Research Critiques and PICOT Statement Final Draft

Quantitative Research Critique and Ethical Considerations

Qiu Sun

Grand Canyon University

Nursing research

Prof. Thatcher

March 20th, 2022

Introduction And Background of Study

The purpose of this essay is to conduct a comprehensive critical appraisal of two research papers titled 'Preventing Pressure Ulcers' and 'Protecting Fragile Skin: Nursing Interventions to Decrease Pressure Ulcer Development in Pediatric Intensive Care', respectively, published by Reddy et al. (2006) and Schindler et al. (2010). The purpose of assessment is to focus critically on the study's strengths and weaknesses. To begin, a concise description of critical appraisal and its significance will be discussed. Following that, the contents of peer-reviewed papers will be critically analyzed, discussed, and evaluated in order to verify the study's validity and reliability. As a result, a judgment will be formed on their applicability to general pressure ulcer prevention strategies among pressure ulcer patients.

Critical assessment aides in the process of weeding out irrelevant data and identifying research that is pertinent to the intervention's subject. However, the evaluation of an article is conducted using a post instrument that promotes a more thorough and systematic approach; it is customized for each study design and asks specific questions about the study's validity, such as whether the study addressed the research question and met its stated aims and objectives, the methodology, analysis, and interpretation of findings. Effective critical appraisal is necessary for evidence.

The study's history is informed by the need to comprehend pressure ulcer, which is a confined lesion to the skin and inner tissue, generally over a bony prominence, caused by pressure alone or pressure combined with shear. pressure ulcers are the third most expensive type of disease, after cancer and cardiovascular disease (Schindler et al., 2011). Pressure ulcers are more prevalent in the tissues of the extremities and bony extensions such as the sacrum and heel of inpatients. Low physical activity, diminished awareness, urine and fecal incontinence, malnutrition, and old age are the most common causes of pressure ulcers-based practice.

Supposed PICOT question

PICOT is testing the effectiveness of preventing pressure ulcers in hospital or long-term care settings and comparing the results, including a faster healing time, to patients who didn't receive any preventive interventions. A variety of interventions are applied to pressure ulcer patients and compared to those left without any preventive intervention. Support surfaces, mattress overlays on operating tables, and specialty foam and sheepskin overlays were all effective solutions mentioned in the first article. the second article mentioned about strategies associated with less frequent development of pressure ulcers included use of specialty beds, egg crates, foam overlays, gel pads, dry-weave diapers, urinary catheters, disposable under-pads, body lotion, nutrition consultations, change in body position.

Method of Study

The article by Reddy et al. (2006) is pertinent to general pressure ulcer prevention strategies in patients who have pressure ulcers since it examines in detail the systematic evidence investigating preventative measures to prevent pressure ulcers. It employed randomized control trials with varying. Using randomized control trials enhances the reliability of the research process and findings. For instance, one treatment is can be compared with another to determine which is more appropriate and relevant. The researcher can also make causal inferences because this approach gives strong empirical evidence of the study. Support surfaces, mattress overlays on operating tables, and specialty foam and sheepskin overlays were all effective solutions for addressing limited mobility. While repositioning is an essential component of the majority of pressure ulcer prevention procedures, there was inadequate data to propose special turning regimens for patients with reduced mobility. Supplements were effective in people with nutritional deficiencies. It is unknown if certain topical treatments provide an additional advantage above basic moisturizers in people with compromised skin health. Three types of therapies were evaluated in the studies: those that addressed mobility, nutrition, and skin health deficits.

The second article by Schindler et al. (2010) used Randomized clinical trial multivariate logistic regression models in its research. This was a great choice of a model because it perfectly fits studies where the objective is to test for cause-effect relationships between two sets of data obtained from randomized trials or experiments. However, if there are lurking variables, the developed model might incorrectly represent the relationship and potentially lead to incorrect conclusions on the data collected from the study. The influence of age, duration of stay, and various treatment strategies on the development of pressure ulcers were determined using multiple logistic regression analyses. Prior to developing the strongest model, a series of multivariate models were created in order to determine the influence of risk variables on the development of pressure ulcers. To evaluate which preventative measures had the greatest influence on the development of pressure ulcers, each preventive measure was included into each of the multivariate logistic regression models independently.

Results of study

The paper Reddy et al. (2006) evaluated three types of treatments, namely those that addressed mobility, nutrition, and skin health deficits, while the second examined how good nursing care combined with tailored interventions can help minimize the occurrence of pressure ulcers. Reddy et al. (2006) examined various approaches, including repositioning on a special mattress, incontinence care, skin care, and nutritional supplementation, all of which are beneficial in reducing or preventing pressure ulcers. In contrast, Schindler et al. (2010) focused on determining the incidence of pressure ulcers in critically ill and injured infants and children, comparing the characteristics of patients with and without pressure ulcers, and identifying prevention strategies associated with fewer pressure ulcers.

Outcome and Recommendations

In the first article by Reddy et al. (2006) RCTs assessing therapies to prevent pressure ulcers is unsatisfactory, they give some useful information on which to make recommendations for effective ways to avoid this frequent ailment. The most promising therapies are those that include the use of suitable support surfaces like bedding overlays on operating tables, specialty foam overlays, and specialized sheepskin overlays plus dietary optimization, and sacral skin moisturization. Although repositioning is a cornerstone of ulcer prevention, it is unknown if certain techniques are superior to others. Additional well-designed RCTs that adhere to standard reporting standards for nonpharmacological treatments are required. Given the variety of the study populations in the RCTs article analyzed, further research is necessary to validate the generalization of these therapies' efficacy across patient groups and contexts. Prospective data collection on cost-effectiveness in such RCTs would be extremely beneficial.

Article authored by Schindler et al. (2010), pressure ulcers continue to be a significant clinical concern in critically sick babies and toddlers. Effective nursing care combined with focused treatments can help these patients avoid developing pressure ulcers. It also recommends a prospective randomized clinical study to be prepared to confirm that certain nursing treatments are related to improved outcomes. Children receiving standardized nursing care can be compared to children getting standardized nursing care plus placed on an appropriate support surface to assess if expensive support surfaces have a meaningful effect in preventing pressure ulcers. The recommended study would provide critical care nurses with a set of well-established strategies to significantly minimize the risk of pressure ulcers in critically sick babies and toddlers.

References

Donnelly, J., Winder, J., Kernohan, W. G., & Stevenson, M. (2011). An RCT to determine the effect of a heel elevation device in pressure ulcer prevention post-hip fracture. Journal of wound care, 20(7), 309–318. https://doi.org/10.12968/jowc.2011.20.7.309

Reddy, M., Gill, S. S., & Rochon, P. A. (2006). Preventing Pressure Ulcers: A Systematic Review. JAMA, 296(8), 974.doi:10.1001/jama.296.8.974

Schindler, C. A., Mikhailov, T. A., Kuhn, E. M., Christopher, J., Conway, P., Ridling, D., … Simpson, V. S. (2010). Protecting Fragile Skin: Nursing Interventions to Decrease Development of Pressure Ulcers in Pediatric Intensive Care. American Journal of Critical Care, 20(1), 26–35.doi:10.4037/ajcc2011754