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Evidence and Practice: Pressure Ulcer Management

The present paper considers the process of translating evidence into practice, using the example of the implementation of pressure ulcer management practices, which are based on high- and moderate-quality evidence. It is suggested that the engagement of the staff is crucial for the successful implementation of the practice. It is planned to achieve this engagement by using training sessions to communicate the effectiveness and significance of the practice while paying attention to the specific concerns of the staff.

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The following PICOT question is considered in this paper: in long-term care patients with stage IV pressure ulcer (PU), what is the effect of pressure redistribution surface mattress (PRSM) as compared with manual re-positioning (MR) or the combination of both in the prevention and treatment of stage IV PUs within a given time?

PUs are a significant health concern (Bååth, Idvall, Gunningberg, & Hommel, 2013; Kruger, Pires, Ngann, Sterling, & Rubayi, 2013), which is rather typical for long-term care settings; elderly patients are rather susceptible to it (Sullivan & Schoelles, 2013). However, multiple studies find that the topic is under-researched (Murray, Noonan, Quigley, & Curley, 2013; Sullivan & Schoelles, 2013). As a result, it is significant for nursing practice and needs additional research.

Research evidence indicates that both PRSM and MR are typical approaches to PU management (Bååth et al., 2013; Kruger et al., 2013; Lozano-Montoya et al., 2016; Murray et al., 2013; Sullivan & Schoelles, 2013). Lozano-Montoya et al. (2016) and Kruger et al. (2013) demonstrate that various surfaces, including PRSM, are a popular intervention among researchers and practitioners. Lozano-Montoya et al. (2016) indicate that there is a large amount of moderate-quality evidence that demonstrates the effectiveness of the approach in PU management. However, Kruger et al. (2013) highlight the fact individual trials for particular types of mattresses may be in order.

Like other support surfaces, PRSMs are designed to reduce pressure: its duration, intensity, or both (Lozano-Montoya et al., 2016). They can be low- or high-tech, but Lozano-Montoya et al. (2016) point out that few RCTs compare the two groups. Still, Kruger et al. (2013) and Lozano-Montoya et al. (2016) state that there is sufficient evidence to advance surfaces being more effective in preventing PUs than standard foam mattresses. The failure to employ appropriate surfaces results in less efficient pressure management, which can increase the risk of PU development.

Reposition has the same aim of reducing or eliminating pressure in certain areas, and it is viewed as a best practice and standard intervention (Bååth et al., 2013; Kruger et al., 2013; Sullivan & Schoelles, 2013). However, the guidelines on the frequency and methods of repositioning vary and can be inefficient (Lozano-Montoya et al., 2016). Lozano-Montoya et al. (2016) find only one moderate quality study that indicates the effectiveness of repositioning in older patients, but the other studies that the authors review register no consistent positive results. This practice is employed at my workplace, but the implementation of revised guidelines may contribute to the improvement of the outcomes; the failure to review the practice may result in the persistence of outdated and ineffective approaches.

Both mentioned practices would require collaboration with the management: appropriate mattresses would have to be bought after their feasibility is proved, and new MR guidelines would have to be developed. Also, nurses would need training, which should help them master practice-related skills and implement the practice (Melnyk, Fineout-Overholt, & Mays, 2009). However, training maybe not sufficient. Sullivan and Schoelles (2013) review the process of implementing evidence-based PU intervention programs, and they find that the engagement of the staff is often problematic. Thus, the implementation of a practice depends on the communication of its importance to the staff.

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A typical dissemination practice is the presentation of the results of a study on the topic (Polit & Beck, 2017). Thus, an appropriate dissemination strategy should include a review of relevant high- and moderate-quality studies (Krainovich-Miller, Haber, Yost, & Jacobs, 2009). The key points can be presented to my coworkers during a meeting to highlight the significance of the issue and the effectiveness of the intervention (Dogherty, Harrison, Graham, Vandyk & Keeping-Burke, 2013). Also, the full paper version and the presentation from the meeting should be available to the staff. The meeting should be followed by training sessions which can reinforce the idea of the importance of the practice and move the process through dissemination to implementation.

