EVIDENCE-BASED DECISION MAKING

Description of Case Study

In the study, the case of a 78-year-old patient named M with pressure sore is to be discussed. According to the NMC Code of Practise, the personal data of the patient is to be maintained confidentially and not to be shared in the public without their prior permission (NMC, 2018). Therefore, the anonym M was used to indicate the patients so that confidentiality is maintained. According to consultation with the physicians, it is determined that the patient M with pressure sore is to be repositioned in the bed every 2-4 hours as initial care while treating his health condition. The key issues to be considered while making decision to reposition M in the bed is any harm or bruises to the pressure sores that may occur and inappropriate body positing that may cause pain or discomfort to the individual. This is because due to inappropriate handling of the patient with pressure sores during repositioning there is probability to get bruises on the sores which worsen the healing of the sores and causes pain as well as suffering by the patient (Gillespie et al., 2020). Moreover, during repositioning of the patients the nurses may make them stay on the pressure sores which cause increased pain for the patient (Andayani, Nurhaeni & Wanda, 2020). The key important things considered while making the decision to reposition M is time interval of changing the position, comfort of the individual and the proper repositioning position.

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Linking decisions to evidence

The NICE guidelines mention that people with pressure sores or risk of developing pressure sores are to be repositioned in the bed every 2-4 hours. The patient is to be instructed to change the position on their own and if the action cannot be done by them it is responsibility of the nurses to assist the patients in repositioning themselves (NICE, 2014). Thus, the decision of repositioning the patient named M every 2-4 hours was taken to prevent the worsening of his pressure sores or additional development of sores. The changing of patient’s position with pressure sores every 2-4 hours is important as it helps to ensure enhanced flow of blood in the body and to the affected area leading the patients to make their skin healthy and gradually heal (Avsar et al., 2020). The study by Brandford (2016) reviewed various studies since 2018, but could not found any evidential information that mentions which position is perfect for repositioning of the patients with pressure ulcer. Thus, in case of M, no specific position was determined during repositioning and it was only ensured that the individual is not allowed to lie on the back where the pressure sores are present. This is because lying on the pressure sores creates additional pressure on the affected areas and incidence of bruises that increases the time for healing of the sores (Duvall et al., 2019). The patient satisfaction is reached in care when the support provided enhances their health and well-being (Duvall et al., 2019). Therefore, during repositioning of M, it is ensured that the turning is done in a comfortable manner and the person is placed in the position which does not cause any additional injury or pain.

Discussing the barriers and enablers for evidence-based decision

The access to effective electronic search sites regarding the topic was an enabler in making effective evidence-based decision in the case study. This is evident as easy access to sites such as Cochrane Library, Google scholar and other were available that contains various articles and journal with scientific and surveyed information regarding repositioning decision in case of pressure sores patients (McGowan et al., 2016). The other enabler was effective understanding of the research information present in the articles. This is because mostly the articles written in English were available on the electronic sites. Since, as a person living in UK, I had effective understand of English Language, therefore exploring the data and identifying the best evidence to be used in making the care decision for M was effectively accomplished. The ability to critically analyse data acted as enabler in making decision recommended for patient M. This is because effective critical analysis skill helped to thoroughly evaluate information from the article and compare them effectively to determine the best evidence to be considered in making the decision.

The lack of enough time in making analysis and identifying the evidence acted as barrier in making evidence-based decision of care for M. This is because the lack of time led to execute the tasks in retrieving evidence for decision to be made in a hurry which may have led to poor quality data collection and inability to critically present data (Polyakovskiy & M’Hallah, 2018). The other barrier faced is lack of support from the healthcare organisation to access existing patient records who have suffered pressure sores and are healed. This is evident as out of limited time in making the decision I was unable to gather permission in exploring existing data of patient records of similar patients like M.

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References
  • Andayani, R. P., Nurhaeni, N., & Wanda, D. (2020). Assessing effectiveness of regular repositioning in preventing pressure ulcers in children. Pediatric Reports, 12(11), 23-26. Retrieved on 28 October 2020 from: https://www.mdpi.com/2036-7503/12/11/8696
  • Avsar, P., Moore, Z., Patton, D., O'Connor, T., Budri, A. M., & Nuget, L. (2020). Repositioning for preventing pressure ulcers: a systematic review and meta-analysis. Journal of Wound Care, 29(9), 496-508. Retrieved on 28 October 2020 from: https://www.magonlinelibrary.com/doi/abs/10.12968/jowc.2020.29.9.496
  • Duvall, J., Karg, P., Brienza, D., & Pearlman, J. (2019). Detection and classification methodology for movements in the bed that supports continuous pressure injury risk assessment and repositioning compliance. Journal of tissue viability, 28(1), 7-13. Retrieved on 28 October 2020 from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382541/
  • Gillespie, B.M., Walker, R.M., Latimer, S.L., Thalib, L., Whitty, J.A., McInnes, E. & Chaboyer, W.P., (2020). Repositioning for pressure injury prevention in adults. Cochrane Database of Systematic Reviews, (6). 39-56. Retrieved on 28 October 2020 from: https://ueaeprints.uea.ac.uk/id/eprint/75459/1/Published_Version.pdf
  • McGowan, J., Sampson, M., Salzwedel, D. M., Cogo, E., Foerster, V., & Lefebvre, C. (2016). PRESS peer review of electronic search strategies: 2015 guideline statement. Journal of clinical epidemiology, 75, 40-46. Retrieved on 28 October 2020 from: https://www.sciencedirect.com/science/article/pii/S0895435616000585
  • NICE (2014), Pressure ulcers: prevention and management, Retrieved on 28 October 2020 from: https://www.nice.org.uk/guidance/cg179/chapter/1-Recommendations#prevention-adults
  • NMC (2018), Professional standards of practice and behaviour for nurses, midwives and nursing associates, Retrieved on 28 October 2020 from: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf
  • Polyakovskiy, S., & M’Hallah, R. (2018). A hybrid feasibility constraints-guided search to the two-dimensional bin packing problem with due dates. European Journal of Operational Research, 266(3), 819-839. Retrieved on 28 October 2020 from: https://arxiv.org/pdf/1703.07244.pdf

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