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A pressure ulcer is a skin wound that can penetrate deeper into body tissues including muscles and bones. The wound results from prolonged pressure on tissue, usually bony prominences, due to immobility. A decubitus ulcer is one of the critical problems in health care. The National Pressure Ulcer Advisory Panel (2016) estimated that about 11 billion U.S. dollars are spent annually on the management of decubitus ulcers (Lima, Italiano, and Araujo, 2015). The quality of life is adversely affected due to chronic pain and discomfort. The findings indicate that pressure ulcers can increase hospital stay, and hospitalization costs can increase to 70,000 U.S. dollars (Lima et al., 2015). The management of decubitus ulcers is complicated due to the associated risk factors and their co-existence with other chronic illnesses. The paper explores how the introduction of a mobile application can enhance the collection and analysis of data associated with decubitus ulcers. The mobile application concept can also be used by the patient to alert caregivers when the need arises. Thus, the mobile application plays a significant role in the prevention of pressure ulcers, reducing their severity, and minimizing the health care cost.

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Introduction

The quality improvement projects are aimed at promoting health care and preventing diseases among the population, reducing health care expenditure, and ensuring better clinical outcomes as well as improving the patient’s overall experience. One of the problematic issues which have been persisting for a long time is a pressure ulcer. The risk factors for decubitus ulcers include immobility, advanced age, and chronic health conditions. Decubitus ulcer cases in hospitals and homes are very common. In fact, it is a worrying trend because pressure ulcers are associated with skin breakdown and underlying tissue injuries which can result in life-threatening conditions, such as infections and gangrene. The mobile app can be used to help with data collection or wound assessment and act as an alert system for the patients and caregivers, hence, promote effective decubitus ulcer management.

The paper discusses one of the most effective solutions concerning the issue of quality improvement in nursing: the introduction of a special mobile application since this concept in pressure ulcer care is a critically important project. The paper also studies the management of decubitus ulcers taking into account particular ideas of change and considering the evaluation of mobile application impact on pressure ulcer management. Kotter’s model of 8 steps for effective change is utilized during the integration of the mobile application idea into health care delivery.

Incidence and Prevalence of Decubitus Ulcers

A decubitus ulcer is a prevalent health problem in the hospital, at home, and in the nursing homes. The incidence of decubitus ulcers can act as a quality indicator in clinical settings; however, epidemiological information associated with the frequency and risk factors for decubitus ulcers in the course of care is still insufficient (Eberlein-Gonska, Petzold, Hela, Albrecht, & Schmitt, 2013). The research experts estimate that the prevalence of decubitus ulcers stands at 9.2% among all the patients in the health institutions (Anders, Heinemann, Leffmann, Leutenegger, Prfener, & von Renteln-Kruse, 2010). Anders et al. (2010) provide the following figures concerning the issue: decubitus ulcers affect 5-10% of patients at the hospital, about 30% at geriatric clinics and elderly homes, and approximately 20% of the clients who need nursing services and are staying at home. Such factors as the advanced age, longer hospital stays, clients undergoing management in the intensive care unit, and transfer from a residential nursing care setup were viewed as predictors for the occurrence of decubitus ulcers during the hospital stay (Eberlein-Gonska et al., 2013). Eberlein-Gonska et al. (2013) showed that gender and the severity of the diseases did not affect the incidence of decubitus ulcers. However, the incidence rates of decubitus ulcers vary depending on the type of wards or units in the hospitals. The higher risks for developing a decubitus ulcer were associated with surgical wards while the slightly lower ones were in medical wards; and the lowest risks were in psychiatric units (Eberlein-Gonska et al., 2013). Thus, there are differences in the risk factors for decubitus ulcers among different departments in the hospital. In addition, Anders et al. (2010) observed that 60 % of all the patients affected by pressure sores are geriatric patients.

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The Management of Decubitus Ulcers

Decubitus ulcers significantly contribute to the disease burden being characterized by the rising health care costs, morbidity, and mortality among other indicators. Moreover, the pain and discomfort reduce the quality of life of the affected patients (Barker et al., 2013). Thus, an elaborate and comprehensive decubitus ulcer management plan ought to be formulated. The management strategy of pressure sores should be an inclusive process that encourages the participation of all relevant stakeholders who include the patients, the families, the hospitals and other forms of health care facilities, the health care providers, the community, and the government. Furthermore, decubitus ulcers should be cited as one of the critical health problems that require undivided attention. In addition, new policies associated with competent decubitus ulcer management can be initiated: they would be aimed at preventing decubitus ulcers and also providing guidelines for effective treatment strategies.

