Efficacy of Bundle care in reducing pressure Ulcers among bedridden patients
S. Deivanai1, R. Saraswathi2, Umapathi Mariappan3, Maheswari Ganesan4
1Oxford College of Nursing, Bangalore, India.
2Swami Vivekananda College of Nursing, Tamil Nadu.
3Najran University, Kingdom of Saudi Arabia.
4Najran University, Kingdom of Saudi Arabia.
*Corresponding Author E-mail: mahipraneeth@gmail.com
ABSTRACT:
Bundle care is a set of three to five evidence-informed practices that improve the quality of care and reduce the risk of pressure ulcers. A study was conducted to assess the effectiveness of bundle care on pressure ulcers among bedridden patients in Krishnagiri. A quasi-experimental design was adopted, with 60 patients with mild to moderate pressure ulcers selected. The Braden scale and PUSH score tool was used to assess the risk of pressure ulcer and wound status. The first day pre-test was conducted, followed by intervention implementation. The control group had a higher mean and standard deviation (SD) in pressure ulcer risk and wound status. The experimental group had a significantly higher mean post-test pressure ulcer risk and wound status. The study concluded that bundle care has improved the positive effect among bedridden patients in reducing pressure ulcer risk and wound status. It is evident that bundle care is effective, safe, and more beneficial for bedridden patients with mild to moderate pressure ulcers. The results suggest that bundle care is effective, safe, and more beneficial for bedridden patients.
KEYWORDS: Bedridden patients, Pressure ulcer, Bundle care.
INTRODUCTION:
Pressure ulcers, affecting over 3 million people globally. Pressure ulcers are the second most common reason for re-hospitalization after spinal cord injury, particularly in individuals with chronic spinal cord injuries. Recent studies suggest that temperature and moisture may contribute to the development of pressure ulcers1,2,3,4
A study in eight Australian hospitals tested an innovative pressure ulcer
prevention care bundle, focusing on patient participation. Nurses' perceptions
of the intervention's usefulness and impact on clinical practice were assessed
through semi-structured interviews with nursing staff. The findings revealed
five themes: 1) Awareness of the care bundle, 2) Improving awareness,
communication, and participation with the bundle, 3) Appreciating the positive
aspects of patient participation in care, 4) Perceived barriers to engaging
patients in the bundle, and 5) Partnering with nursing staff to facilitate
implementation. Nurses found the care bundle feasible and acceptable, but
believed it was not appropriate for all patients, particularly those with
cognitive impairments. (Zuo, X. L., and Meng, F. J. 2015).5
The researchers aim to determine the impact of bundle of care on pressure ulcer and wound status among bedridden patients in the experimental and control groups, based on studies that provide support for their findings.
OBJECTIVE:
1. To evaluate the effectiveness of bundle of care on pressure ulcer and wound status among bedridden patients in experimental and control group.
HYPOTHESIS:
H1: There is a significant difference in pressure ulcer and wound status between experimental group and control group after the intervention.
OPERATIONAL DEFINITION:
Bundle care: In this study, bundle care is defined as hydrocolloid dressing, posture, back support, and wrinkle-free bedding for patients who are bedridden. In the present study, sodium carboxymethyl cellulose has been attached to a foam pad or vapor-permeable film as a hydrocolloid dressing. It promotes wound healing and aids in absorbing excess water without drying out the wound. The hydrocolloid dressing lasted for three to five days.
METHODS AND MATERIALS:
This study examined the effects of treating pressure ulcers on sixty bedridden patients at the Government Medical College Hospital in Krishnagiri using a quasi-experimental design and a quantitative technique. Sixty individuals with mild to moderate pressure ulcers and extended hospital stays were included in the study. Their ages ranged from thirty to sixty. The pressure ulcer risk and wound condition were evaluated using the Braden scale and PUSH score tool. Bundle care was given to the experimental group, which included posture adjustments, hydrocolloid dressing, wriggle-free mattresses, and back care. The fifteenth day was designated for the post-test, and patient confidentiality and anonymity were always upheld during the study. Both descriptive and inferential statistics were used to analyse the data.
RESULTS AND DISCUSSION:
Table 1. The effectiveness of bundle care on among bedridden patients Mean, SD, Mean difference, paired t- test and p- value between pre and post-test control group in selected hospital, Krishnagiri n=60
|
level of wound status |
Experimental pre test |
Experimental post test |
Mean difference |
‘t’- value |
P-value |
||
|
Mean |
SD |
Mean |
SD |
|
|
|
|
|
Length x width |
4.9 |
0.80 |
3.33 |
0.88 |
1.57 |
11.09 |
P<0.001*** (HS) |
|
Exudate Amount |
1.93 |
0.25 |
1 |
0 |
0.93 |
20.14 |
P<0.001*** (HS) |
|
Tissue type |
1.87 |
0.34 |
0.8 |
0.41 |
1.07 |
23.02 |
P<0.001*** (HS) |
|
Overall |
8.7 |
1.11 |
5.13 |
1.13 |
3.57 |
20.88 |
P<0.001*** (HS) |
The pre-test mean and SD score for wound state in length x width was 4.9±0.80, while the post-test score was 3.33 ±0.88. The estimated paired t-test value is 11.09, with a P-value of <0. 001.The pre-test mean and SD score for exudates was 1.93±0.25, while the post-test value was 1±0. The estimated paired t-test value is 20.14, with a P-value of <0.001. The pre-test mean and SD score for tissue type was 1.87±0.34, while the post-test score was 0.8±0.41. The estimated paired t-test value is 23.02, with a P-value of <0.001.
