During This Program, You Will Complete An Evidence-Based Practice Project Addressing A Problem, Issue, Or Concern In Your Specialty Area Of Professional Practice

According to Sullivan (2022), Hospital-acquired pressure injury (HAPI) represents a heavy emotional, clinical, and financial burden for patients, caregivers, and healthcare organizations. The health care institutions end up with reimbursement penalties when a patient develops a stage 3, 4, unstageable and/or deep tissue injury (DTPI). According to Black & Berke (2020), The National Pressure Injury Advisory Panel (NPIAP) has defined DTPI as “Intact or non-intact skin with a localized area of persistent non-blanchable deep red, maroon, purple discoloration, or epidermal s), separation revealing a dark wound bed or blood-filled blister. Pain and temperature change often precede skin color changes. Discoloration may appear differently in darkly pigmented skin. DTPI presents the greatest challenge due to the propensity for deterioration to costly, life-altering, full thickness tissue wounds, even with optimal care Sullivan (2022, as cited in EPUAP et al., 2019). DTPIs are challenging in differentiating from other skin injuries such as hematoma, stage 2 pressure injures and bruises. The DTPI is not visible immediately because the damage evolves at a deep level of the muscle and bone. After the purple discoloration of the skin is noted, the epidermis lifts about 24 to 48 hours (Canfor et al., 2023). This might evolve rapidly into a full thickness wound causing emotional, physical, psychological, and financial burden for the patient and family. For example, DTIs can occur when an elderly patient falls at home and lays on the floor for hours or days causing prolonged pressure to an area of the body or patients that are in the ICU with medical devices that are in place for hours to days as well.  With that said, this has been a concern at our hospital, differentiating DTPI from other skin injuries. Although differentiating DTPIs from other skin injuries has improved at our hospital, I feel there’s more that can be done to improve at an optimal level.

According to Gonzalo (2023), Dorothea Orem’s Self-Care Deficit Theory focuses on each “individual’s ability to perform self-care, defined as ‘the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.’” The Orem’s general theory of nursing is composed of three separate theories: the self-care theory, the self-care deficit theory, and the theory of nursing systems. In wound care practice, we educate patients to be independent on performing wound care, preventative measures, etc. If patients are not able to perform self-care and depend on others, we educate family and/or caregivers. The nursing process of Orem’s theory is also essential in wound care practice because it involves the assessment, diagnosis, planning, implementation, and evaluation of patient care. The Nursing Process presents a method in determining self-care deficits and defining the roles of persons or nurses to meet the self-care demands (Gonzalo, 2023).