The nursing practice problem is pressure ulcers or injuries. Pressure ulcers are a major concern in long-term care facilities such as hospice care. Pressure ulcers and healthcare-associated infections are considered the most harmful healthcare events in hospitals globally (Hommel et al., 2018). The rate of pressure ulcers in an organization indicates the quality and the safety of the settings. Pressure ulcers are defined as an injury to the skin that may extend to the joints and the bones. Pressure ulcers are caused by pressure shear, friction, or a combination of these factors. It generally occurs over the bony prominences, including the scapular regions and the trunk. Pressure ulcers in long-term care centers generally result when the patients remain in one position without moving for a long period (Metozinhos et al., 2017). This results when the nurses and other healthcare practitioners do not frequently turn and reposition the patients. The incidence of pressure injury is on the rise globally. It ranges from seven percent to seventy-one percent in the U.S., Europe, and Canada. In the United States, it affects around three million individuals in long-term care facilities. Pressure ulcers have devastating consequences on the healthcare setting, patient, and the country. It contributes to a significant economic burden on the country. It does this by increasing the length of hospitalizations. It leads to poor health and predisposes them to numerous infections in individuals. Pressure ulcers can be a source of entry of disease-causing microorganisms. Healthcare settings need to conduct a risk assessment and plan for interventions to reduce the prevalence of pressure ulcers in their institutions.
Pressure ulcer has different stages. A pressure injury is staged from stage I-IV. In stage I, the skin is intact, but the healthcare practitioner can notice a reddened area over the bony prominences (Mervis et al., 2019). In the second stage, partial loss of the second layer of the skin. A shallow open ulcer develops with a reddish or pinkish wound bed. The second stage is not characterized by sloughing of the skin. In the third stage, full-thickness loss of the second layer is noted by the healthcare provider. Subcutaneous fat in this stage is seen, but the bones, muscles, and tendons are not exposed. In the fourth stage, full-thickness skin loss is noted. Tendons, muscles, and bones are evident. Slough is noted on some areas of the wound bed. Undermining and tunneling may be evident.
The research question is derived in the form of a PICOT research framework model. The population in focus is hospice-bound patients. The intervention is repositioning these patients every 2 hours using an alternating air pressure mattress. The comparison intervention is repositioning every 2 hours without an alternating air pressure mattress. The outcome expected is decreased occurrence of stage 1 pressure injury. The time of investigation is 3 hours. Hence the research question is, “In-home hospice bound patients do repositioning the patient every two hours with an alternating air pressure mattress compared to repositioning every 2 hours without an alternating air pressure mattress decrease the occurrence of stage 1 pressure injury within three months.”
Four articles were reviewed for the study. Bai et al. (2020) conducted a prospective observational cohort study to establish the relationship between pressure injuries and pressure redistributing devices. The researchers recruited two hundred and fifty-four participants admitted to the intensive care units. The inclusion criteria include individuals with a higher risk for developing pressure injuries. The purpose of the study was to establish whether using pressure redistributing foam mattresses significantly reduced the incidence of pressure ulcers in the healthcare setting. The research question was “Does using pressure redistributing foam mattresses significantly reduce the incidence of pressure ulcers in the healthcare setting?”. The study is crucial to the nursing profession. It enables individuals to appreciate the role of pressure-relieving devices and repositioning play in reducing pressure ulcers in a healthcare setting.
Choi et al. (2021) conducted a quasi-experimental study to compare the prevalence and incidence of pressure injuries based on support surfaces and repositioning intervals. Two hundred and fifty-one critically ill individuals were recruited for the study. The purpose of the study was to compare the cost and the effectiveness of an alternating air pressure mattress and a static air mattress to prevent pressure injuries in healthcare facilities. The research question included, “What are the cost and effectiveness of an alternating air pressure mattress and a static air mattress to prevent pressure injuries in healthcare?” the research also provides crucial information to nurses regarding interventions that can be used to reduce pressure ulcers.
Stone (2020) conducted an observational study to analyze the effectiveness of an alternating pressure support surface in reducing pressure injuries in high-risk patients. Twenty-five participants were selected for the study. The purpose of the study was to establish the effects of alternating pressure overlay in patients admitted to healthcare settings. The research question is “What is the effect of pressure distributing devices in patients admitted to healthcare settings?” the research can help nurses understand the role of repositioning and the use of alternating air pressure devices in reducing pressure injuries in high-risk patients.
Finally, Sarraes& Beekman (2016) conducted a study to evaluate the impact of static air support surfaces in preventing pressure ulcers. The article focuses on using a pressure-relieving device in reducing pressure injuries. The purpose of the study is to investigate whether static air support devices reduce the prevalence of pressure ulcers. The research question is, “Do static air support devices prevent pressure injuries?” The article will help nurses understand the role of a static air support device in reducing pressure injuries in healthcare settings.
How The Articles Support The Practice Issue Chosen
four articles have been selected to support the practice problem. Bai et al. (2020) conducted a prospective observational cohort study to establish the relationship between pressure injuries and pressure redistributing devices. Bai et al. (2020) established that using pressure redistributing foam mattresses significantly reduced the incidence of pressure ulcers in the healthcare setting. Therefore, the article confirms the PICOT questions. Choi et al. (2018) investigated the effectiveness and the cost of using static air and pressure mattresses. The researcher will confirm if pressure reiving devices reduce pressure ulcers in healthcare, hence answering the PICOT framework question. Sarraes & Beekman & Beekman (2016) and stone (2020) also confirm that using pressure ulcers reduces the prevalences of pressure ulcers, thus confirming the PICOT question. All the selected articles either analyze the use of repositioning in conjunction with pressure reliving devices or repositioning alone in reducing the causes of pressure ulcers among high-risk individuals in healthcare settings.
