Decubitus ulcers have been a problem for the chronically ill, debilitated, and disabled patient since recorded history began. Even today, decubitus ulcers not only prolong the morbidity and interfere with the rehabilitation of the chair or bed confined patient but have been implicated as a frequent contributing factor leading to the patient's demise.
Bardsley et al1 reported in 1964 that over an 18-month period when she surveyed 30 patients, 4,874 patient days (13.3 patient years) were lost from active rehabilitation therapy due to decubitus ulcers.
Schell and Wolcott2 have estimated that each decubitus ulcer increases the cost of the medical care program by $5,000.00.2
Statement of the Problem
The purpose of this project is to develop a tool for nonnurse employees to use as a guide for integumentary assessment. Utilization of an assessment tool by nonnurse employees will reduce the development of decubitus ulcers in health care facilities.
Assumptions. First, the majority of physical care is provided by nonnurse individuals. Second, nonnurse employees lack developed skills to adequately assess for the prediction and prevention of decubuti without an assessment instrument.
Définitions. A nonnurse care giver refers to an individual who gives physical care but does not possess a nationally recognized license. These persons may be referred to as aides, orderlies, or attendants. Decubitus ulcer may be used synonomously with pressure sore and refers to an area over a pressure point that may be a reddened area with skin intact, a blister or broken skin, necrosis of tissue.
Review of Literature
Extensive reference is available in the popular' literature. Often commonalities surrounding the de»i cubitus ulcer problem have become evident. Many studies identify age, immobility, weight, and control of1 body functions as variables correlating with ulcer! formation. Assessment is seen as being crucial in theseï areas to predict and prevent ulcer formation:
1. Sustained pressure predisposes to ulcer formation.3
2. Advanced age appears to be significant in the development of pressure sores.4
3. Poor nutrition associated with anemia, hypoproteinemia, and vitamin deficiencies.5
The Assessment Tool
The assessment tool is developed for use by the nonnurse employee who then reports the score and/oiij initiates action as directed by the tool. The instrument is not seen as being comprehensive but identifies thoses areas commonly enumerated in the popular literature as being related to ulcer formation.
Directions for The Use of The Assessment Tool
The skin is the bodies first line of defense againsf illness. Assessment of the condition of the skin is necessary to help an individual protect himself from unnecessary complications of illness.
Skin Condition of Patients Encountered (SCOPE represents an approach for the prediction, preventioa¿ and recovery potential of the skin. Each person ii assessed in four areas.
A. Age. Skin breakdown can occur at any age but the incidence increases with age.
B. Body Structure. This factor depends not only oni visual inspection of the patient but also the body weight can be compared with norms for the age.
C. Control of Functions. This category refers to the following body functions:
1. Excretory-control of bowel and/or bladder.
2. Skeletal-has cast or traction applied.
3. Neuromuscular-paralysis or loss of muscle control.
4. Vascular-swelling, abnormal color or temperature of skin.
An individual with one of these conditions present would be considered moderately impaired. The loss of two or more functions would be considered markedly impaired.
D. Degree of Present Integrity. Any condition such as redness, swelling or pain over a pressure point that does not include broken skin would be scored as a moderate alteration. Broken skin indicates a lesion is present and is scored as three.
- 1. Bard s lev C el al: Pressure sores: a regimen for treating them. Am J Murs 64:82. 1964.
- 2. Schell V, Wolcott L: The etiology, prevention and management of decubitus ulcers. Mo Med 63:100, 1966.
- B. Gruis M, Innés B: Assessment: essential to prevent pressure sores, Am J Nurs 1762:64. 1976.
- 4. Gerson LW: The incidence of pressure sores in active treatment hospitals. Int J Nurs Stud 12(2):201 -4, 1975.
- 5. Bererek K: Etiology of decubitus ulcers. Nurs Clin North Am 10:157-170. 1975.