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Comparison of the use of Protein Supplementation in Persons with Chronic Wounds
Student name
Minnesota State University, Mankato
NURS 320W- 02 Critical Inquiry and Evidence-based Practice for RNs
Dr. Ellen Vorbeck, DNP, ANP-BC, APRN
date
Comparison of the use of Protein Supplementation Versus no Protein Supplementation in Persons with Chronic Wounds
Chronic wounds can be very troublesome for people who experience them. Wounds can affect their daily lives if they are not cared for correctly. An untreated wound can lead to other life-threatening conditions such as infection and sepsis if not taken care of properly. Nutritional supplementation is one way to aid in faster healing times for patients with chronic wounds. Protein supplements are beneficial and have been proven in assisting with healing. “Amino acid uptake accelerates to support wound healing, tissue rebuilding, and glycemic control” (Smith-Ryan, 2020, p. 920). Evidence-based practice is the basis on which health care professionals care for their patients. By conducting an integrated research review one can gain the knowledge of nutrition and its aid in healing is essential for caregivers and persons to understand to facilitate the best outcome possible for people with chronic wounds.
Background
The process for wound healing is very involved and can take a considerable amount of time. The time it takes is especially true for chronic wounds. By taking a holistic approach and gathering evidence-based practice, the nurse can assess each person while considering their individual needs. Proper nutrition can shorten the healing time of wounds in some cases.
Wound care by a trained professional can help shape a favorable outcome for persons with wounds. Ensuring the person is getting the proper nutrition is essential in healing and shortening wound healing times. After conducting a full research review, the writer has learned that many factors can contribute to or hinder various people's healing rates. According to the research review, the baseline nutrition status is an essential factor that could be the key to understanding why nutritional supplementation works for some people with wounds but not for all. It is understood that wounds "heal better, and more quickly if people are well-nourished. Food supplements containing certain vitamins and protein can be given to people" (Moore et al., 2020, p. 2). This nutritional approach can assist in healing chronic wounds at a faster rate.
Research Problem Statement
Some data suggest that a person's nutritional status before having the wound can affect healing. Identifying this gap in the data when it comes to baseline nutrition is a vital factor to consider when looking at whether or not nutrition plays a role in faster wound healing in patients with chronic wounds. "The baseline nutritional status of the participants is important to understand" (Moore et al., 2020, p. 34). There are many different factors to consider when considering a patient's nutritional status before the wound. The quality of life and income level could play a role in how well the supplements work to assist in the total healing of chronic wounds.
Research Purpose
The purpose of the paper is to determine whether or not nutrition supplementation in the form of protein is helpful in the healing time of patients with chronic wounds.
Research Question
In persons with chronic wounds, what are the effects of high dietary protein supplementation versus no protein supplementation on wound healing rates in the first twenty-eight days?
Research Utilization Model
The Johns Hopkins Nursing Evidence-Based Practice Model “guides bedside nurses in translating best evidence into practice for clinical, learning, and operational practice” (Melnyk & Fineout-Overholt, 2019, p. 412). This particular model bridges the gap between the standard for nursing practice and implementing the best and most updated evidence-based practice. The evidence-based question the nurse is researching regarding protein supplementation for improved wound care rates is guided by the best available evidence. By using this particular research model, the nurse can gather information and evaluate whether or not the method of adding additional protein to a person's diet is beneficial in the healing of chronic wounds.
The JHNEBP Model includes a process that consists of a practice question, evidence, and translation. This process provides a “systematic approach for nurses to develop and refine a practice question, see out the best evidence, and translate the best evidence into practice” (Melnyk & Fineout-Overholt, 2019, p. 413). The nurse chose this particular model as it was the best fit for the research question at the top of this explanation. “The JHNEBP model applies to clinical, learning, and operational questions in any setting where nursing is practiced” (Melnyk & Fineout-Overholt, 2019, p. 416). In coordination with the nurse's research, this particular model will create change that will benefit patients who have chronic wounds by implementing the findings of this research into practice.
Figure 1
The Johns Hopkins Evidence-Based Practice Model
Practice Question
In persons with chronic wounds, what are the effects of high dietary protein supplementation versus no protein supplementation on wound healing rates in the first 28 days of use?
Evidence
Evidence suggests that protein supplementation may improve the healing rates of chronic wounds. Healing rates have been noted to be faster in patients who use protein supplementation.
Translation
Plan to implement the use of protein supplementation in coordination with the physician, nutrition specialist, and the nursing staff to ensure that adequate protein is given to aid in healing of chronic wounds.
