The present paper aims at formulating the formal project proposal by covering the topics essential for this purpose. The selected healthcare issue is pressure ulcers, which is one of the greatest burdens in nursing care. The paper will incorporate such elements as the explanation of the problem’s significance, the formulation of the PICOT question, the evaluation of evidence, and the implementation of the evidence in practice. Further, the outcomes of the practice change will be evaluated, and the dissemination of findings will be discussed. The conclusion will summarize the main aspects of the project.
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The Spirit of Inquiry Ignited
The definition of pressure ulcers is frequently associated with the indication of nursing care quality. A bedsore, which is another name for pressure ulcers, is characterized as local skin or tissue damage that is initiated by friction and pressure. The defined problem most commonly occurs in intensive care units since patients receiving treatment there are usually immobile. The severity of the problem is justified by the fact that as many as 30% of senior patients staying in the U.S. hospitals develop pressure ulcers (Hahnel, Lichterfeld, Blume-Peytavi, & Kottner, 2017). Thus, it is crucial to find viable options for reducing the incidence of this condition.
There are many indications of the severity of bedsores in professional and scholarly literature. Specialists distinguish between four stages of pressure ulcers:
- non-branch able erythema,
- partial thickness,
- full-thickness skin loss,
- full-thickness tissue loss (Kottner & Raeder, 2014).
The issue can be complicated by cellulitis, necrotizing fasciitis, osteomyelitis, and peri-wound candida infections (Thomas, 2014). The seriousness of this problem made me wonder what could be done to eliminate the development of infections and minimize the deterioration of patients’ health. The ultimate goal of the project was to use evidence-based practice (EBP) to find out whether the initiation of a pressure ulcer protocol in the emergency care department could reduce the incidence of hospital-acquired pressure ulcers.
The PICOT Question Formulated
In patients identified as at high risk for pressure ulcer development (P), does the initiation of a pressure ulcer protocol at the emergency department (I) as compared to usual care (C) reduce the incidence of hospital-acquired pressure ulcers (O) on day 3 of hospitalization (T)?
Search Strategy Conducted
Several databases were employed to find scholarly papers focused on the problem of pressure ulcers, namely PubMed, CINAHL, and Cochrane. The keywords and phrases used in the search were “pressure ulcers,” “pressure ulcers prevention,” “pressure ulcers management,” and “pressure ulcers in the emergency department.” A systematic review by Sullivan and Schoelles (2013) allowed identifying the main themes of further search. In the process of search, studies with levels II, III, and IV of evidence were located.
Critical Appraisal of the Evidence Performed
The articles found with the help of search databases were appraised for the reliability, validity, and applicability to practice. Several sources discussed the role of documentation in reducing the incidence of pressure ulcers. In the study by Li (2016), which had the level III evidence, it was concluded that nursing documentation did not have much effect on the problem’s elimination. However, an IV-level evidence article by O’Toole et al. (2017) confirmed the possibility of reducing the risk for bed sores with the help of evidence-based protocols.
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The level II evidence, a randomized controlled trial by Santamaria et al. (2015), found that the application of multi-layer soft silicone foam dressings assisted in the prevention of hospital-acquired patient ulcers. Two other research papers were focused on combined approaches to the healthcare issue. Lam et al. (2018) advocated for a comprehensive program for hospital-acquired pressure ulcer prevention. Mallah, Nassar, and Kurdahi Badr (2015) offered a multi-model intervention to reduce the progress of pressure ulcers. All of the found sources were considered relatively or highly reliable, and their findings were further employed in the project.
Evidence Integrated with Clinical Expertise and Patient Preferences to Implement the Best Practice
The project’s major goal was to translate the EPB approaches found in scholarly sources into nurses’ practice in the form of one-hour educational sessions focused on pressure ulcers protocol preparation. Another objective was to evaluate the effectiveness of such education combined in relation to the patients staying at the emergency department. Nurses are the specialists responsible for patients’ predisposition to pressure ulcers since a nurse has to take care of the patient before and after the surgical involvement or during the treatment.
