Research Korner: Pain Assessment Tools

Research Study Sample on Nurses’ and Doctors’ Knowledge of Pain after Surgery

1          The first article, “Nurses’ and Doctors’ Knowledge of Pain after Surgery” aims to analyze the links between levels of acute pain management knowledge, perceptions of clinical skills, and the acute pain management education history of doctors and nurses working in orthopedics and general surgery in an acute hospital. This aim of the research is clearly stated in the study. An abstract was also given at the beginning of the study.             Various literature have already emphasized that despite the ideals of professionalism, education and the establishment of acute pain management, some health care practitioners still lack knowledge of pain management and have misconceptions of pain behaviors and pain relief methods, which are not conducive to high-quality care. It must be noted that pain is the most common symptom for which patients seeks help and can reflect either physical or emotional discomfort (The Merck Manual, 1999). Knowledge of pain assessment and management is therefore vital.             To gather data, the researchers structured a questionnaire that was designed to identify professional demographics and educational input, barriers to acute pain management, perceived competence in clinical skills and to test knowledge using an abridged version of a validated questionnaire which was annotated to trust standards.             A convenience sample was taken from one of the three acute hospitals in the trust. It consisted of 101 permanent, trained doctors and nurses from three orthopaedic and two surgical wards. The sample was purposefully selected to coincide with the end of the junior doctors' six-month appointments, when they should have had greatest knowledge of the trust's standards.             An ethics approval to perform the study was not sought since the researchers reasoned out that there were no vulnerable subjects. However, a proposal outlining the study's method of enquiry was registered and scrutinised for scientific worthiness by the trust's research and development department through a process of peer review and supervision. Questionnaires were distributed by hand in sealed envelopes with guidelines on the purpose and objectives of the study. Participant anonymity was assured. In an attempt to reduce bias the respondents were requested not to disclose, discuss or reproduce the questions with anyone else to ensure that the respondents' answers were not influenced by others.             The results identified the most useful sources of acute pain management education and who accessed these; barriers to good acute pain management, other than a lack of education; differences between doctors and nurses in standards of education, levels of perceived competence and knowledge in assessment, pharmacology and analgesic delivery systems.             The evaluation of pain is one of the many physician (Bickley & Szilagyi, 2003) and nursing responsibilities that require effective critical thinking (Potter & Perry, 2004). The patient’s behavioral response to pain relief management and interventions is not always obvious, thus the physicians and nurses must be knowledgeable in observing and knowing patient responses to pain relief interventions and management. 2          The second article is “Nurses’ Knowledge, Attitudes, and Practices: Regarding Children’s Pain” by Catherine Van Hulle Vincent. It aims to describe the knowledge and attitudes of nurses about relieving children’s pain, perceived barriers to optimal pain management, and analgesics administered by nurses in relation to levels of children’s pain. Management of pain is a prime consideration for many health care professionals (The Merck Manual, 1999).             The data used in the study is collected from 67 nurses and 132 children in their care. This is appropriate since from the sample mentioned in the study, the population comprised of children with different racial identities and different sexes. The age of these children ranges from 3.5 to 17 years, experiencing pain of variety. The sample could therefore be considered as a representative of a whole. An approval was obtained from the Behavioral Institutional Review Board at the participating agency. Nurses were recruited and consent was obtained, children who were patients cared for by the sample nurses were recruited, and parental consent for their child to participate and child assent were obtained.             The nurses’ knowledge and attitudes were measured with a 33-item instrument derived from the 37-item Nurses’ Knowledge and Attitudes Survey Regarding Pain. This instrument was used with permission from the original developer. As this instrument has already been used, it is likely that the results from the answers of the nurses would be valid. On the part of the children levels of pain were measured on a scale of 0 to 5 using six photographic scales of the Oucher. The photographs of a child’s face on each vertical scale represent increasing levels of pain. It must be noted that this is more of an observation on the part of the one observing the faces of the children. Misinterpretation could likely occur. The nurse must therefore be aware of possible errors in pain assessment. Using the right tools and methods can help to avoid errors and to ensure that the right pain interventions are chosen. Failure of clinicians to assess a patient’s pain, accept the findings, and treat the report of pain is a common cause of unrelieved pain and suffering (Kozier & Erb, 2004).             