Research Proposal on the Effectiveness of Alternating Pressure Air Mattresses for the Prevention of Pressure Ulcers

This section provides an overview of pressure ulcers and the use of APAMs to prevent it. It presents background information on pressure ulcers and the use of alternating pressure air mattresses to prevent this condition. Discussed are the Background information, Objectives of the study, Hypothesis, and Significance of this Research.  Background information

The probability of an occurrence of a disease is usually a prediction of the risks the patient may be subjected to in an event the disease occurs. The likelihood and severity of a disease can be treated as a risk to a patient. Risk factors prompt an individual to prolonged durations of ischemia, which is as a result of pressure induction increasing the inability of tissue recovery from any injury resulting from ischemia. This may be associated with internal or external factors. Injuries that develop from pressure discourage and worry patients and additionally serve as gateways to infection, preventing recovery, increasing the duration required for nursing care, which is costly and increases mortality in some patients. The degradation of the integrity of the skin results to significant effects on individual patients, the primary care institution, and the community (Anand & New Jersey Institute of Technology, 2006).

The occurrence of pressure ulcers has risen in recent years because of high life expectancy of the population, advances in modern drugs, the possibility of patients with serious diseases surviving and before lethal, which advances into chronic diseases and gradually wasting. Despite the advances made in health care, pressure ulcer is still a basic cause of ill health and mortality and the effect on patients quality of life together with their families resulting in a social and economic problem (House & Johnson, 2013). Each year, more than one million people suffer from pressure ulcers. With pressure ulcers, the frequency in a given sector can be termed as the number of patients with at least one pressure ulcer that can be found in a populace of patients in a given duration.

Various danger factors are very vital for the increase of pressure ulcers, these factors impose physical, social, and emotional burden on patients and their families. The patient may feel demotivated to continue with their treatment thus increasing their susceptibility to the worsening of the quality of life, raising costs for health care since special dressing and medication increase with reference to the duration of stay in the hospital. Additionally, when the patient stays longer in the hospital, he or she predisposes him/herself to prolonged periods of ischemia prompted by pressure, minimizing the aptitude of ischemic tissue wound recuperation and raising ill health and mortality through infections (John & Hicks, 2013). Anemia, vasoconstriction, edema, malnutrition, immobility, incontinence, different level of consciousness, and vascular syndromes maximize the development of pressure ulcers, resulting in additional problems like suffering, pain, and increased mortality and morbidity, increase the length and budget of hospitalization. The factor of reduced movement is the risk factor for pressure ulcers, allowing the existence of local pressure on bony fames without oscillations, and having tissue malnourishment.

Tissue damage by pressure is a wound, which results in distress and discomfort, stigmatization and minimization through systemization of nursing care to explain the changes in protocols, and position of deterrence of ulcers through scientific systems minimizing the risk of shear and friction, and the body prominences. To reduce the risk scales that have been translated and validated on pressure ulcers, the use of alternating pressure mattresses would help in continuous change of pressure in the body prominences and increasing blood flow thus reducing the likelihood of ischemia area. Discharging pressure is the most significant prophylactic pointer, which can be achieved by positioning a patient properly in bed and reducing the utilization of pressure machines (Registered Nurses' Association of Ontario, 2011). The change of position is required to relieve and redistribute pressure on the skin, enabling the flow of blood into the ischemic areas thus helping in the repossession of tissue from the impacts of pressure.

Most often, it is necessary to use pressure relief systems especially for bedridden patients such as the elderly who are highly vulnerable to risk factors as a preventive measure to relieve pressure on bony distinctions, inhibiting the development of pressure ulcers. The use of pressure mattresses can help reduce the working time for nurses, enabling movement and changing the position of bedridden patients would enable them to engage in other activities. This system is also advantageous as it is cost effective since it helps patients save materials and hospital equipment, because with the deterrence of pressure ulcers, avoiding the many complications that would take place if they are present in a patients body is possible together with reduction of the consumption and utilization of resources in the health care (Park-Lee, Caffrey, & National Center for Health Statistics (U.S.), 2009).

Objectives of the study

This study aims at evaluating the effectiveness of the use of an alternating pressure air mattress (APAMs) for the prevention of pressure ulcers to elderly in coronary care units.

Significance of the study

Pressure ulcers are grave impediments of hospitalization that require prevention whenever possible. Pressure ulcer is an area of confined mutilation to the skin and underlying tissue that is caused by shearing forces and pressure. Effective preventive mechanisms reduce the degree and duration of pressure and shearing forces. Pressure relieving mattresses, postures, and cushions minimize the intensity of pressure and shearing forces. Repositioning and APAMs reduce the duration of pressure and shearing forces. APAMs cause alternating high and low boundary pressure between the body and support, by causing rise and decrease of cells filled with air.

