Pressure ulcers (PUs) are a significant problem that lowers the quality of life in patients; it can also have complications, which result in increased mortality (Sullivan & Schoelles, 2013). Apart from that, the prevention and management of PUs require complex and costly interventions that do not always demonstrate desired results (Kruger, Pires, Ngann, Sterling, & Rubayi, 2013). The present paper reviews the research questions and search keywords related to this issue and focuses on the feasible and researchable topic of testing a particular method of PUs management: pressure redistribution surface mattresses (PRSM).
The problem of PUs cannot be viewed as under-investigated, but certain specific topics are reviewed to a lesser extent. For example, a search for a recent discussion on the treatment of PU in elderly patients in long-term care facilities was largely unsuccessful. However, PUs is a relatively common issue in long-term care facilities and elderly patients, which is why the specific settings and population need to be considered (Sullivan & Schoelles, 2013). Possibly, the future research will include less recent studies, but more recent works imply more updated information, which is important (Barker, n.d.; Robeson, Dobbins, DeCorby, & Tirilis, 2010).
When reviewing the potential questions without formulating them in the PICOT format, it is possible to suggest the following areas of interest. The first question may consider the effective modern-day evidence-based methods of preventing PUs in elderly patients in long-term care facilities. The second question is concerned with the methods of the management of PUs in the population. The two questions are rather broad, which makes them less feasible: they are likely to require much time (Polit & Beck, 2017).
Also, a review of the literature on the topic shows that while the precise population and settings of the proposed research are not typically examined on their own, the reviews of relevant management approaches can be found in modern studies (Kruger et al., 2013; Sullivan & Schoelles, 2013). Therefore, while it is possible to research the specific topic from these perspectives, they appear to be less immediately helpful as compared to the following questions.
The causes of PUs are also worth investigating. For example, the determination of the most frequent cause in the population and the settings could provide some guidance for the development of updated approaches to the prevention of the issue. This topic is fascinating and has great potential for improving healthcare. However, this question does not appear to be very feasible: it would require a large sample to ensure the validity of the results and, therefore, much time, which is why it is not chosen for this work (Polit & Beck, 2017).
The fourth question can consider the prevention or treatment methods of a particular facility to check if they are appropriate (possibly, begin a change). It is an engaging and locally useful topic, and such studies are necessary for many facilities. However, it requires the support of the facility’s management, which makes the research less feasible for cooperation (Polit & Beck, 2017).
In the end, the question that is chosen for this work consists of reviewing a particular approach to pressure ulcer prevention and management: pressure redistribution surfaces (mattresses). The approach has received some review in modern literature (Kruger et al., 2013; Sullivan & Schoelles, 2013); for example, Huang, Chen, and Xu (2013) demonstrate that PRSM is more effective in preventing surgery-related PUs when compared to usual foam mattresses.
However, a review of the literature does not reveal works that are devoted to the specific settings, population, and comparison interventions that are going to be studied. Therefore, the question has a chance of providing meaningful evidence for practice in the settings. The question is also based on the first two questions, but it is more narrow and researchable; therefore, it can be suggested that the development of this question follows the advice of Polit and Beck (2017) on narrowing the topic by first considering broader questions.
The final version of the PICOT question, the format of which is based on the advice of Davies (2011) and Polit and Beck (2017), can be phrased as follows. In long-term care patients with stage IV pressure ulcers, what is the effect of pressure redistribution surface mattress as compared with manual repositioning or the combination of both in the prevention and treatment of stage IV PUs within a given time? The Patients (with the problem) that are going to be studied are elderly patients with stage IV PUs in long-term care facilities: it is a vulnerable population that often suffers from the Problem (Kruger et al., 2013; Sullivan & Schoelles, 2013), which explains the choice.
The Intervention that is going to be tested is PRSM, which is an appropriate method of issue management. The study will compare this approach to manual repositioning and the combination of the two. The Expected Outcomes are the changes in the prevention and management of stage IV PUs (better quality, worse quality, the lack of change); the Period is not defined yet and requires more research.
Polit and Beck (2017) suggest that the keywords that can be used to search for the appropriate literature on the topic are related to the PICOT variables. Thus, the keywords that are likely to be useful include the following ten suggestions: pressure ulcer, stage IV pressure ulcer, pressure ulcer management, pressure ulcer prevention, elderly patients, long-term care, pressure redistribution, pressure redistribution surface, pressure redistribution mattress, manual repositioning. They should be combined to achieve the desired outcomes and discover recent research on the topic to refine the PICOT question.
References
Barker, J. (n.d.). Basic search tips and advanced Boolean explained. Web.
Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75–80.
Huang, H. Y., Chen, H. L., & Xu, X. J. (2013). Pressure-redistribution surfaces for prevention of surgery-related pressure ulcers: a meta-analysis. Ostomy Wound Manage, 59(4), 36-8.
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.
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
Robeson, P., Dobbins, M., DeCorby, K., & Tirilis, D. (2010). Facilitating access to pre-processed research evidence in public health. BMC Public Health, 10(95), 1-10.
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.