The project makes an attempt to address the issue related to effectiveness of different dressings in the management of pressure ulcers. As such, the aim of the study is to find out which is the best dressing for pressure ulcer. A pressure ulcer is the damage that is caused to the skin as a result of constant local exposure to pressure (Agrawal and Chauhan, 2012). Being serious health impairment, pressure ulcers are a common problem among the people with reduced motility. These are the people who are care dependent and immobile due to disability. These are wounds that cause great deal of pain and suffering to the elderly people. As these are secondary healing wounds, bed sores have a tendency of poor healing as oxygen supply to the tissues is cut. Also, the nutrients required for wound healing could not be supplied to the wound because of compressing of the smaller arteries (Weller and Sussman, 2006). In this regard, dressings are an intervention that are crucial for the treatment of pressure ulcers. However, it is important to consider that it is the appropriate choice of dressing that assists the ability of the body to heal a wound such as decubitus ulcer. A dressing is required to be effective in keeping the wound bed moist, providing a barrier against any kind of infection, removal of excess exudate as well as facilitating proper exchange of gases (Morison, 2007). This is essential for increasing the healing rate of the wound, reducing the pain as well as decreasing the possibilities of infection. These are the areas that develop into serious issues if not attended properly. Nurses are in a position where they possess considerable degree of autonomy in the area related to management of pressure ulcer wounds. It is they who take the responsibility and accountability for applying the best dressing to the decubitus ulcers. For minimizing pain, chances of infection as well as improving wound healing application of the most effective dressing is one of the efficient methods that can be used by the nurses (Miguel, Bou and Soriano, 2007). This would assist in reducing the suffering to the elderly as well as improving the quality of life of the bed ridden patients.
A search for relevant literature was performed so as to find out the most effective dressing for the management of pressure ulcer. It was determined to explore the role that nurses play in making the choice of the most effective dressing that could be used for dealing with pressure ulcers and avoiding the complications associated with them. For conducting an exploration of the relevant literature, electronic search was taken up. This was done for answering the research question as to what is the most effective dressing to be applied on pressure ulcers in elderly bed ridden patients. Electronic searching is considered to be one of the best methods for locating large amounts of study material; hence it was employed for the research. Examination of certain databases such as PubMed, Google scholar and CINAHL was done. CINAHL was the principal database that was used with the reason that it helps in obtaining top nursing as well as allied health literature. It also provides various nursing journals along with the publications from National League for Nursing as well as American Nurses’ Association (CINAHL, 2014). For searching the literature, the key words that were used were pressure ulcers, bed sores, and effective dressings.
The exploration was guided by certain parameters. Only those literatures done in the past ten years were included for the project. This parameter would assist in the creation of current research sources. Studies that have been done in only English language were reviewed. The main reason behind this was that English language facilitated in making the researcher familiar with the area of study. Also, only those studies that have been done on the effectiveness of different types of dressings in the control of decubitus ulcers were considered to be included in the literature search (Miguel, Bou and Soriano, 2007). These assisted in obtaining relevant literature to the topic as what can be the best dressing to be applied to pressure ulcers.
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Different kinds of evidence were produced from the search. However, there was no evidence that indicated the effectiveness of any other type of dressing for pressure ulcers other than hydrocolloid, polyurethane and Transparent Absorbent Acrylic Dressing (TAAD). Also, no evidence was found that linked the type of dressing to the age of the patient and stage of pressure ulcer. Indication was also not found relating the type of dressing to the location of pressure ulcer, however, books such as Conn's Current Therapy 2014: Expert Consult: Online, were suggestive of the fact that hydrocolloid dressings are particularly suited for areas that are subjected to urinary and fecal incontinence (Bope and Kellerman, 2013).
A number of other quantitative studies were obtained that compared the effectiveness of different types of dressings for bed sores. Brown-Etris and et.al. (2008) studied patients of above 18 years of age. Guillén-Solà and et.al. (2013) included a sample of patients who were present with at least one pressure ulcer at second stage. Both these authors used patients above 18 years of age.