Search Criteria and Results
The research for this study was completed utilizing, CINAHL Plus and Chchrane including 133 articles from 2016 to the present. Table one notes the keywords used in these searches.
Table 1
Data Research Table
|
Keyword |
CINAHL |
PubMed |
Medline |
PsychInfo |
Cochrane |
other |
|
Nutrition AND healing Full Text 2016-2021 |
114 |
|
|
|
|
|
|
Wound care AND protein supplementation Full Text 2016-2021 |
6 |
|
|
|
|
|
|
Wound healing AND Systematic review AND Dietary Protein AND Quantitative Full Text 2016-2021 |
5 |
|
|
|
|
|
|
Wound healing AND Dietary Protein AND Qualitative Full Text 2016-2021
|
5 |
|
|
|
|
|
|
Wounds AND Healing AND Supplements Full Text 2016-2021 |
|
|
|
|
3 |
|
Five research articles were included in this research project: three systematic reviews, three randomized-controlled trials, three case studies, eighty article reviews, three experimental studies, two case study analyses, one non-experimental analysis, two meta-analysis and two follow up analyses. Figure 2 illustrates the strength of evidence of this research visually with the Strength-of evidence rating pyramid which was found in Melynk & Fineout-Overholt (2019,p. 116, Figure 4.2).
Figure 2
Evidence Summaries:
3 sources
Experimental Research Studies:
3 sources
Nonexperimental Studies:
1 source
Qualitative Studies, Expert Opinion, Theory, Basic Science:
6 sources
References
Cereda et al. (2017). Efficacy of a disease-specific nutritional support for
pressure ulcer healing: A systematic review and meta-analysis. Journal of
Nutrition, Health & Aging, 21(6), 655-661.
Kurmis, R et al. (2021). The importance of nutrition in wound management: new evidence
from the past decade. Wound Practice & Research, 29(1), 18-40.
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing
& healthcare: A guide to best practice (4th ed.). Wolters Kluwer.
Moore, Z., Corcoran, M., & Patton, D. (2020). Nutritional interventions for
treating foot ulcers in people with diabetes (Review). Cochrane Database of
Systematic Reviews, (7), 1-73.
Smith-Ryan, A. E. (2020). Nutritional Considerations and Strategies to
Facilitate Injury Recovery and Rehabilitation. Journal of Athletic Training
(Allen Press), 55(9), 918-930.
Appendix
Literature Review Table 1
|
Article, Source, year
|
Cereda, E et al. (2017). Efficacy of a disease-specific nutritional support for pressure ulcer healing: A systematic review and meta-analysis. Journal of Nutrition, Health & Aging, 21(6), 655-661.
|
|
|
Purpose
|
Researchers identified that high calorie, high protein nutritional formula showed a significant difference in healing at eight weeks.
|
|
|
Sample
|
N= 273 n= 138 disease specific n= 135 The study was conducted on persons in a long-term care setting with pressure ulcers.
|
|
|
Design and level of evidence (Melnyk 4.2) |
Several Randomized clinical trials provide a high level of evidence. The information presented was searched for in an electronic database over a period of 18 years focused on comparing disease-specific nutritional support. Randomized clinical trials provide accurate information (Melnyk & Fineout-Overholt, 2019, p. 117).
|
|
|
Variables, measurement
|
Studies comparing disease-specific nutritional support (oral supplements or tube feeding) to a control nutritional intervention from enabling the satisfaction of energy requirements regardless of the use of high-calorie formula or placebo or no supplement for at least 4 weeks were considered eligible.
|
|
|
Results, findings
|
P=0.030 Wound healing rates were higher in persons participating in the study for eight weeks. Study outcomes were the percentage of change in the pressure ulcer area, complete healing, and reduction of the pressure ulcer at 8 weeks, and the percentage of change at 4 weeks.
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Implications
|
The use of disease-specific formulas improved wound healing in persons with pressure ulcers. Future studies could focus on persons with varying types of wounds.
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Limitations of Research
|
Understanding that there are external factors at the bedside that can promote or hinder healing. It is the nurse’s duty to do what is best for the person they are caring for. Good nutrition and dietary supplementation is a big component that many overlook. Risk of bias, random sequence generation, blinding of participants and nursing staff.
