Introduction
Preventing pressure sores and the need for early detection in nursing care for geriatric patients is challenging. Standard nursing practices usually include turning patients and wiping, which help to reduce the effects of tissue compression. Combination strategies can be more successful and reduce the risk of pressure sores. This paper aims to establish the relevance of combining practices to prevent pressure sores in elderly patients.
PICOT Question
In elderly patients in nursing homes or long-term care (P), how well does a combination of different strategies, including skin care regimens, nutritional support, use of different support surfaces, and repositioning schedules (I) compare with standard care practices (C) in preventing and treating pressure ulcers (O) over a given period or course of treatment (T)?
Background
Bedsores are lesions of the skin and soft tissues resulting from compression. This problem occurs in an average of 4-5% of the elderly, making it a common issue that requires nurses’ attention (Lavallée et al., 2018). They can disrupt a person’s everyday life because they cause pain and discomfort. Complications of bedsores include wounds and necrosis, so nurses should increase the prevention of this condition (Lavallée et al., 2018). Additional care for pressure sores seriously burdens healthcare and puts patients in difficult conditions.
The study aims to establish and evaluate the nature of the impact of combined practices and integrated strategies for the prevention of pressure sores. The study’s objectives include evaluating two quantitative articles describing the effects of the strategy used to deal with bedsores and analyzing the findings. The main research question is to determine the effectiveness of combining different methods for preventing pressure sores in elderly patients.
Evidence-Based Support
Two quantitative studies will be used as the primary evidence base. Shi et al. (2021) describe three components related to pressure sores prevention – incidence, time to the occurrence, and cost-effectiveness. They focused on evaluating the effect of surface material on the occurrence of pressure sores. They found that surfaces that react with air can reduce the risk of pressure sores and increase the rate of healing of the resulting wounds (Shi et al., 2021). This could be used for the PICOT question to establish the dynamics of the effect of different interventions on the problem. By comparing the data in the article with the PICOT question, it can be established that both research questions point to the importance of support surfaces as a strategy to prevent the development of pressure sores.
Another study drew attention to dynamic strategies to prevent pressure sores. An article by Gillespie et al (2020) suggested evaluating the role of repositioning patterns for prevention. They indicated that a body position change schedule may influence the magnitude of the risk of pressure sores, and a repositioning regimen may contribute to changes in compression force. They found that the body position schedule and repositioning mode can influence the development of pressure sores, but this has low efficacy and insufficient evidence (Gillespie et al., 2020). This could be used for the PICOT issue to show that not all practices have the same role in preventing pressure sores. Comparing the data in the article with the aims of the study, it can be concluded that the selected interventions in PICOT are ineffective.
Methods
Both articles used similar methods to evaluate the intervention’s effects. Shi et al. (2021) included a search for reviews and randomized controlled trials in a network meta-analysis. The authors utilized efficacy evaluation methods and the GRADE approach, which includes evidence validation. In contrast, Gillespie et al. (2020) used only randomized controlled trials, including cluster studies. The authors used a ‘risk of bias’ assessment and conducted a validity assessment using the GRADE approach.
Network meta-analysis aims to perform comparisons using multiple assessment pathways. It has the advantage of obtaining consistent results on the relative effects of all interventions studied. It has the disadvantage of requiring more careful planning of the inclusion and exclusion criteria described.
A risk of bias assessment is performed to determine the statistical probability of making an error, depending on the researchers’ baseline characteristics. The advantage is the transparency of the evidence obtained, while the disadvantage is the lack of specific consistency when changing instruments. The GRADE approach is used to assess the strength of recommendations in practice. This has the advantage of ensuring that the assessment is systematic and the limitation that judgments must be taken into account in any case because of their potential relevance.
Results
Based on the findings from the articles studied, the following conclusions can be drawn. The overall level of evidence for practices such as positioning and change of support surfaces could be a lot higher. Only new research and evaluation of the combination of practices can bring positive results. Shi et al. (2021) indicate a medium level of evidence, so a search for an underlying correlation of interventions is needed.
On the other hand, Gillespie et al. (2020) are not convinced that positioning has significant preventive and cost-effectiveness. The previous finding confirms that a single approach and its isolated impact are insufficient to prevent pressure sores. PICOT is a relevant issue; different interventions are required to confirm the effectiveness of the combined effect of the strategies. In addition, it is necessary to integrate the combined approach in evaluating the evidence obtained to design ways to improve nursing practices.
The findings have implications related to the continued belief in integrating a combination of strategies to prevent pressure sores. Future research must expand the search for interventions and evaluate their combined impact. In nursing practice, this can be used to design new intervention strategies. The results and insights can be valuable for future research and developing a systematic approach to evaluating interventions.
Ethical Considerations
Ethical considerations may include voluntary consent to process and use data and to communicate results. The value of voluntary consent is that study authors respect patients’ rights and values and carefully explain the interventions implemented without foreclosing the right to refuse. Informing outcomes is an explanation of the reasons why the research was conducted and the meaning behind it.
Results will help patients in the future and keep them open to the possibility of treatment development. Shi et al. (2021) and Gillespie et al. (2020) did not violate these considerations and requested permission to use articles in their reviews. This respects the chain in which patients are always notified of who is using the results of interventions and how this impacts strategies to pre-empt their problem.
Conclusion
Consequently, the study showed shortcomings in the use and evaluation of one intervention. The reviewed articles found that the evidence level is insufficient to consider positioning and support surfaces as sufficiently weighted preventive measures against pressure sores. Instead, there should be an emphasis on combining different interventions and evaluating them transparently and ethically. Prevention of pressure sores is a complex problem that requires increased attention and a combination of strategies.
References
Gillespie, B. M., Walker, R. M., Latimer, S. L., Thalib, L., Whitty, J. A., McInnes, E., & Chaboyer, W. P. (2020). Repositioning for pressure injury prevention in adults. Cochrane Database of Systematic Reviews, 6(6). Web.
Lavallée, J. F., Gray, T. A., Dumville, J., & Cullum, N. (2018). Barriers and facilitators to preventing pressure ulcers in nursing home residents: A qualitative analysis informed by the Theoretical Domains Framework. International Journal of Nursing Studies, 82, 79-89. Web.
Shi, C., Dumville, J. C., Cullum, N., Rhodes, S., McInnes, E., Goh, E. L., & Norman, G. (2021). Beds, overlays and mattresses for preventing and treating pressure ulcers: An overview of Cochrane Reviews and network meta-analysis. The Cochrane Database of Systematic Reviews, 8(8), CD013761. Web.