1.1 Describe the anatomy and physiology of the skin in relation to skin breakdown and the development of pressure sores
The skin includes exterior and internal structures that are physically linked; the skin has three layers: the outermost layer (epidermis), which has a thickness of around 0.04mm and lacks a network of blood vessels on its own, relies on the dermal layer below it for nourishment. According to research, this layer totally renews itself every four weeks owing to the wear and tear of the outside cells, which are supplemented by new cells from the dermis. It serves as a waterproof barrier and helps the skin tone due to the presence of melanin.
The middle layer (dermis) lies beneath the epidermis and contains connective tissue, hair follicles, blood vessels, lymphatic vessels, and sweat glands. It is about 0.5mm thick. It contains collagen, fats, and elastic fibres, which provide toughness and flexibility to the skin. It is the skin’s active layer.
The deeper subcutaneous tissue, which is made up of fat and connective tissues and lies beneath the dermis, protects the internal organs and serves as a site of energy production for the body.
Friction, moisture, or pressure exerted on the skin or a portion of the skin causes skin breakdown, such as cuts, tears, blisters, or burns, and this is limited to the top layer of the skin. Ageing significantly impacts on skin breakdown because as a person ages, cell division in the epidermis decreases, resulting in thinning of the layer. Collagen content in the dermis decreases by approximately 1% per year, resulting in decreased elasticity of the dermis and wrinkling and sagging of the skin.
The presence of keratinised epithelium in the epidermis allows the skin to protect the body by forming a waterproof barrier.
The skin regulates its temperature through a negative feedback system that includes the skin, skeletal muscles, sweat glands, and the hypothalamus. Even in extreme heat, this regulates the body temperature. For example, if the body temperature rises too quickly, the arterioles dilate, causing heat loss. This causes sweat glands to produce sweat, allowing the body to lose up to 580kcal of heat all at once.
The skin aids sensation due to the presence of sensory receptors: encapsulated endings are found around hairless areas such as palms and soles, and non-encapsulated endings are found in areas of extreme sensitivity such as the lips, eyelids, tongue, and gums.
1.2 Identify pressure sites of the body
Pressure sites are areas of the body where pressure is commonly applied, resulting in pressure injuries. Pressure points are commonly found in bony parts of the body or areas where skin folds on itself, as well as parts of the body where medical equipment applies pressure, such as where an oxygen tube presses on the cheek or ears. Pressure injuries can occur anywhere on the body, but they are more common in certain areas due to unrelieved pressure on the skin, either directly or indirectly.
The most commonly affected sites where pressure injuries occur are the back of the head due to lying on one’s back and the thinness of the scalp skin covering the bony cranium; the ear because of the fragility of the human ear; the shoulders, the elbows that are rested on whenever the hand has to take pivot position; the lower back that is always bending and stretching and exacting a pressure on the thin skin at the back and moving in the opposite direction as the spinal bones; the buttocks that sits still on hard and harsh surfaces all day absorbing all the pressure, frictions, and shearing that comes with sitting and resting the upper body solely on it; the hips, which receive all of the pressure when someone sits on our laps for an extended period of time and during exercises like running and jumping; the inner knees as we bend our legs in movement while walking, dancing, running, and so on; the heels; the part of the body where skin folds on itself; and parts where medical equipment puts pressure on the skin.
1.3 Identify factors which might put an individual at risk of skin breakdown and pressure sores.
There are several factors that can put an individual at risk of skin breakdown and pressure sores, also known as pressure ulcers. These include:
Limited mobility or immobility: Individuals who are unable to move around easily or who are bedridden are at a higher risk of developing pressure sores because they are not able to change position frequently. This can cause constant pressure on certain areas of the skin, leading to breakdown and sores.
Poor nutrition: A diet that is low in protein, calories, and essential vitamins and minerals can impair the body’s ability to heal and repair damaged tissue. This can increase the risk of developing pressure sores.
