Prevention of Pressure Ulcers

PICOT Question

Will you have a comparison group or will subjects be their own controls?

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As the project focuses on the prevention of pressure ulcers and not on their treatment, it would not be possible to use subjects as their own controls. Based on the evidence collected, using historical data on pressure ulcer incidence could be an option. However, the presence of a comparison group significantly improves the validity of the study because it helps to ensure that the results are not influenced by other factors. Therefore, a control group is required for this study. Whereas patients in the control group will be tended to using regular pressure ulcer prevention strategies, patients in the intervention groups will receive care in accordance with a new pressure ulcer protocol.

Is a ‘time’ appropriate with your question—why or why not?

The project will look at the incidence of pressure ulcers on day 3 of hospitalization. The majority of surgical procedures in the emergency department take place within the first 24 hours of admission. Therefore, if a patient has not developed a pressure ulcer by day 3 of hospitalization, it is unlikely that they will develop it later during their stay. The set time limit is thus appropriate to the PICOT question, and there is no need to adjust it.

Evidence Synthesis

Database: Pubmed Study #1 Study #2 Study #3 Study #4 Study #5 Synthesis
(p) Population Intensive care unit patients Patients with tracheostomy tubes placed in the operating room Inpatients from 19 hospital units Patients admitted to trauma services Trauma and critically ill patients in an emergency department All studies focus on inpatients in various departments
(i) Intervention Pressure ulcer documentation An institutionally adopted quality improvement protocol A multi-model intervention program A 7-step care process, acquisition of specialized equipment, and an educational intervention The use of soft silicone multi-layered foam dressings Most interventions included a change in care protocols
(c) Comparison Comparison among the facilities Data from before the adoption of a protocol Regular pressure ulcer preventive care Routine preventive care Usual pressure ulcer prevention strategies Most studies compared the results with usual preventive care
(o) Outcome The correlation between the quality and comprehensiveness of pressure ulcer documentation and pressure ulcer incidence was insignificant The incidence of pressure ulcers decreased as a result of a comprehensive quality improvement protocol A significant reduction in pressure ulcer incidence The intervention was efficient in reducing the incidence of hospital-acquired pressure ulcers A reduction in the incidence of hospital-acquired pressure ulcers was 10% Four out of five interventions achieved a reduction in hospital-acquired pressure ulcers
(t) time 13 months 12 months 16 months 3 years 20 months The minimum recommended data collection time is 1 year, the average length was 19.4 months

Evaluation Table

Citation Design Sample size: Adequate? Major Variables:

Independent Dependent

Study findings: Strengths and weaknesses Level of evidence Evidence Synthesis
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. A retrospective, descriptive, comparative, correlational study. 196 ICU patients, a relatively small sample size Independent variables: quality and comprehensiveness of pressure ulcer documentation
Dependent variable: incidence of pressure ulcers
Strengths: a comprehensive literature review, appropriate study design, well-founded conclusions

Weaknesses: small sample size, which makes it impossible to generalize the results to other settings

VI The study showed that pressure ulcer documentation quality or its comprehensiveness does not have a significant effect on the incidence of hospital-acquired pressure ulcers.
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. A quantitative, comparative, retrospective study Intervention group: 155 patients Control group: 183 patients
Moderate sample size, but adequate given the specificity of the intervention
Independent variable: the adoption of a quality improvement protocol
Dependent variable: pressure ulcer incidence
Strengths: evidence-based protocol used for the intervention, reliable data analysis tools used

Weaknesses: only one facility included, weak description of the study design

III Evidence-based protocols can reduce the incidence of pressure ulcers following a tracheostomy tube placement.
Mallah, Z., Nassar, N., & Badr, L. K. (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. A quantitative, descriptive, prospective study 468 patients in the intervention group, a sufficient sample size Independent variable: the adoption of a multi-model intervention program
Dependent variable: pressure ulcer incidence
Strengths: well-documented evidence from prior research, a comprehensive multidisciplinary intervention, data from 19 units was included

Weaknesses: a descriptive design, did not consider organizational risk factors, documentation of procedures was provided by nurses

VI Pressure ulcers are a significant problem affecting patient outcomes and their length of stay. A multi-model intervention is effective in reducing the incidence of hospital-acquired pressure ulcers.
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. A quantitative, prospective study design 9,755 patients, an excellent sample size Independent variable: the adoption of an intervention program
Dependent variable: the incidence of pressure ulcers
Strengths: a large sample size, accounted for organizational risks, such as the lack of specialized equipment and education, results supported by other studies

Weaknesses: only included the data from trauma units, compared with chronological data rather than a control group

III Applying a comprehensive program for hospital-acquired pressure ulcer prevention can help in reducing the incidence of pressure ulcers.
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. A randomized controlled trial 440 patients, 220 in each group, an adequate sample size Independent variable: the use of multi-layer soft silicone foam dressings
Dependent variable: the incidence of pressure ulcers
Strengths: a randomized controlled trial with a good quality of evidence, a sufficient sample size, uses an evidence-based intervention, provides a thorough review of prior literature

Weaknesses: data collectors were not blinded, the results cannot be applied to general patient populations, only to trauma and critically ill patients in emergency departments

II The use of multi-layer soft silicone foam dressings assisted in the prevention of hospital-acquired patient ulcers.

References

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., & Badr, L. K. (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.

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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.

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StudyCorgi. (2021, July 22). Prevention of Pressure Ulcers. Retrieved from https://studycorgi.com/prevention-of-pressure-ulcers/

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"Prevention of Pressure Ulcers." StudyCorgi, 22 July 2021, studycorgi.com/prevention-of-pressure-ulcers/.

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