using the Gibbs (1988) framework, this essay will demonstrate how I was involved in this intervention by applying my skills of compassion, person-centred care and teamwork. I have chosen PU prevention as the subject for this reflection; since, the majority of PUs are preventable (Watret and Middler, 2012) and the cost of treating them ranges from £1,214 to £14,108 (Dealey, Posnett and Walker, ...view middle of the document...
Since, I had previous experience of preventing PUs, I felt confident about being involved in Ruby’s care. However, my mentor, whose supporting role is to guide me in my practice (Royal College of Nursing (RCN), 2007), explained that confident nurses are not necessarily the most skilled (Luhanga, Yonge and Myrick, 2008); therefore, I could still benefit from enhancing my knowledge.
The positive aspect of my experience was that I quickly assessed Ruby using the Waterlow tool, discovering she had a significant risk of developing PUs. Additionally, as a team we successfully prevented her from developing PUs through the use of pressure relieving equipment and the application of the APC; thus achieving the aforementioned Scottish Government (2010) HQS improvement intervention. Moreover, I delivered compassionate and person-centred care, which encouraged Ruby, to have direct involvement in her own care; therefore, also achieving a quality ambition of the HQS.
Identifying an individual’s risk of developing a PU is a fundamental aspect in prevention (NHS Healthcare Improvement Scotland (HIS), 2011). Whiteing (2009) re-iterates the importance of this early risk identification, also declaring that prompt recognition of those at risk is vital. Therefore, NHS Quality Improvement Scotland (QIS) (2009) suggest that individuals should be assessed within six hours of their admission to hospital. The most commonly used tool for assessing PU risk is the Waterlow (Watret and Middler, 2012). However, Chamanga (2010) discusses how the Waterlow can be criticised; since, it is open to judgemental inaccuracies. Consequently, NHS QIS (2009) recommend assessment tools are not used in isolation, but should be used in addition to clinical judgement. In order to promote the Scottish Government (2010) HQS aim of involving individuals in their care, I explained the purpose of the Waterlow and APC tools to Ruby; thus actively involving her in the process. The National Institute of Health and Clinical Excellence (NICE) (2005) also discuss the importance of verbally providing information to individuals who are vulnerable to PUs, suggesting that this can support prevention.
NHS Dumfries and Galloway employ the APC tool as a strategy to reduce the prevalence of PUs (Stevenson, 2011). APC involves regularly checking a patient’s skin integrity, incontinence, repositioning and nutritional intake. However, in order for assessment tools to succeed; all members of the healthcare team must be committed to using them accurately to prevent any adverse consequences (Wharvell and Sheldon, 2013).
The inability of a person to move and re-position their body can increase the chances of friction, pressure and shear; three extrinsic causes associated with PU development (Elliot, 2010). The RCN (2005) discuss the importance of using appropriate pressure relieving apparatus alongside other preventative methods such as regular body rotations, to reduce PU occurrences....