Incontinence: Exposure to moisture and irritants, such as urine and faeces, can cause the skin to become weak and susceptible to damage.
Age: As we get older, our skin becomes thinner and less elastic, making it more prone to damage and slower to heal. Older adults are, therefore, more likely to develop pressure sores.
Medical conditions: Certain medical conditions, such as diabetes, vascular diseases, and neurological disorders, can affect the blood flow to the skin and impair the body’s ability to heal. This can increase the risk of developing pressure sores.
Smoking: Smoking can decrease blood flow to the skin and impair the body’s ability to heal. It can also reduce the amount of oxygen that reaches the skin, making it more susceptible to damage.
Poor hygiene: Not maintaining good personal hygiene can increase the risk of developing pressure sores. This includes not cleaning the skin regularly, not using moisturisers, and not protecting the skin from friction and pressure.
It is important for individuals who are at risk of developing pressure sores to take steps to prevent them, such as changing position frequently, maintaining good nutrition, and keeping the skin clean and moisturised. Early detection and treatment of pressure sores can help to prevent them from becoming more serious.
1.4 Describe how incorrect handling and moving techniques can damage the skin
Handling the body carelessly can result in skin damage, which can occur when the body is handled in such a way that the skin is subjected to a lot of pressure from immobility and excessive resting on it, causing tissues to wear and tear. Wearing the wrong clothing material is another example of improper skin care; some clothing and fabric materials are too harsh on the skin, exerting pressure, friction, and scratches.
Incorrect moving techniques and careless body movements also cause skin damage. Shearing, for example, involves severely moving parts of the skin that are thin and close to bony areas across a surface in the opposite direction so that the skin is severed. This is an improper body movement technique that can cause skin damage and pressure sore development. Also, standing, sitting, lying down, kneeling, using the elbow as a support pivot, and other still positioning of the body in one fixed point for a period of time leading to blood flow obstruction and pressure or friction can cause skin tissues to be damaged, and this does not happen all at once but happens over time and when the skin is subjected to improper handling and moving techniques.
Sometimes medical treatment methods, such as bandaging parts of the body while treating fractures and dislocations of bones, are very incorrect ways of handling the skin and can result in skin damage. Wearing tight foot wears, socks, underwear, gloves, and many other items are also not the correct ways of handling the skin. The techniques of movement of the body during daily activities are very important, and it is important to learn moving techniques that will reduce skin damage and thus reduce skin breakdown and the development of pressure sores.
1.5 Identify a range of interventions that can reduce the risk of skin breakdown and pressure sores
The risk of skin breakdown and pressure sores can be reduced, especially if they are discovered early. The severity of the damage done to the skin and tissues determines the effectiveness of the interventions that can reduce pressure sores and skin breakdown.
Severe or not, the risk of pressure sores and skin breakdown can be greatly reduced by repositioning oneself frequently to avoid stress on the skin, as well as by maintaining good nutrition that would aid in the quick repair of tissues in case of wearing and tearing.
Proper water intake has also been observed to be another preventive way of reducing the risks of tissue wearing and the development of pressure ulcers, sores, and skin breakdown, according to studies.
Smoking is another barrier to skin tissue repair; therefore, quitting smoking is recommended to reduce the risk of pressure sores and skin breakdown.
Stress management and daily body exercise are essential methods for lowering the risks of skin breakdown and pressure sores.
As previously stated, the majority of interventions for preventing skin breakdown and pressure sores are associated with constant, intentional, and frequent repositioning of the body and areas affected by pressure, friction, and shearing, and these include some repositioning tips such as; frequent weight shifting at least every hour, lifting the body off the same position; This could be applicable to people sitting in wheelchairs or people who are used to sitting in one position in their workspaces or offices; there is a recommendation for wheelchair push-ups and chair push-ups, as well as choosing cushions and mattresses that relieve pressure and ensure that the body is well positioned, and doughnut cushions should be avoided because they can focus pressure on surrounding tissue. Another repositioning tip is to adjust the bed’s elevation to avoid shearing.
