Evidence-based Clinical Practice Guidelines for Caregivers of Palliative Care Patients on the Prevention of Pressure Ulcer

Abstract

Objectives: Pressure ulcers are the most common condition among palliative care patients at home care facilities and impose a significant burden on patients, their relatives, and caregivers. Caregivers play a vital role in preventing pressure ulcers. When the caregivers are knowledgeable about preventing pressure ulcers, they will be able to avoid lots of discomfort for the patients. It will help the patient to achieve the best quality of life and spend the last days of life peacefully and comfortably with dignity. It is essential to develop evidence-based guidelines for caregivers of palliative care patients on pressure ulcer prevention, which may play a major role in preventing pressure ulcers. The primary objective is to implement evidence-based guidelines for caregivers of palliative care patients on pressure ulcer prevention.The secondary objective is to improve the knowledge and practice of caregivers and enable them to take measures to prevent pressure ulcer development among palliative care patients, thereby improving the quality of life of palliative care patients. Materials and Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), a systematic review was conducted. The search was conducted using electronic databases Pub Med, CINHAL, Cochrane and EMBASE database. The studies selected were in the English language and with free full text. The studies were selected and assessed for quality using the Cochrane risk assessment tool. Clinical practice guidelines, systematic reviews, and randomized controlled trials conducted on pressure ulcer prevention in palliative care patients were selected for the review. Twenty Eight studies were found to be potentially relevant after screening the search results. Twelve studies were not found suitable. 5 RCTs did not meet the inclusion criteria. Finally, four systematic reviews, five RCTs, and two clinical practice guidelines were included in the study, and guidelines were prepared. Results: Based on the best available research evidence, clinical practice guidelines were developed on skin assessment, skin care, repositioning, mobilization, nutrition, and hydration to prevent pressure ulcers to guide caregivers of palliative care patients. Conclusion: The evidence-based nursing practice integrates the best research evidence with clinical expertise and patient values. Evidence-based nursing practice leads to a problem-solving approach which is existing or anticipated. This will contribute to choosing appropriate preventive strategies for maintaining patients’ comfort, thereby improving the quality of life of palliative care patients. The guidelines were prepared through an extensive systematic review, RCT, and other guidelines followed in different settings and modified to suit the current setting.

Effects of bundle‐care interventions on pressure ulcers in patients with stroke: A meta‐analysis

“…Patients with stroke are also prone to bedsores due to impaired consciousness, paralysis, being bedridden, psychological stress, malnutrition and are prone to pressure ulcers 44,45 . Once pressure ulcers develop, they are difficult to cure and often cause pain and complications in patients, leading to increased nursing workload, prolonged hospitalisation and can even lead to death 46,47 . Nursing staff play a crucial role in the prevention of pressure ulcers.…”

Pressure injury risk assessment for palliative care patients in the acute hospital setting: A scoping review

“…Of the 1,906 remaining articles screened by title and abstract, 80 advanced to full-text review. Full-text review resulted in the inclusion of 15 articles [15,[39][40][41][42][43][44][45][46][47][48][49][50][51][52]. See Figure 1.…”

“…Over half (n = 9; 60%) were from Europe, with a further third (n = 5; 33%) from North America. Articles were set in a variety of clinical contexts, including specialist palliative care departments or units [42,50,51], hospice settings non-speci c to terminal or EoL patients [40,45,46], inpatient hospitals [44,49], cancer centres [41,43], and non-speci c palliative care settings [15,39,47,48,52]. Six primary studies were included [41,45,46,[48][49][50].…”

“…Two articles were described as systematic reviews. Antony et al [39] included 11 articles in their review of clinical practice guidelines for caregivers on the prevention of PI, and Ferris et al [15] included 12 articles in their review of prevalence and incidence. The remaining three articles included a discussion on palliative wound care principles [40], guidelines and recommendations on the prevention and care of PI in palliative care patients [47], and a review of PI prevention strategy literature, which included 14 articles [52].…”

“…Seven articles reported the population as palliative care [15,39,40,42,[47][48][49]. All authors used the broad term palliative care to describe all individuals, patients, or persons receiving palliative care and six articles described an advanced cancer (oncology) population [41,[43][44][45][46]50].…”