The results of the study show that most nurses demonstrated knowledge and positive attitudes about relieving children’s pain but lacked knowledge about the incidence of respiratory depression and thought that children over-repot pain. Inadequate or insufficient physician medication orders for pain were identified by 99% of nurses as the greatest barrier to optimal pain management. Of the 117 children who reported pain, 74% received analgesia. Nurses administered means of 37.9% of available morphine and 22.8% of available total analgesia.             Several pain assessment tools have been developed for children, but these tools have not been consistently used in practice. Similarly, pharmacological and nonpharmacological advances in the management of pain have been documented to be effective, but their use in practice has not been maximized (Puntillo, 1999), as could be seen in the study.             The use of analgesics is the most common method of pain relief. The nurses using this in the study could significantly affect the children’s perception of pain. Although analgesics can effectively relieve pain, nurses and physicians still tend to undertreat the patients because of incorrect drug information, concerns about addiction, anxiety over errors in using opioid analgesics, and administration of less medication than was ordered (Potter & Perry, 2004).          Nurses in practice therefore need to become more aware of the adequacy of their analgesic administration, the value of children’s self-report of pain, and the limitations of relying on children’s behavioral manifestations to judge pain intensity. It is therefore necessary for nurses to understand the drugs available for pain relief and their pharmacological effects on the children. This study also demonstrates the importance of examining attitudes about children’s pain relief and learning more about respiratory depression in children receiving. 3          The third article is “Influences of Patient Behavior on Clinical Nurses’ Pain Assessment: Implication for Continuing Education” by Horbury, Henderson, and Bromley. This study was realized as a result of poor attendance by nurses at inservice sessions discussing pain assessment and management.             The aim of this investigation was to study nurses' intention to treat pain in different patients. The study participants were registered nurses working in the inpatient areas of the Divisions of Surgery, Medicine, and Oncology, including critical care areas in a tertiary Australian teaching hospital. All nurses on the roster for each ward area during 1 calendar month were targeted. Consent was obtained from the Nursing Directors of the participating areas together with ethics approval from the Nursing Research Committee at the hospital. A 10-page questionnaire with eight different patient scenarios was distributed to 886 nurses across all clinical divisions of an acute tertiary facility. A questionnaire, comprising eight vignettes was used. Each vignette described a hypothetical situation and asked the respondents to select a dosage of pain relief medication they would administer. Data were analyzed using descriptive statistics. It was an expectation that further analysis could be undertaken between the different groups within the hospital. However, given the low response rate, there were not significant numbers representative of any specific group to make reliable comparisons. Results indicate knowledge deficits regarding optimum pain relief for patients. These findings support existing literature that nurses do not necessarily accept patients' self-report of pain. They suggest nurses are influenced by patients' age and behavior when rating pain. Nurses were more comfortable accepting the self-report from elderly patients, particularly with a grimacing expression, than from the younger group. However, they were reluctant to administer appropriate levels of analgesia due to fear of respiratory depression. These trends were also consistent with the literature. But nurses must remember that respiratory depression is only clinically significant if there is a decrease in the rate and depth of respirations from the patient’s baseline assessment (Potter & Perry, 2004). The study also mentioned its limitations, that being the sample not a representative of the whole population. But despite that, the findings suggest that a more active role in the provision of education about pain assessment and management to nursing staff is required. This article highlights the need for innovative teaching strategies and approaches in the clinical context to heighten nurses' awareness of their lack of knowledge of pain assessment and management.

