Introduction
Pressure ulcers are a growing issue in the world of medicine and the main research problem of the article. One of their worst aspects is that they can develop in hospital settings due to the prolonged recovery period of some patients. One of the proposed solutions is the use of multi-layered soft silicone foam dressings to prevent pressure ulcers from developing in patients of the intensive care unit. The effectiveness of this solution is the research question of the article. It is supported through research on a large sample of ICU patients. The presented article hypothesizes that patients with multi-layered soft silicone foam dressings are less likely to develop sacral and heel pressure ulcers than those who receive standard care. The results have shown a decrease in the rate of pressure ulcer development in the intervention group through comparison with the control group. This paper will provide a critique of the presented article.
Evaluation
The authors begin the article with a small but comprehensive literature review. Reviewed literature includes information about the risk factors that lead to pressure ulcers, an increase in pressure ulcer incidence rates, the mechanism of the pressure ulcer development, and the use of various dressings such as prophylaxis. The authors state that after the review of the available information, the results have shown a lack of relevant research about the use of dressing as a measure of pressure ulcer prevention in the heel and sacral areas of critically ill patients (Santamaria et al., 2013).
The research provided by the authors is highly relevant due to the increased rates of patients developing pressure ulcers in hospitals. This method is one of the more promising prevention methods in the opinion of other researchers (Gould et al., 2016; Swafford, Culpepper, & Dunn, 2016). Pressure ulcers can be very damaging to the body of the patient, and at times they may lead to worse outcomes than the initial condition of the patient. The increased number of pressure ulcer cases is often associated with the lack of appropriate bedding surfaces and the rare use of skincare products for patients due to the low funds of the hospitals (Demarré et al., 2015).
The research was quantitative and done through a randomized controlled trial. It involved an experiment where one group of patients was treated with soft silicone multilayered foam dressings, and the other was not. The difference in the development of pressure ulcers between the groups determined the effectiveness of the preventative solution (Santamaria et al., 2013).
The criteria for the participation in the study specified that the patients must have been “admitted to ED and ICU for critical illness or major trauma” while being “over 18 years of age” (Santamaria et al., 2013, p. 3). However, patients who had a spinal injury that prevented their movement on the bed, those with pre-existing sacral or heel pressure ulcers, and patients who experienced trauma to sacrum or heels had to be excluded from the study. The sample included more than 400 patients that were selected based on predefined inclusion and exclusion criteria. The patients were randomly assigned to the control group and the trial group. The control group included 221 patients, while the trial group included 219. Members of the trial group were treated with usual care but also had Mepilex Border Sacrum and Heel dressings applied to them, while the control group only received the usual care (Santamaria et al., 2013). The sample was appropriate for the specified research because it was chosen randomly out of the most relevant candidates for participation. No sign of bias was identified during the reading of the article.
The research presented in the article is highly practical because it examines a real possible solution to an issue of pressure ulcers developing in ICU patients. It provides concrete results that have previously been left unexamined and even in the state that they are presented in the research, the dressings can be applied to patients at risk of developing pressure ulcers. The authors suggest that due to the decreased incidence rate of the sacrum and heel pressure ulcers in they may be used in practice at ICUs when combined with thorough risk assessment. 10% reduction was recorded by the researchers who may seem like a lower percentile (Santamaria et al., 2013), but with the frequency that pressure ulcers develop, even a 10% prevention rate can help a significant number of people.
The study could be improved in a few ways, however. Even though the ICU is one of the primary units where pressure ulcers develop, other hospital units could have also been examined because places such as the burn care unit are also at risk of patients developing them. The focus just on the sacrum and heel pressure ulcers helped to provide a very specific result, but with such dressings still being a relatively rare prevention solution, the authors could have gained more useful results if they provided a complete course of skincare to the patients. A more wholesome care program could likely provide an increased rate of pressure ulcer prevention among ICU patients. However, the information presented in the article is still significant.
The writing style of the article is extremely clear and well organized. Every element of research is separated into its section and is written without the use of excessive terminology. The key elements of the article are even outlined so that no important information gets lost in the text of the article. It is plausible that a medical professional of any level would be able to understand the importance of the study and should be able to implement its suggestions if it is required.
Further research can and needs to be done on this topic. The increased incidence rate of pressure ulcers is a signal of larger issues with the hospital practice because it is a relatively new development. Not only should additional research be conducted but the majority of positive outcomes should be implemented as soon as a credible amount of evidence becomes available in their favor. It is one of the critical issues of medicine, and if it is left untreated, it could undermine medicine as a whole. Patients expect care and treatment at hospitals, but if the hospital is unable to save them from hospital-created negative outcomes, then their trust in the work of medical professionals would become compromised.
Conclusion
The issue of pressure ulcers requires attention. The researchers of the presented article approached this issue through the implementation of soft silicone dressing to the sacrum and heels of the patients. Their results suggested that at least 10% of all cases can be prevented with these dressings. The study was carefully compiled and presented some concrete evidence of the effectiveness of this solution. However, it could be expanded upon with more types of dressing and other hospital units.
References
Demarré, L., Van Lancker, A., Van Hecke, A., Verhaeghe, S., Grypdonck, M., Lemey, J., … Beeckman, D. (2015). The cost of prevention and treatment of pressure ulcers: A systematic review. International Journal of Nursing Studies, 52(11), 1754–1774.
Gould, L., Stuntz, M., Giovannelli, M., Ahmad, A., Aslam, R., Mullen-Fortino, M., … Gordillo, G. M. (2016). Wound healing society 2015 update on guidelines for pressure ulcers. Wound Repair and Regeneration, 24(1), 145–162.
Swafford, K., Culpepper, R., & Dunn, C. (2016). Use of a comprehensive program to reduce the incidence of hospital-acquired pressure ulcers in an intensive care unit. American Journal of Critical Care, 25(2), 152–155.
Santamaria, N., Gerdtz, M., Sage, S., McCann, J., Freeman, A., Vassiliou, T.,… Knott, J. (2013). A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: the border trial. International Wound Journal, 12(3), 302-308.