The Art of Repositioning in Pressure Ulcer Prevention
Unlock the secrets to healthier skin! Ever wondered about preventing painful pressure ulcers? Learn simple, effective techniques to keep your loved ones comfortable and ulcer-free. In this week’s episode, nursing home abuse attorney Rob Schenk welcomes guest Dr. Iblasi to talk about practical ways to master the art of repositioning for pressure ulcer prevention, ensuring your family receives the best care.
Schenk:
Hello out there. Welcome back to the nursing home abuse podcast. My name is Rob Schenk. I am an attorney and I will be your host for this particular episode. This week we have an exceptional topic, we have an exceptional guest, we’ll be talking to Dr. Abdulkareem Iblasi about the essentially the science and dare we say the art of repositioning as it pertains to preventing Pressure injuries. So if you have watched this, or listen to this podcast in the past, you know, we’ve dealt with pressure injuries.
On many occasions. If you want a refresher, before listening today’s episode, I would recommend going to probably Episode 121, where we talk about five ways to prevent pressure injuries where we do get into repositioning a little bit not like we do today. But from a general standpoint. Also maybe 151, which was comprehensive pressure ulcer prevention in nursing homes, great episodes. Those are just two we’ve had several episodes dealing with this, but I would recommend that you go check that out if you want to learn more about preventing Pressure injuries in nursing homes.
So we’re talking about the art of repositioning in terms of pressure injury prevention. We are doing that with a special guest Dr. Abdulkareem Iblasi is an accomplished healthcare professional with a distinguished academic background. He earned his Bachelor of Nursing from Jordan University in 2005, and a master’s in nursing service administration. 2009 Dr. Iblasi furthered his education by obtaining a PHD with a university in Thailand.
With the wealth of experience Dr. Iblasi has contributed significantly to the health care sector. He has served in various capacities including roles as intensive care nurse, infection control specialist, and wound care manager. In addition to his clinical roles, Dr. Iblasi has made substantial contributions to academia as an assistant professor in Jordan. He plays a pivotal role as part of the AWS team focusing on hospital operations and healthcare system reform in Qatar and in the Gulf region, and we are so happy to have him his experience centers knowledge are with us today. Dr. Iblasi. Welcome to the show.
Dr. Iblasi:
Thank you very much for this kind invitation.
How Can Repositioning Residents Help Prevent Pressure Ulcers?
Schenk:
I just want to kind of jump right into it. I know that at least in the nursing homes that I’ve come across in the residence that I’ve come across, the prevention of pressure injuries is typically paramount. Like, it’s like one of the more critical categories of health that we’re really worried about. And when we always talk about the prevention of pressure injuries in nursing home residents, the primary category of prevention interventions is always repositioning. So that’s why I’m so glad that you’re on a talk about this. So kind of from like a, I guess, a just a broad standpoint. What, how can repositioning help prevent pressure ulcers, or pressure injuries in the first place? What is refinancing? What does repositioning do to the body that would prevent that from happening?
Dr. Iblasi:
Yes, thank you very much for this question. I think this is going to start with we learned a lot about the importance of making reposition to prevent pressure, injury, or pressure. But here in nursing, we have we should stand point on two important factors. First, since the time of Florence Nightingale that illustration is something important, the Florence she had in her talking about the requisition, and that’s apart from the standard of nursing care. But always we have the fact that we know how to prevent pressure ulcers, but the pressure ulcer is not prevented. That’s happening. So we have cases that report happening of pressure injuries.
There’s the first part the second gap is how we define the leadership and this is I think, important for us when we are looking for the nursing context or knowledge about how we are going to say what’s the meaning of reposition now, now we are living in the AI era right. So, if I put all this information that we have about repositioning in the context of pressure injury prevention, we found that is it positioning or any positioning?
