Signature Assignment - Evidence-Based Project Proposal

December 13, 2020

Your faculty name

Improvement in the healing process of pressure ulcer among elderly patients

Introduction

Improvement in the healing process of pressure ulcers among elderly patients

The successful implementation of the negative pressure wound therapy is helpful in the improvement of the healing process of the pressure ulcers of the elderly patient during hospitalization. Negative wound pressure therapy is a widely used technology on wounds by carefully exerting controlled pressure to a dressing covering pressure ulcers. It carefully sucks any wound and tissue fluids away from the treated area into a canister

PICOT Question:

The key terms used and the search engines

The search for the articles used for this discussion was guided by key terms such as pressure ulcer, medical device-related, pressure injury, the wound dressings, cost, flap, negative pressure, reconstruction, and pressure healing. The search engines used were Pubmed, CINHAL, Cochrane, ProQuest Nursing, and ScienceDirect. The selection criteria employed was that the selected articles were to be within the last five years of publication.

Critical Analysis of the Five Research Articles

Papp, A. A. (2019). Incisional negative pressure therapy reduces complications and costs in pressure ulcer reconstruction. International Wound Journal, 16(2), 394-400. https:// 10.1111/iwj.13045

This is a prospective non-randomized trial with a historic control that is aimed at reducing the postoperative wound healing complications using the incisional negative pressure wound therapy as an intervention (iNPWT). The study included surgically treated pressure ulcer patients who were receiving iNPWT as the treatment group and a historic patient cohort of all the consecutive surgically treated pressure ulcer patients during the two years before the initiation of the iNPWT as the control group. There were a total of 24 patients in the control group and 37 patients in the treatment groups. Data were analyzed using the percentage of the in-hospital complications in the treatment group, length of stay, and the presence of open wounds.

The data are presented in percentages for example the study reveal about 74 percent reduction in the in-hospital complications among the participants in the treatment groups. The study belongs to the level of evidence III since it is a non-randomized with participants assigned to the control and the treatment group. The outcome of the study revealed that incision negative pressure wound therapy was helpful in shortening the hospital stay, reduced the postoperative complications, and the number of recurrent open wounds at three months following the reconstructive negative pressure ulcer surgery.

The strength of this study is based on the fact that it was an experimental study that provides the first hand information. This helps in confirming the validity of the data and making them more reliable. The data are also presented in figures and percentages, therefore, this can be used to give a presentation of the effects of the study intervention (incisional negative therapy) on the complications and the healthcare costs in the pressure ulcer reconstruction. The weakness of the study is however based on the failure of the authors to indicate the age of the participants and other ailing conditions of the participants since this might also interfere with the overall outcomes of the effects of the intervention.

The study is valuable to improve the health needs especially for the patients who are experiencing the recurrent wounds and having the previous history of the surgical process. The adoption of the incisional negative pressure wound therapy is helping in dealing the potential complications that might be presented by these patients. The study is important for the proposed project since it reveals the importance of incisional negative pressure wound therapy in dealing with the issue of pressure ulcers (Papp, 2019).

Bauer, K., Rock, K., Nazzal, M., Jones, O., & Qu, W. (2016). Pressure ulcers in the United States' inpatient population from 2008 to 2012: Results of a retrospective nationwide study. Ostomy/Wound Management, 62(11), 30-38.

This is a retrospective study aimed at identifying the features of the patients that associates them with one or more pressure ulcers and this, therefore, makes the study belong to the level of evidence VI. The purpose of this study is to assess the short-term effects associated with pressure ulcers within the inpatient population in the United States. The International Classification of Disease, Clinical Modification (ICD-9 CM) diagnosis codes were as instruments in this study for the screening purposes. The data presented in the article were collected through analysis of the US Nationwide Inpatient Sample (NIS) database. The analysis was performed using the screening tools of International Classification of the Disease and the Clinical Modification diagnosis codes. The data used were on the inpatient pressure ulcers that were recorded from 2008 to 2012. The targeted data from the articles generated were focused on the patient demographics, primary outcomes of the length of stay, total hospital discharge, the in-hospital deaths, and the discharge dispositions and they were identified using ICD-9 code.

The analysis of the data was performed using a t-test or the ANOVA test. The continuous non-normal distributed variables like the length of stay (LOS) and the total hospital discharge (TC) were presented using the median. The chi-square test was used to compare categorical data in various groups.

The outcome of the study reveal about the significant differences between the patients with and without the pressure ulcers for the median LOS. There was higher mortality rate in patients with pressure ulcers as compared to patients without pressure ulcers i.e. 9.1 percent vs., 1.8 percent.

The study can be used to improve the health need of the population especially individuals with pressure ulcer disease. The outcome of the study showed that the prevention initiatives were important in reducing the negative effects associated with pressure ulcers on the patient outcomes as well as the cost of healthcare. Therefore, healthcare facilities and providers can be encouraged to support and adopt the negative pressure ulcers management strategy as an intervention in reducing the symptoms associated with the pressure ulcer conditions of the patients.