The use of advanced surfaces is unlikely to meet opposition from the staff, but it might be correlated with concerns, especially if expensive high-tech surfaces, which are perceived as difficult or unfeasible to use, are employed (Hadorn, Comte, Foucault, Morin & Hugli, 2016). The staff’s confidence can be improved during and with the help of training. New RM guidelines can meet both concerns and opposition. The latter can be addressed with the explanation of the need for change, a trial period used to test the change and the consideration of more specific concerns. In other words, the feedback of the staff should be taken into account (Dogherty et al., 2013); it can be solicited, for example, through pre-, middle- and post-training surveys (Keough & Tanabe, 2011).

Thus, the translation of evidence into practice can depend on the specifics of the practice to be introduced, but some general aspects of the process include providing training to the staff and engaging them by proving the significance of the issue and the effectiveness of the practice. The concerns that the staff can have may be addressed in general as well: for instance, the perceived complexity of change is likely to be addressed through training. However, a more customized approach to concerns appears to be preferable.


Bååth, C., Idvall, E., Gunningberg, L., & Hommel, A. (2013). Pressure-reducing interventions among persons with pressure ulcers: Results from the first three national pressure ulcer prevalence surveys in Sweden. Journal of Evaluation in Clinical Practice, 20(1), 58–65. Web.

Dogherty, E., Harrison, M., Graham, I., Vandyk, A., & Keeping-Burke, L. (2013). Turning knowledge into action at the point-of-care: The collective experience of nurses facilitating the implementation of evidence-based practice. Worldviews on Evidence-Based Nursing, 10(3), 129-139. Web.

Hadorn, F., Comte, P., Foucault, E., Morin, D., & Hugli, O. (2016). Task-shifting using a pain management protocol in an emergency care service: Nurses’ perception through the eye of the Rogers’s diffusion of innovation theory. Pain Management Nursing, 17(1), 80-87. Web.

Keough, V. A., & Tanabe, P. (2011). Survey research: An effective design for conducting nursing research. Journal of Nursing Regulation, 1(4), 37–44. Web.

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Krainovich-Miller, B., Haber, J., Yost, J., & Jacobs, S. (2009). Evidence-based practice challenge: Teaching critical appraisal of systematic reviews and clinical practice guidelines to graduate students. Journal of Nursing Education, 48(4), 186–195. Web.

Kruger, E. A., Pires, M., Ngann, Y., Sterling, M., & Rubayi, S. (2013). Comprehensive management of pressure ulcers in spinal cord injury: Current concepts and future trends. The Journal of Spinal Cord Medicine, 36(6), 572–585. Web.

Lozano-Montoya, I., Vélez-Díaz-Pallarés, M., Abraha, I., Cherubini, A., Soiza, R., O’Mahony, D., … Cruz-Jentoft, A. J. (2016). Nonpharmacologic interventions to prevent pressure ulcers in older patients: An overview of systematic reviews. Journal of the American Medical Directors Association, 17(4), 370. Web.

Melnyk, B., Fineout-Overholt, E., & Mays, M. (2009). The evidence-based practice beliefs and implementation scales: Psychometric properties of two new instruments. Worldviews on Evidence-Based Nursing, 6(1), 208-216. Web.

Murray, J., Noonan, C., Quigley, S., & Curley, M. (2013). Medical device-related hospital-acquired pressure ulcers in children: An integrative review. Journal of Pediatric Nursing, 28(6), 585–595. Web.

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer. Web.

Sullivan, N., & Schoelles, K. M. (2013). Preventing in-facility pressure ulcers as a patient safety strategy: A systematic review. Annals of Internal Medicine, 158(5), 410–416. Web.

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