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Is it repositioning or positioning or changing changing the patient position or is it moving in the context of nursing literature, they in many places, they put the two concepts together, then said positioning and reposition or moving and positioning. So, this indicates something that we have some misunderstanding about the meaning of repositioning that we are referring to, as Michelle focus on we should first start to define what are the picture or the photo that I should see to say this is the repositioning here the issue coming from the fact happened between the standards and the compliance on the real practice?
We know from time off from the fundamentals, nursing and medical surgical box and so on, they will give you an Lippincott whatever they give you an A strict 1234 What should be done. And these steps are the best methodology to prevent the pressure injury from happening. But when we come to the real practice, the pressure injuries already happened. So what was the problem? I think it’s not from my my viewpoint, that there are problems from transferring the actual of the repositioning to the practice. And that issue related to this transfer. It’s coming part from it related to how the nursing literature have the knowledge deal with the repositioning and how the nurses understand that. That’s why we come now to the compliance.
What Are the Most Effective Techniques for Repositioning Residents for Pressure Ulcer Prevention?
We need a couple of nurses agree on the same time to do the same procedure, it and this procedure should be repeated it frequently on the same standard. But this is not happening. And this make the repositioning as the week Turner among the system of preventing Russia. It’s a human based intervention.
Until now, there are a lot of trials among the manufacturers to build a new system that helps Nurses also it’s very our heavy intervention. It’s required muscular additive to our coordination. So all your body working while you’re doing the reverse shape on the same time, while you’re doing health education or while you’re maybe preparing the medication, you’re providing a lot of efforts. And the third one is the the specific kind of cooperation team working until it’s happened. So there are several parts that make the ribbon auditioning technique, further focus of how we will match all these circles together to make the repositioning happening in the proper way, this issue of definition and issue of a practice, then our points are the compliance if we’re talking about the nurse adding a 12 hour duty.
So, based on the common nursing standard and say this is common out of discussion, scientific about it, but this is what the practice at least we have Middle East, that every two hour the patient in risk for pressure injury should have directorship. Now, do you think the quality of repositioning from the first episode of the nurse do it similar to the last revulsion into it before end of the duty and added effects can happen among each one of these, it make or means the pressure injury is going to happen? Whatever we are doing are trying defining the concept and defying the compliance of making this is what we are looking for. And I think this is what we should provide further about.
For those seeking to understand the critical aspects of repositioning and its impact, reference materials such as this comprehensive study on PubMed and practical guidelines from CEC provide valuable knowledge.
Schenk:
Sure. Okay, well then tell me about that. Like, what how do how do we define repositioning then like, what’s the difference between repositioning and then moving from side to side, like, Tell me about that. And then I guess that that’s important, that sense of what you’re saying that there’s might not be congruence between what the nurse did at 12am. And the nurse is going to do at 2am when they come back. So to kind of expand on that a little bit. Now,
Dr. Iblasi:
if we make further focus to what already repositioning had from inside, we will, we will see five main components working together until the repositioning as a concept had already realized. The first stage what we call it, the B or the preparation stage. And this is when the nurse realized the need for repositioning, so the patient can the assessment tool, whatever cetera, and the nurse put it among the plan for doing the emotion. And then we come to turn.
So, the current science defined between the repositioning as the bigger umbrella and a component within the umbrella, which is the terming. So the term gets apart from the repositioning, but they’re not replaced the meaning repositioning because we need the plan for it. And then we will go for turning. And we need the harmonization I call it because anyway, I started in Thailand. So I put it this is b Thai, or B then T H AI. The second one is harmonization between the nurses, the repositioning require this kind of harmonization.
And after that we come to the third component, I call it unsure, or make sure that the patient in the proper position that we would like this patient to stay among the coming time. and I are the information which apart from the presentation, if we are able to fix all the cycles among our practice, that mean we reach the meaning of repositioning that we are looking for. And in effect in any part from this one. That means there are parts from the body or organ already under the pressure. And that mean this will lead for pressure injury.
What Are the Misconceptions About Repositioning for Pressure Injury Prevention?
