Pressure ulcers are areas of localised damage to the skin and underlying tissue caused by pressure. (Stechmiller et al. , 2008) Pressure ulcers still one of the most significant health problem in our hospitals today, It affects on patients quality of life patient self-image and how long they will stay in hospital then the cost of patient treatment . Moore (2005) estimate that it costs a quarter of a million euro’s per annum to manage pressure ulcers in hospital and community settings across Ireland . which allows one to take immediate actions and prevent the ulcer if possible.
To support pressure ulcer risk assessment several standardized pressure ulcer risk assessment scales have been introduced and their application in clinical practice is recommended (Stechmiller et al. , 2008).
one of the most common scales used in our hospitals is the Waterlow scale, This scale was designed by Waterlow in 1985, from study in elderly and acute wards (waterlow,1985).
The Waterlow Scale assigns believed to predispose patients towards developing pressure ulcers: build/weight, continence, skin type mobility, sex/age, appetite, tissue malnutrition, neurological deficit, surgery/trauma and specific medication.
The Term Paper on Pressure Ulcer Medicare Payment
Medicare like all health insurers is constantly looking for ways to avoid paying for unnecessary medical care. The latest attempt sounds perfectly reasonable until you consider who will bear the burden. Problem: Last year federal centers for Medicare and Medicaid Services announced that they would no longer reimburse hospitals for treatment of new pressure sores in Medicare patients. The ruling, ...
The total scores achieved within each factor are summed to derive the Waterlow score, with higher scores believed to mark greater vulnerability. (Waterlow, 1985) A score of more than 10 is classified as(at risk) between 15 to 20 as (high risk) and more than 20 as (very high risk).
This essay incorporates three major aspects with regards to the waterlow scale in respect to pressure ulcer. These aspects includes the high risk population ,the reliability /validity and advantages and disadvantages of waterlow pressure ulcer scale.b which population(s) the waterlow scale is applicable to? Waterlow scale one of the famous scales to assess the pressure ulcer. the Waterlow Scale is the most widely used in health care settings (Thompson, 2005).
and widely use with patients after surgery and trauma (orthopaedic and spinal surgery) also with patients have neurological deficits (DM,CVA) ,organs failure and in bad peripheral circulation. (waterlow,1985).
When we use this tool with elderly we should know the elderly people already have bit of neurogenic deficit, weakness and continent. (cook et al. ,1999).
The scale used for Patients admitted to hospital or otherwise confined to a bed, chair, or wheelchair because they are at risk from developing pressure ulcers. ( Anthony et al. ,2000).
Researchers have identified advanced age (older than age80), low diastolic blood pressure (less than 60), increased body temperature, and poor current dietary intake of protein as important predictors of Pressure ulcer risk. Other risks that should be taken into account are peripheral vascular disease, prolonged surgery (particularly involving extracorporeal oxygenation), or intractable pain.
Allman (1995) found we need to use the pressure ulcer scale for hip fracture patients who will stay on bed more than 4 days and with unconscious patients more than 5 days . Anthony et al (2000) found the elderly people more than 64 years old need pressure ulcer assessment but we need to be aware the elderly people complain from neurogenic deficits and loss of appetite.
The patients who are on ventilator and complete bed rest especially in ICU unit they risk for skin breakdown, so they need monitoring and assessment to prevent any pressure ulcer. Watkinson (1996)reliability: Through the reading to select the reliability and validity of waterlow pressure ulcer scale , the researchers suggested the waterlow scale is unreliable as method for pressure ulcer assessment. Several studies found the variance in scores because different in knowledge level not acceptable. A risk-assessment scale must be reliable regardless of the assessor. Many studies have evaluated the reliability, where two independent raters or observers assign the same ratings/values for an attribute being measured of the Waterlow Scale. Polit and Hungler (2001) . In (Shukla et al.,2008) study the Waterlow scale was used on 15 patients in two wards. Each patient was assessed daily by two different nurses over a period of seven days.
The Research paper on Patient Centered Care
Introduction Different governmental policies endorse nurses to use each and every reachable chance to encourage the health and wellbeing of patients (Department of Health 2010). Nurses enjoy a unique and distinct connection with patients, which promotes trust that patients can have in nurses. Therefore, it is the essential duty of nurses that they should use their powers and trust to inspire ...