Methods Of Study
Choi et al. (2021) conducted A Quasi-Experimental Pragmatic Study. The quasi-experimental study design is conducted by manipulating an independent variable without assigning the participants to orders of conditions or conditions. The independent variable, in this case, will be repositioning and the use of support surface devices. Stone (2020) and Bai et al. (2020 ) conducted an observational study to analyze the effect of using pressure-relieving devices on the incidence of pressure ulcers. The observational study allows the researcher to visualize the impact of the intervention on the study groups. The researcher does not need to implement any intervention. Finally, Sarraes & Beeckman conducted a cohort study. A cohort study is a longitudinal study design that exposes participants to intervention over time.
Limitations of the Studies
During the literature review, the research team noted that none of the articles established patient repositioning protocols. Some individuals reposition patients after every 2 hours, while others do it every four hours to reduce the risk of pressure ulcers. The other limitation is that few studies compared the correlation between repositioning using pressure redistributing devices and repositioning without the devices and the impact on the incidence and the prevalence of pressure ulcers.
Results of the Studies
Various results were made on the four selected articles. Bai et al. (2020) established that using pressure redistributing foam mattresses significantly reduced the incidence of pressure ulcers in the healthcare setting. Choi et al. (2021) found that pressure injuries are reduced when individuals utilize repositioning in conjunction with support surfaces. Stone (2017) found that using alternating pressure overlay significantly reduced the cases of pressure injuries in nursing homes. Serraes and Beeckman (2019) found that static support devices reduced the prevalence and the incidence of pressure ulcers in nursing homes in Belgium.
Implication To Nursing Practice
The four studies have implications for nursing practice. Healthcare settings such as hospice centers need to use alternating air pressure mattresses and other pressure-relieving devices to prevent the development of pressure ulcers. The pressure ulcers should be implemented in addition to repositioning. Finally, the healthcare setting should set protocols and guidelines that reduce the prevalence and the incidence of pressure ulcers in patients.
The researchers followed the ethical guidelines before conducting the studies. Firstly, approval was obtained from the relevant bodies that regulate research for human subjects. Secondly, participation in all of the studies was voluntary. The participants were required to sign an informed consent before participating. All the risks and benefits of the study were articulated to the study participants.
The anticipated outcomes include repositioning, and the use of pressure distributing devices will reduce the cases of pressure ulcer injuries. Additionally, the use of repositioning every two hours in addition to pressure distributing mattresses will significantly reduce the rate of pressure ulcers in healthcare settings. The outcomes of the four articles confirmed that using repositioning and pressure redistributing devices reduces the prevalence of pressure ulcers.
Proposed Evidence-Based Practice Change
There is a link between pressure ulcers, the PICOT question, and the selected research. The research articles selected focus on the practice problem. They attempt to show how various interventions can reduce the rate of pressure ulcers in the healthcare setting. The PICOT question attempts to propose an intervention and establish whether it will effectively manage the practice problem (Pressure ulcers). Nurses and other healthcare providers need to conduct pressure injury risk assessments for every patient. This will help them to plan for interventions to eliminate the risks. The study articles confirmed my hypothesis to be right. It confirmed that bed-bound patients repositioned every 2 hours with an alternating air pressure mattress had a decreased chance of developing pressure injury than those repositioned 2 hours without an alternating air pressure mattress.
Bai, D., Liu, T.-W., Chou, H.-L., & Hsu, Y.-L. (2020). Relationship between a pressure redistributing foam mattress and pressure injuries: An observational prospective cohort study. PLOS ONE, 15(11), e0241276. https://doi.org/10.1371/journal.pone.0241276
Choi J. S., Hyun, S. Y., & Chang S. J. (2021). Comparing Pressure Injury Incidence Based on Repositioning Intervals and Support Surfaces in Acute Care Settings: A Quasi-Experimental Pragmatic Study. Advances In Skin & Wound Care, 34(8), 1–6. https://doi.org/10.1097/01.ASW.0000755912.27170.9a
Hommel, A., & Santy-Tomlinson, J. (2018). Pressure injury prevention and wound management. Fragility Fracture Nursing, 85-94. https://library.oapen.org/bitstream/handle/20.500.12657/23127/1007029.pdf?sequence=1#page=99
Matozinhos, F. P., Velasquez-Melendez, G., Tiensoli, S. D., Moreira, A. D., & Gomes, F. S. L. (2017). Factors associated with the incidence of pressure ulcer during hospital stay. Revista da Escola de Enfermagem da USP, 51. https://doi.org/10.1590/S1980-220X2016015803223
Serraes B., & Beeckman D. (2019). Static Air Support Surfaces to Prevent Pressure Injuries: A Multicenter Cohort Study in Belgian Nursing Homes. J Wound Ostomy Continence Nurs. 2016 Jul-Aug; 43(4):375-8. https/doi.org/1097/WON.0000000000000244.
Stone, A. (2020). Preventing Pressure Injuries in Nursing Home Residents Using a Low-Profile Alternating Pressure Overlay: A Point-of-Care Trial. Advances in Skin & Wound Care, 33(10), 533-539. https://doi.org/1097/01.ASW.0000695756.80461.64
Mervis, J. S., & Phillips, T. J. (2019). Pressure ulcers: Pathophysiology, epidemiology, risk factors, and presentation. Journal of the American Academy of Dermatology, 81(4), 881-890. https://doi.org/10.1016/j.jaad.2018.12.069
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