Research Study Sample on Nurses’ and Doctors’ Knowledge of Pain after Surgery

1 The first article, “Nurses’ and Doctors’ Knowledge of Pain after Surgery” aims to analyze the links between levels of acute ...

Implementation of Pain Assessment Tools Using Audit and Feedback Strategy

Implementation of Pain Assessment Tools Using Audit and Feedback Strategy   Various assessment strategies for pain are needed in order to provide qualitative and quantitative information because pain is both a sensory and emotional experience. Qualitative assessment refers to the location, duration and characteristics of the pain, while quantitative assessment refers to the evaluation of pain intensity by way of a pain scale. Pain control interventions should be timely, comprehensive and coordinated.[1]   Quantitative pain assessment scales provide reliable measures of pain intensity and can aid in pain management and be easily implemented in an outpatient setting. Routine pain assessment is sustainable over time and its recording of results allows regular reassessment of outpatients.[2]   The recommended best practice for assessment and management of pain include:[3] The daily screening of all persons at risk for pain based on self-reports and care provider reports. The selection of the pain assessment tool for the patient to assess the parameters of pain such as its location, its effect on daily living functions, the medication usage, the  quality of pain and the precipitating factors of pain. The formation of a plan for the pain management of a patient in collaboration with an  interdisciplinary team. The selection of the appropriate individualized analgesics to be administered to the patient. The monitoring of a patient’s analgesic medication for any side effects. The documentation of all pharmacological interventions in a patient’s pain record.   The best available evidence should guide the best practice of pain assessment.[4] The recommended grades based on the required strength of the evidence are as follows:[5] A – requires the inclusion of at least one randomized trial B – requires the conduct of clinical studies without randomized trial C – requires evidence from experts’ reports or opinions and/or        clinical experiences.   In the implementation of pain assessment tools, the following can be used a guide:[6] A model of behavior change can be used to develop the strategies for implementation. A combination of strategies can be used to influence practice change because no one intervention works in all cases. The organizational environment has to be considered in designing implementation strategies.   The validated tools for quantitative pain assessment include the following:[7] The Visual Analogue Scale (VAS), which provides for  the indication of pain intensity on  a 10 cm. line with no pain and pain as bad as it could possibly be on opposite ends. The Numeric Rating Scale (NRS), which provides for the rating of pain on a 0 to 10 scale. The Verbal Rating Scale (VRS), which provides for the indication of pain using verbal descriptions on a scale from no pain to worst possible pain. Facial Grimace & Behavior Checklist Flowcharts, which provide facial expression illustrations and behavior descriptions for the scoring of levels of pain. 	   	 		 		 		 		 		[1] “Assessment of Pain”, Cancer 		Pain Management in Children, 1994, 		<http://www.childcancerpain.org/frameset.cfm?content=assess01> 		[accessed 27 April 2011] 	 		 		 		 		 		[2] Deborah J. Rhodes et al, 		“Feasibility of Quantitative Pain Assessment in Outpatient Oncology 		Practice”, Journal of 		Clinical Oncology, 2001, <http://jco.ascopubs.org/content/19/2/501.full> 		[accessed 27 April 2011] 	 		 		 		 		 		[3] “Assessment & Management of 		Pain”, Nursing Best Practice Guideline, 2007, 		<http://ltctoolkit.rnao.ca/sites/ltc/files/resources/pain/RNAOBPG_Pain_and_Supp.pdf> 		[accessed 27 April 2011] 	 		 		 		 		 		[4] ibid 	 		 		 		 		 		[5] ibid 	 		 		 		 		 		[6] ibid 	 		 		 		 		 		[7] “Appendix E: Tools for 		Assessment of Pain”, Nursing Best Practice Guideline, 2000, 		<http://ltctoolkit.rnao.ca/sites/ltc/files/resources/pressure_ulcer/AssessmentTools/RNAO_pg83t84_ToolsPainA.pdf> 		[accessed 27 April 2011]

Implementation of Pain Assessment Tools Using Audit and Feedback Strategy

Implementation of Pain Assessment Tools Using Audit and Feedback Strategy Various assessment strategies for pain are needed in orde...