Nursing care plays a proactive role in the management of pressure sores. Decubitus ulcers have been a burning issue in the health care system due to the poor ability of health professionals to prevent and treat them. Thus, nursing quality improvement activities are likely to be especially useful strategies in combating decubitus ulcers. The nursing care improvement activities or projects are the changes that can be introduced to decubitus ulcer management with the aim of improving clinical outcomes among the patients. Thus, the nursing quality improvement projects associated with the management of decubitus should have a set of realistic, measurable, and achievable goals to be achieved within a given period of time.

Furthermore, the clinical management of pressure ulcers can take diverse approaches. First, the position changes help with the prevention of decubitus ulcers by relieving the pressure (Barker et al., 2013). However, lack of adequate competence of the nurses in the health care facilities may contribute to the inefficient turning of the immobile and bedridden patients. The clients who stay at home are predisposed to decubitus ulcers and thus need caregivers who can change their position after certain periods of time. The absence of sufficiently competent caregivers is partly to blame for the rising incidence of decubitus ulcers (The National Pressure Ulcer Advisory Panel, 2016). Therefore, a special mobile application can be a recommendable solution because the pressure ulcer patients and the clients at risk can install the pressure ulcer app on their phones and use to alert the nurses and other caregivers when they feel the need for changing their positions or turning. Second, effective wound care and adequate debridement of the devitalized and necrotized tissue help with pressure ulcer management immensely (Agrawal & Chauhan, 2012). Third, managing and controlling infection significantly contributes to the reduction of pressure ulcer severity. Fourth, sufficient level of nutritional intake is likely to facilitate the wound healing process. Fifth, surgical interventions, such as flap reconstructions, may be required for the grade 3 and grade 4 decubitus ulcers (Agrawal & Chauhan, 2012). Finally, some specific methods have greatly been helping in the management of pressure ulcers. These means include particular ointments, innovative mattresses, ultraviolet heat lamps, solutions, creams, sugar, and dressing. The introduction of the mobile app can be integrated into decubitus ulcers care in order to enhance the effectiveness of its management through evaluation, collection of data, assessment, and reporting.

The integration of technology through the use of a mobile app in the management of pressure ulcers is a critical advancement and change: it is aimed at bridging the communication gaps in the course of medical care. The utilization of special mobile applications is one of the telemedicine advancement that can facilitate interactive audio and visual communication in the health care system. In fact, mobile communication can assist health professional with the implementation of decubitus ulcers care protocols and facilitate the monitoring of the patients or clients who are at higher risks of developing pressure sores. The mobile app presents a control platform through which a patient’s decubitus ulcer status can be monitored during the entire period of treatment. Rodrigues, Pedro, Vardasca, de la Torre-Diez, and Martins (2013) affirmed that the stand-alone mobile app version is recommendable because it can be integrated into the health records system. The mobile app is a very useful tool in the provision of nursing care services: since it can be incorporated into the health information recording system, it can enable the hospitals and various health institutions to integrate nursing care plans for decubitus ulcers. In addition, there is an increasing number of people owning smartphones, and it provides an opportunity to create a mobile app that is compatible with most smartphones, including LG Optimus One P500, HTC Magic, Galaxy i5700, Samsung Galaxy S, and Samsung Galaxy Tab among many other popular models.

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The System Design of the Mobile Application

The mobile app for managing pressure ulcers ought to have unique designs that facilitate its use. The mobile app in this project can be used by both the nurses and the clients. It has two interfaces designed specifically for the health care provider and the patient. The application allows the patients suffering from decubitus ulcer to alert the health care providers when they need to change their position. In addition, the clients can be taught how to use the advanced features of wound assessment. The mobile app would allow nurses to receive new patient information faster and easier, assess new wounds and re-assess the wounds of the hospitalized or bedridden clients. The Pressure Ulcer Scale for Healing (PUSH), Bates-Jensen tool, and Braden Scale are some of the useful tools that can be installed with the mobile app (Friesen, Hamel, & McLeod, 2013).

The aforementioned wound assessment tools would assist caregivers in collection of the information about the wound which consequently, will aid the management and treatment of the disease. The simplicity of the user interface ought to be guaranteed: there should be a minimum number of visual elements on the screen to reduce clutter. However, the use visual color cues which highlight critical information are strongly encouraged. Furthermore, the mobile app design takes the following aspects into consideration: the battery duration, infection control, and portability. In addition, the application ought to be compatible with most available gadgets, including smartphones and tablets.

