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Introduction of subject

I have been involved in clinical practice for over ten years. I am currently working as a staff nurse at Ulster Hospital. I have been working in the emergency department. Working in a similar condition with more than ten years of experience, pressure ulcer has been one of the important areas of attraction for me as a subject.

Pressure ulcer is also considered as a pressure source or mainly injuries that year prevalent to the skin and underlying tissue, which are caused by prolonged pressure on the skin. Lechner et al. (2021) stated that it is mainly the damage to the area of the skin which reduces the blood flow to the affected area. Alvarez et al.

(2016) mentioned that pressure ulcers often develop on the skin covering bony areas of the body such as elbows, heels and ankles. In the following context, Galvão et al. (2016) evaluated that constant pressure leads to the impairment in the local blood flow to the soft tissue for a long period. Etafa et al. (2018) evaluated that tissues are mainly capable of withstanding significant amounts of pressure for a certain period. 

It has been evaluated that in the UK, older people are also most likely to have pressure. Individuals having spinal injuries are a distinct group that has this particular disease. The prevalence of this group is nearly 20% to 30% 1 to 5 years after injury. Old patients associated with this particular disease have increased fivefold in the UK (Gov. UK, 2022). In hospital mortality and getting associated with this disease has also enhanced from 25% in the year 2019 to 33% in the year 2022 (Gov. UK, 2022).

Pressure treatment costs more than £1.4 million every day in the respective country (Gov. UK, 2022). Twilley and Jones (2016) mentioned that early symptoms include part of the skin becoming discoloured in terms of individuals having pale skin that tends to get red patches. It also includes discoloured patches not turning white when it is pressed. Apart from that, Saleh et al. (2019) stated that pain and richness are also prevalent within the affected area. 

Clear points of articles

Jaul et al. (2018)

The concerned article has conveyed information on the prevalence of pressure ulcer associated with comorbidities among older adults. Jaul et al. (2018) mentioned that this particular article has also provided information on the impact of ageing on pressure ulcers, as well as the prevalence of other diseases and their impact on the development of this particular disease. Jaul et al. (2018) stated that it had provided information on various diseases such as diabetes, chronic pulmonary diseases, renal diseases and cardiovascular disease that leads to the development of pressure ulcers. 

Kaddourah et al., (2016)

The respective article has conveyed information regarding knowledge and attitudes of health professionals towards pressure ulcers at hospitals. Kaddourah et al. (2016) mentioned that it had conveyed knowledge regarding common conditions that are experienced by older adults during hospitalisation and substantial burdens that are created on healthcare professionals due to the development of this particular disease. Apart from that, Kaddourah et al. (2016) stated that this article has also illustrated different prevention methods that are incorporated by nursing professionals in order to reduce pressure ulcers among the older population.  

Lichterfeld-Kottner et al., (2020)

This particular article has conveyed information on the impact of pressure ulcer on the basis of sex-specific differences. Lichterfeld-Kottner et al. (2020) mentioned that the concerned article had conveyed information on the differences between men and women having the respective disease in terms of their social, economic position, health behaviours and severity of disease. It has also illustrated the mortality rate associated with the respective disease. 

Amir et al., (2017)

The prime objective opens on pressure out the patients and their preventive and major in English and General Hospital. This particular study has provided information on prevalence of pressure outside in Indonesia as well as patients characteristics. This particular article has also provided information on pressure ulcer and it is defined as a localised injury that takes place in skin and underlying tissue. It is also misclassified as other type of ones in terms of moisture associated skin damage that have a significant impact on quality of life among individuals. 

Arora et al., (2017) 

This article has focused on highlighting different societal perspectives regarding cost effectiveness and cost utility of telephone-based support in order to manage pressure also. In the following context, Arora et al., (2017) stated that this article has conveyed new information associated with pressure, ulcer and implementation of different cost effectiveness telephone-based support for the purpose of Improving health and well-being of individuals. This particular article has also illustrated different interventions that are required to be applied for managing pressure also which in turn is also valuable for improving the satisfaction level appropriately. 

Findings / strans regarding pressure ulcer 

Jaul et al. (2018)

This article has focused on highlighting the presence of ulcer among the older adult population associated with different chronic diseases. Jaul et al. (2018) stated that it has focused on highlighting comorbidities along with pressure ulcers in three diverse patient locations in terms of community, hospital and long-term facilities for the purpose of examining the disease. In addition, it has considered a proper conceptual framework developed by European and National pressure and Advisory panels for highlighting the concerns of risk factors. 

Kaddourah et al., (2016)

This article has focused on elaborating knowledge and the attitude of healthcare professionals towards pressure also. It has focused on a survey where 105 participants in terms of healthcare professionals participated to illustrate the issue. Kaddourah et al. (2016) stated that in this particular case, it has been evaluated that healthcare professionals implement various steps for the prevention of the concerned disease in acute rehabilitation hospitals. 

