Critical Analysis: Strategies to Improve the Prevention of Pressure Ulcers

Critical Analysis: Strategies to Improve the Prevention of Pressure Ulcers


Hospital acquired pressure ulcers are a big challenge to healthcare delivery in the world. In the United States alone research shows that an estimated 5 to 10 patients develop facility acquired pressure ulcers (Cooper, 2013). This results into devastating effects for patients healthcare facilities as well to the overall health economy. These effects include; increased patient suffering, high morbidity and mortality and as well as the depletion of the NHS budget by approximately 4 percent every year (Moore & Cowman, 2008). Consequently, numerous researchers have been carrying out research seeking to establish strategies of improving prevention of pressure ulcers in hospitals. This study analyses Judy Elliott’s (2010) article on strategies of improving prevention pressure ulcers prevention in relation to protection of human participants. It will also analyze the aspects of data collection, data management and analysis invoked in the study as well as the interpretation of the findings.

Patient protection

According to Bennett, Dealey & Posnett (2014), healthy human beings are always moving around meaning that they get to readjust their body posture and prevent excess pressure and shear forces. However due to the fact that high risk patients are usually bedridden in healthcare facilities, their reduced mobility renders them vulnerable to tissue damage. In Elliot’s article, the author identifies several benefits to patients who participated in this study including improved patient access to examination equipment, especially when it comes to new devices being used in detecting the possibility of pressure ulcers development in a patient. The author also identified early intervention as a benefit for participating in a clinical study as a patient (Elliott, 2010). However, the author also argues that there are also risks be associated with these devices since their benefits remain uncertain more so in terms of cost and clinical effectiveness. As a matter of fact, the author is of the perception that they should be considered in together with other support surfaces as inconsistent or delayed use could negate their potential benefits. However, the author of this article failed to mention other benefits of participating in a clinical research such as gaining access to new treatments methods that may not yet be available to the public, obtaining expert medical care in leading facilities, help others with one’s contribution to medical research and also playing an active role in one’s health care. There are also other risks involved such unforeseen life-threatening side effects from unperfected treatments, the treatment may fail to work, the study might be exhausting and time consuming, and the insurance may not cover the whole cost of study (Cooper, 2013).

The author of this article primarily uses an exploratory study on hospital acquired pressure ulcers undertaken in a project hospital trust in 2007/08 as indicated in the ‘Background’ section.  In this research, a case study methodology was applied in conjunction with a range of perspectives in which quantitative and qualitative data was used. Although the author argues that “These processes were influenced by the level of communication and collaborative care” (Elliott, 2010), she does not indicate whether there was any informed consent that was obtained from the participants. This article also fails to establish whether the state of the patients used in all the mentioned studies. This is more so on whether they participated voluntarily or not, which a very significant aspect of clinical research. This study also fails to indicate whether the aforementioned exploratory study carried out had the institutional board approval from the agency in which the study was conducted.

Data collection

The author of this article applied major variables in identification of strategies of improving prevention of hospital acquired pressure ulcers. These variables used in the aforementioned exploratory study included improving early risk assessment by observation and other assessment tools, intervention and as well as focus on heel ulcers. Qualitative and quantitative data was also used to consider a wide range of perspectives into pressure ulcers prevention. From the study, there was a steady reduction in all pressure ulcers in all high risk patients (Elliott, 2010). The author of the article says data was also obtained from focus groups interviews from multidisciplinary clinicians. The interviewed clinicians highlighted challenges experienced in efforts of delivering timely as well as optimal preventive care. Additionally, the annual prevalence audit methodology into pressure ulcers prevention in the U.K. was revised with the hopes of improving data collection reliability. This process was carried out in February 2009 and repeated exactly one year later in February 2010 (Moore & Cowman, 2008). Data on tissue viability was recorded by nurses at the bedside indicating skin inspections and he preventive measures implemented. Data was then analyzed by the clinical audit team of the trust.

