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Pressure Injury Point Prevalence: Research Ethics

Broad Topic Area

Health care reform, medical care quality, quality management, safety regulations

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Problem Statement

Hospital-acquired pressure injuries (HAPIs) are preventable events yet still occur because of various factors, including noncompliance to safety guidelines.

Purpose Statement

To determine the commonness and attributes of pressure injuries and to indicate important factors related to HAPIs and adherence to regulations to identify areas that should be improved.

Research Questions

Are National Safety and Quality Health Service Standards (NSQHSS) developed by the Australian Commission on Safety and Quality in Health Care (ACSQHC), which include guidelines to prevent and control HAPIs, being thoroughly followed?


Preventative measures are not being thoroughly undertaken even after patients are determined to have pressure injuries after an inspection within eight hours of presentation.

Dependent and Independent Variables and Type of Data for the Variables

Independent variables: percentage of patients with a full body inspection conducted within 8 hours of presentation; percentage of patients with documented use of pressure injury risk assessment tool within 8 hours of presentation.

Dependent variables: percentage of patients identified as at risk of developing a pressure injury.

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Population of Interest for Study

Patients of Western Australian hospitals


Multiday-stay public in-patients in acute/subacute wards of hospitals, which have more than 40 acute or subacute beds and admit public patients.

Sampling Method

Cluster sampling

Data Collection

Survey teams, which were composed of 400 surveyors in total, examined medical records for each patient and conducted full-body skin inspection on patients that gave consent.

Data Collection Approach

Surveys and document reviews

Data Analysis

Types of statistical tests that were used for the variables

Pearson’s chi-squared test, univariable and multivariable logistic regression models

Results of Study

Despite the documented use of prevention strategies, 18% of the documented pressure injuries are medical device-related.

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Summary of Assumptions and Limitations

Surveyors had varying levels of clinical and audit experience, and the preventative strategies which were applied were seen on management plans but not in practice. Other potential limitations: Survey days occurred only in May of 2014 and were not scattered throughout the year, which may potentially lead to a “Time of Observation” bias.

Ethical Considerations

Research ethics, as an idea, concept, and practice, have always occupied an important place in academic work. The presence of standardizing values ensures the existence of a unique scientific morality, following which contributes to the development of science and enhancement of its role and influence within society. Standards of research ethics, however, differ in different countries: various social institutions and bureaucratic procedures control them. With the growing number of international projects in the humanities and social and other sciences, flaws in the rules and protocols of research ethics are increasingly being discussed. Thus, clearance from a research ethics organization may not be enough to consider a study thoroughly ethical.

The Department of Health Human Research Ethics Committee (DHHREC), as stated in the paper, approved this research to be ethically compliant (Ferguson, Crouchley, Mason, Prentice, & Ling, 2019). All audits took place in the presence of both a hospital-based clinician and a surveyor (Ferguson et al., 2019). No representative from DHHREC, however, participated in the study during the survey days (Ferguson et al., 2019). This leaves questions on whether the audit resulted in any ethical considerations. Further studies on whether the patients felt disturbed during the survey days were not conducted.

The study interacted with both the patients, their personal data, and medical records (Ferguson et al., 2019). While the researchers state that full-body skin inspections were carried on only those patients who gave consent, they do not clarify whether they were informed of all implications of the research. The paper does not discuss whether the patients voluntarily participated in the survey knowing about the reasons for this study and its inferences. There is no evidence proving that the intrusion of the external party into the daily operations of the hospitals did not result in any distress and anxiety on behalf of the patients.

Medical records of the patients were examined as part of the study, but the researchers do not mention whether written consent to reveal medical records to them was attained from each patient. There is no information on where the medical records were examined, whether they were extracted out of the facilities, and whether members of the survey teams signed non-disclosure agreements before reviewing the data. There is also no information on whether the data was copied or sent over a network. This uncertainty raises privacy concerns about the personal data of the patients.

Ethical considerations have a significant impact on the choice of methodology and the nature of research. Ethics acts as a tool of choice in difficult situations in the event of a conflict between two moral positions. It involves balancing between the two truths when there is no uniquely correct answer to the questions. It is easy to choose between two contrasting colors, but difficulties arise when it comes to semitones. Thus, research ethics is a common topic when designing and implementing research activities. This study raises several questions in the context of research ethics. The fact that the DHHREC approved this research, however, may warrant it to be ethically compliant if the competency of the entity is assumed to be sufficient. Additional clarification on the points mentioned in the previous paragraphs would help dispel some of the raised concerns.


Ferguson, C., Crouchley, K., Mason, L., Prentice, J., & Ling, A. (2019). Pressure injury point prevalence: state-wide survey to identify variability in Western Australian hospitals. Australian Journal of Advanced Nursing. Web.

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