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Pressure Ulcers: Identifying a Clinical Question

A Clinical Question Related to the Area of Practice

One of the most crucial clinical issues in the question of pressure ulcers since this type of injury is a prevalent burden in the healthcare system. Whereas major achievements have been gained in various spheres of care, no effective solution to managing bedsores has been identified yet. Lam et al. (2018) note that the process of preventing pressure ulcers is “one of the greatest healthcare challenges” (p. 1122). The incidence of bedsores in the USA is 0-6% in rehabilitative care, 0-17% in-home care, and 2.3-23.9% in long-term care (Lam et al., 2018). Meanwhile, the overall annual statistic varies between 0.4% and 38% of hospitalized patients (Lam et al., 2018). Therefore, the identified clinical question demands serious consideration and requires effective solutions.

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Healthcare professionals have identified a range of interventions aimed at reducing the risk of developing pressure ulcers. For instance, Qaseem, Mir, Starkey, and Denberg (2015) mention such methods as wheelchair cushions, low-air-low beds, advanced static mattresses, and nutritional supplementation. At the same time, scholars distinguish between the following risk assessment tools: the Cubbin and Jackson scale, the Braden Scale, and the Norton, Ramstadius, and Waterlow scales (Qaseem et al., 2015). Still, the authors admit that none of the instruments has enough sensitivity to identify patients most susceptible to developing bedsores. Frequently, pressure ulcers are associated with nurses’ attitude toward patient care. However, a study by Mallah, Nassar, and Kurdahi Badr (2015) indicates that such a statement is not true, patients’ condition being the most decisive factor of pressure injury initiation.

Taking into account the mentioned data, the PICOT question is, “In patients that are identified as high risk for developing a pressure ulcer (P), does the implementation of a pressure ulcer protocol initiated in the emergency department (I) as compared to patients who receive usual care (C), reduce the incidence of hospital-acquired pressure ulcers (O) on day 3 of hospitalization (T)?”

Why the Clinical Question is an Opportunity for Improving Health Outcomes

The identified healthcare issue is a viable possibility to enhance health outcomes in the clinical area of practice. Bedsores constitute a prevalent burden in healthcare settings (Qaseem et al., 2015). Hence, finding a solution to this problem would result in a raised patient satisfaction level and a decreased financial loss rate for hospitals. A review of recently published academic research articles justifies the significance of the selected clinical question.

A study by Fremmelevholm and Soegaard (2019) discusses a nurse-led clinical quality improvement intervention as a means of preventing pressure ulcers in hospital settings. Scholars emphasize the need to assess each patient on bedsore risk upon admission and every day of hospital stay. The authors conclude that the quality-improvement intervention can significantly reduce the incidence of pressure ulcers (Fremmelevholm & Soegaard, 2019). The participation of nursing specialists was a factor that increased the positive outcomes of the intervention.

Hughes (2014) investigates the potential of silicone pressure-reducing pads to prevent pressure ulcers. The author mentions that bedsores serve as a “key quality of care indicator” (Hughes, 2014, p. 46). The scholar emphasizes the necessity to find proper management of pressure ulcers since they cause not only financial but also emotional distress to individuals staying at healthcare facilities. Hughes (2014) concludes that silicone pressure-reducing pads are an effective method of averting the development of bedsores.

Lam et al. (2018) offer an overview of strategies that can be employed to eliminate the risk of pressure ulcer emergence. Scholars consider such measures as the use of pressure-reducing beds, changing patients’ position every two hours, early surgical attendance, patient education, and enhanced nutritional support as the most beneficial. What is more, Lam et al. (2018) argue that the implementation of pressure ulcer prevention protocol is likely to reduce the incidence of bedsores.

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The article by Swan (2018) investigates the effectiveness of dermal gel pads in the reduction of pressure ulcers. The scholar notes that the majority of cases occur in intensive care units since the patients staying there experience a loss of sensory and motor skills. Hence, Swan (2018) suggests that the use of dermal gel pads can help in the prevention of bedsores among such inpatients.

