Ethical and Cultural Perspectives of Inquiry

Ethical and Cultural Perspectives of Inquiry

Pressure ulcers occur in up to 23% of patients in long-term and rehabilitation facilities. (Russo, 2003). The Agency for Healthcare Research & Quality (AHRQ) (2012) states that more than 2.5 million people in the United States alone develop pressure ulcers each year.

The development of pressure ulcers is highly complex, and their complexity is sometimes due to ethical and cultural issues that hinder the implementation of evidence-based preventative practices. Some of these barriers include but are not limited to informed consent, confidentiality, methodological uncertainties, and the conflict between accountability and responsibility.

According to Guy (2004), “removing the factors that lead to their occurrence can prevent pressure ulcer development, although it is not always possible to remove intrinsic factors such as age, medical conditions and medication.” However, not all pressure damage can be avoided, but it is likely that the incidence can be reduced (Bennett, 2004). This paper seeks to answer and validate the ethical and social factors that hinder pressure ulcer prevention and how these factors affect the control of their occurrences.

Ethical Perspective: What ethical obstacles affect how the medical community addresses pressure ulcer prevention and care?

Pressure ulcer prevention and its management in long-term healthcare facilities continue to raise a lot of challenges for patients and their clinicians. Most of these challenges include but are not limited to poor inter-agency working relations, poor training, the inability of nurses to stage pressure ulcers, poor relations between clinicians and patients, lack of proper equipment to treat and prevent pressure ulcers, and lack of risk and preventative awareness. All long-term healthcare facilities have their general intervention measures in place to control the incidences of these wounds, some of which include policies to control pressure ulcers and their infections, proper hand hygiene, education and training on evidence-based practices and strategies to control pressure ulcers and use of protective clothing by health professionals (Emmerson, 1995). For many years, the presence of pressure ulcers has been viewed and regarded as substandard patient care. Because nurses and other healthcare employees are responsible for their prevention, there have been unaddressed ethical issues surrounding their accountability which arise from both policies and practice perspectives. Hence, all healthcare professionals, including those at management levels, are responsible in strategic, financial and administrative duties that oversee the set strategies for pressure ulcer prevention and ensure adherence.

For many years, ethics has been defined as the philosophical consideration of right and wrong and the consequences of human actions (Welch, 2014). One of the biggest challenges is when clinicians and other caregivers fail to acknowledge their contribution to pressure ulcer development. Most healthcare facilities use a collective approach to pressure ulcer prevention, and that affects vulnerable adults and the frailest older persons or those with learning difficulties who receive substandard care in return. In most healthcare facilities, there is evidence of a lack of enough staffing and lack of supplies to deal with the prevention of pressure ulcers, lack of good nutrition to promote healthy skin, poor hydration, and lack of basic hygiene to promote well-being. It is the responsibility of all healthcare facilities to ensure the delivery of safe practices within their organization to promote better patient outcomes.

State and federal authorities have applicable laws that govern and protect the occurrences of pressure ulcers in long-term healthcare facilities. These laws provide a safety net to patients and their families by ensuring that pressure ulcer occurrences are reduced and controlled. The laws are particularly addressed to the healthcare industry, healthcare departments, and any other healthcare provider (Bryan, 2017). The state government regulates all healthcare providers with effective coordination of federal requirements and statutory rules and regulations addressing the need for a safe patient environment. Patient safety and dignity are the driving force for any healthcare facility. Nurses and clinicians have moral and ethical duties to ensure the same. The ethical theories that are applicable in the prevention of pressure ulcers act as a guideline on how healthcare professionals must address their knowledge and perception of pressure ulcer prevention practices. These same theories provide guidance to patients on the best strategies and possibly daily routines they should use in order to ensure their safety and freedom from acquiring pressure ulcers in healthcare facilities.

Cultural Perspective: Which cultural values and/or norms influence the prevention and care of pressure ulcers?

In today’s healthcare industry, most facilities have developed and adopted culture that is embraced by employees to control of pressure ulcers occurrences. An effective preventative program is facilitated by a multi-disciplinary team composed of nursing staff, nutritionists, physical therapists, dermatologists, consultants, and other clinicians. These teams focus on the prevention and control of pressure ulcer occurrences in their clinical settings. The team is also responsible for articulating the required control measures to promote positive patients outcome (Baral, 2015). Some aspects of culture within the healthcare setting affect the prevention of pressure ulcers.

One of these factors is the lack of comprehensive skin evaluation. A general assessment must include identifying and effectively managing the medical diseases and health problems such as urinary incontinence, nutritional status, pain level, and psychosocial health issues that may have placed patients at risk for pressure-ulcer development. There is no universal agreement on a single system for classifying pressure ulcers. It is evident that each stage of an ulcer determines the appropriate treatment plan. For preventative measures for pressure ulcers to be effective, there must be a collaboration between the senior management team and the clinical staff. This is also important and very critical in promoting high-quality patient outcomes, positive feedback, and patient-to-staff collaboration in promoting interventions seeking to prevent pressure ulcers.

Healthcare facilities have policies and procedure manuals available to staff to provide guidelines for the daily running of their tasks. Some healthcare facilities do not promote or encourage educational programs for their employees that promote and enhance compliance with their set policies and procedures for the prevention of pressure ulcers. Also, some patients, nurses, clinicians, and other healthcare employees do not follow or adhere to provided clinical policies and procedures due to a lack of awareness, familiarity, agreement, and self-efficacy with the guidelines (Baral, 2015). Most healthcare facilities are run by cooperation, and at the end of the day, their bottom line will determine the level of care the patients will receive. When the ratio of patients to nursing staff is low, most of the patients get substandard care. The community surrounding a healthcare facility has a major role in patient outcomes. They can organize community activities that include patients to promote movement and active lifestyle. Also, activities such as gardening will promote healthy nutrition in patients who are malnourished, dietary consultation is recommended, and a swallowing evaluation should be considered periodically.

