s part 1 and the third attachment is part 2.
Human Resource and Organisational Development. The first assignment consists of 2 parts. The first part is “Description of Learning Event” and the second Part is “ Critical Evaluation of Learning Event”. So I have got the assignment from my friend and I need you to make a comprehensive paraphrase for the two parts. Also I need you to use another references where possible in part 2.     Additional file
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Client     Additional file
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Identifying a problem
Introduction
Each day around the globe, there is a soaring number of individuals that often demand various responsive services as measures to counter various medical conditions that often require prompt and radical responses. These may include acute exacerbation of chronic illness, and pressure ulcers among others (Goodman, Schindler, & Washington, 2014).
Description of the problem
Pressure ulcer (PU) is a localized injury to the skin and underlying tissue usually over a bony prominence, as a result of pressure, friction and shear, and sometimes combination of all (Glasgow, et al., 2014). The development of pressure ulcerdepends on various factors, such as age, mobility status, length of stay in the health care facility, continence, initial skin state and other medical conditions. For instance, an elderly incontinent person with limited mobility is more likely to develop a pressure ulcer.
Moreover, based on the study held in Germany in 2009findings suggest that immobile patients in hospitals have a higher probability to develop pressure ulcers than immobile residents in nursing home.(Kottner et al., 2010). Hence, it is important to determine why the patients with limited mobility are at higher risk of developing pressure ulcer in acute care settings rather than long-term care facilities. Furthermore, it is vital to find the best approach in preventing and/or avoiding pressure ulcer development in these population.
Impact of the problem in the work environment, quality of care and patient outcome
Patients tend to develop PU within the first week of hospital admission (Barton, 2009).Patients in acute care settings have a higher risk of developing pressure ulcer as compared to patients in long term care facilities. One of the reasons can be the prioritization of tasks. According to Newham & Hudgell (2015) in intensive care units (ICUs) stabilizing patient medically, administering medications, and monitoring vital-signs come before repositioning patients.
Different factors facilitate in increasing the risk of developing pressure ulcers.The risk of the patient to develop PU also increases with the time spent in the hospital especially those in the intensive care unit.Patients using respiratory equipment, sequential compression devices and urinary catheters among others are at higher risk of developing PU as they limit the ability to reposition them frequently. Mechanical ventilation also increases the risk of developing Pressure Ulcers in patients. Pressure ulcers secondary to medical devices present a significant health burden (Glasgow, et al., 2014).
In addition, according to Goodman, Schindler, Washington, Bogie and Ho (2014), pressure ulcer is very common in patients with spinal injuries leading to repeat hospitalization. The duration of injury plays a significant role in increasing the risk of developing Pressure Ulcer in patients. The heel, sacrum and ears are the most vulnerable parts to develop Pressure Ulcer (Cooper, 2013).
Proposed Solution
Pressure ulcers are most of the time avoidable or preventable. In order to implement pressureulcer prevention in patients with limited mobility, thorough initial assessment is imperative. Nurses, who spend the most time at the patient’s bedside, must identify the risk factors for each individual and adopt the most appropriate method of preventing pressure ulcer development. The clinical judgment of the nurses is considered to be very important in the assessment of the risk of developing PU (Balzer, et al., 2014).
Different units take different measures in the assessment and prevention of development of pressure ulcers in patients. According to Sving, Idvall, Högberg, and Gunningberg (2014), nurses in some hospitals concentrate on helping patients recover quickly and pay little or no attention to the pressure ulcers. Nurses need to have adequate awareness about the pressure ulcers for them to provide the most appropriate care to the patients.
According to Waugh (2014), pressure ulcers can be prevented by providing pressure-redistributing surfaces to patients at risk and ensuring that they receive frequent repositioning. Furthermore, it is advisable to ensure that the patient’s skin is protected from moisture and excessive dryness. Different guidelines have been developed to assist nurses take part in the prevention of PU development in patients.
According to Cooper (2013), alongside the pressure redistribution mattresses, lifting the heel with a pillow or with the heel lift boots are necessary for the prevention of the development of PU. Furthermore, it is also important to ensure that the nutrition of the patient is closely monitored to prevent PU as undernourished patients are found to be at a higher risk.
Earlier, it was also mentioned that frequently patient suffer from pressure ulcers secondary to medical devices. Dyer (2015) in her article on how to prevent device-related pressure ulcers suggests ten tips. It begins with the risk assessment, includes patient education, and ends with recommendations of collaborative work among multidisciplinary teams and shared learning (Dyer, 2015). The goal is, first of all, to identify the risk factors and then focus on preventing the pressure ulcer development.
Gravity of the problem
Pressure ulcers have become very common and challenging issue which represent expensive adverse events and are a significant cause of pain and distress to patients (Keen & Gaudario, 2014).Patients in different care settings have varying risks of developing PU. From the discussion, it is clear that patients in acute care setting are at higher risk of developing pressure ulcers as compared to those in long-term care setting. There were different reasons mentioned above, such as nursing prioritization when it comes to patients in acute care settings, as well as use of medical devices on acute patients which also increase the chances of developing pressure ulcers. Since PU is preventable in most cases, it remains imperative to implement the importance of skin assessment and appropriate care, involve other disciplines, for example the department who supplies with special mattresses and other assistive devices, along with providing continuous education to staff so that nurses can translate their knowledge to practice for a better patient outcome.
Rapid appraisal of each article
1.    How does each article describe the nature of the problem, issue, or deficit you have identified?
The articles address the problems at hand in a comprehensive manner and are up-to-date. They are based on certain studies and are evidence-based. In addition, some articles propose different solutions to prevent the identified problem.
2.    Does each article provide statistical information to demonstrate the gravity of the issue, problem, or deficit?
No. Not all articles provide statistical data to demonstrate the gravity of the problem. Some are only limited to certain geographical locations.
3.    What are example(s) of morbidity, mortality, and rate of incidence or rate of occurrence in the general population?
The general incidences of such factors as morbidity and mortality are relatively fair among the different articles.
4.    Does each article support your proposed change?
No. Not all articles support the proposed change, but the majority of the articles do. In this case, some articles address the issue with some specificity.