This article is important to the project since it reveals some of the problems encountered by elderly individuals for example increase in healthcare costs and a longer hospital stay. It is also important to the healthcare facilities since it reveals the importance of adopting negative pressure ulcer control as one of the prevention strategies to this problem.

Lima RVK, Coltro PS, Farina JR JA (2017). Negative pressure therapy for the treatment of complex wounds. Revista do Colégio Brasileiro de Cirurgiões, 44(1), 81-93. https://doi. 10.1590/0100-69912017001001

This article is a systematic review of studies conducted from 1997 to 2016. The focus of this review was to assess the effectiveness of negative pressure therapy (NPT) in treating complex wounds (Lima et al (2017). The data were collected by using the search tools of PubMed and the Medline databases for the articles that met the inclusion criteria of being published from 1997 to 2016. The study belongs to the level of evidence I since it involves a systematic review of the multiple research studies. The descriptive factors used while searching the articles included the negative pressure therapy, isolated or associated with wound, ulcer, pressure sore, trauma, dehiscence, burn, venous ulcer, and the diabetic wound among others. The authors targeted randomized controlled clinical studies from the search engines. From the search using the search tools or engines, a total of 46 articles were generated to help in addressing the issue presented by the authors.

The study is appropriate to help in the improvement of the health needs. The intervention presented by (negative pressure therapy) can be adopted by the healthcare providers to improvement the condition of the pressure ulcer of the patients. The intervention gives an opportunity of assessing its effects on the physical well-being of the patients for example the symptoms of edema, exudate, and the perfusion among others.

Based on the outcome of the reviews, it appears the negative pressure therapy causes physical effects like the increase in perfusion, controls edema and exudate, reduces the wound dimensions and the bacterial clearance, and biological effects such as the process of stimulating the granulation of the tissue formation, micro-deformations, and the reduction of the inflammatory responses (Lima et al., 2017).

The outcome of this study reveals its role in clinical practice. This article supports the projects that are focused on negative therapy to help in the reduction of pressure ulcers in patients with spinal cord injury. The study is important since it further reveals other roles played by the negative pressure therapy like helping in solving complications like traumatic wounds, operative wound dehiscencesdehiscence’s, burns, necrotizing wounds, venous ulcers, diabetic wounds, skin grafts, open abdomen, and the prevention of the complications in closed incisions (Lima et al., 2017).

The data generated by the authors are based on the percentages and the p values for both controlled and the interventions groups. The strength of this study is based on the fact that the data collected are based on the systematic review of the experimental controlled studies. This means that the data collected are based on the first hand information that were generated from the experimental thus making the article to be more reliable and valid. The weakness of the study is that the authors failed to provide the limitation of the study and the ethical considerations while performing the research work.

Atkinson, R. A., & Cullum, N. A. (2018). Interventions for pressure ulcers: a summary of evidence for prevention and treatment. Spinal Cord, 56(3), 186. https://doi. 10.1038/s41393-017-0054-y

This is a systematic review or the narrative review whose purpose is to give a summary of the evidence about the intervention aimed at preventing and treating pressure ulcers. This study is a synthesis of the evidence from all the relevant randomized controlled trials, therefore it belongs to the level of evidence I. The study is also aimed at highlighting the degree to which individuals suffering from spinal cord injury have been included in the randomized controlled studies in the Cochrane reviews (Atkinson & Cullum, 2018).

The strength of this study is that it gives a highlight on some of the cushions or the types of seating system associated with the potential benefits of reducing the seating interface pressure or the risks of the pressure ulcers. However, the study is having the weakness of failing to include the incidence of the new pressure ulcers as an outcome in the review. This is therefore limiting the ability of drawing the general conclusion to help in informing the clinical practice.

This study is supporting the use of various interventions for the prevention and treatment of the pressure ulcer. It supports the use of the quality interventions that is biased free. There were no participants used for the study, however, the study was based on the review of the articles from the Cochrane library and PubMed. The selection criteria was based on the use of articles published up to July 2017. Through searching the articles using the Cochrane Library and PubMed for systematic reviews, a total of 38 published systematic reviews were used and they revealed the presence of an array of the interventions (Atkinson & Cullum, 2018).

The authors of this article discusses various interventios that are being adopted to prevent and treat pressure ulcers in people with spinal cord injury. The instruments used by the authors are based on the search engines for example the Cochrane and PubMed. The outcome of this study reveals that there are several interventions for clinical use, nevertheless, few have been assessed enough among individuals with spinal cord injury.

