NURSING RESEARCH

Running head: LITERATURE REVIEW AND CRITICAL APPRAISAL 1

LITERATURE REVIEW AND CRITICAL APPRAISAL 2

Literature Review and Critical Appraisal

United States University

563

February 21, 2021

Part 3

Title: The Prevalence of Pressure Ulcers in Elderly/ At-Risk Patients in Acute Care Hospitals and Skilled Nursing Facilities

Key words: Pressure ulcers; Prevention; Acute hospital; Risk assessment; Pressure relief; Education.

Literature Review

This literature review seeks to explore the prevalence of pressure ulcers as well as the preventative measures that an acute care setting should implement to control and prevent the development of pressure ulcers in elderly or at-risk patients. When a hospital implements appropriate preventive measures, the prevention of hospital-acquired pressure ulcers is possible. Also, as () asserts, the quality of nursing services provided in the healthcare facility is determined by the level with which pressure ulcers are controlled. The following section will review the five articles to show the vast amount of research conducted to curb the problem as well as recommend multi-dimensional practices in preventing elderly pressure ulcers.

The first article was a research conducted by Aydin et al. (2015), who examined various case studies’ aspects that caused bedsores to admitted patients. The research investigated the problems and factors contributing to the development of bedsores and nurse workload. Authors found that patients developing pressure ulcers could be triggered by a lack of expertise, education, and nurse workload. However, critics of this research stipulate that further research should be conducted to validate this claim.

Another study conducted by Brown (2016) investigated preventive measures such as dressings used in the facility to reduce and prevent bedsores development. The author explored the use of dressings in preventing pressure ulcers using different publications to ascertain their function. Brown used various peer-reviewed journals to determine the effectiveness of preventive dressings in selected case studies. However, it was revealed that pressure ulcers less likely develop when preventive dressings are used. When dressings are used with a controlled amount of humidity prevent shear and skin breakdown in hospitalized patients.

Another study by Heywood, Arrowsmith & Poppleston (2015) showed how healthcare givers use ulcer prevention programs called Rapid Spread to control and prevent older adults from developing bedsores. The program starts with an initiation stage, an immersion phase, and an action stage and sustainability. Some of the results recorded were reduced costs and pressure ulcers prevented and reduced in a twelve-week process. Some of the key goals the research aimed to accomplish were to collect data to measure the impact on pressure ulcer prevalence, embed a new nursing protocol, reduce cost, and increase patient experience. The implemented pressure ulcer prevention pathway led to reductions in pressure ulcer cost, prevalence, and incidence.

Also, Bredesen et al. (2015) examined the function of a multilevel approach implemented in an acute care setting in reducing the development of elderly pressure ulcers. The authors collected data in a local hospital located in Norway, where they used cross-sectional analysis to improve the safety and preventive practices in various hospital departments and educate healthcare providers on appropriate levels of care to use to reduce and enhance pressure ulcer prevention protocols alongside repositioning. The article is beneficial in relating patient safety and satisfaction with the available effective preventive pressure ulcer management practices.

Lastly, another study by Kim, Lee & Lee (2019) showed eight risk factors that predispose the elderly population to develop pressure ulcers. These factors include underlying diseases such as respiratory disease, anemia, hypertension; low preoperative Braded Score; a low ASA grade; female gender, a low BMI; and old age. Every healthcare provider should understand these pressure ulcer indicators in order to know how and when to use different preventative interventions before tissue injury starts. The article's findings revealed that implementing early preventative practices would lead to the early identification of risk factors. The authors also discussed different preventive interventions that should be implemented in hospitals, such as patient and caregiver education on skincare and nutrition, use of Visco-elastic polymer gel pad on the surgery table, prophylactic multi-layer dressing, and using alternative pressure mattresses.

Critical appraisal

Strength of the Evidence

The author used previous research to demonstrate the efficacy of repositioning, hourly rounds, and nursing education to prevent pressure ulcers. Because of the increase in hospital stays and the higher hospital bills, research shows that improving patient experience reduces pressure ulcer prevalence. “There is minor disagreement about the level of evidence required to make a recommendation regarding use of a structured risk assessment scale” (Brown, 2016).

Weaknesses of the Evidence

The author did not specify which kinds of Risk assessment tools are more practical to prevent the development of pressure ulcers. This is a broad topic, and researchers could conclude because of multiple studies being conducted with inconclusive results.

What do we know?

We know that the most optimal prevention strategy for elderly pressure ulcers is using a relieving device and repositioning schedule based on a patient’s risk status.

What are the gaps?

This study focused on exploring the prevalence of pressure ulcers in the elderly population, but the gap is which type of EBP preventative practice and education to be used by nurses in pressure ulcer prevention.

References

Aydin, C., Donaldson, N., Stotts, N. A., Fridman, M., & Brown, D. S. (2015). Modeling hospital-acquired pressure ulcer prevalence on medical-surgical units: nurse workload, expertise, and clinical processes of care. Health Services Research, 50(2), 351-373. doi:10.1111/1475-6773.12244

Brown, J. (2016). The role of dressings in the prevention of pressure ulcers. British Journal Of Nursing, 25(15), S6-S12.

Bredesen, I. M., Bjøro, K., Gunningberg, L., & Hofoss, D. (2015). Patient and organizational variables associated with pressure ulcer prevalence in hospital settings: a multilevel analysis. BMJ Open, 5(8), e007584.

Heywood, N., Arrowsmith, M., & Poppleston, A. (2015). Using Rapid Spread methodology to reduce the incidence of hospital-acquired pressure ulcers. Wounds UK, 11(2), 42-50.

Kim, J., Lee, J. Y., & Lee, E. (2019). Risk factors for newly acquired pressure ulcer and the impact of nurse staffing on pressure ulcer incidence. Journal of nursing management.