Recommending an Evidence-Based Practice Change

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Barakat-Johnson M., Lai M., Wand T. & White K. (2019). A qualitative study of the thoughts and experiences of hospital nurses providing pressure injury prevention and management. Collegian, 26(1), 95-102. https://doi-org.ezp.waldenulibrary.org

/10.1016/j.colegn.2018.04.005

Park S. H., Lee Y. S. and Kwon, Y. M. (2016). Predictive validity of pressure ulcer risk assessment tools for the elderly: A meta-analysis. Western Journal of Nursing Research, 38(4), 459-483.

Boyko T., Longaker M. T., and Yang G. (February 1, 2018). Review of the current management of Pressure Ulcers. Journal of Advances in Wound Care, vol. 7, issue No. 2. Pages 57-67.

Ferris, A., Price, A., & Harding K. (2019). Pressure ulcers in patients receiving palliative care: A systematic review. Palliative Medicine, 33(7), 770-782. https://doi-org.ezp.waldenulibrary.org

/10.1177/0269216319846023

Evidence Level *

(I, II, or III)

Level 3 evidence. The study is a qualitative study without a meta-analysis, and the majority of qualitative studies fall under the category of level 3 evidence.

Level 2 evidence. The information comes from the meta-analysis of all the relevant and randomized, as well as the controlled trials.

Level 1 evidence. The article offers evidence from the systematic review of the randomized as well as the controlled trials from the experiments.

Level 1 evidence. The information is evidence from the systematic reviews of trials that have been relevant and controlled while the researchers were trying to carry out the research.

Conceptual Framework

Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**

The theoretical basis that led to the research was an increased number of injuries resulting from pressure ulcers. This led to the need to have a study to find ways that were effective in preventing such occurrences.

The theoretical framework that led to this study was that pressure ulcers had become a significant obstacle and a challenging goal when it comes to providing healthcare for patients with pressure ulcers. Therefore, it led to the need to have a study that could deal with the challenge.

The theoretical framework that necessitated this research was the incidence of pressure ulcers that were increasing because of the aging population as well as the population living with incidences of disability.

Pressure ulcers were highly associated with significant mortality and morbidity, as well as high costs of healthcare services. This led to the need for a study to review the situation.

Design/Method

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

An exploratory study design was applied in the study and entailed using semi-structured interviews. Sampling was also done and used for obtaining the participants and information from the relevant individuals of the study.

A qualitative study was used in analyzing the situation. A systematic review was also carried out and involved a meta-analysis of 29 studies that used three pressure assessment tools like Waterflow scales, Braden, and Norton tools.

A qualitative study was undertaken, and this revealed essential information concerning the issue of pressure ulcers and the causation as well as the preventative measures that would be undertaken.

A systematic review was carried out and meant to quantify the incidence and prevalence of pressure ulcers in individuals that were receiving palliative care.

Sample/Setting

The number and characteristics of

patients, attrition rate, etc.

Voluntary participation was involved, and patients that had suffered from pressure ulcers were mainly used which provided essential information regarding the situation being examined. The inclusion criterion mainly comprised the consideration of age where the elderly people were mainly used in the study. Nurses with relevant experiences were also involved in the study. The exclusion criterion mainly focused on individual experiences where those that had no past experiences of pressure ulcers were highly disregarded.

Elderly individuals were mainly used in this study. The inclusion criterion involved the use of patients that were suffering from pressure ulcers and those that had recovered from the occasion. The exclusion criterion mainly comprised the aspect of age and personal knowledge regarding pressure ulcers. In this case, the young and less-knowledgeable were avoided since they had never been involved in such a situation.

The elderly individuals, especially those that were suffering from pressure ulcers or those that had faced a similar ordeal were involved in the study. The inclusion criterion was using older adults that had experience of pressure ulcers and those people that provided care to those suffering from pressure ulcers. The exclusion criterion involved avoiding people that had not been affected by the situation or had little information regarding pressure ulcers.

Elderly individuals that were receiving palliative care and those that were exposed to the risks of pressure ulcer development were included in the study to investigate the aspect of pressure ulcers. The young individuals were excluded while the elderly and vulnerable were highly involved, and, in this case, it may be regarded that age and prior knowledge on pressure ulcers were the key aspects considered in the exclusion criterion.

Major Variables Studied

List and define dependent and independent variables

The important variables that were used in this case included age and gender as well as different levels of education and occupations or job positions. The notable inclusion that was used was individuals who had experienced the situation, and the notable exclusion that was utilized was the underaged and those that never faced the situation.

The notable variables involved in this case included the age and gender where the underaged were avoided, and the aspect of gender involved the use of both the male and female individuals although they were in different age brackets.

Significant variables involved in the study were age brackets and the length of time the individuals have had the pressure ulcers.

Age, gender, and education levels were involved, whereby people of different ages, genders, and levels of education were involved.

Measurement

Identify primary statistics used to answer clinical questions (You need to list the actual tests done).

The level of knowledge and experiences of nurses that had been involved in providing wound care for patients was the significant aspect that was being measured in this study. The actual testing that was carried out involved testing the experiences of the nurses regarding the application of knowledge from the nurses and then relating the information to the issue of pressure ulcers and palliative dressings.

Risk assessment tools involved in this case included those that were meant for evaluating the accuracy of predictability, especially in the elderly adults. The actual test that was undertaken in this study was the accuracy of predictability of the recovery of pressure ulcers through palliative dressing which prevented the ulcers and facilitated the healing of the patient.

Primary statistics involved in answering the study question entailed identification of people that had experienced pressure ulcer as well as the causes and the preventative measures that aided in their healing. The test undertaken in this case was the identification of the preventive measures that would reduce pressure ulcers and aid in the recovery of the wounds. There was also the testing of the four stages or levels of pressure ulcers and distinct features of each level.