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Comments
|
Wound care is such an important part of the nursing profession. Taking a look at the whole picture by including nutrition in the care plan can make a difference in healing time for the person and wound closure can occur at a faster rate. Conducting a research review is turning out to be very beneficial in the process of learning more information. |
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Literature Review Table 2
|
Article, Source, year
|
Kurmis, R et al. (2021). The importance of nutrition in wound management: new evidence from the past decade. Wound Practice & Research, 29(1), 18-40.
|
|
|
Purpose
|
The purpose of this review is to explain that malnourished people experience impaired wound healing. Malnourished people are twice as likely to experience delayed healing. There is evidence to support data that when nutritional supplements are used as an intervention there is a better outcome for people with wounds.
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Sample
|
The sample size for the review consisted of 80 full-text articles.
|
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Design and level of evidence (Melnyk 4.2) |
A research review was done using the online database PubMed. The data collected was studied for a period of ten years which included RTC’s. This included 61 primary studies and 6 systematic reviews. A 95% confidence level was shown in the data. This study is a meta-analysis which included RTCs. Randomized clinical trials provide accurate information (Melnyk & Fineout-Overholt, 2019, p. 117).
|
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Variables, measurement
|
The variables included in the article are the discussion of a variety of types of supplements and a variety of different types of wounds. Arginine specifically has been studied and showed low quality of evidence when used on its own. Omega 3 fatty acids have been shown to have a significant impact on pressure ulcer sizes in a 12-week study. The ulcer length (p=0.03) width (p=0.02) depth (p=0.01). These findings were significant in showing that the results were much better than the sunflower oil that was given to the placebo group.
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Results, findings
|
The RTC’s that were conducted by Najmi and colleagues included 100 patients with 10-20% second-degree burns. The people were provided an oral diet consisting of 20% protein, 60% carbohydrates, and 20% lipids until discharge. An interesting note in the study showed that the intervention group was given olive oil as their lipid. It was reported to reduce the duration of wound healing. (p=0.01). A significant improvement was noted in wound healing progress when amino acids were given via supplementation and nourished persons faired better than malnourished people.
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Implications
|
The nutritional status of the person prior to the wound was found to have a positive effect on healing if the person was not malnourished. It was found that people who are malnourished experienced less success even with supplementation of protein and other nutrition.
|
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Limitations of Research
|
The information regarding the person’s pre-nutrition status was not included in the research study. There study groups were too small and not in the same settings. Pre-assessment and post-assessment data was considered in the study.
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Comments
|
Good nutrition is a critical component in overall health and can aid in faster healing times especially when the patient already practiced good nutrition habits prior to the wound.
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Literature Review Table 3
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Article, Source, year
|
Moore, Z., Corcoran, M., & Patton, D. (2020). Nutritional interventions for treating foot ulcers in people with diabetes (Review). Cochrane Database of Systematic Reviews, (7), 1-73.
|
|
|
Purpose
|
Researchers identified that “nutritional interventions may improve wound healing of foot ulcers in people with diabetes” (Moore et al., 2020, p. 4).
|
|
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Sample
|
N= 629 participants in nine studies. 72% of participants were men of the average age of 59.2. Most of the studies took place in hospital outpatient clinics. (Moore et al., 2020, p. 6).
|
|
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Design and level of evidence (Melnyk 4.2) |
Overall the level of evidence is high. RTC’s were used. Searches were conducted by using The Cochrane wounds specialized register in addition to Ovid Medline, Ovid Embase, and EBSCO Cinahl Plus. Researchers also searched current clinical trial registries for ongoing and unpublished studies and scanned reference lists of relevant studies and reviews and meta-analysis. Randomized clinical trials provide accurate information (Melnyk & Fineout-Overholt, 2019, p. 117).
|
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Variables, measurement
|
The studies focused on persons with diabetic foot ulcers. This type of wound is complicated to treat and heal. Three studies explored a nutritional support drink that contained protein compared with a similar glass but with no nutritional value. (Moore et al., 2020, p. 6).
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Results, findings
|
Analysis showed that findings revealed a 95% confidence interval about people with diabetic foot ulcers who use nutritional supplements. People using nutritional supplementation experienced a more significant portion of ulcers healed than those who did not use supplements.
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Implications
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Of the nine studies, the compared difference between the outcome of patients using oral supplements versus the placebo is not clear.
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Comments
|
The baseline nutritional status is a crucial component in the outcome of this study. Each patient's level of nutrition status can have a wide range due to many factors such as income and the ability to purchase and consume nutritious foods before the ulcer occurs. If the patient had optimal nutritional status before the wound, the outcome might have been very different. (Moore et al., 2020, p. 34).
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