StudyCorgi Health & Medicine

Pressure Ulcer Management Elements

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).

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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.

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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.

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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.

Citation Type of Study

Design Type

Framework/Theory

Setting Key Concepts/Variables Findings Hierarchy of Evidence Level
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. Type of Study: cross-sectional.

Design Type: a review of surveys.

Framework/Theory: customized study choice criteria.

All Swedish hospitals (all-nation coverage). Concepts: pressure ulcer, pressure-reducing intervention, preventive intervention.

Independent Variable: none.

Dependent Variable: none.

Controlled Variable: none.

Low level of preventive measures; high prevalence of pressure ulcers; surface manipulation, heel protection, and repositioning are the key interventions. V (a review of surveys).
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. Type of Study: qualitative.

Design Type: literature review.

Framework/Theory: none.

None. Concepts: nursing research, research ethics, nursing, decision-making.

Independent Variable: none.

Dependent Variable: none.

Controlled Variable: none.

Key ethical concerns (which can be complicated by dilemmas) in nursing research include the informed consent, the lack of harm, and the endeavor to ensure and protect anonymity, confidentiality, and privacy. Also, the author points out that vulnerable groups of people require specific attention. VII (reviews literature and expert opinions).
Citation Study
Design Type
Framework/Theory
Setting Key Concepts/Variables Findings Hierarchy of Evidence Level
Houghton, C. E., Casey, D., Shaw, D., & Murphy, K. (2010) Ethical challenges in qualitative research: Examples from practice. Nurse Researcher, 18(1), 15–25. Type of Study: qualitative.

Design Type: multiple case study.

Framework/Theory: research ethics guidelines synthesized from multiple sources.

Unspecified clinical skills laboratory (interviews); affiliated hospitals (observation). Concepts: qualitative research, ethics, informed consent.

Independent Variable: none.

Dependent Variable: none.

Controlled Variable: none.

Key ethical challenges in qualitative research include the informed consent (in particular, determining if it is necessary and choosing its specifics: respondent, form, and so on), researcher-participant relationships (to avoid exploitation), the correlation of risks and benefits, and confidentiality. VI (a qualitative study).
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. Type of Study: descriptive.

Design Type: literature review.

Framework/Theory: research protocol for systematic reviews and meta-analyses.

None. Concepts: nursing research, systematic review, meta-analysis, comparative effectiveness research, evidence-based practice.

Independent Variable: none.

Dependent Variable: none.

Controlled Variable: none.

An algorithm can be offered for systematic reviews and meta-analyses (from research question formulation through the choice of inclusion criteria to methods for extracting and analyzing data). Both are valuable due to their ability to synthesize information; they can inform clinical decision-making. Level V (synthesis of literature with various levels of evidence).
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. Type of Study: invited review.

Design Type: literature review (80 articles).

Framework/Theory: customized study choice criteria.

None Concepts: pressure ulcer, spinal cord injury, comprehensive pressure ulcer management.

Independent Variable: none.

Dependent Variable: none.

Controlled Variable: none.

Pressure ulcers are prevalent and difficult to manage; they can be caused by external (for example, pressure, moisture) and internal (for example, infection) factors. There are four stages. Key interventions include dealing with the causes. Pressure redistribution surfaces can be viewed as one of the options. V (a review of various studies, including trials and descriptive ones).
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. Type of Study: systematic review and meta-analysis.

Design Type: literature review (110 studies).

Framework/Theory: customized study choice criteria.

None Concepts: systematic review, pressure ulcer, older patients, nonpharmacologic intervention.

Independent Variable: none.

Dependent Variable: none.

Controlled Variable: none.

The authors report the lack of quality evidence for all the interventions; the most wide-spread intervention is support surfaces (high- and low-technology); other interventions are repositioning and nutrition interventions. I (a review of reviews of randomized and non-randomized trials).
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. Type of Study: integrative review.

Design Type: review of IV-VII-level evidence (32 articles).

Framework/Theory: Cooper’s five-stage framework.

None Concepts: medical device-related pressure ulcers, pediatric patients.

Independent Variable: none.

Dependent Variable: none.

Controlled Variable: none.

Numerous medical devices are associated with pressure ulcers; contributing factors include immobility or inactivity, as well as moisture, insufficient hydration or nutrition, and friction. Nursing practice consists of general preventative and customized management interventions. V (a review of various studies which includes IV-VII-level studies)
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. Type of Study: systematic review.

Design Type: review of 26 implementation studies (including RCT).

Framework/Theory: customized study choice criteria.

None Concepts: pressure ulcers, prevention, intervention, implementation study.

Independent Variable: none.

Dependent Variable: none.

Controlled Variable: none.

There are typical barriers to the implementation of intervention programs for pressure ulcers: standardization, engagement of staff, training, documentation, and audit. Nursing leadership improves the process. Future research is needed. Interventions include support surfaces, repositioning, as well as nutrition, hydration and moisture management. V (a review of various studies; includes II-, IV-, VI-level studies)
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StudyCorgi. (2020, December 3). Pressure Ulcer Management Elements. Retrieved from https://studycorgi.com/pressure-ulcer-management-elements/

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"Pressure Ulcer Management Elements." StudyCorgi, 3 Dec. 2020, studycorgi.com/pressure-ulcer-management-elements/.

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