Аssеssmеnt3 Essay Example

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Аssеssmеnt3 8


it is very important that nurses be informed about evaluating and planning of care on wounds. This is largely because wound care forms a major part of nurses’ daily activities. The first step should always be the evaluation of the wound as this helps the nurse in selecting the best treatment. This will help in reducing the cost of treatment and improved patient recovery. In case a wound is not properly taken care of it might attract infections which delays healing and in the process lowers the quality of life of the patient. According to Ubbink, et al (2008)A wound can be described as an interference of integrity and how tissues function in the body.

people with wounds usually suffer a lot of problems such as pain, mental anguish, and physical disability among others. These issues should be looked into by skilled personnel who have a lot of information on wound care. Nonetheless, having a lot of knowledge and experience in wound care practice is not enough to heal a wound or even enhance the life of the person. In their research work, Cole-King and Harding (2001) noted that,

In patients with wounds P, Does proper assessment of wounds I, Compared with poor assessment C, affect the healing process of the wound O.

P -Problem/Patient-Patient

I- Intervention/Indicator-Assessment

C -Comparison-Poor assessment

O- Outcome-Healing Process

Does proper assessment of wounds affect the healing process in patients as compared to poor assessment of the wounds?

1. Learn about levels of evidence

Code + Course Name

Nursing: 6S/Foreground InfoSource:

An efficient clinical system should be based on proof and should be able to bring together all the summaries and evidence about a clinical issue.


insists that if computerized Decision Support Systems are not available then the other option is summaries. They include statements from textbooks and clinical information that bring together facts about certain clinical issues. According to Naylor, et al., (2006)

Synopses of syntheses

Synopses of syntheses are brief statements of the systematic reviews. There is an increase in the number of sources of evidence and the 6S pyramid of evidence helps to bring out two layers to emphasize the fact that synopses of syntheses offers a powerful level of evidence as compared to synopses of single studies.


This is whereby a clinical question is brought up and data from the systematic summaries is used to build an answer to it. It may be done using databases.

Synopses of original studies

It is the final level of pre-appraised evidence. It usually contains brief statements of one study that should be of high standards. It is followed by a description of the effects of the clinical practice and the standards of methods used.

Original Studies

These are studies that are carried out by a single or many researchers to scientifically craft answers to clinical questions. This research is usually reported in journals. The journals are clinical or even professional.

2. Clinical databases

most by far of the Australian clinical databases in wound management association standards for wound administration are intended to be reflective of best practice as described in the written work and in the accord conclusions searched for from expert injury clinicians. The measures are acquainted as a guide with clinicians, instructors and researchers, health students and wellbeing mind providers who long to propel ideal results under the vigilant gaze of individuals with wounds or those at danger of injuring. As argued by Mathieu, Linke and Wattel (2006)

the standards are required to be far-reaching, which mulls over their adaptable application according to the necessities of individual disciplines and practice settings. The execution criteria recorded in the benchmarks are believed to be base criteria for achieving each standard. In any case, solitary wellbeing experts and health care providers are at opportunity to alter the criteria in setting for fulfilling each standard as demonstrated by the desires of individual master parts, rehearse settings, sanctioning representing practice and institutional necessities for deciding a standard of care.Parahoo, (2000) States that

. Search strategy3

the search strategy used in this paper work comprised of software system mainly designed to look for information in the world of nursing. The search results were generally presented in a line of results which were referred to as (SERPs). The information gathered was from a mix of web pages as well as other forms of files. Different databases worked in different ways hence one needed to adopt the search strategy for each of the used. This process referred to as tailoring the search was of much use. Also, there was use of separate search strategies for different phases of the research. topic and give ideas for keywordshis or her topic — picking keyword(s) Determining on the keyword(s) or expression(s) that sum up the statistics one wants. Also, one needs to be as exact as possible. There is also use of theme encyclopedias and vocabularies to help one elucidate or herin preparation the search approach, one should come up with first, describing hisVelnar, Bailey and Smrkolj (2009) noted that

4. Search for evidence using clinical databases.

Answers on the appendix file

  • to find the article. wound healing, inflammation, proliferation, tissue remodelingutilized key words such as
    S. Guo and L.A. DiPietroFactors Affecting Wound Healing, by In the search for clinical databases used in the appendix, key words were used to search for relevant materials covering the intended topics. The first article titled

  • . Evaluation research; Nursing practice; Wound assessment tool; Wound Management was found by searching key words such as Wound assessment tools and nurses’ needs: an evaluation study by Sheila Greatrex-White1& Helen MoxeyThe second article,

  • Amputation; lower limb; complications; wound healing; stump. was found by searching key wordsJudy HarkerWound healing complications associated with lower limb amputation by The third article,