Risk Management

Introduction Within the myriad of incidents that occur in a healthcare organization a small, but significant, number result in avoidable death or life long injury to either patients or members of staff. Creating a framework to review such incidents, learn from them and institute appropriate improvement strategies is central to any risk management strategy. As well as defining what constitutes a serious event in multi professional teams, occupational health departments and staff side committees there are also considerable learning outcomes to be gained from assessing those incidents that do not have tragic consequences for the affected parties. Some, although not defined as serious, may highlight significant risk potential for a local health provider, including loss of public confidence, loss of ability to provide a service and adverse publicity Within the health economy there is clear value in 'taking a second look' at all incidents that do not result in severe harm, as part of the overall safety and quality improvement process. Using a risk assessment tool can help provide a structured management framework to evaluate each incident and assign clear accountability for actions and learning, post event. Instituting a systematic approach to the risk assessment of incidents that do not result in tragic harm (life long injury or death) delivers significant benefits. It enables organizations to introduce clearly defined levels of accountability for action and learning from adverse events and the identification of potential future disasters. It also aids in the exploration of quality and safety failures before anyone is hurt and the development of a safety culture Local teams and organizations can demonstrate 'due process' in their decision making and this would also lead to the introduction of qualitative analysis within the incident management process and the systematic determination of which events deserve closer review. Risk Assessment and Prevention of Pressure Ulcers               Pressure ulcers, also known as pressure sores, bedsores and decubitus ulcers, are areas of localized damage to the skin and underlying tissue. This damage is generally a result of external forces – pressure, shear and/or friction. Pressure ulcer development occurs in institutional and community settings, and is most often seen in elderly, debilitated and immobile (e.g., orthopaedic) clients, those with severe acute illness (e.g., those in intensive care units) and in individuals with neurological deficits (e.g., spinal cord injuries) ( 1995).             The high prevalence of pressure ulcers is a significant health care concern. A recent study reported by  (2004) reviewed data that surveyed over 14,000 patients from 45 health care institutions across Canada, and estimated the prevalence of pressure ulcers as follows: Acute Care Hospitals: 25.1% Non-Acute Facilities (Long-term care, Nursing Homes, etc) 29.9% Mixed Health Care Facilities (acute and non-acute) 22.1% Community Care 15.1% Overall, the estimate of the prevalence of pressure ulcers in all health care institutions across Canada was 26.2%. This data suggests that pressure ulcers are a significant concern in all health care settings in Canada (2004). Estimates have indicated that up to 10% of those admitted to hospital develop a pressure ulcer, the elderly being at the highest risk with approximately 70% of all pressure ulcers occurring in elders (2002). In those individuals who develop pressure ulcers, approximately 60% occur in the acute care setting – usually within the first two weeks of hospitalization (1989). With the increased acuity of those admitted to hospital, it is estimated that 15% of elderly patients will develop pressure ulcers within the first week of hospitalization ( 2002). In the long term care setting, pressure ulcers are most likely to develop within the first four weeks of admission ( 1992). Malnutrition is a significant problem for the elderly, and is a risk factor for the development of pressure ulcers. Rates of malnutrition in the institutionalized elderly are estimated to affect 23-85% of the population, while the rate for those being admitted to hospital is estimated to range from 20-50%. Pressure ulcer risk increases by 74% with the combination of immobility, stress to the immune system and loss of lean body mass (muscle) (2004).             Mortality is associated with pressure ulcers – several studies have reported mortality rates as high as 60% for elders with a pressure ulcer within one year of discharge from hospital. The pressure ulcer is not generally the cause of death, but rather it develops after a decline in the health status of the older person (2002).  The burden of pressure ulcers and their treatment impacts on quality of life for the client and family, but also creates significant financial strain for those living with a pressure ulcer, their families, and the health care system. Costs associated with the treatment of pressure ulcers in the United States have been conservatively estimated to be $500 to $50,000 (US) per ulcer, with more severe wounds being significantly more expensive to manage than less severe ulcers (2001). AHCPR (1992) estimated that the total national cost (United States) for pressure ulcer treatment was at that time $1.3 billion dollars (U.S.) annually and rising. Although there is no comparable Canadian data related to national costs, the (2004) reported on a study conducted in the late 1990s that estimated the cost of treating an individual with a pressure ulcer within a long term care facility to be an average of $24,050 for three months of treatment. Similarly, a recent case study ( 2004) estimated the total cost for 12 weeks of treatment in the community, including electrical stimulation, to be $27,632. These costs, however, do not address the burden of pain and suffering and the impact on the individual’s quality of life.   Risk Assessment Outline for Pressure Ulcers                         Early intervention is essential for those at risk of developing pressure ulcers. The principle components of early intervention are outlined as follows: (1) Identification of at-risk individuals who need preventive interventions and of the specific factors that place them at risk (2), protection and promotion of skin integrity (3),  protection against the forces of pressure, friction and shear and (4) reduction of the incidence of pressure ulcers through educational programs for health professionals and clients.   