Sleep Deprivation and Guidelines to Prevent Pressure Ulcers
Release Date: 01/13/2025
Rejecting Pure Narrative Pressure Ulcer Research and Literature
The Wound Centre
Following the provision of accurate and relevant information about the healthcare intervention and alternative options available; and with adequate knowledge and understanding of the benefits and material risks of the proposed intervention relevant to the person who would be having the treatment, procedure or other intervention (Australian Commission on Safety and Quality in Health Care, 2020). None of my narrative papers have been accepted for the new 2025 pressure ulcer prevention Guidelines. Yet my suggestions work… I can tell you how to have a pressure ulcer free facility. References...
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Sleep Deprivation and the Sundowning Syndrome
The Wound Centre
Human rights and litigation. Sleep, like eating or drinking, is essential for living. Almost everyone has experienced the feeling of ‘falling to pieces’ after a night of poor sleep. Sleep and Alzheimers Gaur et al., (2022) described how inadequate sleep causes the aggregation of soluble amyloid beta protein and this may raise the likelihood of poor cognitive outcomes. One mechanism, they explained, is that, during slow wave sleep, the brain may be able to remove metabolic waste more effectively. In my opinion this puts an even greater responsibility on healthcare facilities to prioritise...
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Ludwig Guttmann Watching Nurses Work in 1944
The Wound Centre
In 1944 Ludwig Guttmann went into the hospital at night to see how nurses were preventing pressure ulcers. After he explained the importance of repositioning to the nurses, the problem dissipated but still teams of three orderlies and a nurse repositioned patients 24 hours a day to prevent pressure ulcers. There was no mention of sleep deprivation caused by repositioning. References Frankel, H. L (2012). The Sir Ludwig Guttmann Lecture 2012: the contribution of Stoke Mandeville Hospital to spinal cord injuries. Spinal Cord, 50(11), 790-796. doi:10.1038/sc.2012.109
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Preventing Pressure Ulcers With No Staff!
The Wound Centre
Large cell alternating pressure air mattresses will prevent pressure ulcers. Geriatrician Mary Bliss. Ventilated patients. Nothing has changed in 58 years. All healthcare facilities run on a lack of nursing staff. Foreseeable and Preventable This is the moment in nursing history to introduce informed consent to prevent pressure ulcers in hospitals, the community and residential aged care, and allow patients to sleep. Because pressure ulcers are so painful failing to prevent them is a human rights issue. REFERENCES Bliss, M. R., McLaren, R., & Exton-Smith, A. N (1967)....
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Falls and Bedrails, Sensor Mats
The Wound Centre
Poorly fitting bed rails have caused deaths where a person's neck, chest or limbs become trapped in gaps between the bed rails or between the bed rail and the bed, headboard, or mattress. Other risks are: rolling over the top of the rail or climbing over the rail. Floor sensor mats can be placed around the bed or room and that can alert staff the moment an elderly person is wandering and at risk of a fall, allowing for immediate assistance. That’s fine but as I keep saying, if the staff are busy in another room helping a patient they will not be able to get to the wandering resident to...
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Falls And The Late Effects of Polio (LEoP)
The Wound Centre
Many people who acquired polio in their childhood experience new or increased impairments decades after their initial infection, so-called post-polio syndrome or late effects of polio (LEoP) []. Common impairments in persons with LEoP are muscle weakness, muscle fatigue, general fatigue and musculoskeletal pain during everyday activities and physical activities. The causes of LEoP are not clear, but it seems that the new impairments occur due to a distal degeneration of axons in the enlarged motor units that developed during the recovery of the acute paralytic polio. It is my experience as a...
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Falls, Socks and Footwear
The Wound Centre
Use the safe shoe checklist to assess footwear. This checklist is a reliable tool for evaluating specific shoe features that could potentially improve postural stability in patients. Discourage patients from walking in socks, because this is associated with a 10-fold increased risk of falling.164 This is particularly relevant in the hospital setting: patients should not walk in TEDs (antiembolism stockings) without appropriate footwear on their feet. Make sure that, while mobilising, the patient wears fitted, nonslip footwear (discourage the patient from moving about in socks, surgical...
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Falls Prevention Best Practice
The Wound Centre
For older patients suffering from delirium or cognitive impairment, where it is unsafe for them to mobilise or transfer without help, individual observation and surveillance must be increased, and help with transfers must be provided as required. Ideally, one-on-one supervision should be applied for those patients with a mobility impairment for which they lack insight (eg cognitive impairment), and who impulsively attempt to exit their bed or chair without assistance. A fall happens in a split second and if there is no nurse in the immediate vicinity it is more likely than not that the patient...
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Medico-Legal Issues and the Standard of Nursing Care
The Wound Centre
A bit about my training and going to Uni in my 40’s in Sydney Pressure ulcer on a forearm IV cannulation in the antecubital fossa and wrist causing extravasation of iron and chemotherapy drugs. Chemotherapy drugs destroyed the whole of the forearm. Years and years ago we (nurses) had to stand and count the IV drops for a whole minute to ensure the correct amount of intravenous fluid was being infused. Then IVACs and IMEDs (machines) were introduced. They were set to ensure the correct amount of intravenous fluid was being infused. One annoying thing about these machines is the constant noisy...
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Unintentional Institutional Abuse and Maggots
The Wound Centre
Alternating pressure air mattresses Maggots “In the 21st century, eighty years after William Baer presented his ground-breaking work treating bone and soft tissue infections with live maggots, thousands of therapists around the globe have rediscovered the benefits of maggot therapy” (Sherman, 2009). For many years now Lucilia sericata, and other, maggots have been used in pressure ulcers. LINKS Cairwave and Nodec A mattresses Sherman, R. A (2009). Maggot Therapy Takes Us Back to the Future of Wound Care: New and Improved Maggot Therapy for the 21st Century. Journal of...
info_outlineSleep deprivation resulting from repositioning and waking without consent is unacceptable, is a form of abuse, and may contribute to a cognitive decline in the elderly. If patients are allowed to sleep and only repositioned when awake, staff workload is reduced, manual handling injuries are minimized and consequently the risk of skin tears, an added problem in the elderly who have tissue-paper like skin, is decreased.
The Pressure Ulcer Prevention Guidelines are lengthy and complex for care staff to read, are not evidence-based and will, more likely than not, fail to prevent pressure ulcers in residential aged care facilities.
LINKS
Nodec A mattress
Sharp, C. A., & Campbell, J (2022). Preventing pressure ulcers in aged care by auditing, and changing, work practices. Asian Journal of Medical Sciences, 13(4), 191-195. DOI:10.3126/ajms.v13i4.41855
Sharp, C. A. (2022). Do clinical practice guidelines for the prevention of pressure ulcers really prevent pressure ulcers? An analysis of the guidelines. Asian Journal of Medical Sciences, 13(6). doi: https://doi.org/10.3126/ajms.v13i6.43030