5. Briefly discuss three pieces of evidence

the wound healing process is a vibrant process which consists of four incessant, overlying, and accurately programmed stages. Hence it is a must of each phase to happen in an exact and structured way. Any disturbances, distortions, or augmentation in the technique may prompt conceded wound recuperating or even a non-healing constant injury. In aged people, best would healing incorporate the following occurrences: quick hemostasis; reasonable aggravation; mesenchymal cell partition, expansion, and movement to the injury site; suitable angiogenesis; fast re-epithelialization (new development of epithelial delicate tissue over the injury surface); and right creation, cross-connecting, and development of action of collagen to offer quality to the remedial fleshLee, (2005) States that

Those Wounds related with amputation of the lower edge remain to be a challenge. Patients who withstand such wounds are regularly in poor condition, with co- current health pathologies. Wound healing results for amputees can be enhanced by multidisciplinary groups of physicians operating collectively. Such healthcare specialists must be armed with the suitable information and abilities in wound management to meet the requirements of this susceptible patient populace. Surgical wound execution in the lower edge amputee has moved into a fresh era where snags such as contamination, tissue necrosis and dehiscence are demanding supplementary cultured treatments.As evident from Meulen (1979)

Answer PICO (T) question

Wound healing complications in lower limb amputations

surgical wounds that heal by primary objective are expected to heal effectively without problems. Nevertheless, there is little proof to prove that this truly occurs in practice. Though wound contamination is recognized to be a substantial problem in surgical wounds, there are subjective reports that other problems such as dehiscence, the splitting open of a sealed wound, and skin sweltering happen, yet these hitches do not happen extensively in the literature. As evident from Ramasastry (2005) work,

Patients are frequently extremely weakened, with numerous co-existing cardiovascular risk issues. The prognosis following amputation is poor: approximately a third of unilateral amputees lose the another limb within three years and half of them will pass on within five years. Dealey (2008) States that it has been projected that over six million processes were carried out in Australia in2008-09. Nonetheless, improvements in surgery would propose that the number of surgical processes and their resultant wounds are set to upsurge. Within the populace of patients with outlying vascular illness, major lower extreme exclusion results in substantial perioperative illness and death.According to Desmouliere (1995)

Wound healing problems linked with the stump of an amputee are vital because in some cases these control a patient’s capability to walk with a prosthetic limb.

Significant factors in healing and consequence of amputation comprise the patient’s nutritious status, age, whether or not the patient smokes, the presence of old possibly infested graft material and the existence of co-existing illnesses such as renal failure, diabetes and anemia. Site selection is considered a critical aspect as healing is determined by on the competence of perfusion. Healing also is influenced by on the technical exactness of the physician. As evident from Harker, (2006)

Wound assessment tools and nurses’ needs: an evaluation study

the thought-provoking nature of wound healing has steered calls for doctors globally to embrace an all-inclusive and systematic methods to wound care. These comprise initial and continuing wound valuations and have several determinations. Precisely, it provides standard facts against which development can be checked, allows goal setting and the precise variety of dressings. Poor valuation can result to unsuitable wound management. It is for that reason critical that valuation is carried out according to the uppermost Standards. If assessment is not done properly, consequent wound care will suffer causing in hindered healing and/or severe impediments. Wound assessment is thus central to good wound managing and ought to be an essential part of wound care practice.As argued by Sussman and Bates-Jensen (2007)

, nurses ought to ask three questions following their valuation of a wound. First, ‘at what phase is this wound?’ second, ‘what do i want this wound to do afterward?’ third, ‘how can i accomplish this objective without harming healthy tissue?’ therefore, it is vital for nurses to be capable to precisely establish the present condition of the wound, assess whether it is improving or worsening, and agree upon the most appropriate management.In their research work, Shifaza, Evans and Bradley (2014)

Factors affecting wound healing

Multiple elements can lead to lessened wound healing. In common terms, the factors that affect overhaul can be branded into local and universal. Local aspects are those that directly affect the characteristics of the wound itself, while universal factors are the general health or disease state of the individual that distress his or her aptitude to heal. Several of these factors are interrelated, and the universal factors act through the local effects disturbing wound healing.