A lot of times there’s this misconception, misconception happened among them that the first misconception is that we are in general, looking forwards, you know the marshmallow experience, we are looking for the current results, the motivation for the nurses, or the motivation for people in general that when we do something, then we see the result direct in the requisition. The pressure injury when it happens, maybe it takes three days until it’s discovered.
So when we come to say that patient now developed social injury, maybe the defect that’s happened from the prevention not from today, but it’s backward and that cannot be detected or very hard for us to detect. So, this make part or the sense of the nurses that we are doing this and there is no results from this is an effect happening among the pressure injury prevention related to the repositioning or how we practice the revision. The second is how we are dealing with the positioning among the other context which is the big context of pressure injury prevention as we are doing air mattress or we applied all over offloading mattresses for the patient.
So, misconception can happen for the nurses that are okay, so we are already doing what we should do. And when we are started to weight, the repositioning among the other nursing intervention in general, our nurses are very, very busy. And we have a lot of patients and the workload is every time increasing upon. So the nurses, even unintentionally, they will come in the economic mind to say that which is more important than which giving them medication now, or postpone the repositioning because I’m working in a hospital and so maybe the doctor come and this is the doctor around. So what about postpone the repositioning little bit and this was born can be within the busy busy day of nurses it can taking to the consequences of delay the actual reposition. So I think still defining the repositioning among these five cycles, which is preparing terming harmonization and choosing an information or documentation among the need for compliance and consistency and compliance, make a consequence regarding to the how we provide the quality of care, or the most complicated issue is how we to measure this intelligence in the quality world, the focus always on the result.
So, they focus on how much how, how, how many patients develop pressure injury by month, or by week or the day, whatever. But there are defects in measuring the process of prevention. And in the process of prevention, we found that Brandon or whatever the assessment tool that was already used, so is it done or not done? So it’s clear, so I can measure the process here? Is the offloading mattresses or uploading devices applied? So is it yes or no? So easy to be caught. But when we come to repositioning, which one should I catch that complex, it’s long, and it’s only left for the people who are already providing this intervention home to other nests. It’s something individualized, where they come to us or measure the requisition in compliance. I make us some researchers, I want to measure the requisition in compliance.
It’s really a complex issue, which is repositioning compliance that will matter. What about my presence as a manager or quality in front of nurses while they are doing the repositioning? So what about the Hawthorne effect? Are they they change their own behavior? Because they saw me already? What about if I rely on their memory? This is normal intervention so that people don’t recognize how many times they do it this way? And what about the changes or daily community changes that’s happened during the nursing beauty. This what makes the repositioning I think, did not take its weight among the pressure ulcers context. And the need to have more focus and support for the people who are doing this with me, when we come to a lot of studies, or researchers all over the world that discuss the importance of pressure, pressure, injury prevention, right, that all follows maybe on a daily basis.
And all of them focus on several interventions or methodologies and panels to prevent the injury from happening. When they come to the repositioning you’ll see that there is a need to have much more focus. Or let’s let’s expand the idea and see exactly how this already applied on why we can count now a lot of universities or educational institute make an researches about pressure injury prevention. And you discover that at the beginning of the study, the situation was not satisfactory than they make intervention, then the result already gets to be satisfactory. After one year, they make another one another researcher come to make the same study and the repositioning was not satisfactory. So the sustainability of this one also means we need to explore the factors make our intervention maybe the problem in the knowledge or in the way that we lead for this issue that I’m able to sustain. In this way, we need to explore more what we mean by repositioning and what is the problem happened when we apply what we mean on the production of pressure? Sure.
