Introduction
As modern medicine constantly evolves and discovers new techniques for treating patients, more and more clinical problems inevitably arise. In my work, I would like to discuss one of such problems – the use of prophylactic dressings to relieve the condition of patients with ulcers. An ulcer is a long-lasting non-healing tissue defect that results from vascular damage to superficial and deeper veins. These lesions result in impaired lymph and blood flow and, as a consequence, inadequate tissue nutrition. One of the methods of treatment is special dressings for the treatment of ulcers, the choice of which is influenced by the condition of the ulcer and the surrounding tissues. Ulcer dressings should prevent infection, clean the wound surface of necrotized tissue, absorb wound exudate, and promote epithelialization. Applying a wound-healing dressing for ulcers must be comfortable for the patient, mainly that it does not stick to the wound.
According to the PICO system, four components of this clinical problem can be distinguished. The first component, the problem, is the presence of the ulcer. The second, which can be characterized as an intervention, is the application of a prophylactic dressing. The next component is the problem, which in my case is not using a prophylactic dressing. Finally, according to the PICO system, the fourth part of the problem is the outcome. For the practice I am investigating, it is pressure ulcer reduction. To further parse the clinical problem, we need to develop an evidence-based practice question. My question is formulated as to whether the use of prophylactic dressings leads to healing and reduction of ulcers in patients. This question takes into account all components of the clinical problem according to the PICO system. Also, it involves comparing the conditions of patients with and without the use of a dressing.
Analysis of Scientific Articles
To analyze a scientific article that would help me answer the EBP question, I chose the “Use of Prophylactic Silicon Adhesive Dressings for Maintaining Skin Integrity in Intensive Care Unit Patients: A randomized control trial.” The purpose of this article was to evaluate the effect of maintaining skin integrity through the use of a silicone foam dressing (Lee et al., 2019). The advantages of this dressing are that it is easy to remove and reapply without damaging the skin of intensive care unit patients. The fact is that patients in the ICU are very debilitated and virtually immobile. These patients have many risk factors for the progression of skin side diseases such as bedsores, ulcers, and inflammation. That is why an essential task of nursing is to alleviate these patients, including the use of preventive dressings. The methodology for this study was a randomized controlled trial involving 71 subjects (Lee et al., 2019). Patients for the experiment were selected from two hospitals in South Korea.
The main conditions for inclusion in the sample were the absence of skin lesions, several health conditions, and age of at least 65 years. Patients’ medical records were used to collect preliminary data. Patients were divided into two groups during the study – a control group of 31 patients and an intervention group of 35 patients (Lee et al., 2019). The intervention group was treated with a prophylactic dressing, which was changed every three days. In order to assess the evidence for this study, I turned to the Johns Hopkins nursing evidence-based practice model. I checked this article against the criteria of a quantitative study because that is the type of data the researchers were primarily using. According to the Johns Hopkins model, this study has a high level of evidence due to several factors (Upstate Medical University, n.d.). First, the authors established a clear purpose and background for the study at the beginning of the article. Second, all participants in the sample had similar health conditions, which were clearly described in the methodology section.
The data collection and analysis methods are also reliable, as proven statistical tools, such as the Student’s t-test, were used among them. Finally, the experiment results were clearly presented at the end of the paper (Upstate Medical University, n.d.). A discussion of their significance for future practice was provided. To determine the results and analyze the collected data, two samples were combined. The homogeneity of the intervention and control groups was tested using a χ2 test for categorical variables and an independent t-test for numerical variables (Lee et al., 2019). Multivariate linear regression analysis was used to determine differences in values between groups. All calculations were performed using SAS software. There was also an ethical dimension to the study I discussed. First of all, it had to do with the data collection of the participants in the experiment. Informed consent was obtained from the participants or their proxy to collect and process relevant data from their medical records. Therefore, from an ethical point of view, the study conformed to the standard of similar procedures.