Local aspects that effect healing


Oxygen is significant for cell breakdown, particularly energy production by means of ATP, and is dire for nearly all wound-healing procedures. It stops wounds from infection, encourages angiogenesis, upsurges keratinocyte differentiation, relocation, and re-epithelialization, improves fibroblast proliferation and collagen production, and encourages wound tightening White and Moxey (2015)‐According to Greatrex


the minute skin is wounded; micro-organisms that are usually confiscated at the skin exterior find right of entry to the underlying soft tissue. The state of contagion and reproduction status of the micro-organisms regulates if the wound is classified as having infection, colonization, local contamination/critical colonization, and/or spreading aggressive contamination. Inflammation is a usual part of the wound-healing procedure, and is significant to the elimination of polluting micro-organisms. In the nonexistence of active sanitization, conversely, infection may be lengthy, since microbial clearance is inadequate. According to Liuet al (2010)

Systemic aspects that effect healing

The aging population (people above 60 years of age) is rising faster than any other age cluster (world health organization), and increased age is a main risk issue for reduced wound healing.

Sex hormones in elderly persons

sex hormones play a part in age-linked wound-healing shortfalls. Compared with elderly females, elderly males have been shown to have deferred restorative of severe woundsDavieset al (2008) states that

Stress has a pronounced influence on human wellbeing and social manners. Many illnesses—such as circulatory disease, cancer, compromised wound healing and diabetes—are linked with stress. According to Guo and DiPietro, (2010)


Diabetes has emotional impact on hundreds of millions of persons globally. Diabetic persons display a recognized deficiency in the curing of severe wounds. Furthermore, this people are susceptible to develop long-lasting non-healing diabetic foot ulcers (dfus), which are projected to happen in 15% of all people with diabetes. Chrisman (2010) States that


providing an optimum wound healing atmosphere entails acquaintance of the extrinsic and intrinsic aspects that may affect the path of wound healing. Awareness of these dynamics will allow nurses to set accurate expectations for the development of the wound healing, and support them formulate a plan of care which reduces the undesirable consequences of these factors.Hess, (2011) States that a subtle physiological equilibrium must be main­tained during the process of wound healing to make sure there is generation of impaired tissue. Wounds may possibly fail to patch up or healing time may be significantly increased when harsh conditions are permitted to persevere. Bryant and Nix (2015) states that

Barriers to Using/Implementing EBP

that the gap between the best practice and the clinical care is one of the barriers of using EBP. Studies carried out in Australia reveal that about 30per cent to 40 percent rarely receive care based on scientific evidence. The practitioners are required to be exposed, informed and trained about the latest evidence or information available. Factors such as lack of knowledge of the existence of such information, lack of courage from the experts to perform using EBP and also lack of motivation. In their research work, Arnold and Barbul, (2006) noted

strategies such as carrying out interviews can be engaged in order to create awareness. Another strategy that can be used is the use of focus groups. The clinicians can be assembled together and participate in a guided discussion where they are sensitized about the use of EBP. In wound care, lack of efficacy may lead to the clinicians not using EBP. Another reason may be lack of awareness in the institutions where the clinicians do not know about the existence of the latest information based on wound care. Casey (1998) States that

barrier to the use of investigation in clinical exercise have been cited repeatedly. Studies have inspected probable hurdles to the embracing of EBP by nurses. These studies have recognized collective barriers across a number of diverse countries. Generally, the main barriers to the use of inquiries in practice have been connected to the support given by the association in which nurses’ work, the nurses’ study values and abilities, the superiority of research, and how the investigation is conversed or presented. Bereznicki (2012) states that

many organizers of research use have been recognized in the literature. These architects comprise decision-making and peer support, accessibility of time to appraise and implement research discoveries, obtainability of applicable research, coworkers’ support, helpful policies, and training openings. Barriers and organizers to research utilization were branded into administrative factors, personal factors, communicational factors, and quality of study.As evident from Adesanya, et al (2000)

Numerous authors have recognized delays in nurses’ acceptance, adoption, and sponsorship of change. The reasons for this phenomenon are indeterminate, but likely multifactorial, and are exacerbated by current and emerging complexities confronting the healthcare industry. Current and projected social and economic indicators, nevertheless, validate a need for urgency in hastening translation of new knowledge into clinical applications of evidence-based improvements in patient care. Improvements in patient management services are particularly pertinent to the direction of the healthcare industry, which is tasked with responding to new patient management paradigms imposed through new directions in patient safety science.

Additional challenges to the healthcare industry continue to emerge as a result of socioeconomic factors, particularly those attributable to the expansion of a demographically diverse and aging patient population. In light of these dynamics, the historical gap between information discovery and its influence is accepted as improper “the transfer, transformation, and adoption of evidence-based practices are strategic imperatives for science and are critical to ensuring the integrity of practices in the health professions” (p. S42). Bereznicki (2012) described evidence-based practice as both a process requiring activities to evaluate evidence, and a product that is the translation of evidence into a change in practice. The importance of embracing change in the increasingly competitive healthcare marketplace is underscored by Arnold and Barbul, (2006), who posit that, in order to maintain vitality, healthcare organizations must support and operate within evidence-based best-practice guidelines.


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