Schenk:
Okay. Well, then let’s let’s talk about that then like what what are the what are the specific ways in which this process can be integrated in in in the nursing process? Like how, what are the specific positions? What are some of the mechanisms that we can use to make sure that it gets accomplished in the way that you’re talking about and again, just for the audience’s sake, I’m linking in the show notes, the link to Dr. Iblasi, paper Repositioning Practice of Bedridden Patients: An Evolutionary Concept Analysis that you can read and and you can actually really goes into depth like we’ve been talking about or Dr. Iblasi has been talking about the the essentially and this is so this is like new to me. I’ve been doing this for a long time, but basically breaking down the process of turning repositioning when he was talking about pre Turn, turn the harmonization super interesting read in that article. So I really would stress that everybody go and check that link out.
Are There Specific Positions That Prove More Beneficial Than Others for Pressure Ulcer Prevention?
Schenk:
And with that, I’m sorry, I hand it back over to you Dr. Iblasi in terms of like specific positions, how can we integrate this in nursing?
Dr. Iblasi:
Yes, thank you. And this will lead us to the next or the most influential part within dealing with that equation, you know, our target or our role now as people interest to help patients or support the pressure injury prevention on the same time understand the nursing phenomena related to repositioning practice itself. While we already discovered this gap, so what is the next what are the proper solutions that should take it in this in this gap? There are factors really related to patients. We know that the idea or algorithm the same like in the BLS or MSLs, they have algorithms. So if I show some signs and symptoms among the patient, I will know what I should. I think this also responsibility among the schooler to start to deal with the repositioning in algorithmic way, maybe an a patient in under specific condition or parameters.
The two hour is not enough gap for the repositioning we need to expand it or increase maybe the part from the hypertension, hypertension, a fever that the clinical signs or symptoms require us to make a decision. On the same time. There are other patients to ours so much annoying for them. They need they can tolerate two hour and a half or three hour or even four hour as the third Demetri Beckman says that it depends on the patient’s condition Doctor given he had he making a study about the bio mechanical mechanism of the cellular, and that depends on the weight and age and an even kinetic factor. Let’s start first to define the repositioning on this algorithmic way, as the second one is equip the nurses with the ability to make the proper decision based on the patient needs. So we transfer the repositioning from the normal standardization way that we already know. And we deal with a repositioning intervention and you should do 1234, the same like whether we end with a hand hygiene or medication restoration, to be individual based on the patient care.
How Can Providers Integrate Repositioning into Standard Care Plans for Optimal Results?
Dr. Iblasi
And this we come here to transfer what is already on theory to make it as we know the algorithmic way of the repositioning and at the same time we equip the nurses by the knowledge and information. And then we come to prevent or assure the repositioning of the applied in a proper ways. Maybe I’m optimistic, but we already for example, here in the Middle East, the nurses should renew their own pls course iniquity, why we don’t have an renew course, or at least the geriatric nurses, the nurses deal with a bit written in ICU and repositioning course every two years and build the evidence based on the changes that will happen in the pressure injury prevention. In this way, we are able to transfer what we are discussing now. From the theoretical pace to the applied pace, and we start to listen for the people what are the problems that they have during this application for the procedure. A lot of studies discussed that, let’s say that opportunities to improve the nursing practice, but limited number of studies focused on the most heaviest nursing intervention or one of the most heaviest nursing division. So the reverse check, I think this may be optimistic solution or future based solution but this what we are in need, because now the geriatric population three is now we have a lot of bedridden patients coming from the the a’s and the wards and injuries and so on.
So the pressure on farther and farther in here to have an a proper strategy to prevent pressure injuries. And when we come to that understanding of the impact of the pressure injury, the long impact of failure to prevent the pressure injury, you will see a massive catastrophic results that coming from the small defects happening here and there. Now, we come to this interventions. The third part is related to the organization.
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Let’s ask that is it part from the hospital license or the hospital standardization that they will have repositioning aid to support the nurses with the patient? And till now, for example, we’re talking about Middle East in general, this is not an apart from the required facilities that After the hospital should have the lifting devices, that assistant bed that can support the repositioning. And even now there are a lot of studies follow and track the patient moving, moving. And in this way by AI, they are able to know like, for example for the chief nursing or director of nursing or hit nurse or charge nurse, that this patient did not take in a proper way of the flooding, I think, apart from what we are supporting is a start to push forward for these to be in a commercial use and applicable at the hospital. And after that, we come to say this is part from improving the practice or the compliance, instead of just put the standards and say that yeah, every two hours and that’s.