1.6 Describe changes to an individual’s skin condition that should be reported
Skin inspection can easily detect minor changes in the skin’s normal conditions. Skin inspection is an effort directed toward either self-inspection or assisted inspection of the skin in order to detect changes in skin structure; it entails checking the skin over bony areas such as the heels, sacrum, and buttocks. Skin problems and pressure ulcers should be reported to health care providers if any of the following changes are observed in an individual’s skin: redness of any part of the skin resulting in permanent red patches on the affected areas, blisters or bubble-like layers forming on areas of the skin that look like burns, patches of hot skin, skin breakouts, areas of extreme dryness in the skin, areas of extreme hardness of the skin, redness of any parts of the skin, break in any part of the skin, observed sore on the skin, and marked parts of the skin are also to be reported.
2.1 Identify legislation and national guidelines affecting pressure area care
A significant number of national guidelines and legislation affecting pressure area care and nursing have been initiated and established. Some of them are as follows:
The National Institute for Health and Care Excellence (NICE) Pressure Ulcer Quality Standard: This is a national guideline that provides recommendations for the prevention and management of pressure ulcers.
Other pieces of legislation relevant to pressure area care is:
The Management of Health and Safety at Work Regulations, which established the need for risk assessment, state that risk must be assessed, acted on, and reviewed when moving and positioning individuals.
The Lifting Operations and Lifting Equipments Regulations (LOLER) established the requirement for employers to provide safe and simple-to-use lifting equipment.
The Manual Handling Operations Regulations for Employers detail that employers must conduct risk assessments for all moves and reduce the risk of injuries by avoiding dangerous moving and handling.
The National Pressure Ulcer Advisory Panel (NPUAP) is a piece of legislation that affects the pressure care field.
The Care Quality Commission is a body designed to keep people safe from unsafe care and treatment while also preventing avoidable harm or risk of harm.
The Care Act (2014) is a piece of legislation endorsed by NHS England in accordance with Health and Social Care (2012).
2.2 Describe agreed ways of working relating to pressure area care
Health and social care professionals working in pressure area care will typically have a number of agreed ways of working together. These may include ensuring that staff are adequately trained in how to deal with the pressure, using checklists or protocols to monitor residents’ welfare, setting up systems for communication between teams and other relevant stakeholders, providing support and respite for staff when needed, maintaining accurate records and tracking data relating to resident’s health/wellbeing.
The agreed ways of working in the pressure care area generally have to do with employers’ responsibility to put in place workplace and work-area policies and safety procedures that are expected of employees for moving and handling during operations.
The employer must explain in detail every procedure developed for the operations in which they are involved, as well as provide effective training of standard operating procedures and policies to such trained employees and place such trained employees under constant supervision.
The employee’s role in this agreement is to read the procedures of operation provided by the employer, and if they don’t understand, ask questions; additionally, the employee must be present at the scheduled training and properly understand the employer’s needs, requirements, extremes, and limits of operation.
The employee must understand and receive the skill training required for operation and proper handling of the equipment used in operations with all diligence. When repositioning people who are experiencing high levels of stress or discomfort, care must be taken to ensure that they are not placed in a position where they feel even more pressure. Also, staff should be careful not to move people too quickly or excessively, as this could further aggravate their symptoms.
Finally, pressure area care must be integrated into the overall care plan for a vulnerable person. This means that staff are aware of how to provide support when needed and that any interventions (such as decongestants or cold therapy) are prescribed in line with the individual’s specific needs.
2.3 Describe why team working is important in relation to providing pressure area care
Working as a team is important in providing pressure area care because it helps to relieve pressure on one person. Teamwork helps to bring internal supervision done by employees themselves into operations, providing checks and balances in the operation procedures.