Based on the analysis, the statistical data were presented in terms of percentages for example the total number of the participants who described to be having spinal cord injury were 4.3 percent in one of the 14 systematic reviews that were performed by the authors. This study is important in clinical practice since it reveals the existence of numerous interventions that can be adopted after adequate assessment to help in addressing the problems faced by patients with spinal cord injury. This gap can be addressed by ensuring that there are high-quality randomized trials, for example, the interventions for spinal cord injury. It is also important for the capstone project that is focused on the prevention and treatment of pressure ulcers (Atkinson & Cullum, 2018). However, the study does not give specific interventions that can be relied on to achieve such specific goals in caring for patients with spinal cord injury.

Boyko, T. V., Longaker, M. T., & Yang, G. P. (2018). Review of the current management of pressure ulcers. Advances in Wound Care, 7(2), 57-67. https://doi. 10.1089/wound.2016.0697

This is a systematic review study aimed at giving a highlight on the benefits and the drawbacks of the dressings and the treatment modalities to assists healthcare providers to make appropriate selection of the tools. According to this study, there are several dressings as well as treatment methods that have been developed over recent years to help in the management of pressure ulcers. The level of evidence of this study is V since it involves the description of the qualitative studies.

The process of the study adopted by the author involved highlighting on some of the benefits as well as the drawbacks of the dressings and the treatment approaches according to the author, some of the treatment strategies that can be adopted include debridement of the devitalized tissue, control of the remaining infection using antibiotics, medical and the nutritional patient optimization, suitable dressing selections, and the frequent monitoring of the wound evolution.

The study is appropriate and valuable to improve health since it promotes the necessity of having the first understanding of the prevention and the treatment that is required for the wound care by the specialists. Based on the sample size and the statistical tools, the authors failed to specify criteria used for the collection of the data. There is no evidence of exclusion and inclusion. The study does not show any evidence of statistical work performed. The work performed by the authors appears to be based on volunteering with no competing financial objectives.

The intervention of the study is focused on the care management i.e. the prevention and the treatment of the pressure ulcers. Nevertheless, the authors did not perform the statistical analysis, therefore, there are no evidence of instruments used. The outcome of the study reveal that the adoption of the standard approaches prevents further process of pursuing wound therapies.

The study is important for the capstone project since it shows the important efforts that are needed to ensure that there is a successful process of managing pressure ulcers. The reliability of the data presented in the article is confirmed by the specializations of the authors. This means that they had a good understanding of the area of study. Nevertheless, the study also has some weakness for example it is not based on the experimental work and the authors failed to provide the inclusion and the exclusion criteria used for the collection of the data. This therefore makes it hard to believe on the sources of the information presented.

The article fails to give a direct intervention that can be specifically relied on to help in the improvement in the process of managing pressure ulcers. The authors simply discuss the increase in the number of therapies in the market without even mentioning the most successful and effective intervention that clinics or hospitals can rely on in managing the pressure ulcers of elderly patients. The authors fail to provide the approach undertaken in analyzing the data drawn from the articles. The authors also fail to provide information about specific search machines used in reviewing the articles used (Boyko et al., 2018).

Summary of what is known and how the gap is being addressed

Summary of what is known and Gaps in the Literature

The complications associated with pressure ulcer reconstructions are common and this means that there are higher chances of wound recurrence. Some of the complications include burns, necrotizing wounds, diabetic ulcers, and increased wound dehiscencesdehiscence’s among others. Bauer et al (2016) study reveals that there are existence of several interventions for clinical use, nevertheless, few interventions have been assessed to help in addressing the problems faced by the patient with spinal cord injury. There has been an increase in the number of therapies in the market, nevertheless, none has shown clear benefit over each other, and therefore, this means that pressure ulcers remain a frustrating and time-consuming issue. Negative pressure wound therapy has proven to be effective in addressing the issue of pressure ulcers among elderly patients.

According to Papp (2019), different efforts have been made to address this issue but little attention has been given to the intervention involving the use of incisional pressure wound therapy. Study by Boyko et al (2018) reveals about the failure of the novel dressing and therapies to help in the improvement of the pressure ulcers management. It offers an opportunity for the specialists to focus on the understanding the prevention and treatment of the pressure ulcers and having a future research to help in the prevention approaches.

Study by Atkinson & Cullum (2018) there is existence of uncertainty concerning the effectiveness of interventions aimed at preventing and treating pressure ulcers even though some are being used in healthcare facilities. According to Lima et al (2017), the negative pressure therapy has become an established adjuvant for the treatment of the complex wounds. Nevertheless, this therapeutic approach is still raising doubts for many surgeons despite being a simple procedure.

Concluding remarks

The process of dealing with pressure ulcer issues among elderly individuals is presenting a huge challenge. Numerous interventions are available and some are being implemented while others are not. Negative pressure wound therapy has been considered an effective approach in dealing with pressure ulcers amongst this population. Nevertheless, this intervention is receiving little attention from healthcare professionals. Therefore, healthcare providers and hospital organizations must work as a team towards ensuring that there is an effective implementation of this intervention.

References