Therefore, the implementation of the educational intervention was initiated to teach nurses how to keep the protocol that was expected to reduce the incidence of pressure ulcers among patients. During the session, healthcare workers were instructed how to keep the protocol and how to adjust caring techniques in case they noticed that the patient was prone to developing bedsores.
The outcome of Practice Change Evaluated
- Purpose. The assessment aimed to find out whether the implementation of EBP helped manage the problem of pressure ulcer development.
- Clinical question. In patients identified as at high risk for pressure ulcer development (P), does the initiation of a pressure ulcer protocol at the emergency department as compared to usual care reduce the incidence of hospital-acquired pressure ulcers?
- Time. Three days.
- Stakeholders. The project leader, nurses, and patients.
- Theoretical framework. Lewin’s change model was used as a theoretical framework for the project. The model includes three phases: unfreezing, changing, and refreezing (Mitchell, 2013).
- Design. Semi-experimental.
- Confidentiality. All the involved patients were informed about the project. They signed informed consent, but either way, none of their data were used. Only some demographic factors, such as age, gender, and ethnicity were recorded for the sake of a thorough analysis of results.
- Sample/setting/procedure. At the time of the project, twelve patients were staying at the emergency department. It was decided that six of them would receive usual care whereas, for the other six, nurses would keep protocols. In the following three days, results were collected, and then they were compared.
- Instrument. A self-report was prepared by each nurse on each patient’s condition before and after the intervention.
- Outcomes to be evaluated. The assessment criterion was the development (or non-development) of pressure ulcers in patients staying at the emergency unit in three days. It was found that the group where protocols were kept had a lower rate of pressure ulcer development: one out of six patients, in contrast to three out of six in the group receiving usual care.
The project’s findings were disseminated through a report prepared by the project’s leader. It is expected that a summarized version of the report will be prepared and shared between colleagues and also sent to other healthcare institutions. Nurses working in different hospitals will be able to promote their patients’ health and wellbeing with the help of these guidelines.
The project was developed to improve nursing care about patients at the emergency care unit that are prone to developing pressure ulcers. EBP was used to find a viable approach to the issue. As a result of the project, it was found that the initiation of a pressure ulcer protocol at the emergency department reduced the incidence of hospital-acquired pressure ulcers. However, the sample was rather small, and further research is recommended to reach more reliable and valid outcomes.
Hahnel, E., Lichterfeld, A., Blume-Peytavi, U., & Kottner, J. (2017). The epidemiology of skin conditions in the aged: A systematic review. Journal of Tissue Viability, 26(1), 20-28.
Kottner, J., & Raeder, K. (2014). Assessment and documentation of pressure ulcers. In D. R. Thomas & G. A. Compton (Eds.), Pressure ulcers in the aging population: A guide for clinicians (pp. 47-65). New York, NY: Humana Press.
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.
Li, D. (2016). The relationship among pressure ulcer risk factors, incidence and nursing documentation in hospital-acquired pressure ulcer patients in intensive care units. Journal of Clinical Nursing, 25(15-16), 2336-2347.
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.
Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management, 20(1), 32-37.
O’Toole, T. R., Jacobs, N., Hondorp, B., Crawford, L., Boudreau, L. R., Jeffe, J.,… LoSavio, P. (2017). Prevention of tracheostomy-related hospital-acquired pressure ulcers. Otolaryngology – Head and Neck Surgery, 156(4), 642-651.
Santamaria, N., Gerdtz, M., Sage, S., McCann, J., Freeman, A., Vassiliou, T.,… Knott, J. (2015). 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.
Sullivan, N., & Schoelles, K. M. (2013). Preventing in-facility pressure ulcers as a patient safety strategy: A systematic review. Annals of Internal Medicine, 158(5.2), 410-417.
Thomas, D. R. (2014). General principles of pressure ulcer management. In D. R. Thomas & G. A. Compton (Eds.), Pressure ulcers in the aging population: A guide for clinicians (pp. 67-80). New York, NY: Humana Press.
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