Planned teamwork assists employers in introducing adherence to correct moving and handling and reduces the risk of harm and pain to personnel during work operations. Each team member who has been trained to know what to do before moving a person or handling equipment will reduce the occurrence of risk and harm to personnel and service user.
Teamwork entails each person adhering to the agreed-upon care plans and always recording and reporting; that each person in the team maintains their training and ensures that their training, moving and handling skills, and knowledge of how to carry out operations are kept up to date; and that each personnel ensures that the other team members are adhering to the same instructions to prevent the development of pressure area sores.
3.1 Describe why it is important to follow the agreed care plan
The agreed-upon care plan outlines the standard caregiving procedures that nurses and caregivers must adhere to. It is critical to adhere to the agreed-upon care plan because:
- If agreed-upon care plans are adhered to, service users are less likely to develop pressure sores. The agreed care plan is in the best interests of the service users, and if employees are up to date on the agreed care plan, they can work under clear instructions rather than separate routines.
- Adhering to the agreed-upon care plan reduces the likelihood of service users and employees developing sores and skin damage.
- Following the agreed-upon care plan assists in identifying any concerns or potential sources of harm or risk on a regular basis.
- Adherence to the agreed-upon care plan ensures that the service user employs the appropriate pressure-relieving equipment.
- Adhering to the agreed-upon care plan ensures that the proper is maintained to relieve pressure.
- Adhering to the agreed-upon care plan makes diagnosis simple and easy. It reduces the severity of pressure sores or skin damage if they develop because they are discovered early and treated easily, reducing harm, pain, or risks.
3.3 Identify any concerns with the agreed care plan prior to undertaking the pressure area care
When a patient is diagnosed with bed sores, pressure sores, or skin breakdown, pressure area care is required. Pressure sores are very prone to infection because they are open ulcers on the skin’s outermost layer. The following are the concerns associated with performing pressure area care:
Cleanliness is an extremely important aspect to consider in pressure area care because pressure sores are prone to infection if a proper cleaning routine is not implemented.
Prevention is another concern with an agreed care plan before beginning pressure area care, which includes constantly turning the patient or constant repositioning, being aware of shear or friction that could cause a severe pressure sore, continuous monitoring of patients, ensuring the patient follows the agreed care plan, practising a good skincare routine, healthy eating habits, and identifying and treating signs of pressure ulcers.
If the service user refuses to follow the preventive measures above, there may be cause for concern. It is also mandatory that the equipment specified in the care plan is appropriate for the job.
3.5 Identify the pressure area risk assessment tools which are used in own work area
The Braden scale is a risk assessment tool used in my workplace to predict the risk of pressure ulcer development, determine the overall risk for pressure ulcer development, and determine the severity of the most significant risk factors for the purpose of developing a care plan. The Braden scale includes a nutritional subscale for screening common factors that lead to nutritional risks, such as pressure ulcers, sores, and skin breakdown. It is frequently the first method used to screen for dietary adequacy as a potential contributor to overall pressure ulcer risk.
The Braden scale is a standard, evidence-based assessment tool used in my field for determining and documenting a patient’s risk of developing pressure injuries. Risk factors are rated on a Braden scale from 1 to 4, with one being “completely limited” and 4 being “no impairment.”
Another risk assessment tool used in my field is the Waterlow risk assessment tool, which is used to determine a patient’s risk of developing pressure ulcers. The Waterlow risk assessment tool includes the build/weight, height, visual skin assessment, sex and age assessment, continence, mobility, and appetite, as well as specific risk factors such as tissue malnutrition, neurological deficit, major surgery, and medication.
3.6 Explain why it is important to use risk assessment tools
When a high-risk service user enters a setting, it is critical that their pressure ulcer risk be assessed, and this should be done as soon as possible because pressure ulcers do not develop slowly. It is also important to note that a person’s condition can change without any previous serious case. Many times, when a person’s condition changes, their risk of developing a pressure ulcer should be re-evaluated.