Lichterfeld-Kottner et al., (2020)

This article has implemented a secondary data analysis, and information is mainly collected from nursing homes and hospitals for the purpose of illustrating the difference between men and women when suffering from pressure also. Lichterfeld-Kottner et al. (2020) analysed that woman had an enhanced likeability of the concerned disease than men. 

Amir et al., (2017)

This article has provided information on pressure ulcers in Indonesian hospitals. It has focused on implementing a multi-centre cross-sectional design in the study and Indonesia was divided into 33 provinces. This particular design was mainly incorporated for the purpose of analysing prevention and treatment measures that are applied to individuals for supporting them and improving their well-being. Along with that this particular article has also provided knowledge regarding the cause of pressure also and a proper data collection procedure has also been incorporated. From this context, Amir et al., (2017) analysed that there is a significant prevalence of pressure ulcer and various preventive and treatment measures are quite to be incorporated for the purpose of reducing the impact. However, it has also been enacted that Indonesian nurses deal with complexities of pressure ulcers in daily nursing care and hospitals are required to improve their pressure ulcer care process.

Arora et al., (2017)

Pressure ulcer is considered as a major complication that takes place within the spinal cord which also leads to spinal cord injury in lower and middle income countries. They are also associated with significant consequences and influence functional limitations that affect the family life of individuals. This particular article has focused on implementing parallel, pragmatic and randomised controlled trials. This has focused on considering suicidal perspective for the purpose of analysing economic evaluation within the healthcare sector. In the following case, it is enacted that a low-cost treatment option for management of pressure ulcer is important as this can facilitate in improving health and well-being as well as it can also improve financial consequences of individuals. Arora et al., (2017) stated that Prolonged bed rest is considered as a prime factor for managing pressure ulcer and it is also essential for managing treatment cost by telephonic-based system. 

Elaborate findings 

Theme 1: Both direct and indirect causal factors influence pressure ulcer amoung older adults 

This article has provided information on pressure ulcers and its impact on older adults having different comorbidities. In the following context, Jaul et al. (2018) evaluated that this particular article has focused on utilising the conceptual framework provided by the European and national pressure ulcer advisory panel for the purpose of recognising different risk factors associated with the development of the respective disease.

Jaul et al. (2018) illustrated different complicating conditions in terms of malnutrition, anaemia and polypharmacy, as well as other infectious diseases for the generation of the concerning infection. It is evaluated that different factors affect comorbidities of the development of pressure ulcer and it also influences this particular disease. Kaddourah et al., (2016) stated that it is required to generate a comprehensive plan for the purpose of reducing the chronic condition which in turn can also be valuable for the purpose of improving health outcomes among individuals.

Similarly, Arora et al., (2017) stated that proper bed rest is also required in order to treat pressure ulcers among older people. Direct causal factors associated with the concerned disease include comorbidity, immobility and the development of skin pressure and improper perfusion. Correspondingly, Lichterfeld-Kottner et al., (2020) highlighted that it is required by healthcare professionals to focus on gender specific intervention processes for the purpose of reducing the impact of pressure ulcers, which in turn can be valuable for improving health and well-being. Amir et al., (2017) mentioned that it is also essential to classify different types of pressure ulcers and their impact which in turn can also help in improving the treatment process among older people. 

Elaborate second findings

Theme 2: Complexities among healthcare professionals are experienced while providing care to patients having pressure ulcers 

This paper has provided information regarding attitudes of health workers towards the development of pressure ulcers among older patients. This has incorporated a cross-sectional study at King Fahad Medical City Hospital, and the study population encompasses nurses, physical therapists and occupational therapists. Kaddourah et al., (2016) mentioned that Likert scale was mainly used for accumulating responses, and two variable combinations of strongly agree and agree, as well as combination of uncertain disagree and strongly disagree, was incorporated.

Likewise, Arora et al., (2017) evaluated that nursing professionals are also required to focus on proper management of pressure ulcers and they are also required to consider different techniques in order to improve quality of life. Amir et al., (2017) stated that it is also required by hospitals to improve their settings so that complicating conditions can be treated appropriately. Kaddourah et al. (2016) stated that it is also necessary to provide and formulate different strategies for healthcare professionals and increase their knowledge so that evidence-based practice can be conducted for the reduction of that particular disease. Correspondingly

Jaul et al. (2018) highlighted that nursing professionals are required to focus on different risk factors in terms of nutrition and other aspects for the purpose of development of pressure ulcer, which in turn can influence them to implement treatment accordingly. This can also facilitate them in generating evidence-based practice, which in turn can reduce complications. Lichterfeld-Kottner et al., (2020) evaluated that women are more likely to get pressure ulcers and therefore nursing professionals need to have effective treatment plans for treating women and men differently.

