By Glenna Murdock, RN, contributor
In the early 1970s, as a divorced mother of a young son, Margaret Talley, RN, BSN, MSN, CNS, scrambled to find ways to financially support her family of two. She worked as a bus driver, a PBX operator and made jewelry to make ends meet.
“Those jobs could never be considered careers,” Talley said. “They were simply a means to make money.”
It was a job as a nursing assistant on the night shift at a nursing home that would lead to a career that has been her passion for more than 30 years.
“I had great admiration for the dedication and devotion of the nurses who were my co-workers there,” Talley added, “and they inspired me to become a part of the nursing profession.”
Not only has she been a part of the profession, she has made significant contributions to it, particularly in the area of her nursing specialty, wound care.
For her innovations that resulted in a superb wound care program for her employer, Palomar Pomerado Health (PPH) in San Diego, California, Talley was honored with a 2007 Cherokee Inspired Comfort Award. She is one of just 10 grand prize honorees nationwide.
The award recognizes those who demonstrate exemplary service and sacrifice and who have a positive impact on the lives of others. Grand prize winners receive a Caribbean cruise for two, a crystal award, a wardrobe of Cherokee apparel and are featured in a nationally distributed Cherokee Inspired Comfort Award calendar.
Ann Moore, RN, CWCN, director of wound care services for PPH, conducted a pressure ulcer prevalence study that resulted in disturbing numbers. Two acute hospitals within the PPH system had a higher occurrence of pressure ulcers among its patient population than what was considered the average nationally and Moore realized she needed to bring on board a specialist with a proven track record. Moore and Linda Urden, M.D., PPH director of nursing quality and research, focused on Talley and, in 2004, actively recruited her for PPH based on the stellar results of an ulcer prevention program she directed at the University of California-Irvine.
Hospital-acquired pressure ulcers (HAPU), commonly known as bedsores, are widely prevalent among acute care patients whose mobility is limited. The serious ramifications of HAPU include increased incidence of infection, prolonged recovery periods and extended hospital stays, which result in significantly increased costs. Prevention of HAPU has become an even more critical issue with the recent announcement by the Centers for Medicare and Medicaid Services that treatment of HAPU would no longer be reimbursed.
“When I first came to PPH, the incidence of pressure ulcers was sometimes as high as 30 percent,” Talley explained. “It was obvious and imperative that in order to combat the problem there had to be nurse driven changes at the bedside.”
As part of a concerted effort to decrease the occurrence of HAPU at PPH, Talley instituted a training model for nurses that encompasses five key actions:
Accurate assessment of the patient’s skin condition upon admission.
Having in place for the patient a good skin care team knowledgeable about incontinence care,
the prevention of skin breakdown, topical applications, etc.
Evaluation of all bed and support surfaces.
Ensuring optimum nutrition.
Developing standardized order sets for pressure ulcer care.
All new nurses receive orientation regarding skin care and HAPU prevention. Talley works one-on-one with RN members of the skin care team to ensure they feel confident regarding all facets of assessment and prevention.
“It is important that mentoring be done at the bedside,” she said. “Being in the classroom is not the same as being at the bedside, and taking care of a wound is not the same as taking care of the whole patient.
“I receive a great deal of satisfaction from working with both the nurse and the patient at the bedside,” Talley continued. “My work is relationship based and community based. Nurses express such gratefulness for being taught the specific skills they need. Home health agency nurses are especially grateful because we can point them to the resources they need to deal with their patients’ pressure ulcers.”
“The skin team is always working on something,” Talley explained. “We have retreats where nurses can express which skills they feel they are rusty on or the skills they’d like to enhance. We demonstrate the newest and latest techniques to keep them up-to-date.”
In 2006 PPH saw a dramatic decrease from 10% to 3% in the occurrence of HAPU in acute care patients.
Praising Talley, Wendell Mobley, director of Cherokee Uniform’s charitable and scholarship programs, stated, “Her actions directly and profoundly impacted the quality of health care within her hospital system.”
Talley gives credit for the success of the HAPU prevention program to PPH.
“Having the organization 100% behind me, and so totally supportive, have been huge factors in our achieving such significant results,” she said.
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