Practice Recommendation for Risk Assessment             A head-to-toe skin assessment should be carried out with all clients at admission, and daily thereafter for those identified at risk for skin breakdown. Particular attention should be paid to vulnerable areas, especially over bony prominences. As pressure ulcers usually develop over bony prominences, it is recommended that these areas be the focus for assessment (1992;  2000; 2000; 2001). Skin inspection should be based on a head-to-toe assessment of those areas known to be vulnerable for each patient. These areas typically include the temporal region and occiput of the skull, ears, scapulae, spinous processes, shoulders, elbows, sacrum, coccyx, ischial tuberosities, trochanters, knees, malleoli, metatarsal areas, heels, and the toes. In addition, areas of the body covered by anti-embolic stockings or restrictive clothing, areas where pressure, friction and shear are exerted during activities of daily living, and parts of the body in contact with equipment are also considered vulnerable. Additional areas should be inspected as determined by the individual’s condition ( 2001;  2001). The client’s risk for pressure ulcer development is determined by the combination of clinical judgment and the use of a reliable risk assessment tool. The use of a tool that has been tested for validity and reliability, such as the Braden Scale for Predicting Pressure Sore Risk, is recommended. Interventions should be based on identified intrinsic and extrinsic risk factors and those identified by a risk assessment tool, such as Braden’s categories of sensory perception, mobility, activity, moisture, nutrition, friction and shear. Risk assessment tools are useful as an aid to structure assessment. In order to determine the client’s level of risk, the AHCPR guideline (1992) recommends the use of a standard risk assessment tool. The Braden Scale and the Norton Scale have been tested sufficiently for reliability and validity to be useful adjuncts to nursing assessments and care planning. The Braden Scale has good sensitivity (83-100%) and specificity (64-77%), while the Norton Scale has a sensitivity of 73-92% and specificity of 61-94%. Positive predictive values are documented as: – approximately 40%;  – approximately 20% ( 2002).             Frequency of Risk Assessment Although the optimum frequency of risk assessment has not been substantiated in the literature, there are clinical standards that are widely accepted and reported. It has been noted that the majority of pressure ulcers develop within the first two weeks after admission to a facility (1996). One prospective study of new admissions to a nursing home over three months showed that of those who developed pressure ulcers, 80% did so within the first two weeks and 96% did so within three weeks ( 1992). These results support the need to identify those clients “at risk” for developing pressure ulcers early in their care, preferably on admission. The literature also supports reassessments for “at risk” individuals ranging from daily to weekly, however, many sources agree that whenever a client’s condition changes, reassessments should be conducted (2000;  2000;1996;  2001;2000).  (2001) suggests that the frequency of risk assessments should be based on the findings of the initial admission assessment and the rapidity of the client’s change in health status. Ideally, the client should be assessed for risk on admission, again in 48 hours and as often as the level of morbidity indicates. In addition,  (2001) makes recommendations for assessment of specific populations according to the following schedules: (1) Long-term care facilities – At admission, then every week for four weeks and quarterly thereafter.  (2)Intensive Care Units – Daily. (3)General medical/surgical units – Every other day. (4)Community – Every home visit.   Intrinsic/Extrinsic Risk Factors in Pressure Ulcers               The determination of risk for pressure ulcer development is established by the combination of the use of a reliable risk assessment tool and clinical judgment. There is discussion in the literature regarding the need to look beyond assessment tools in considering risk, as the development of pressure ulcers may be influenced by factors not addressed within these tools. The potential to develop pressure ulcers may be influenced by intrinsic risk factors that relate to aspects of the client’s physical, psychosocial or medical condition. These factors should be considered when performing a risk assessment, and include nutritional status (malnutrition and dehydration), reduced mobility or immobility, repetitive stress syndrome (involuntary movements), posture/contractures, neurological/sensory impairment, incontinence (urinary and fecal), extremes of age, level of consciousness, acute illness, history of previous pressure damage, vascular disease, and severe chronic or terminal illness (1998; 2000;  2002; 2001; 2000). Extrinsic factors derived from the environment can also influence the development of pressure ulcers. These include factors such as hygiene, living conditions, medication, pressure, shearing, friction, garments, transfer slings, restraint use and the support systems used to relieve pressure (1998; 2000; 2001; 2001; 2000). Clinical assessment of all factors that increase the client’s risk for skin breakdown must be considered to facilitate early identification of those at risk. All data should be documented at the time of assessment and reassessment. Proper documentation provides an accurate record of a client’s progress and risk status. Any skin changes should be documented immediately, including a detailed description of what was observed and what actions were taken (RCN, 2000) and should be made accessible to all members of the health care team (2001). The literature addresses the need for the use of clinical judgment, in conjunction with a recognized risk assessment tool, in the identification of risk (2000;1998; 2000). Both the development and revision panel strongly support the need for clinical nursing judgment in conjunction with the overall client profile as a basis for determining risk and planning of appropriate care. This recommendation is based on current practice, clinical experience and opinion.   