Elaborate third findings 

Theme 3: Gender wise development of pressure ulcer influences different intervention process 

In this article, the development of pressure ulcer between men and women is evaluated. Amir et al., (2017) stated that healthcare providers are required to generate specific plans for the purpose of improving health and well-being and specific gender-based plans are required. Both male and female patients above age 18 years old were invited in this data analysis technique for the purpose of highlighting the development of pressure also.

In the following context, Lichterfeld-Kottner et al., (2020) evaluated that there have been sex-specific differences in the development of the concerned disease and prevention and treatment processes are also different. Arora et al., (2017) mentioned that cost estimation is required as it facilitates in generating proper financial foundation which is also advantageous for older people. Along with that, Lichterfeld-Kottner et al. (2020) enacted that women are more likely to have more risk in the development of the concerned infection than men.

Jaul et al. (2018) comorbidities influence pressure ulcer which in turn is also responsible for performing evidence-based practice. Kaddourah et al., (2016) enacted that various strategies are required to be applied for improving health and well-being effectively.


From the above articles, it has been evaluated that pressure ulcers are mainly related to older adults, and they are likely to get infected due to the presence of other complications. It has been evaluated that, different chronic diseases, including stroke, diabetes and advanced dementia, are considered as major aspects that enhance the development of that particular disease. Along with that, it has also been enacted that it is essential for healthcare professionals to gain relevant knowledge for the prevention and treatment of pressure ulcers so that health and well-being among older adults can be sustained. It is also essential to change attitude and maintain a learning attitude so that preventive measures can be incorporated ineffective. 

Conclusion and recommendation

Thus, it can be concluded that pressure ulcers take place due to injuries that affect tissues. Different symptoms highlight discolouration of the skin and development of red patches. Selected articles have conveyed knowledge on various steps that are required to be incorporated for treating the concerned infection and attitude of healthcare professionals regarding the treatment of the disease. 

Reference list 

Alvarez, O.M., Brindle, C.T., Langemo, D., Kennedy-Evans, K.L., Krasner, D.L., Brennan, M.R. and Levine, J.M., (2016). The VCU pressure ulcer summit. Journal of Wound, Ostomy and Continence Nursing43(5), pp.455-463.

Amir, Y., Lohrmann, C., Halfens, R.J. and Schols, J.M., (2017). Pressure ulcers in four Indonesian hospitals: prevalence, patient characteristics, ulcer characteristics, prevention and treatment. International Wound Journal14(1), pp.184-193.

Arora, M., Harvey, L.A., Glinsky, J.V., Chhabra, H.S., Hossain, M.S., Arumugam, N., Bedi, P.K., Cameron, I.D. and Hayes, A.J., (2017). Cost-effectiveness analysis of telephone-based support for the management of pressure ulcers in people with spinal cord injury in India and Bangladesh. Spinal Cord55(12), pp.1071-1078.

Etafa, W., Argaw, Z., Gemechu, E. and Melese, B., (2018). Nurses’ attitude and perceived barriers to pressure ulcer prevention. BMC nursing17(1), pp.1-8.

Galvão, N.S., Serique, M.A.B., Santos, V.L.C.D.G. and Nogueira, P.C., (2017). Knowledge of the nursing team on pressure ulcer prevention. Revista Brasileira de enfermagem70, pp.294-300.

Gov. UK (2022) Pressure ulcers: applying All Our Health [accessed on: 15/10/2022]

Jaul, E., Barron, J., Rosenzweig, J.P. and Menczel, J., (2018). An overview of co-morbidities and the development of pressure ulcers among older adults. BMC geriatrics18(1), pp.1-11.

Kaddourah, B., Abu-Shaheen, A.K. and Al-Tannir, M., (2016). Knowledge and attitudes of health professionals towards pressure ulcers at a rehabilitation hospital: a cross-sectional study. BMC nursing15(1), pp.1-6.

Lechner, A., Kottner, J., Coleman, S., Muir, D., Beeckman, D., Chaboyer, W., Cuddigan, J., Moore, Z., Rutherford, C., Schmitt, J. and Nixon, J., (2021). Outcomes for pressure ulcer trials (OUTPUTs) project: review and classification of outcomes reported in pressure ulcer prevention research. British Journal of Dermatology184(4), pp.617-626.

Lichterfeld-Kottner, A., Lahmann, N. and Kottner, J., (2020). Sex-specific differences in prevention and treatment of institutional-acquired pressure ulcers in hospitals and nursing homes. Journal of tissue viability29(3), pp.204-210.

Saleh, M.Y., Papanikolaou, P., Nassar, O.S., Shahin, A. and Anthony, D., (2019). Nurses' knowledge and practice of pressure ulcer prevention and treatment: an observational study. Journal of tissue viability28(4), pp.210-217.

Twilley, H. and Jones, S., (2016). Heel ulcers–pressure ulcers or symptoms of peripheral arterial disease? An exploratory matched case control study. Journal of Tissue Viability25(2), pp.150-156.