No intensive research has been conducted on APAMs. PubMed search identified only 16 identified studies on this area between 19995-2004. Out of the total number, only eight Randomized Controlled Trials (RCTs) were pertinent to the focus under study. Five studies showed no statistical distinctions in APAMs efficiency and various low pressure machines. Others showed significant differences. The comparative benefits of using APAMs and constant low-pressure machines are not clear. Besides APAMs another strategy that is commonly used is repositioning to minimize the duration of shear forces and pressure (Park-Lee, Caffrey, & National Center for Health Statistics (U.S.), 2009). Even though relocation is accepted generally, there is scanty evidence on literature regarding the effectiveness of repositioning. Turning patients after every four hours on a visco-elastic spray mattress, which are combined with pressure-reducing locations are highly recommended for use by the Dutch and Belgian pressure ulcer procedures. The findings obtained will act as a basis for future research on the effectiveness of an alternating pressure air mattress for the prevention of pressure ulcers. Future inferences, references, and conclusion of the study can be used to offer additional content to the literature in the nursing field.

Literature Review

Decubitus ulcers are common in most elderly people. It restricts patients mobility and most often they end up bedridden, and additionally, results to extended pressure on different parts of the skin causing necrosis, sloughing, and eventually ulceration. These sores increase the morbidity and mortality of patients. This condition is usually remedied using ulcer prevention mechanisms, which minimize the duration and magnitude of pressure at the interface of patients and support surfaces. This is usually achieved through repositioning and/or using pressure releasing support surfaces. Pressure Ulcers are among the most prevalent medical problems in care units with elderly and immobile patients (Registered Nurses' Association of Ontario, 2011). The medical problems occur as a result of cell necrosis that develops when a soft tissue is damaged by a prominence bone for a long period. The existing protocols and techniques designed to prevent pressure ulcers are majorly based on the advancement of the skin-support boundary and on a behavioral and postural education (Registered Nurses' Association of Ontario, 2011).

Pressure Ulcers affect patients who have reduced mobility and poor health. The pressure and shearing forces affect blood circulation in the bodys underlying tissues leading to depletion of oxygen in soft muscles and tissues. Classical treatment for Pressure Ulcers is majorly extended days for bed rest, which many physicians believe increase the deterioration of a patients general well-being. According to Japanese statistics, the frequency of Pressure Ulcers for inpatients is 23.1%, which is higher than those with severe illness. In the USA, the occurrence rate of Pressure Ulcers ranges from 4.7-32.1% for inpatients and for nursing homes is 8.5-22%. Canada has a prevalence of 25.1% and the disease is highly affecting the elderly resulting in high death rates (Registered Nurses' Association of Ontario, 2011). Studies show that surface shear force reduces the flow of blood more than a normal force. Applied pressure and shear forces reduce the blood flow to the skin of the body which eventually leads to PUs.

Sustained pressure causes ulcers, pressure surface is very important for ulcer development. The standard hospital mattress in many medical facilities exerts a pressure of approximately 120mmHg. This pressure is so high and can cause pressure ulcers in vulnerable patients if they maintain the same position for a long duration. This is among the many factors that predispose patients to ulcers. Skin conditions, general hygiene, and moisture accumulation of patients also predispose patients to pressure ulcers (Wagenheim, 2015). In as much as minimizing the pressure at the mattress and patients interface is important, maintaining the overall health of the skin of patients is also important to prevent ulcers. Accumulation of moisture on the skin is an essential physical factor that predisposes patients to the occurrence of pressure ulcers. Skin moisture reduces the level of acidity thus acts as an antibacterial (Wagenheim, 2015).

The frequency and incidence of skin break down is projected to continue rising in the elderly population, patients with polytrauma, and those severely debilitated. Looking for ways to prevent skin breakdown development and effectively treat it would create economic benefits as it prevents the possibility of too much spending on medication since lots of resources are required for expensive equipment and treatment (Kottner & Raeder, 2013). The recognition and management of pressure ulcers at an early stage to prevent skin lesions from elevating into pressure ulceration are essential to victims. The support surface of these mattresses helps in preventing pressure ulceration. The advancement in this modern scientific era has enabled the availability of specialized beds for pressure ulcers. Air mattresses are known remedies for this condition and the prevalence of pressure sores.

As pressure ulcers increases, the need for an affordable means of treatment increases. The introduction of APAMs into medical care units present a cost effective and manageable measure of treatment for pressure ulcers patients. APAMs are known to reduce pressure ulcers to a high degree. Patients who have used them have registered severe ulcers while using APAMs....