What Role Does Consistent Repositioning Play in Long-Term Resident Care and Overall Well-being?
Schenk:
So if I understand you correctly, this process would benefit. If there would say be a checklist just like there is for like the Braden scale, or the Morse Fall Scale where an individual Okay, once we’ve established this person should be offloaded and turned reposition. Here’s a checklist of how we’re going to accomplish this, how the turn occurs, how the harmonization occurs, the how we’re going to manipulate this person’s body on the support surface. And there’s a checklist like so if I hear you correctly, like it’s not enough to say this person needs to be turned repositioned. Even it’s not enough to say they need to be turned revisits in every two hours, we have to really have a checklist and get into the specifics of how that’s going to be accomplished.
Dr. Iblasi:
Exactly, exactly. Because in this way, we want to protect the patient and the provider. Others. Let’s think it in this in this way. For example. Now we talk about the patient’s condition, right. What about the nurse because of the busy world and the busy working day, she decided that she wanted to reposition the patient alone. What about her the trauma that will come to her the Back Bay, that company? Sure, even if there are floating happen, this is based on my concept analysis way if the flooding habit for the patient, and we show that when they’re applied to the revolution, and the flooding happened for the patient, this is not a proper reposition.
Because it’s failed in the harmonization which require two people to participate in making the offloading and this also because we want to sustain the nurse as apart from the resources. If the nurse after one or two days she gets back pain or Yeah, so what is the benefit that we have the proper way of dealing with a repositioning that will keep the patient safe and the nurses and sustain the intervention in so I would love really to see and a checklist that to be international that assured by all that this is what should be done. And all the people or the scientific start to critique. Maybe this is a definition this is part from my defining maybe this is not the the correct definition or not the best to always there is opportunity to improve. But this opportunity to improve should be applied and observed and edited based on evidence. So this is the cycle that we need to have for the repossession.
What Would You Recommend to Families of Nursing Home Residents with Respect to Repositioning for Pressure Injury Prevention?
Schenk:
That’s that’s I couldn’t agree more. Well, Dr. Iblasi in the last few minutes. Can you speak a little bit about any recommendations that you might have for the family have a nursing home resident? Who is bedridden? Like what are some of the things that you would tell them about repositioning, why it’s important or what they can do to monitor make sure it’s being done.
Dr. Iblasi:
And you’ll come to a very critical point. In fact, I participate with a home health care project in Saudi Arabia. And we apply it so we did not transfer it as apart from the recommendation, but I will tell you about what we already did. That pressure injury among the category of patients that we dealt with was catastrophic was very severe heart condition. And it was complicated. There are patients living in a rural area away from the large cities, so their own coming to the hospital was not easy.
And even the home health care teams when they are going to the home, they have a lot of the problems and the nature of or the lifestyle that we have in that area. Usually they don’t use beds. So the people try and think that either from the culture or religion that if they sleep on the bed, so they are ground, not on the bed on the ground direct so they just put the mattress and they will be much more closer to the earth. So the health will be better. And so we transfer our idea from a category that we provide online course that explains step by step what are the pressure injury? That shouldn’t shouldn’t be have entered, and how they can do the repositioning can we put or make the videos and make it an assembly language for them. And we start to distribute this on a USPS for them and give some buy them to social media.
And we start to follow up from the distance, the difference is between what’s happened between this category and a second. Of course, also, we include the nutrition, the kind of mattress how they will choose, because the patient, they will choose Are they able to buy or showcase the mattresses that suitable how they will define what the suitable for them just go to the market. And so the cost was four hours.