Data management and Analysis

In the article, a six-hour risk assessment plan when a trust-wide pressure ulcer campaign was launched in September 2009 in the UK (Bennett, Dealey & Posnett, 2004). This campaign mainly focused on support surface, heel offloading and position and repositioning as the three main intervention strategies. The results obtained from the data collected were analyzed in terms of pressure ulcers prevalence and also in terms of patient prevalence. According to Elliott’s article, audit results collected in February 2010 showed significant reduction in pressure ulcers by up to 6 per cent, and also showed “…a reduction in total pressure ulcer prevalence by 4.7 percent” (Elliott, 2010). The audit results also suggested that there was reduced prevalence of patients with hospital acquired pressure ulcers by about 2.1 percent. The information collected from the assessments enabled a comparisons with audits carried out in the previous years. However, even though Elliot’s article was able to capture all this information in several convincing data tables, there was no evidence that a rigor process was assured. Since the article mainly focuses on an exploratory study, the author does not say whether a paper trail of critical decisions were made during the analysis of data or whether that was statistical software used to ensure accuracy of the analysis.  Elliot’s exploratory study compares data from other researcher’s studies; hence, one cannot convincingly argue that there was no research bias involved. However, all the studies investigated suggested that the implemented research strategies improved prevention of pressure ulcers.


Elliot’s exploratory study was aimed at establishing whether improving early risk assessment, focusing on heel ulcers and early intervention can improve prevention of pressure ulcers in high risk patients. This article suggested that indeed these strategies helped in preventing pressure ulcers. According to Elliot (2010), “Audit results from February 2010 showed a reduction in hospital-acquired pressure ulcers prevalence by 6% and a reduction in total pressure ulcer prevalence by 4.7%. Prevalence of patients with pressure ulcers had reduced from the previous audit by 2.1 percent to 13.4 percent.” Since these results were from more than half of the total inpatient population of patients from 44 hospitals in the U.K. in 2010, I have no reason to doubt these findings. I also believe that these findings were a valid reflection of reality since they have been used in different hospitals all over the world for the last few years.

Although there was a coherent and logic presentation of the findings as indicated in the tables found in this article, there were some limitations experienced in the study. For starters, researchers of these findings also argued that since the trust operated a linked nursing system, especially when it came to tissue viability education, it could limit dissemination to the entire nursing staff (Moore & Cowman, 2008). Additionally, these researchers argued that there was lack of documentary evidence in terms of risk assessment on care planning and admission in the 44 UK hospitals where the trust’s study was carried out. As a result, they called for improvement in allocating appropriate resources for early risk assessments as well as immediate intervention practices. They also argued that these two aspects could be hampered by focusing too much on emergency care at the admitting areas. As earlier mentioned, the findings of this research have had several implications for they have been applied in general nursing practice for the last few years now. Additionally, the authors of the initial trust study were of the perception that improvements in the above mentioned limitations would lead to better strategies of preventing pressure ulcers. They also suggested more research in the technological advances that were used at the time as measures of preventing pressure ulcers in patients.


The fact that hospital acquired pressure ulcers undermine the efforts carried out by healthcare providers can be regarded as one of the greatest challenge in quality healthcare delivery in the world. This is because not only do they lead to increased mortality and morbidity rates in patients, but also because there are also other economic reimbursements involved (Cooper, 2013). As a result, researchers have to continue seeking means and inventing strategies aimed at improving prevention of pressure ulcers in high risk patients. Elliott’s article may lack some elements of a convincing research such as proper statistical analysis, but it delivers on means of preventing pressure ulcers in high-risk patients.  Furthermore, that was its purpose after all; improving skin tissue viability from admissions up to patient discharge through early risk assessment and intervention strategies. This article has taught me important strategies used in preventing pressure ulcers in high-risk patients. It has also helped me understand the benefits of early risk assessments and intervention initiatives as well as focusing on heel ulcers. It has also motivated me to seek more knowledge on further initiatives aimed at eliminating avoidable hospital acquired ulcers in healthcare.


Bennett, G., Dealey, C., & Posnett, J. (2004). The cost of pressure ulcers in the UK. Age and ageing, 33(3), 230-235.

Cooper, K. L. (2013). Evidence-based prevention of pressure ulcers in the intensive care unit. Critical care nurse, 33(6), 57-66.

Elliott, J. (2010). Strategies to improve the prevention of pressure ulcers. Nursing Older People, 22(9), 31-36 6p.

Moore, Z. E., & Cowman, S. (2008). Risk assessment tools for the prevention of pressure ulcers. The Cochrane Library.