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Table of Contents

Wadula tool

Understanding the Puzzle.

Clarifying the Purpose.




Wadula Tool

Practice development is considered to be a process associated with the course of providing healthcare by means of organized action by the user that leads to direct improvement. Development in the aspect of culture relative to the person-centered care developmental practices leading to the practice of creative methodology. All these types of development are considered as the person-centered design that is instrumental in bridging the contextual gap that lies in between the two, that is, the rhetoric as well as that of the practice related to the values associated with the cultural aspects (Fernstrom et al 2016). These cultural practices in the form of development are considered to be a continuous process that is directly related to the development of evidence related to the cultures. Going further it seems to be challenging in the process of the implementation of these pieces of evidence that are based on respective practices. It is because of the fact that it is uncomfortable to adapt in accordance with the daily changes. On the other hand, the dynamics on the basis of the healthcare industry that keeps on changing continuously. It ongoing further tends to demand a contextual change in terms of the practices that are as developed. The “wadula puzzling cube” is considered as one of the effective tools that are placed in the practice development that are used in the context of this assignment. It is further identified in the form of personal practice experience in relation to the native country, Australia. Throughout the assignment, this paper deals with the clinical issue (Delaney, 2018).

This section was designed to help groups of staff who are instrumental in clarifying their thoughts through the spread of an all-around form of a practice issue that was prevalent. It has been our experience that staff would often seek to engage in the order of the existing issues, those are, left out with only a vague idea in regards to the type of issue. There was almost no to the very little amount of evidence, that are either their perceptions, that the issue was an issue. To make matters worse, staff frequently formulated solutions to an issue which they would then try to 'sell' or convince others they should adopt. In these conditions, engagement almost inevitably failed (Fernstrom et al. 2016).

The WADULA Puzzling Cube uses a current type of issue that can evaluate the bedsore issue, also known in the form of pressure ulcers, in the hospital. When a given health care area of a healthcare user’s body is under pressure for a comparatively longer period of time this type of condition tend to develop. It is often seen as a preventable side-effect associated with care procedures used by a poor healthcare user. Whereas healthy individuals can easily shift their position whenever the body is feeling sore, in many instances’ healthcare users cannot do so. They would not be able to change position or they might not even feel the pressure. The action plan or proposal which shows a good understanding of the purpose of WADULA practice evaluation tool is the proposal that entails using this tool to prevent the incidences of pressure ulcers at the hospital (Delaney, 2018).

The main question for the issue is: How to use WADULA practice evaluation tool that is put into use to prevent bedsores?

Understanding the Puzzle

In this first step of using WADULA, the issue would be turned into a puzzle question. The issue of bedsores is restated as in the form of a puzzle question that is as follows:

How the occurrences of bedsores can be prevented by us in the hospital?

Clarifying the Purpose

This second step would entail clarifying the purpose behind one’s thinking. The purpose of a contextual puzzle would be related to the finding of ways or development of certain strategies to prevent hospital-borne bedsores. If a solution to the puzzle is found, healthcare users would be given proper care considerably reducing the risk of developing bedsores. At the hospital, the healthcare workers offer high-quality healthcare while catering to the needs of the users. These entire healthcare services as offered by hospitals would let to a user safety enhancement associated with healthcare along with the hospital would save costs. All these are associated with hospital-acquired pressure ulcer treatment (Brzeziński & Martini, 2019).

Evidence of Practice Development Tool

This third step would entail finding evidence that supports the viewpoint that the issue of bedsores at the hospital is something that is, in fact, worth spending time on. The evidence would help confirm that the issue of bedsores at the hospital is significant and it would help when presenting the proposal to other people. Facility-acquired preventable pressure ulcers are pointed out as costly as well as widespread hence; a lot of hospitalized healthcare users who develop this condition, with the occurrence of acute care settings that range from 0.4-38%. In 2005, the "International Pressure Ulcer Prevalence Study” was instrumental in finding a 7.3 percent as a prevalence rate. According to Brzeziński and Martini (2019), the risk of getting hospital-acquired pressure ulcers is developed amongst 1 of every 5 hospitalized healthcare users. This condition is an expensive problem considering that the costs for treating this condition range from S2.000 - S7.000 for every wound, with the average total costs for the hospital annually being between $410,000 and $690,000. The healthcare user occurs pressure ulcers after his/her admission to a health care institution indicates inexcusable nursing care negligence.