A total of 28 clinical nurses were involved and a total of 210 assessments obtained. Statistical analysis demonstrated weak or a moderate degree of inter-rater reliability. Other authors suggested the water low scale too long and time consuming. Pang and Wong (1998).
Edwards (1995) examined the reliability of the Waterlow Scale he did a cross-sectional observation survey of 40 elderly patients with or without ulcers in a community setting.
The results failed to display high levels of reliability and in line with other studies over predicted ulcer development. Literature suggests that there limitation to using this scale with elderly people because the continence, neurological deficit and medication affect on scale result. (Cook et al. , 1999) said the Categories where disagreement occurred the most were (skin type), (build/weight for height) and (mobility) again indicating that the score is affected by a lack of adequate definitions in these categories.
Furthermore, this study highlights that the elderly population proves difficult to obtain scores at the low end of the range. This indicates a limitation of the scale that perhaps the risk thresholds are too high for elderly people Other Literatures examined the scale parts and examined if the variation between nurses affect on scale result or not? Then Literatures suggested The categories of sex, age, and minor surgery showed a high degree of consensus in scores, but the raters varied most in the categories of mobility and skin type.
The Term Paper on Cholesterol High Risk Heart
Cholesterol is a soft, fat-like, waxy substance found in the bloodstream and in all your body's cells. It's normal to have cholesterol. It's an important part of a healthy body because it's used for producing cell membranes and some hormones, and serves other needed bodily functions. But too high a level of cholesterol in the blood is a major risk for coronary heart disease, which leads to heart ...
Also difficult to differentiate between at risk, high risk, and very high risk status (Shukla et al. , 2008).
The studies have indicated the Waterlow scale not having clear description and instructions for scale items and the scale result dependent on assessor judgment. Pang and Wong (1998).
Kelly (2005) found lack of reliability of the Waterlow Scale is due to different perceptions of the patient by the nurses, According to Kelly (2005) found other problem may be due to the absence of the actual patient, Furthermore, this study highlights that nurses are not using the scale for the purpose intended.
The studies shows the items poor nutrition, mobility and skin type are difficult to rate and cause to errors in the total score. Furthermore, the reliability of the total score and the items has never been investigated in clinical practice. And clinical value of using this instrument is not clear and it should only be applied with caution. (Gould at al. , 2002) Validity Several Literatures examined the validity of waterlow scale. (Pancorbo-Hidalgo et al. , 2006) suggested the scale has very good pressure ulcer risk prediction capacity, offers a high-sensitivity but a low-specificity score.
Other studies found the scale’s high sensitivity and low-specificity level include Pang and Wong (1998), and (Balzer et al. , 2007).
The studies highlighted the scale to display high-sensitivity but low-specificity levels. Edwards (1996) believes the scale performs better as a diagnostic rather than a predictive tool. Although it contains a category for skin assessment, it will almost inevitably achieve high sensitivity. Another point suggested by Edwards (1996) is its inappropriateness in dealing with the elderly. This is because of high weighting given to age within the score.
Although the Waterlow Scale has been reported to be of use in a variety of clinical specialties, some studies emphasised that the scale is not good to all groups, for example, wheelchair users (Anthony et al. , 1998).
Other studies suggest some subscales its poor predictive validity. Such as the mobility, continence, neurological deficit and medication subscales have created problems, in assessing a patient due to lack of clarity and descriptions. (Cook et al. , 1999).
The Homework on A Comparative Study on High School Students Between the United States and China
With the development of global economy, the competition in education is becoming an important part of the international competitions. Students all over the world are competing with not only the students in their country but the students in the world. To some degrees, the future competitiveness of a country relies on how great their students are. As for students, their high school time is the ...
Recent studies reviewed the three most commonly used pressure ulcer risk assessment scales.
The Waterlow scale, the Braden scale and the Norton scale. The study shows The Waterlow scale is the most widely used risk assessment scale in the united king dome and Ireland, even though there is no evidence to suggest it is more effective than the other most commonly used scales. Frank et al ( 2003) found the waterlow scale may over predict risk, then that cause cost implications as expensive, preventative equipment is employed when it may not be necessary; or under predict risk so that someone assessed as not being at risk develops a pressure ulcer.
