Date of Award

1-1-2012

Document Type

Campus Access Dissertation

Department

College of Nursing

Sub-Department

Nursing Practice

First Advisor

Joan Culley

Second Advisor

Kathleen Scharer

Abstract

Pressure ulcers are defined areas of cellular death that are produced when tissue is deprived of adequate blood flow and oxygen by the compression of tissue between a supporting surface and places where bone is close to the skin. When pressure exerted by the weight of an individual against a surface exceeds the capillary filling pressure for a period even as short as two hours, necrosis and ulceration can begin. Shear and friction are other forces that contribute to pressure ulcer development. These forces cause tiny tears and ruptures as pressures exceed capillary filling pressure, resulting in ischemia. Ischemia leads to inflammation and tissue anoxia which produces necrosis and ulceration---all within as little as two hours of unrelieved pressure.

Even though established guidelines for the prevention of pressure ulcers have been readily available for years, current practice has not aligned as well as was expected with the practices recommended in those guidelines. There have been identifiable knowledge-to-action gaps between what nurses have known and what they have done on a daily basis. These gaps inhibited nurses and others from using knowledge that was readily available to provide the best possible care to patients who were at-risk of developing pressure ulcers. This project focused on identifying evidence-based practices that appeared to be problematic in terms of implementation and making recommendations for how these gaps can be closed. The end result is intended to be improved outcomes for patients through improved implementation of evidence-based practices brought about by closing knowledge-to-action gaps in the assessment, prevention, and documentation of pressure ulcers for ICU patients.

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