According to the Johns Hopkins method of evaluating the quality of an article based on research, this article is comprehensive and of high quality. It presents enough discussion space both before and after the description of the study (Upstate Medical University, n.d.). The article also clearly describes the background of the study and its immediate results. The material is clearly and coherently presented but does not make it difficult to understand (Upstate Medical University, n.d.). According to the study results, silicone adhesive bandages helped reduce skin disease in intensive care patients. The article also concludes extensively that the diagnostic method used in the study can be effective and applied in future practice. Overall, the article’s conclusion echoes the results of the study and simplifies it for quick and easy understanding. This article may help answer my EBP question because it provides evidence-based information regarding the effectiveness of preventive dressings. This experiment also has a control group, making the evidence base more comprehensive and illustrative.
Non-Research Article
As a non-research article, I chose “Prophylactic Dressing Use to Prevent Heel Ulceration in Post Epidural Orthopedic Patients” by Carol Johnson et al. The background to this article is the deterioration of the skin condition of ICU patients. Although all standards of treatment were maintained, patients inevitably continued to develop bedsores and other painful skin manifestations (Johnson et al., 2018). The aim of the article was to find out what the problem was and how it could be eliminated. Accordingly, the type of evidence, in this case, is a quality improvement project. This case examines the quality of care in a medical facility and the elimination of the causes of poor skin conditions in patients. One methodology for eliminating ulcers, bedsores, and other skin conditions has been the use of preventive dressings (Johnson et al., 2018). Using the JHNEBP model as for the previous article, one can determine its level of evidence. According to this system, the article has a good level of evidence for several reasons. First, it clearly states the purpose of the test as well as the qualifications of those who participated in it.
Second, the article provides a well-defined conclusion derived from the analysis of practical observations in a particular health care institution. Finally, the authors provide a scientific rationale for their final conclusions, as well as some jamming in the middle of the article. The quality rating of this article is also high. This is due to the presence of a clear evidentiary basis for the conclusions of its authors. In addition, the article is published by a verified source of medical publications, and all of its sources are not more than ten years old. This indicates that the authors have an up-to-date view of the problem and, consequently, the relevance of their conclusions. For my EBP issue, this article is valuable primarily because it provides a practical perspective on solving a quality problem with prophylactic dressings. It also gives the information that such dressings can become the best option even for conditions where all measures to prevent bad skin conditions in patients are followed.
Conclusion
Based on the research and non-research articles that I discussed earlier, I would recommend introducing the active use of preventive dressings to prevent skin conditions in patients. I will involve hospital management, nurses working directly with patients, and the patients themselves to support my recommendation. To attract the hospital management, I will show them the results of my literature research, as well as convincing results of scientific research of primary sources. They need to be explained that preventive bandages are a relatively practical and effective way to prevent lousy skin conditions in intensive care patients. To attract nurses, it will be necessary to conduct educational training since they already know about the use of bandages in general but do not know about their comparative effectiveness. Prevention of skin conditions can significantly facilitate and optimize nursing practice. To do this, they need to use preventive dressings.
Finally, in order to attract patients, it is necessary to explain to them that preventive dressings are one of the most effective and painless ways to prevent bad skin conditions. When implementing this practice, I may encounter the reluctance of hospitals to abandon their old system without the use of bandages. In order to cope with this, one can hold special meetings for hospital managers, where people can talk about the benefits and practicality of bandages. In addition, it is necessary to prepare scientific, educational material that will be able to convince directors and managers of the need to implement this practice. After the practice of using preventive dressings is implemented, nurses will be able to compare much more effectively with the poor skin conditions of intensive therapy patients. In addition, the patients themselves will feel better since the removal and replacement of bandages is painless. Thus, the experience of patients with ulcers or bedsores in the hospital will be improved, and the system for preventing the occurrence of these conditions will be more effective.
References
Lee, Y. J., Kim, Y. J., & Shin, W. Y. (2019). Use of prophylactic silicone adhesive dressings for maintaining skin integrity in intensive care unit patients: A randomized controlled trial. International Wound Journal, 16(1), 36-42.
Johnson, C., Renwick, C., Parkinson, J., Burn, K., & Colledge, D. (2018). Prophylactic dressing use to prevent heel ulceration in post-epidural orthopaedic patients. Wounds UK, 14(1), 84-89. Web.
Upstate Medical University. (n.d.). Johns Hopkins nursing evidence-based practice. Upstate Medical University.