Elderly healthcare users who have hospital-acquired pressure ulcers could develop joint and bone conditions including squamous cell carcinoma and osteomyelitis that may result in life-threatening and/or chronic conditions. The other possible complication of bedsores is cellulitis brought about by an infection that spreads to connected soft tissues. This complication could result in life-threatening conditions and causes severe pain. In addition, a healthcare user who has bedsores and suffers from incontinence could easily become vulnerable to sepsis, which is a life-threatening infection that could bring about organ failure (Cabello-Granado & Arévalo-Velasco, 2016). The strategies based on the evidence for the prevention of bedsores are as shown in the below-mentioned table:

Table 1: Strategies for reducing bedsores and improve healthcare user outcomes







The sooner, the risk identified at the starting point the quicker it is addressed. A tool based on a structured risk assessment is used in the process of identifying the bedsore risk in healthcare users at the earliest possible. Other risk factors like existing pressure injuries, as well as illnesses like vascular problems and diabetes, are also identified. Repeated risk assessment in regular terms along with the changes as needed to be addressed. A care plan is developed after based on the risk assessment. Then the identified issues are prioritized as well as addressed (Abdulwadood & Ali, 2016).


Skin Care

It is important to protect and monitor the condition of the skin of the healthcare user to prevent bedsores and identify Stage One bedsores as early as possible so they could be treated before they become worse. The skin of the healthcare user needs to be inspected on the patient’s admission daily for bedsores signs. Assess temperature, pressure points, and skin underneath the medical devices. Do not position the healthcare user on a region of pressure injury (Kayala, Manasa & Reddy, 2019).



Healthcare users in a hospital have a high risk of undernutrition. a tool used to assess individual malnutrition risk. Healthcare users at-risk referred to as a registered nutritionist or that of a dietitian needs to assess the healthcare user’s weight regularly and must offer supplemental nutrition.


Mobilization and Positioning

Immobility could be a significant factor in bringing about bedsores. Immobility could be a result of sedation, coma, age, paralysis, or general poor health condition. Healthcare users who at at-risk should be turned and repositioned. Have a scheduled frequency of turning and repositioning die individuals. When placing a healthcare user on any support surface, use pressure-relieving devices (Inchingolo et al. 2017).

p. 66).


Monitoring. Training and Leadership Support

The change would be successful with appropriate support of leadership, training, as well as monitoring. Incidence Monitoring and bedsore prevalence train as well as educate every interdisciplinary team member ensuring that they understood the deliverable care plan to the healthcare user. Ensure leadership oversight, support, and allotment of sufficient resources (Kayala, Manasa & Reddy, 2019).

Reflection of Practice Development Tool

We see that this context can be measured in association with health structures by identifying the problem of developing bedsores while hospitals stay. The healthcare user has pressure ulcers after admission to a healthcare facility, which indicates inexcusable neglect in nursing. The concept of providing effective care associated with services is directly relative to the aim of creating a feedback scenario from the previous form of interventions. The "puzzling cube WADULA " is considered to be one of the effective tools in this development of the practice and which are used within the framework of this task. As observed by us, it is mostly caused by the lack of confidence in those with whom they engage during his/her hospital stay. The WADULA Puzzling Cube uses a current problem type that can assess the problem of bedsores, in the hospital. We attempt to find an answer to this problem and focused our study on the use of WADULA practices. It also helped us in the evaluation of the other tools which are used to prevent pressure ulcers. Furthermore, we observed that these ulcers are considered to be of exerting a significant amount of financial burden both from the hospital's and patient party's perspectives.

References for Practice Development Tool

Abdulwadood, M. Z., & Ali, S. H. (2016). Simple nutritional and inflammatory markers associated with bed sores in elderly stroke people. Advances in Aging Research5(2), 58-69. doi:10.4236/aar.2016.52006

Brzeziński, P., & Martini, L. (2019). Pressure ulcers in diabetic old patients: a case report of two volunteer, the former smoker, the latter no-smoker. doi:10.7241/ourd.2019e.36

Cabello-Granado, P. A., & Arévalo-Velasco, J. M. (2016). Estimation of the Sanitary Cost of Bedsores (Pressure Sores) in Patients with Medullary Lesions. Revista Gerencia y Políticas de Salud15(30), 60-67. http://dx.doi.org/10.11144/Javeriana.rgyps15-30.ecsu 

Delaney, L. J. (2018). Patient-centred care as an approach to improving health care in Australia. Collegian25(1), 119-123. https://doi.org/10.1016/j.colegn.2017.02.005

Fernstrom, K. M., Shippee, N. D., Jones, A. L., & Britt, H. R. (2016). Development and validation of a new patient experience tool in patients with serious illness. BMC palliative care15(1), 99. https://doi.org/10.1186/s12904-016-0172-x

Inchingolo, F., Vermesan, D., Inchingolo, A. D., Malcangi, G., Santacroce, L., Scacco, S., ... & Longo, L. (2017). Bedsores successfully treated with topical phenytoin. Acta bio-medica: Atenei Parmensis88(1), 45. doi: 10.23750/abm.v88i1.5794

Kayala, R., Manasa, K. V., & Reddy, M. (2019). Efficacy of negative pressure wound therapy when compared to gauze dressings in the management of bedsores. International Journal of Surgery3(4), 279-281. https://doi.org/10.33545/surgery.2019.v3.i4e.255

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