Considering the fact that confidentiality is absolutely important in health care, the mobile application has to conform to the confidentiality requirement and preserve the privacy of patients. Therefore, the users of the mobile application will be assigned user IDs and passwords in order to securely log in. The IDs and passwords will be acquired from the centralized administrative unit, and the information sent through the system will be encrypted in a bid to add another layer of security to the accounts and the patient data (Friesen, Hamel, & McLeod, 2013).

The Aims of the Mobile App

It is essential to set goals when new technologies or changes are introduced to facilitate nursing care quality improvement. Setting goals will enable the team members to focus on the implementation of key activities that are aimed at accomplishing the core objectives of improving health outcomes among the patients affected by decubitus ulcers. Some of the particular goals associated with the integration of the mobile app in decubitus ulcer management include the following. First, the mobile app which is one of the telemedicine strategies aims to support health service delivery needs to be properly developed. The mobile app enhances automation, data collections, and aids in various health care operations (Nasi, Cucciniello, & Guerrazzi, 2015). The second objective of this project is to put more emphasis on the self-care management among the patients through active participation in their care. The patients can be taught how to use the app and report any findings that can be related to the progress of decubitus ulcers to health care providers. The contemporary models of care focus on the importance of patient self-care and this mobile app are aimed at promoting the role played by the patients in the course of managing decubitus ulcer. Third, the mobile app is directed at supporting the delivery of health services to outpatient settings, such as rural areas and homes, where the aid of health care personnel may be inaccessible. Thus, the clients who feel predisposed to decubitus ulcers or are already affected by the disease can use the mobile app at home: they can communicate with their health care providers, for instance, nurses, requesting teem to visit their homes in order to provide therapeutic health services that can prevent and reduce the complications associated with pressure sores.

Furthermore, the mobile app is aimed at supporting telemedicine whereby information can be shared using cellular and Wi-Fi networks within the hospital and across different health care facilities. The data exchange is done for the consultation purposes among the experts and other health care professions, and it can save patients from certain inconveniences, such as the need to visit hospitals or far consultations clinics. Next, another goal of the mobile app is to facilitate the data organization and interpretation. The application should present alerts upon login notifying the caregiver to do the assessment of the patient’s wounds. Furthermore, the mobile app would provide the history of the wound, including its previous images and assessment data. Finally, the mobile app is directed at contributing to the health care value chain concerning decubitus ulcers. The mobile app can be used in all relevant phases of the health care delivery processes which include the following: disease prevention, diagnosis, treatment, and follow-up care (Nasi, Cucciniello, & Guerrazzi, 2015). The mobile app enhances data collection, aids monitoring, and conforms to the new health care models; thus, it will significantly contribute to health care delivery if it is integrated in the whole medical care process. The mobile application will support nurses and other health care providers reducing the incidence and severity of pressure sores as well as improving the bedsores prevention strategy.

Rolling the Mobile Application Out

The mobile app should meet some criteria reaching a certain level before being its use is widespread. The mobile app ought to have appropriate design and usability, follow the National Pressure Ulcer Advisory Panel (NPUAP) guidelines, and should be consistent with the HL7 Pressure Ulcer Prevention Domain Analysis Model (Foltz, Stein, Menorca, & Kim, 2013). The best mobile application is the one that can take vital information related to decubitus ulcers which include skin color, moisture content, wound dimensions, and temperature.

A nurse would be introduced to the mobile app and trained on how to use it effectively. In the course of training, simulated patients and manuals would be utilized to demonstrate how to assess and collect information associated with the wound. The training would take two hours, and afterward, the nurses would be provided with phones: the application would be already installed to facilitate further learning and enhance familiarity. The nurses would be asked after 14 days whether they need further training or not: the initial training and subsequent use of the mobile app could be sufficient.