Finally, research by Thorpe (2016) discusses the prophylactic use of dressings in critical care units as a preventive measure. The scholar draws attention to the fact that not all pressure ulcers can be prevented. However, resorting to prophylactic dressings can reduce the risk significantly. With the help of this approach, it is possible to attain a decrease in bedsore incidence in critical care units and raise patient satisfaction.

The Article Best Supporting Nursing Interventions

The scholarly study best-supporting nursing solutions to the identified problem is the article by Lam et al. (2018), which is focused on a novel approach to preventing hospital-acquired bedsores. There are several reasons why this source is the most suitable for analyzing the PICOT question. First of all, in comparison to other articles, Lam et al.’s (2018) study cover more than one prevention technique. Meanwhile, each of the other sources concentrates on one approach. Fremmelevholm and Soegaard (2019) analyze a nurse-led clinical quality improvement intervention in their research. Hughes (2014) investigates the viability of silicone pressure-reducing pads for bedsore prevention and treatment. Swan (2018) outlines the benefits of dermal gel pads’ utilization for patients suffering from or prone to developing pressure ulcers. Thorpe (2016) discusses the prophylactic use of dressings for preventing bedsores in critical care units. Each of these studies contains reliable data on preventing and treatment of pressure ulcers. However, Lam et al.’s (2018) article offer an integrative approach to the problem, which makes it the most suitable source.

Another reason why Lam et al.’s (2018) article is the most appropriate is that it provides a detailed account of the issue of pressure ulcers, including novel approaches to defining it. Lam et al. (2018) differentiate between “pressure ulcers” and “pressure injuries” based on the terminology suggested by the National Pressure Ulcer Advisory Panel (p. 1122). Meanwhile, other scholarly studies do not offer such a distinction between key terms. Additionally, Lam et al.’s (2018) study focus primarily on the USA, whereas some authors base their research on other countries. For instance, the article by Fremmelevholm and Soegaard (2019) investigates the problem from the point of view of the Danish healthcare system. Hughes (2014) and Swan (2018) collected their samples from UK hospitals. Thus, the focus on the US healthcare system is a factor serving as an advantage of Lam et al.’s (2018) study.

Finally, the source identified as the most useful contains an overview of both assessment tools and interventions, one of the – pressure ulcer prevention protocols – is the element of the PICOT question. Lam et al. (2018) note that preventative protocols have the potential to reduce the incidence of pressure ulcers in intensive care units. Therefore, though other academic articles are highly reliable and valid due to their data collection and analysis methods and findings, Lam et al.’s (2018) study support the nursing interventions for the topic best of all.


Fremmelevholm, A., & Soegaard, K. (2019). Pressure ulcer prevention in hospitals: A successful nurse-led clinical quality improvement intervention. British Journal of Nursing, 28(6), 6-11.

Hughes, M. A. (2014). Silicone pressure-reducing pads for the prevention and treatment of pressure ulcers. British Journal of Community Nursing, 19(6), 46-52.

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Lam, C., Elkbuli, A., Benson, B., Young, E., Morejon, O., Boneva, D.,… McKenney, M. (2018). Implementing a novel guideline to prevent hospital-acquired pressure ulcers in a trauma population: A patient-safety approach. Journal of the American College of Surgeons, 226(6), 1122-1127.

Mallah, Z., Nassar, N., & Kurdahi Badr, L. (2015). The effectiveness of a pressure ulcer intervention program on the prevalence of hospital acquired pressure ulcers: Controlled before and after study. Applied Nursing Research, 28(2), 106-113.

Qaseem, A., Mir, T. P., Starkey, M., & Denberg, T. D. (2015). Risk assessment and prevention of pressure ulcers: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 162(5), 359-369.

Swan, J. (2018). Use of dermal gel pads in preventing and managing pressure ulcers in ICU: An audit. British Journal of Nursing, 27(20), 42-47.

Thorpe, E. (2016). Prophylactic use of dressings for pressure ulcer prevention in the critical care unit. British Journal of Nursing, 25(12), 6-12.

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