Various data sources were identified, and information from these sources was analyzed to obtain the essential information and data that were required for the study. The actual test carried out, in this case, was testing overall pressure injury prevalence and incidences in patients.These were found to be 12.4% and 11.7%, respectively.

Data Analysis Statistical or

Qualitative findings

(You need to enter the actual numbers determined by the statistical tests or qualitative data).

The statistical and the qualitative findings that were found in this situation entailed education initiatives being necessary for dealing with pressure ulcers. It was also found that activities like mobility and hospital settings were important for facilitating the survival of the patients.

A qualitative and quantitative analysis of data were utilized in this case.

A qualitative style of data analysis was employed, and it found that pressure ulcers are highly associated with the inability of individuals, especially the elderly, to move and could be dealt with by embracing preventive dressing strategies.

Data was analyzed using a quantitative study design, which was necessary for the analysis.

Findings and Recommendations

General findings and recommendations of the research

Four themes were identified, and they covered the experiences of the nurses providing pressure ulcer prevention. They included managing competing demands in complex hospital settings, the importance of knowledge and skill, clarification of organizational expectations and feeling of ethical challenge in case of inability to provide quality care to a patient.

Pressure ulcers mainly develop from a combination of external conditions and physiologic events. It was also found that the causative factors of the situation involved the presence of sores on the body of an individual.

Pressure ulcers are associated with individuals that are not receiving essential health care and those that are exposed to the predisposing factors of such ulcers.

Appraisal and Study Quality

Describe the general worth of this research to practice.

What are the strengths and limitations of the study?

What are the risks associated with implementation of the suggested practices or processes detailed in the research?

What is the feasibility of use in your practice?

The general worth of this research to the practice is that it provided an awareness of the importance of preventing and managing pressure injuries.

The notable strength was that an in-depth understanding was gained regarding the understanding of the nurses’ experiences about the prevention and management of pressure ulcers in hospital settings. The limitation was that competing priorities and challenges were found during the study at the organization and patient level and therefore hindered the prevention of pressure ulcers.

The risk associated with implementing the suggested practices or processes detailed in the study is that managing pressure ulcers is only one aspect of patient care. Therefore, by focusing on this aspect alone, the patient may be exposed to other complexities that may hinder recovery.

The state or degree of being conveniently used in practice is high in that the findings may be applied in dealing with real cases of pressure ulcers.

The general worth is that the study eradicated the numerous challenges that exist in the current world of pressure ulcer prevention as it is among the most challenging goals.

The strength was that predictive validities of risks of pressure ulcers in pooled specificity and sensitivity indicated similar range with a moderate level of accuracy in all the scales used. The limitation was that there was an increased heterogeneity in the studies carried out, showing a great percentage of variability among the studies carried out.

The notable risk associated with the implementation of suggested practices is that the study revealed a significant level of heterogeneity that may lead to variance in the outcomes of the patients and the results need to be almost uniform if not fully uniform.

The degree of the study being utilized conveniently into practice is medium due to the issue of heterogeneity that was realized from the studies conducted.

The research aided in the development of new dressing and treatment modalities that are highly applicable in the treatment of patients experiencing incidences of pressure ulcers.

The strength of this study is that it aided in realization that management of pressure ulcers is important for all the health care providers in wound care sections. The limitation is that none of the therapies developed demonstrated clear benefit of the other and this makes researching in this field to remain a time-consuming exercise.

The implementation of the suggested practices is associated with the risk of the need for applying several therapies in addressing the issue so that the most effective therapy may be identified.

The feasibility of the utilization of the study in practice is high since the study has certain clinical relevancy especially for the professionals offering wound care and management.

The incidence and prevalence of pressure ulcers were quantified in patients receiving palliative care as well as identification of risk factors for development of pressure ulcers.

The strength of the research was that risk factors for pressure ulcers development were identified, numerous ways of dealing with such ulcers were also identification as well as bringing about the relationship between pressure ulcers and death. The limitation is that the study was carried out according to PRISMA pro forma and this left behind the other essential aspect of doing a research. The effect is that it leaves the study open to criticisms.

Key findings

The major findings were that preventive dressing was important for preventing pressure ulcers. The other findings were that issues like education and enlightenment of the patients were important for helping the patients recover from the injury.

Commonly utilized tools for screening pressure ulcers were found to have limitations concerning their accuracy and validity, especially when used with the older adults because of the heterogeneity that was involved in the various studies.

Pressure ulcers are associated with certain factors. Despite the existence of the situation, pressure ulcers are highly preventable.

Pressure ulcers are preventable, especially by using preventive dressing strategies when caring for patients.

Outcomes

Patients that followed the preventive dressing procedures recovered from the pressure ulcers.

Despite the heterogeneity of the study, the relevant information obtained was that pressure ulcers are likely to affect the elderly, and there was a high need for preventing such an incidence.

Patients that followed the instructions involved in pressure ulcers managed to recover from the injury. The implication is that the situation can be managed.

Patients that are given primary care and preventive measures recover while those not involved in primary care strategies are likely to suffer the most.

General Notes/Comments

The article is highly relevant as it deals with the issue of pressure ulcers appropriately.

The study was effective as risk assessment tools were highly applicable, especially when it came to assessing the risks of pressure ulcers that the patients were facing.

The article is highly relevant as it allows for further study to identify the mitigating factors that could be undertaken to prevent pressure ulcers.

The article is relevant and reliable as it offers an interlink between poor medication and the issue of pressure ulcers, especially in elderly individuals.