The post-test mean and SD scores for overall wound state in the control and experimental groups were (9.43±0.31, 5.13±1.13), with a mean difference of 4.3 between the two groups. The estimated t-value is 11.54, with a p-value of <0.001, indicating high statistical significance. The results revealed that, when compared to the control group, the experimental group's risk of pressure ulcer is lowered and their wound condition improves because of bundle care, which includes hydrocolloid dressing.
Based on the findings of the study the research hypotheses “There is a significant difference in pressure ulcer and wound status between experimental group and control group after the intervention” was accepted.
The current study's findings were supported by Parvaneh Asgari et al. (2022), who conducted a study in Iran comparing hydrocolloid dressings and silver nanoparticles in the treatment of pressure ulcers in patients with spinal cord injuries. The study's findings revealed that both dressings might keep the ulcer moist and speed up the healing process. Hydrocolloid dressings are beneficial in accelerating the healing of stage II pressure ulcers.6 Many other researchers also support the findings of this study.7,8,9
CONCLUSION:
The provision of care One of the best-organized care protocols for patients who are immobilized is the use of bundle elements, which helps to prevent the formation of pressure ulcers. In bundle care, pressure ulcer treatment alone is ineffective. Bundle care includes things like hydrocolloid dressing, wrinkle-free bedding, back care, and posture. The hydrocolloid dressing works well to treat pressure ulcers and helps shield the patient from potentially dangerous medical complications.
IMPLICATIONS:
The findings of this study have implication in various such as,
Nursing practice:
· By using bundle care for patients at risk of pressure ulcers, nurses can intervene to reduce the psychological and physical anguish that bedridden patients experience. The purpose of this study was to inform nurses about the value of bundle care and how it can lower the risk of pressure ulcers.
· Nurses can teach bedridden patients supportive measures, such changing positions and using wrinkle-free beds, which is an affordable kind of treatment.
· Pressure ulcer bundle care on pressure ulcer management point to the necessity of setting up health education sessions on relevant subjects.
Nursing education:
· The nursing curriculum already included the principles of bundle care, but exposure and training in practice should also be prioritized.
· A nurse educator may require bedridden patients to be assessed using the PUSH score and the Braden scale on a regular basis.
· One indicator of the emergence of pressure ulcers is nursing education. It has given nurses the necessary knowledge, abilities, and dispositions to avoid, promote, identify, and treat pressure ulcers early on. Health care services are vital to patient care and should be used to advance medical procedures.
Nursing administration:
· By encouraging nursing staff to use bundle care to prevent pressure ulcers, nurse administrators can lower the chance of developing pressure ulcers.
· More results will be obtained via appropriate and workable organizational interventions, such as physical health promotion initiatives and health education.
· According to this study, there is a sufficient improvement in the management of pressure ulcers and the risk of pressure ulcers with bundle care.
· The administrators are responsible for setting up continuing education and in-service programs for nurses to improve their practice and quality of care for pressure ulcers.
Nursing research:
· Research studies on pressure ulcer risk among bedridden patients can help to identify nursing practice and nursing education and employed. Several effective intervention strategies need to be identified through extensive research in this field.
· This study highlights the need for more research to be done in a variety of contexts and with a range of intervention kinds; it can serve as a baseline for future investigations and inspire other researchers to carry out additional studies involving bedridden patients.
RECOMMENDATION:
According to this study, one of the most structured approaches to care for patients who are immobilized is the implementation of care bundle elements, which helps to avoid the formation of pressure ulcers. Research findings were compared between the experimental and control groups in relation to the bundle care intervention. In bundle care, pressure ulcer treatment alone is ineffective. Bundle care includes things like hydrocolloid dressing, wrinkle-free bedding, back care, and posture. The hydrocolloid dressing works well to treat pressure ulcers and helps shield the patient from potentially dangerous medical complications. Hydrocolloid dressings are easy to apply to the affected area of a pressure ulcer, do not cause discomfort, and aid in the healing process while keeping the area moisturized. Hydrocolloid dressings, which help to avoid pressure ulcers, would have been used in nursing care in the future. Every healthcare provider closely adheres to the bundle care protocol for patients who are bedridden. early detection of the presence of pressure ulcers.
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Received on 11.06.2024 Revised on 16.09.2024 Accepted on 13.11.2024 Published on 22.02.2025 Available online from March 20, 2025 Int. J. Nursing Education and Research. 2025;13(1):41-44. DOI: 10.52711/2454-2660.2025.00009 ©A and V Publications All right reserved
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