Capstone Evidence-Based Practice- Basic Care and Comfort

Capstone Evidence-Based Practice- Basic Care and Comfort

Perform Skin Assessment and/or Implement Measures to Maintain Skin Integrity and Prevent Skin Breakdown

Introduction

The skin is the first line of defense in the human body. It should thus remain intact and not broken. The skin should be warm, have the right amount of moisture, and have good elasticity. Several factors impact skin integrity. They include urinary incontinence, poor fluid intake, poor nutrition, hyperthermia, diabetes, hypotension, drugs, altered peripheral circulation, altered metabolic status, emaciation, aging, cachexia, and body build (Murphree, 2017). External factors include environmental factors, mechanical forces, chemical irritants, and radiation (Murphree, 2017).

In line with the primary objective of basic care and comfort, the relationship between the category from the NCLEX-RN examination blueprint, skin assessment, and implementation of measures to maintain skin integrity and professional practice is emphasized. Skin assessment and implementation of measures to ensure skin integrity is especially critical in achieving one of the significant objectives of healthcare: preservation of the patient’s physiological integrity is ensured during care provision. Skin assessment is an essential aspect of ensuring basic care and comfort since vulnerable patients may have impaired skin integrity and develop complications if proper guidelines are not met within the aspect of the NCLEX-RN blueprint.

NCLEX-RN blueprint Review

NCLEX-RN is a trademark of the National Council of State Boards of Nursing. A nurse’s scope of practice is to implement strategies aligned with the NCLEX-R examination blueprint while assessing skin integrity. One of the primary goals of the NCLEX-RN curriculum is the preservation of the patient’s physiological integrity. Nurses must oversee patient care management and ensure that all healthcare resources improve patients’ health. NCLEX-RN’s objective of basic care and comfort examines related concepts of care provision, such as procedures to be implemented during patient care. In the context of the problem statement, the object is skin assessment and implementation of measures to maintain skin integrity.

The NCLEX-RN blueprint can be used by academic stakeholders when educating their patients. As part of their nursing practice, nurses are trained to assess and maintain skin integrity and consider internal and external factors that may affect skin integrity. Communication is important when implementing strategies to maintain skin integrity. Communication enhances the patient experience, promotes patient-centered care, reduces stress, and enhances professional standing (Howick et al., 2018).

Importance of NCLEX-RN

The NCLEX-RN examination blueprint related to maintaining physiological integrity and skin assessment can be applied when integrating nursing education programs inwards. These categories can help nurses develop holistic, team-based care. This will promote positive communication and cordial, professional relations. While developing strategies to maintain skin integrity, the nursing profession will be positively impacted since nurses will expand their knowledge and skills to enhance patient care. Nurses will also have job satisfaction and reduced stress since they will positively impact patient care.

Shear, friction, and pressure from immobility put an individual at an increased risk for impaired skin integrity (Murphree, 2017). Other people at risk of altered skin integrity include paralyzed, overweight, individuals with spinal cord injuries, those who use wheelchairs, bedridden individuals, and those with edema (Murphree, 2017). Other factors may hasten skin breakdown, including normal loss of elasticity, age, environmental moisture, and vascular insufficiency (Murphree, 2017).

Nurses should have the knowledge and skills to deal with patients at risk of impairment of skin integrity. Nurses should regularly conduct skin assessments and not confine them to admission only. Skin assessments should be conducted regularly to check for any changes in skin integrity (Lawton & Turner, 2020). Failure to continuously conduct skin assessments will mean that nurses have neglected one of their essential duties. This can result in skin impairment, which can be interpreted as professional neglect and misconduct whereby the nurse who does not conduct skin assessments can lose their license, face litigation, or lose their job. Impairment in skin integrity negatively affects the patient’s health. It can result in increased infection, decreased mobility, decreased function, limb loss through amputation, or death (Murphree, 2017). It can also result in increased hospitalization and reduced quality of life.

Healthcare Disparities, Inequalities, and Interventions

The changes in the skin as an individual ages put one at risk of infectious diseases, tissue destruction, and other diseases. These changes during old age increase the risk of extrinsic factors causing tissue destruction. A reduced barrier function enhances the risk of entry of pathogens. Older patients also have dry skin due to decreased sebum secretion (Murphree, 2017). Other populations at risk of impaired skin integrity include overweight individuals undergoing radiation, those who are bedridden, those using wheelchairs, and those who are diabetic and paralyzed (Murphree, 2017).

There are many healthcare resources that nurses can use to implement evidence-based practices to maintain skin integrity. The resources include websites on international organizations such as the World Health Organization and government websites like the CDC. In addition to this, they can obtain resources from journals related to dermatology. The articles selected should be peer-reviewed and scholarly. Finally, they can obtain resources from nursing textbooks.