A similar study was conducted by Guillén-Solà and et.al. (2013) to compare adhesive polyurethane foam dressing and adhesive hydrocolloid dressing (Guillén-Solà and et.al., 2013). The study intended to make comparison between the two types of dressings in patients suffering from grade two pressure ulcers in primary care and nursing homes. The study was a multicentre randomized clinical trial. The sample size was taken to be 820 patients with at least one pressure ulcer at stage two. As such, the sample size was sufficient to a greater degree to consider the findings as true. Also the type of sampling was appropriate to provide answer to the research question. Only these patients were included in the sample that had pressure ulcers of stage two.
The findings support the view that Transparent Absorbent Acrylic Dressing (TAAD) is more effective for managing pressure ulcers. This was supported by Brown-Etris and et.al., (2008), who compared TAAD with hydrocolloid dressings. These dressings were identified with three distinctive features such as transparency, conformability and fully synthetic absorptive polymer. As the dressing is transparent, it allows the nurses to monitor the wound without removing it. Conformability is the feature with the help of which the dressing is able to mold to difficult contours of the body and does not lose shape after absorption of fluid (Chuangsuwanich and et.al, 2011). Although the study showed no significant difference between the effectiveness of the two dressings, mean wear time of TAAD was found to be 5.7 days as compared to 4.7 days for hydrocolloid dressing (Brown-Etris and et.al., 2008). Hence, this difference that was clinically noticeable led to the conclusion that TAAD is more effective in the management of pressure ulcers of stage two and shallow stage three. The findings of the study conducted by Guillén-Solà and et.al. (2013) were also similar to Brown-Etris and et.al., (2008) as no significant difference was found in the wound healing between the two dressing groups.
In summary, there is a reasonable amount of good quality evidence that is suggestive of the effectiveness of dressings to be evaluated on the basis of the amount of pain that is reduced, ease of applying, pain during application and removal, comfort to the patients and cost effectiveness (Heyneman and et.al., 2008). Transparent Absorbent Acrylic Dressing (TAAD) is most effective dressing for pressure ulcer wounds.
On the basis of the evidence summarized at the end of the discussion of the study, the following recommendations can be given. Prior to making decision regarding the types of dressing to be applied, assessment of the pressure ulcer should be done. Dressings should be chosen as per the level to which they satisfy the principles of pressure ulcer management (Selvaraj and et.al., 2014). That dressing should be considered effective that does not cause much pain during application and removal, does not change shape after absorption, prevents any kind of bacterial infection, is easy to apply and cost effective. As such, it is recommended to use Transparent Absorbent Acrylic Dressing (TAAD) as it is transparent which enables nurses to monitor the healing process of the wound without removing the dressing. They also have additional features of conformability and presence of fully synthetic absorbent polymer. In this regard, there has been proposal of knowledge promotion sessions so as to make the nurses capable of assessing the effectiveness of the dressing on the basis of various parameters. Nurses can put the recommendations into practice in the following manner. They would be required to develop their skills so as to assess the effectiveness of a particular dressing. This is essential for enabling them to choose the right type of dressing that not only improves the quality of life of the patient but also proves to be cost effective. Practical training should be provided to the nurses as they carry a greater degree of autonomy in managing pressure ulcers. Training sessions that the management care teams organize regarding the information on dressings could enable the nurses in making sound judgments regarding the most effective dressing to be used for better management of pressure ulcers.
Journals and Books
- Agrawal K. and Chauhan, N., 2012. Pressure ulcers: Back to the basics. Indian J Plast Surg. 45(2). Pp.244–254.
- Bope, T. E. and Kellerman, D. R., 2013. Conn's Current Therapy 2014: Expert Consult: Online. Elsevier Health Sciences
- Brown-Etris, M. and et.al., 2008. A prospective, randomized, multisite clinical evaluation of a transparent absorbent acrylic dressing and hydrocolloid dressing in the management of state II and shallow stage III pressure ulcers. Adv Skin Wound Care. 21(4). Pp.160-174.
- Butcher, M. and Thompson, G., 2009. Dressings can prevent pressure ulcers: fact or fallacy? The problem of pressure ulcer prevention. Wounds. 5(4). Pp.80-93.
- Chuangsuwanich, A. and et.al, 2011. The Efficacy of Silver Mesh Dressing Compared with Silver Sulfadiazine Cream for the Treatment of Pressure Ulcers. J Med Assoc Thai. 94 (5). Pp.559-65.