Bedsores or pressure ulcers are areas of necrosis of skin, muscle, and, in some cases, bone tissue that occur with prolonged compression and impaired blood flow. As a rule, they form during prolonged contact with a solid surface, sometimes combined with friction or shear. Patients with overweight or severe exhaustion are especially susceptible to them. In the clinical setting, pressure ulcers are considered to be a rather signiﬁcant issue since they cause severe psychological, social, and physical problems for patients. They include pain, poor self-image, restricted social life and daily activities, reduced functional ability and mobility, emotional problems, and mood changes. As for hospitals, bedsores are a major economic burden since they require high treatment costs and longer length of stay. To make it easier for both patients and hospitals, a special pressure ulcer prevention training was developed. Its effectiveness is analyzed in the article “Patient Perception of a Hospital Peptic Ulcer Prevention Package: A Qualitative Descriptive Study to Guide Evidence-Based Practice” (Roberts et al., 2017). The purpose of this paper is to provide a critical evaluation of the study and its methodology.
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Summary of the Methodology
The qualitative descriptive study was conducted in four private and public acute care hospitals in two Australian states. Also, these hospitals were the intervention sites for the IntAct trial, which is an intra-operative fluorescence angiography to prevent anastomotic leak in and reduce a serious side effect of rectal cancer surgery. The participating university and each intervention site gave approval for several semi-structured patient interviews, of which the study consisted. Its purpose was to explore the participants’ responses to and perceptions of the pressure ulcer prevention care bundle. In order to make sure that the study included a group of various participants, in other words, female and male, younger and older, surgical and medical patients, with and without pressure ulcers experience, purposive sampling was used (Roberts et al., 2017). Each participant was given an information sheet with the study outline.
Piloting of the intervention and previous literature served as a basis for developing the semi-structured interview guide. Several members of the team who had qualitative research experience reviewed the guide before the study. Besides, “a training manual was developed for interviewers, containing information on study background, interviewing technique, preparation for data collection, interview process, and ongoing development of interviewer and interview guide” (Roberts et al., 2017, p. 387). The semi-structured interview guide helped to maintain the interview’s conversational style, and the participants’ responses were used to determine the conversation’s direction and decide what questions or prompts would be better to ask next. According to Roberts et al. (2017), interviews lasted approximately fifteen to twenty minutes and were audiotaped and transcribed for analysis (p. 387). They stopped when data saturation was reached, and no new themes or ideas appeared.
Evaluation of the Methodology
The methodology chosen for this study may be considered rather appropriate and successful since even though it has some minor disadvantages, the advantages are more significant. For example, as mentioned above, there was a training manual developed for interviewers. When they received this training, they conducted a “practice interview with a patient under the supervision of the study site investigator, who provided feedback and further training speciﬁc to that interviewer” (Roberts et al., 2017, p. 387). This was the way to make sure that the interview was thought through, professional, and helpful. Moreover, all the meetings and interviews “were conducted at the patient’s bedside or another private area at a time of convenience for patients” (Roberts et al., 2017, p. 387). This was rather thoughtful from the team members and showed that they did care about the patients and their comfort.
The team members decided to choose education and training as the problem-solving method. Hence, in order to prevent pressure ulcers, it was selected to provide patients with resource materials such as the brochure, the poster, and the DVD. This is a good way only if all the patients are ready to study this information, remember it, and then use it. As the results demonstrated, not all of them wanted or could do that, which is a significant drawback of the methodology. However, this may be considered as an advantage since it shows that, for future pressure ulcer prevention, some other ways have to be considered.
By facing difficulties in engaging in the intervention, participants were able to choose several ways by which they did or did not want to take part in Pressure Ulcer Prevention care. On the one hand, this gave the patients the freedom and the right to remain comfortable with the chosen ways and avoid unwanted ones. On the other hand, since not all the participants were given the same materials, the accuracy of the study may be called into question.
In order to achieve trustworthiness, there were several strategies employed, which proves the possibility of high evaluation of the chosen methodology. Firstly, members of the research group often discussed codes, topics, and subtopics into which the recorded answers were divided, which ensured reliability, that is, accurate reflection and adequate coverage of all received data. Secondly, to maximize dependability, interviews were conducted within a short period of time in each of the four hospitals, and they were transcribed simultaneously, which marked the beginning of the analytical process (Roberts et al., 2017). Finally, to ensure a wide representation of patients in all the study’s hospitals, that is, transferability, purposive sampling was used.
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Evaluation of the Study
The purpose of the study was to explore the participants’ responses to and perceptions of the pressure ulcer prevention care bundles because bedsores are a rather severe problem that has to be solved. Precisely the seriousness of this issue and the desire of scientists and medics to solve it proves the necessity of this study. However, there were some barriers to participating in pressure ulcer prevention, including patient-related factors like mobility, cognition, and age. Some of them told that tiredness and difﬁculty in concentrating on the process of education and provided materials were the results of recent anesthesia or surgery and medications. Besides, the study team members did not foresee that a busy hospital environment would contribute to a poor recollection of the data (Roberts et al., 2017, p. 388). During the interviews, there were various responses to the provided resource materials, as some participants found them informative and useful, and others told they were unhelpful or hard to remember.
In order to make the intervention encourage the participants to enact their own pressure ulcer prevention strategies, there were three ways. Firstly, all the patients described how their previous knowledge and natural instincts were reinforced by the knowledge obtained during the study, which positively affected their participation. Then, they described how the gained information enabled them to implement pressure ulcer prevention strategies. At last, patients decided that their awareness of bedsore’s risks, “possibility of developing a pressure ulcer, potential consequences, and ways for prevention” increased, and this prompted them to actively pursue those strategies (Roberts et al., 2017, p. 389). These conclusions the participants made it possible to assume that the study was rather successful and achieved its purpose.
Roberts, S., Wallis, M., McInnes, E., Bucknall, T., Banks, M., Ball, L., & Chaboyer, W. (2017). Patients’ perceptions of a pressure ulcer prevention care bundle in hospital: A qualitative descriptive study to guide evidence-based practice. Worldviews on Evidence-Based Nursing, 14(5), 385-393.