The integration of mobile app into health care as a change, particularly in the management of decubitus ulcers, may be met with resistance of the health care staff including nurses and other relevant providers. The change is aimed at improving the quality of nursing care; therefore, it ought to be implemented in a manner that results in the achievement of the intended objectives. Therefore, Kotter’s concept which highlights critical phases in the implementation of change is helpful. Kotter’s 8-step process (Garson, Vakharia, & Kain, 2015) can provide guidelines on how to effectively introduce the mobile app as a telemedicine change in the health care delivery system. First, there is a need to create a sense of urgency. The issue of decubitus ulcers should be adequately described and supported with sufficient data and evidence of the problem being critical and needing undivided attention. The mobile app can be used as one of the strategies to prevent, diagnose, and reduce the severity of pressure sores. The role of the mobile app in the management of the decubitus ulcers ought to be explained and demonstrated to all relevant stakeholders. Second, it is necessary to build a guiding coalition through assembling energetic and skilled team members who would be able to lead and support collaborative efforts in the utilization of mobile app. The selected team members should possess leadership skills, be able to make changes, and share the same vision. In addition, it is necessary to develop a strategic vision and initiatives and share the vision for improving the quality of health care among the patients suffering from decubitus ulcers or those who are at risk of developing it. The strategic vision and initiative will enhance change efforts and ensure that the chosen strategies work toward achievement of the desired results.

Furthermore, enlisting a large group of people who would spearhead the change is an integral part of the introduction of the mobile application. Moreover, it is vital to eradicate any barriers that impede the change. These obstacles may include the systems and structures capable of hindering the integration of mobile technologies into nursing care. In addition, it is necessary to consistently generate and demonstrate short-term gains or wins. The performance of the mobile application in the decubitus ulcer management can be tracked, evaluated, and celebrated: it would encourage the nurses as well as other stakeholders to embrace the usage of the mobile app. The next step involves sustaining the acceleration of the use of the mobile app in the decubitus ulcers care through the usage of credible information to change policies, systems, and structures that are not consistent with the change. Furthermore, there is a need to reinvigorate the change process. Finally, the implementation has to be secured through the articulations of new behaviors exhibited by the health care providers and patients in the course of pressure sores management with the help of the mobile app. The success of the application usage can be emphasized being accompanied by the need to entrench the concept of the mobile app in leadership development and progression.

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The Evaluation of the Mobile App Performance

The nurses will utilize the mobile application more often than any other health care providers. Thus, it is important to train them on how to use the mobile app properly. During or at the end of the training, it would be necessary to do an evaluation in order to determine the outcome of the learning process. The training would take 2 hours, and afterward, the nurses would be asked about the experiences or feelings concerning the training, which would help to determine the effectiveness of the training. After 30 days, the nurses who have been using the mobile app in their clinical practice would be requested to answer the online survey questions about their knowledge, experience, and attitudes concerning the utilization of the mobile app when providing care to the decubitus ulcer patients. The focus group sessions would be held after 3 months to review the results of the survey on the knowledge, attitude, and experiences associated with the mobile app and to evaluate the impact of mobile app on the wound care.

The outcome evaluation is one of the key components in the nursing care process. The results of the integration of the mobile app into the management of decubitus ulcers can be evaluated against the set objectives. The improved health, functional improvement, and the reduction of complications are important indicators that can result from the use of the mobile app in the pressure sores management. The evaluation can be implemented through various means which include audit, peer assessment, and self-reflection. Furthermore, it is possible to carry out a study that can assess the impact of mobile app utilization in decubitus ulcer management. In addition, the study findings can be compared to other relevant research outcomes. Thus, the reduction of incidence of decubitus ulcer and the decrease in its severity are some of the most desirable results of any given health intervention. On the whole, the evaluation of the intervention effectiveness can be done after 6 months; however, the comprehensive study evaluation on the impact of telemedicine on pressure sores care can be done after 2 years of the change being introduced.

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Conclusion

A decubitus ulcer is a critical problem in health care because the disease causes morbidity and mortality. In fact, it is a great burden on the health care system since the issue has been persisting for a long time and has immensely contributed to the rising health care costs and serious health complication. There are several risk factors for pressure ulcers which include advanced age, immobility, and chronic diseases among many others (The National Pressure Ulcer Advisory Panel, 2016). There have been some setbacks associated with decubitus ulcer management due to poor preventions, which can arise from inadequate care. The integration of the mobile application concept in pressure ulcer management is a significant quality improvement project. The mobile application can help the patients to alert the caregivers when they need assistance with changing their positions as well as relieving pressure. Furthermore, the application can enhance data collection and assessment in the course of the decubitus ulcer management. Since the mobile app is a major quality change improvement project, there is a need to introduce the change in a manner that ensures its effectiveness and acceptance by all relevant stakeholders. Consisting of only 8 steps, Kotter’s concept of change can be successfully applied when introducing the new mobile app. Thus, the phone application is a significant change that can improve the management of decubitus ulcers, enhance preventions and treatment, and, as a result, lead to better clinical outcomes.