The attention will now switch to one individuals aspects that comprise the initial evaluation. The Waterlow assessment was developed by Judy Waterlow (1985), it is a application created to assist health practitioners to assess whether a individual is at risk of developing pressure ulcers, it can be by far the most frequently employed assessment tool in the UK (Judy-waterlow. co. uk 2007). The Waterlow can be applied to Mister Adams as a result of his immobility status, as stated by Lareau and Sawyer (2010) if the patient is fixed to understructure rest as part of the management to get a hip crack they are for higher risk of further problems due to immobilisation, these problems include pressure sores.
The Waterlow analysis tool comprises of two parts, the first is a scoring system with a guide to a person’s risk status based on the amount they credit score, the three status’s are ‘at risk’, ‘high risk’ and ‘very excessive risk’. The other part can be described as guide intended for the nursing care necessary according to the patient’s status.
In addition, it has rules to injury classification, providing a description of the different grades of ulcer. The rating system includes areas which might be all deemed to be elements that may lead towards a patient’s risk of developing pressure ulcers. Included in this are a patient’s build, tissue viability, love-making, nutritional status, continence, flexibility and other particular risks including co-morbidities and medications. The idea is, the bigger the patient results within every area and overall the larger the patient reaches risk of obtaining pressure ulcers (Judy-waterlow. co. uk 2007). The tool’s ease of use meant assessing Mr Adams’s Waterlow score was straightforward; even so as Judy (1985) declares due to its simpleness professional thinking should also be used to determine an individual risk position. This includes extrinsic factors which are not listed in the tool, for example the length of time an individual stays in a single position for and whether they are able to shift themselves and recognise whenever they need to do thus (Guy 2007).
This is especially relevant to Mr Adams’s for although this individual has been restricted to bed rest he is still capable of repositioning him self on a regular basis and thus reducing his risk of pressure ulcers. Most of the information had to conduct the assessment was obtained through asking inquiries and mentioning medical notes, however in so that it will fully evaluate Mr Adams’s tissue stability a physical exam needed to happen, this involved obtaining agreement to assess Mister Adams’s skin area especially aroundpressure areas such as the sacrum, heels, elbows and shoulders while suggested by the NICE (2005). In order to preserve Mr Adams’s privacy and dignity the curtains were drawn surrounding the patient over the whole analysis. Another aspect to the analysis tool essential Mr Adams’s to be considered in order to get his BMI, due to his fractured hip this was not likely, therefore an estimate had to be produced; this may impact the reliability from the overall score.
Both Franks et approach (2003) and Nixon and McGough (2001) have challenged the quality of equipment such as the Waterlow assessment recommending that they can either over anticipate the risk creating unnecessary costs with precautionary equipment which is not needed or under anticipate a patients risk leading to a patient to formulate pressure ulcers that should have been prevented. This lack of validity could be as a result of reliability being placed on the clinical judgement of the physician conducting the assessment to accurately report findings (Kelly 2005), by way of example by certainly not properly evaluating a sufferers tissue stability or by simply not asking about a people past good pressure ulcers may can result in a beneath predicted risk score.
On the other hand, in Mister Adams’s circumstance by not assessing that although he could be bedbound he could be capable of repositioning may lead to an above predicted risk score. Reliability is also troubled by responses provided by the patient, such as a patient maybe embarrassed to convey continence concerns (NHS 2010) and give phony answers. Man (2007) amounts up the effectiveness of tools such as the Waterlow well by simply stating that assessing a patient’s likelihood of obtaining a pressure ulcer needs multifactorial consideration, therefore a risk evaluation tool ought to only assist in signposting toward possible risk factors and should not be taken as the only means to determine risk, medical judgement must play an important role in initiating appropriate care ideas.
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