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I was the one who did that course. And we give it for those patients. Now, that pressure injury among the total number of patients was 66 persons of the patient complaint from those category of patients belongs to the home health care to reduce after one and a half year to seven Peters. Wow. And and this is what is really a success story. I think at that time, we already taken recognition from the Minister of Health by this efforts that have ended up now, what are the recommendations we focused on? In fact, what is the patient will be much safe in a home or hospital? We don’t have nursing homes or the constant this concept is not the same in the middle is the patient much safer in his home, within his family?
The second one secondary question. Based on our family relation, that we have it in the Arabic words, the people are much more connected to each other. So if an elder, patient, elderly patient in a home, so all his son and daughters and grandsons are helping him because he’s something special, and this is part from the familiar connection. So the question was why we did not use this, instead of rely on the nursing time and the nursing course, why we don’t modify their own behavior to be tracking on this way. In one family and one example one elderly patient had seven sons. And after they realize this part from the repositioning, they start to make a shift like a nursing job. So each night one of his sons come and sleep with his father, and after five years, and when he was CVA, and he already passed away, but after five years from the last injury he had, it was a free of any rash of injury, while he was totally bedridden, only by using and re analyzing this power, and put it in a proper way.
They love their own father, but why we did not teach them how they can express this love in the scientific way. So we teach them in a simple way that that the needs for the repositioning what they should do, how they can apply the resources that we have it what are the kinds of nutrition they can provide. And they change their own lifestyle, you know, those, those have to change every thing that each week, one of them will be absent from his wife and kids and just take care of his father. And it’s it with a scientific change that happened among this, this patient. Now, is this specific only because we are sitting in that area or in the Middle East, I don’t think so.
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Whatever the situation that happened with a patient in their home, whatever the family, or the families love each other, and this is why we are coming. But this love can be reorganized to provide what we are looking for. Because they are loving, right? So the love is it’s endless power, and the love, it’s that which you should do what what you should do, right. So just only inform them, demonstrate for them how they should be done. And I think they will continue on keep always looking for their own success and celebrate the success. And this is apart from how they can do because those those patients are that they have the experience before the pressure. We follow up until the pressure injury healed.
And then after that they know the target that we don’t have we don’t we don’t want to see this happening again. I of course not only the diversion, or the context of the pressure injury, but to position each part in the proper way the nutritional loading the proper way. And the repositioning why the revolutionary we keep talking because this is the sustain intervention right? The nutrition it’s easy when they bring the suitable for TV shows that I think that guideline and we are waiting the new guideline and it’s published until now we have still in 2019 was clear the issues of the protein carbohydrates how they calculate another formula. It’s over The level of the market the metrics now, I think it’s any very doing very good job. The repositioning This is maybe the some that need more.
Schenk:
I really very much appreciate that. That anecdote that story at the end. That’s great. And I like that. The concept of you said to reorganize the love like that’s I think that’s a good way to put it. Dr Blasey, I really appreciate your time coming on the show and talking about repositioning and just thank you so much. I really appreciate it.
Dr. Iblasi:
Thank you. Thank you very much. Really. I was so much happy to receive your email and really, this will be in a part or initial step. I think for further cooperation and transferring the experience among the globe. And really, this is part from our professional responsibilities and also it’s. Supporting the humanity all over the
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Schenk:
Very good. Said. Said again. Thank you so much. I really appreciate your I don’t know how to say it. The enthusiasm. So I really appreciate that. And once I get everything set up, maybe we’ll do another episode.
Dr. Iblasi:
Yes. Yeah. I would love to see you again and have this kind from. Our responsibility is to make sure that this what we think or feel that important and the others also start to believe on the importance of repositioning in the pressure injury context.
Schenk:
Very good. Very good. Okay. Thank you. Dr. Blasey. I’ll be in touch with you. And I guess thank you to all the audience there as well. Alrighty. See you later.
Dr. Iblasi:
Thank you very much.