Intervention Voluntary and involuntary movements by individuals themselves can lead to friction injuries, especially on elbows and heels. The use of products to minimize contact with surfaces (including bed linens) can reduce the potential for injury (1992;  2000;  2003). Use turning devices such as sheets, trapezes, or manual or electric lifts that will decrease the risk of skin damage (1992;  2000). After using turning equipment, slings, sleeves or other components of the device should not be left underneath the individual after repositioning (2001). Consider the impact of pain. Pain may decrease mobility and activity. Pain control measures may include effective medication, therapeutic positioning, support surfaces, and other nonpharmacological interventions. Monitor level of pain on an on-going basis, using a valid pain assessment tool. Consider also the client’s risk for skin breakdown related to the loss of protective sensation or the ability to perceive pain brought by analgesics, sedatives and neuropathy, and to respond in an effective manner with it and the impact of pain on local tissue perfusion. Pain is a factor that may result in decreased mobility in clients who are dealing with chronic conditions such as arthritis, multiple sclerosis, cancer, and musculoskeletal injuries. Any decrease in mobility as a result of such pain may increase the risk for the development of pressure ulcers. At the same time, however, analgesia and sedatives may depress the central nervous system. This may result in reduced mental alertness, activity and mobility, thereby altering the individual’s ability to respond effectively to ischemic pain ( 2003).   A systematic review conducted by (2004) examined to what extent pressure-relieving surfaces reduced the incidence of pressure ulcers compared with standard support surfaces, and reviewed how effective different pressure-relieving surfaces were in preventing pressure ulcers, compared to one another. It was concluded, from the 41 randomized controlled trials included in the review, that in those at high risk of pressure ulcers, the use of a higher specification foam mattress (low interface pressure) should be considered rather than the standard hospital foam mattress. Standard hospital mattresses have been consistently outperformed by a range of foam-based, low pressure mattresses and overlays, and also by “higher-tech” pressure-relieving beds and mattresses in the prevention of pressure ulcers. Clients at very high risk of developing pressure ulcers may benefit from an alternating pressure mattress or other high-tech pressure redistributing systems ( 2000; 2000). Alternating pressure devices generate alternating high and low interface pressures between the body and support surface (bed), usually by alternate inflation and deflation of air-filled cells. These devices are available as mattress overlays, and single or multi-layer mattress replacements. The systematic review conducted by  (2004) indicates that the relative merits of higher-tech constant low pressure and alternating pressure for prevention are unclear.  (2001) outlines criteria and selection modalities for the use of support surfaces in the prevention of pressure ulcers. Regardless of the type of surfaces used for high-risk clients, thorough and frequent skin assessments should be conducted for evidence of tissue damage (2004; 2003). Clients experiencing surgery are at risk for development of pressure ulcers because of factors that cannot be controlled – length of procedure (2002), hemodynamic state and the use of vasoactive medications during surgery. There are, however, many risk factors that can be controlled to reduce the incidence of pressure ulcer development, including pooled prep solutions, negativity, shearing, friction and the use of warming blankets beneath the client. Another factor that can be controlled in order to decrease pressure ulcers is the surface on which the person is placed during the surgical procedure ( 2001;  2003). Wet skin is fragile and more susceptible to friction and tearing injuries, especially during cleansing. Moist skin also has a tendency to adhere to bed linens, potentially leading to damage when linen is removed. In addition, it is more susceptible to irritation, rashes and infections, such as candida. When the source of moisture cannot be controlled, use of protective barriers and moisture absorbing products are recommended. Absorbent pads, dressings or briefs should be changed as they become saturated, rather than delaying until they reach their absorptive capacity. These products should not interfere with any pressure-redistributing surface an individual may be placed on ( 1992;2000; 2000). When skin is moist from perspiration, cotton linens are recommended to promote evaporation, skin aeration and faster drying. Frequent changing of moist linens is recommended to maintain dry intact skin. Rehabilitation Program Immobility and inactivity has been associated with larger ulcers, and bed and chair-bound persons are at higher risk for pressure ulcer development. Researchers have reported that the use of active and passive range of motion exercises promotes activity and reduces the effects of pressure on tissue. Exercise, ambulation, proper positioning, strengthening and increased range of motion all assist in the prevention process ( 1992;  2000). Conclusion All health care providers should receive relevant education in pressure ulcer risk assessment and prevention. Frequently, the focus of care is on maximizing functional gains in activities of daily living and mobility, and education is informal or minimal. It is essential, however, that individuals be provided with the basic knowledge necessary to return them to home and their communities ( 2000),

Risk Management

Introduction Within the myriad of incidents that occur in a healthcare organization a small, but significant, number result in avoid...

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