Risk assessment tools are important because they help to raise awareness of hazards and risks; identify people who may be at risk; determine whether programs that can control risks like skin breakdown and pressure ulcers are effective; evaluate whether the existing measure of control of an agreed-upon care plan is effective or whether more should be done; prevent illnesses and injuries, especially when done early on; prioritise hazards and control measures of risk assessment; and comply with applicable legal requirements.
4.1 Identify a range of aids or equipment used to relieve pressure
Pressure relief equipment should be readily available in every nursing home. Mattresses such as foam mattresses, air mattresses, and hybrid mattresses are examples of pressure-relieving aids or equipment.
Pressure-relieving mattresses are those that are designed for people who have limited mobility, spend a lot of time in bed, and are prone to developing pressure ulcers. Examples of such mattresses include air mattresses, which are inflatable mattresses or sleeping pads.
Crash mats are also used to relieve pressure; they are also known as crash pads and bouldering mats, and they are used to prevent injuries.
Elbow and hip pads are other aids or equipment that are used to secure the elbows and hips during periods of limited immobility.
Pressure relieving equipment such as pro pads, repose mattresses, toppers, cushions, foot protectors, wedges, airflow mattresses, barrier creams, reliving dressing, and gel cushions are used to protect people from developing pressure ulcers and skin breakdown.
4.2 Describe safe use of aids and equipment
It is critical to first identify the care plan, risks, and aids or equipment in order to determine which aids or equipment will be used and how to ensure the safe use of the aids and equipment. Some examples of safe use of aids and equipment include: Aids and equipment should be installed or operated by trained professionals and not handled ignorantly due to the dangers of risk and hazard of careless handling, Aids and equipment should be operated according to the manufacturer’s instructions and not operated at the users discretion, Aids and equipment should be kept at the correct pressure that is needed by each different person with different conditions, and Aids and equipment should be kept at the correct pressure that is needed by each different person with different conditions in order to provide effective pressure ulcer and pressure sore care to patients in an easily adjustable manner
Despite the fact that most pressure relieving aids or equipment work automatically, opening once certain internal pressure limits are reached or exceeded and closing once the pressure has returned to an acceptable level, safe use of aids and equipments also includes supervision of equipment operation.
The use of pressure relief valves and pressure safety valves to quickly release gases from equipment in order to avoid overpressure and return the equipment to a safe operating level is also a safe practice in the use of aids and equipment.
4.3 Identify where up-to-date information and support can be obtained about:
a.Materials
Up-to-date information and support about materials used can be obtained online; that is, information about the materials used can be found on the internet. Up-to-date information and materials support is also available in the work’s reference section, senior members of staff, CQC, and the material provider. Up-to-date information and support on some equipment can also be obtained from senior members of staff and managers, CQC, or the equipment provider. Up-to-date information and material support can also be obtained from the researcher’s verbal and nonverbal communication, as well as the querying of inventories and journals related to skin breakdown and pressure sores, their care, symptoms, and related issues.
b.Equipment:
For the most up-to-date information and support regarding the equipment used in health and social care settings, individuals should contact the manufacturer or supplier of the equipment. These organizations will have detailed knowledge of the proper use, maintenance, and safety precautions associated with the equipment. In addition, healthcare professionals can provide guidance and support related to the equipment. It is crucial to carefully follow the instructions provided by the manufacturer or supplier and to consult with a healthcare professional if there are any questions or concerns.
c. Resources
The facility library and archives are a great resource for accessing current information on various topics and operational procedures. These materials, such as manuals, textbooks, and research journals, can be useful for research and learning purposes. To make the most of this resource, individuals can ask staff members and librarians for assistance with finding and accessing the materials they need. These individuals are familiar with the institution’s storage procedures and can help to make the process of accessing the materials easier. Overall, the facility library and archives are a valuable resource for gaining knowledge and staying up-to-date on current information.
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