Introduction
The present paper is devoted to a literature review on the following PICOT question; the references used in the paper are summarized in Appendix A. The majority of the articles are systematic reviews, which makes them a good source of synthesized information (Katapodi & Northouse, 2011).
PICOT: In long-term care patients with stage IV pressure ulcer, what is the effect of pressure redistribution surface mattress as compared with manual re-positioning or the combination of both in the prevention and treatment of stage IV PUs within a given time?
Synthesis of the Research Studies
The reviewed articles provide some basic information on pressure ulcer management that are of use for the study. Elderly patients are shown to be a risk group with respect pressure ulcers (Sullivan & Schoelles, 2013). Apart from that, pressure ulcers are an issue for long-term care (Kruger, Pires, Ngann, Sterling, & Rubayi, 2013; Sullivan & Schoelles, 2013). The use of low- and high-technology pressure redistribution surfaces (PRD) seems to be a wide-spread management intervention (Bååth, Idvall, Gunningberg, & Hommel, 2013; Kruger et al., 2013; Sullivan & Schoelles, 2013). Some of the typical surfaces include overlays, mattresses or mattress replacements, and special beds (Kruger et al., 2013).
Multiple researchers point out the fact that the topic is rather under-researched, which is true for pressure ulcer management (Sullivan & Schoelles, 2013), the effectiveness of particular interventions (Kruger et al., 2013), and pressure ulcers in specific populations and conditions (Murray, Noonan, Quigley, & Curley, 2013). No study that would be simultaneously devoted to the specific settings, stage, and population that is targeted by the proposed research was found. However, multiple studies indicate that the interventions that are of interest for the proposed research are known to be employed in practice (Bååth et al., 2013; Kruger et al., 2013; Lozano-Montoya et al., 2016; Murray et al., 2013; Sullivan & Schoelles, 2013).
Still, there is only limited evidence of their effectiveness, especially in comparison with other methods, which can include moisture management and improvement of nutrition and hydration (Sullivan & Schoelles, 2013).
Inconsistencies, Contradictions, and Possible Explanations Within the Research
There are no direct contradictions in the mentioned literature, although their focus differs due to taking into account different populations, settings, and stages of care. For example, the article by Lozano-Montoya et al. (2016) reveals that PRDs seem to attract particular attention of researchers as compared to other methods, including nutritional interventions, which indicates the popularity of the approach. Kruger et al. (2013), on the other hand, view the approach as supplementary and less important than, for example, nutritional interventions.
However, Kruger et al. (2013) consider ulcer management (which they view as prevention and treatment) in specific cases (in patients with spinal cord injury) while Lozano-Montoya et al. (2016) discuss systematic reviews on ulcer prevention, which is likely to affect their focus. In general, the studies consistently reveal the popularity of PRDs and the lack of appropriate evidence on the comparative effectiveness of various pressure ulcer management methods.
Preliminary Conclusion
The above-mentioned articles provide notable information on the topic while also indicating the under-researched elements in modern research. Older adults are a vulnerable population that requires specific ethical considerations (Fouka & Mantzorou, 2011; Houghton, Casey, Shaw, & Murphy, 2010), but this fact cannot explain the lack of research on the management of pressure ulcers in them since they are also at risk of pressure ulcer development. Apart from that, the fact that there is little high-quality evidence on PRDs despite their apparent popularity also calls for action. Finally, the review shows that the topic is of significant importance for the population and settings of the proposed study and healthcare in general. Thus, the literature review proves the need for the study and practice change and offers a basic theoretical ground for it. Additional research should be a continuous process throughout the project.
Summary
The present paper reviews eight articles, which indicate that the PICOT question is under-researched. However, there is some evidence to the topic being of importance for modern healthcare and the practice change being necessary. The literature review reveals under-researched elements of pressure ulcer management and offers basic information on it. Additional research will be carried out throughout the project.
References
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.
Fouka, G., & Mantzorou, M. (2011). What are the major ethical issues in conducting research? Is there a conflict between the research ethics and the nature of nursing? Health Science Journal, 5(1), 3–14.
Houghton, C. E., Casey, D., Shaw, D., & Murphy, K. (2010). Ethical challenges in qualitative research: Examples from practice. Nurse Researcher, 18(1), 15–25.
Katapodi, M. C., & Northouse, L. L. (2011). Comparative effectiveness research: Using systematic reviews and meta-analyses to synthesize empirical evidence. Research & Theory for Nursing Practice, 25(3), 191–209.
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.
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.e1-370.e10.
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.
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.
Appendix A
Literature Review Summary Table.