Applying Middle-Range Theory to Assist in Preventing Hospital Acquired Pressure Ulcer’s

Applying Middle-Range Theory to Assist in Preventing Hospital Acquired Pressure Ulcer’s

Introduction

Working in quality and risk management for a long-term acute care hospital (LTACH), ensuring that our patients stay safe while at our facility is something that I am very passionate about. Whether it is a patient fall, hospital acquired infection (HAI), medication error, or hospital acquired pressure ulcer (HAPU), they are all preventable adverse events and should not happen. The National Pressure Ulcer Advisory Panel (NPUAP) defines pressure ulcers as “localized injury to the skin and/or underlying tissue usually over a bony prominence as a result of pressure, or pressure in combination with shear” (NPUAP, 2015). Various risk factors for pressure ulcer development range from immobility, nutrition, advanced age, duration of mechanical ventilation, and increased length of stay in intensive care unit (Cooper, 2013). The majority of all patients admitted to a LTACH have experienced an extended ICU stay, currently are ventilated, suffer from malnutrition, are elderly, and immobile—basically they meet all the established criteria for acquiring a pressure ulcer during their hospital stay. Knowing all of the evidence that we do about pressure ulcers and their prevention, our facility still has 2-3 patients per year that acquire a HAPU while under our care. The majority are device related and 100% preventable. The significance of this problem is that HAPUs are very costly, preventable utilizing evidence-based nursing practice, result in an increased hospital stay, are associated with higher rates of morbidity and mortality, and are a quality marker for a facility (Cooper, 2013).

Kristen Swanson’s Theory of Caring

When it comes to preventing any adverse event, applying any of the numerous concepts that middle-range theories regarding caring would apply and improve patient outcomes. Kristen M. Swanson, RN, PhD, FAAN, is the Dean of the School of Nursing, Alumni Distinguished Professor at the University of North Carolina at Chapel Hill, and Associate Chief Nursing Officer for Academic Affairs at UNC Hospitals. She earned her BSN from the University of Rhode Island, her masters in Adult Health and Illness nursing from the University of Pennsylvania, and a PhD in psycho-social nursing from the University of Colorado, completing her postdoctoral work at the University of Washington (Smith & Parker, 2015). Swanson’s Theory of Caring was developed based on the meta-analysis of 130 nursing studies related to caring (Smith & Parker, 2015). She defines caring as “a nurturing way of relating to a valued other person, towards whom one feels a personal sense of commitment and responsibility” (Smith & Parker, 2015, p. 525). Swanson’s Theory of Caring is not unique to only nursing, but provides guidance