Religious and cultural beliefs also play a major role in efforts to prevent pressure ulcers. Some people attribute pressure ulcers. For example, some people believe that pressure ulcers are a result of poor patient care and negligence by healthcare professionals. Patients and their families strive to ensure they are provided with the best care possible and always look forward to nurses following the facility guidelines and policies for pressure ulcer prevention. For the prevention of pressure ulcer protocols to be effective, nurses and other healthcare professionals reported negligence and deviation from the set standards must be held accountable and disciplinary actions initiated. Less than 10% of patients who are identified as ‘at risk’ for pressure ulcer development receive appropriate prevention interventions, and up to 40% of patients do not receive care that is based on current best practice (Waugh, 2014). Cultures of African, Hispanic, and Asian descent have a high prevalence of pressure ulcers. This is due to a lack of resources to seek quality medical interventions from the healthcare facilities, which puts them at a higher risk of developing these pressure ulcers, including infections in the low-standard facilities. Due to their financial constrain, they prefer services from healthcare facilities that they can afford. These low-standard facilities have high incidences of pressure ulcer development due to low-waged staff, poor nutrition standards, and insufficient basic supplies.

Therefore, minimal adherence to the prevention guidelines and hence the increased risks for the development of pressure ulcers and other health conditions.

Conclusion:

 Pressure ulcers affect both cultural and ethical issues. The ethical issues mainly involve clinical nursing and management, which ensure that patients and their families receive the highest quality of care, including pressure ulcer prevention. Patients, especially those that are alert, must play a role in preventing pressure ulcers. They must adhere to the set guidelines for self-pressure ulcer prevention. Culture, on the other hand, has a great impact on pressure ulcer prevention. It involves the set of standards in a healthcare facility that must be followed for better patient outcomes. Healthcare facilities with senior leadership support, education for staff, patients, and their families, improved quality assessment and improvement, evidence-based prevention practices, and unit-level champions possess the factors necessary to achieve positive patient outcomes. However, the way in which these factors interact within the facility determines the sustainability of pressure ulcer prevention (Jankowski, 2011).

References;

Bennett, Gerry, Carol, & John. (2004, May 1). cost of pressure ulcers in the UK. Retrieved from https://academic.oup.com/ageing/article/33/3/230/.

Baral, R. (2015). Organizational culture and its implications on infection prevention and control. Journal of Pathology of Nepal, 5(10), 865–868. doi 10.3126/jpn. v5i10.15644

Bryan, C. S., Call, T. J., & Elliott, K. C. (2017). The ethics of infection control. Infection Control & Hospital Epidemiology, 28(9), 1077-1084. doi:10.1086/519863

Emmerson, M. (1995). Surveillance strategies for nosocomial infections. Current Opinion in Infectious Diseases, 8(4), 272–274. doi 10.1097/00001432-199508000-

Guy H. (2004). Preventing pressure ulcers: choosing a mattress. Professional nurse (London, England), 20(4), 43–46.

Jankowski, I. M., & Nadzam, D. M. (2011). Identifying Gaps, Barriers, and Solutions in Implementing Pressure Ulcer Prevention Programs. The Joint Commission Journal on Quality and Patient Safety, 37(6), 253–264. doi: 10.1016/s1553-7250(11)37033-x.

Preventing Pressure Ulcers in Hospitals. (n.d.). Retrieved from https://www.ahrq.gov/patient- safety/settings/hospital/resource/pressureulcer/tool/index.

Russo CA Elixhauser A. Hospitalizations Related to Pressure Sores, 2003: Statistical Brief #3.

Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD); 2006.

Waugh S. M. (2014). Attitudes of Nurses Toward Pressure Ulcer Prevention: A Literature Review. Medsurg nursing: official journal of the Academy of Medical-Surgical Nurses, 23(5), 350–357.

Welsh, L. (2014). Ethical issues and accountability in pressure ulcer prevention. Nursing Standard, 29(8), 56-63.

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Compose a focused paper that explains and describes your healthcare issue/topic from the scientific and mathematical/analytical perspectives of inquiry. (You will cover two perspectives in one paper.)

Address your general topic by forming and answering two levels of research questions for each inquiry.

• Choose a “Level 1 Research Question/Writing Prompt” from both of the lists below to answer in the paper.
• Compose a “Level 2 Research Question/Writing Prompt” for each kind of inquiry that provides detail, specificity, and focus to your inquiry, research, and writing.
• State your research questions in the introduction of your paper.
• Answer each research question and support your assertions with evidence (research) to form the body of your paper.
• In the conclusion of the paper, briefly review the issues, research questions, answers, and insights.

Level 1 Research Questions/Writing Prompts SCIENTIFIC Perspective of Inquiry What are the anatomical, physiological, pathological, or epidemiological issues? Which body systems are affected? What happens at the cellular or genetic level? Which chemical or biological issues are most important?

Level 1 Research Questions/Writing Prompts MATHEMATICAL/ANALYTICAL Perspective of Inquiry What are the economic issues involved? Which economic theories or approaches best explain the issue? What are the statistical facts related to the issue? Which statistical processes used to study the issue provide for the best explanation or understanding?

Your paper must be five pages in length and reference four to six scholarly, peer-reviewed resources. Be sure to follow the current APA Style (e.g., spacing, font, headers, titles, abstracts, and page numbering).