Healthcare disparities may be present for individuals of low socioeconomic status. They may not be able to afford healthcare services such as continuous skin assessments. This may thus increase the risk of suffering from impaired skin integrity. Disparities may also be caused by old age and conditions such as diabetes. Individuals in old age and with diabetes have higher risks of having impaired skin integrity (Murphree, 2017). Evidence-based intervention for solving these disparities can be through patient education. The patient can be educated to identify impaired skin integrity risk factors and home strategies for preventing impaired skin integrity. This is a solution that can help solve the disparities.

Many strategies can be used by nurses to maintain skin integrity. The best way to maintain skin integrity and prevent a breakdown is to prevent them from occurring. The preventive techniques include screening patients for potential skin breakdown and then initiating preventive procedures, performing regular skin assessments, and frequently repositioning bedridden patients (Payne, 2020).  The prioritized evidence-based intervention is screening all patients for potential skin breakdown. This intervention has been prioritized since it will prevent skin breakdown through the implementation of preventive measures. The patients will be advised on proper skincare. They will be educated on the importance of keeping dry skin and applying lotions to prevent breakdown, which will help moisturize the skin.

Legal & Ethical Considerations and Intervention

One legal issue in skin assessments is that nurses have a legal right to refuse to perform medical procedures that violate their religion in some US states, such as California. This may impact skincare. An ethical issue arising from the priority topic is the right to patient autonomy. Patients should be informed of any medical procedures to give informed consent (Haddad & Geiger, 2020). The nurse should thus obtain permission from the patient before performing any skin assessment. One strategy for preventing an ethical dilemma is involving the patient in the decision-making process and being truthful at all times. One strategy for solving the legal issue is assigning nurses duties that do not conflict with their religious views.

One challenge in resolving skin integrity may be a shortage of nurses in hospitals. The nurses available may be strained and overstretched and, hence, may not conduct regular skin assessments. One anticipated challenge for preventing impairment of skin integrity may be the failure of the patients to adhere to skincare routines and the failure of nurses to screen patients at risk due to nurse shortages.

Participants and Interdisciplinary Approach

The participants who will be involved in the interventions include nurses and patients. Nurses will be in charge of conducting regular patient assessments while patients will maintain a proper skincare routine. The human resource department will be involved in hiring more nurses to help in the regular skin assessments. Dermatologists will be involved in skincare and prescription of moisturizers. Interdisciplinary collaboration is essential since it enhances communication, care coordination, and the pooling of ideas that enhance patient outcomes (Hlongwa & Rispel, 2021).

Quality Improvement

One benefit of patient outcomes is the reduction of infection risks associated with impaired skin integrity (Murphree, 2017). One benefit for the nursing profession will be increased job satisfaction and reduced stress due to good healthcare outcomes. The intervention will lead to positive healthcare outcomes. One resource that can be used in electronic health records (EHRs). EHRs contain patient records that can help patients at risk of impaired skin integrity from their medical history. One resource that can improve nursing professional knowledge is scholarly articles that contain information on strategies to maintain skin integrity.

Conclusion

It is critical to educate nurses on strategies to maintain skin integrity in patients at risk of skin breakdown. This will enhance patient outcomes and improve the quality of care offered in clinical environments. The resources that can promote evidence-based practice include EHRs, scholarly articles, textbooks, and government websites. Conducting skin assessments and implementing measures to maintain skin integrity is vital to patients at risk of skin impairments. It will reduce hospitalization rates, complications, and healthcare costs.

References

Haddad, L. M., & Geiger, R. A. (2020, September 1). Nursing ethical considerations – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK526054/

Hlongwa, P., & Rispel, L. C. (2021). Interprofessional collaboration among health professionals in cleft lip and palate treatment and care in the public health sector of South Africa. Human Resources for Health, 19(1). https://doi.org/10.1186/s12960-021-00566-3

Howick, J., Moscrop, A., Mebius, A., Fanshawe, T. R., Lewith, G., Bishop, F. L., Mistiaen, P., Roberts, N. W., Dieninytė, E., Hu, X., Aveyard, P., & Onakpoya, I. J. (2018). Effects of empathic and positive communication in healthcare consultations: A systematic review and meta-analysis. Journal of the Royal Society of Medicine, 111(7), 240-252. https://doi.org/10.1177/0141076818769477

Lawton, S., & Turner, V. (2020). Undertaking an assessment of the skin using a holistic approach. Nursing Times, 44-47.

Murphree, R. W. (2017). Impairments in skin integrity. Nursing Clinics of North America, 52(3), 405-417. https://doi.org/10.1016/j.cnur.2017.04.008

Payne, D. (2020). Skin integrity in older adults: Pressure-prone, inaccessible areas of the body. British Journal of Community Nursing, 25(1), 22-26. https://doi.org/10.12968/

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topic
Perform skin assessment and/or implement measures to maintain skin integrity and prevent
skin breakdown

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topic
Perform skin assessment and/or implement measures to maintain skin integrity and prevent
skin breakdown