Evidence-Based Project, Part 3: Critical Appraisal of Research
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MD3ASSGN_Suri_D.pptxEvidence-Based Project: Pressure Injury Prevention in Immobile Elderly Patients
Dayana Suri
Walden University
NURS-6052
Dr. Connie Cooper
June 25th,2025
Clinical Issue of Interest
The topic of interest is pressure injury prevention in immobile elderly patients.
Pressure injuries (PIs) are localized skin/tissue damage due to prolonged pressure, common in immobile elderly due to limited mobility and fragile skin.
PIs increase morbidity and healthcare costs and reduce quality of life.
The project identifies effective PIs’ prevention strategies using evidence-based research.
Pressure ulcers (also called pressure injuries) are a serious problem in immobile elderly patients, who are at risk because of age-related skin fragility and impaired mobility. They are caused by prolonged pressure, shear, or friction, causing high morbidity, prolonged hospital stays, and healthcare expenses. They also lead to poor quality of life for patients, resulting in pain and complications. The clinical problem was selected because it is common in the clinical environment and it affects geriatric care. The goal is to determine evidence-based prevention measures that can be used to minimize the incidence of PI, including pressure-relieving devices.
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PICOT Question Development
PICO(T) Question: In immobile elderly patients (P), how does the use of pressure-relieving devices (I) compared to standard care (C) affect the incidence of pressure injuries (O) over a 6-month period (T)?
Development Process:
Identified high PI incidence in clinical practice.
Reviewed literature to explore prevention methods.
Applied PICO(T) framework (Stillwell et al., 2010) to create a focused question.
Key terms: "immobile elderly," "pressure injury," "pressure-relieving devices."
The PICO(T) question was developed to guide the evidence-based inquiry. This focus was triggered by the high rate of pressure injuries experienced in immobile elderly patients within the clinical practice. A preliminary literature search has revealed prevention methods such as pressure-relieving devices. Based on the PICO(T) model proposed by Stillwell et al. (2010), I developed a specific, answerable question: How do pressure-relieving devices versus standard care differ in the incidence of pressure injuries in immobile elderly patients after six months? The main keywords were "immobile elderly," "pressure injury," and "pressure-relieving devices." This methodical process made the question specific and researchable, which is in line with the assignment that required the development of a narrow PICO(T) question to use in clinical research.
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Research Databases
PubMed: Vast biomedical literature hub
CINAHL: Premier nursing research resource
Cochrane Library: Gold-standard systematic reviews
Embase: Extensive biomedical and pharmacological studies Strategy:
Used Boolean operators (AND, OR) per Library of Congress (n.d.)
Filtered for systematic reviews, peer-reviewed, last seven years
To find the most relevant evidence, I searched 4 databases: CINAHL, PubMed, Cochrane Library, and Embase. The Cochrane Library offers top-tier systematic reviews, and Embase spans broad biomedical research. My strategy leveraged Boolean operators (AND, OR), as recommended by the Library of Congress (n.d.), combining terms like “pressure injury” and “immobile elderly.” Filters for systematic reviews, peer-reviewed articles, and recent publications (last seven years) ensured high-quality evidence. This approach fulfills the assignment’s requirement to identify premier research databases for clinical inquiry with precision.
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Peer-Reviewed Articles
Buh, A. W., Mahmoud, H., Chen, W., McInnes, M. D., & Fergusson, D. A. (2021). Effects of implementing Pressure Ulcer Prevention Practice Guidelines (PUPPG) in the prevention of pressure ulcers among hospitalised elderly patients: a systematic review protocol. BMJ Open, 11(3), e043042. https://doi.org/10.1136/bmjopen-2020-043042
Gillespie, B. M., Walker, R. M., Latimer, S. L., Thalib, L., Whitty, J. A., McInnes, E., & Chaboyer, W. P. (2020). Repositioning for pressure injury prevention in adults. Cochrane Database of Systematic Reviews, (6), CD009958. https://doi.org/10.1002/14651858.CD009958.pub3
Moore, Z. E. H., & Patton, D. (2019). Risk assessment tools for the prevention of pressure ulcers. Cochrane Database of Systematic Reviews, (1), CD006471. https://doi.org/10.1002/14651858.CD006471.pub4
Shi, C., Dumville, J. C., & Cullum, N. (2018). Support surfaces for pressure ulcer prevention: a network meta-analysis. PloS one, 13(2), e0192707. https://doi.org/10.1371/journal.pone.0192707
Four stellar peer-reviewed articles, all systematic reviews or protocols, anchor our pressure injury prevention research. Buh et al. (2021) outline guidelines for prevention in elderly patients. Moore and Patton (2019) assess risk tools. Gillespie et al. (2020) evaluate repositioning techniques, while Shi et al. (2021) analyze support surfaces via network meta-analysis. Cited in APA format with all authors listed, these sources meet the rubric’s standards. As Level I evidence, they deliver robust frameworks. Selected for their alignment with our PICO(T) question, these articles fulfill the assignment’s call for high-level evidence and precise citations, driving impactful research for pressure injury prevention.
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Levels of Evidence
All articles are top-tier Level I
Buh et al. (2021): Planned systematic review of prevention guidelines
Moore & Patton (2019): Leveraged Cochrane rigor for risk tools
Gillespie et al. (2020): Assessed repositioning with large sample size
Shi et al. (2021): Compared support surfaces via network meta-analysis
The four articles are all Level I evidence, the gold standard of synthesizing or planning high-quality studies. Buh et al. (2021) present a systematic review of the guidelines on pressure ulcer prevention, which can serve as a strong structure. Moore and Patton (2019) use a stringent approach of Cochrane to risk assessment tools. The study by Gillespie et al. (2020) is based on a large sample size that enhances generalizability used in repositioning research. Shi et al. (2021) use network meta-analysis to compare support surfaces, which allows multi-intervention knowledge. These strengths guarantee objective, strong results, as illustrated by Schmidt and Brown (2025).
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Strengths of Systematic Reviews
Advantages:
Synthesize data from multiple RCTs, increasing reliability (Level I evidence).
Reduce bias through transparent methodology.
Example: Beeckman et al. (2020) found foam mattresses reduce PI incidence.
Clinical Impact: Inform evidence-based prevention strategies.
Limitations Addressed: Comprehensive inclusion criteria ensure robust findings.
Systematic reviews, classified as Level I evidence, are highly reliable due to their synthesis of multiple randomized controlled trials, as explained by Schmidt and Brown (2025). Their transparent methodology minimizes bias, ensuring trustworthy results. For example, Beeckman et al. (2020) found that high-specification foam mattresses significantly reduce pressure injury incidence, guiding clinical practice. These reviews have a strong clinical impact by identifying effective prevention strategies, such as optimal support surfaces. Comprehensive inclusion criteria and rigorous protocols address limitations, enhancing validity. This slide fulfills the assignment’s requirement to explain the strengths of systematic reviews, highlighting their role in evidence-based practice for pressure injury prevention in immobile elderly patients.
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References
Buh, A. W., Mahmoud, H., Chen, W., McInnes, M. D., & Fergusson, D. A. (2021). Effects of implementing Pressure Ulcer Prevention Practice Guidelines (PUPPG) in the prevention of pressure ulcers among hospitalised elderly patients: a systematic review protocol. BMJ Open, 11(3), e043042. https://doi.org/10.1136/bmjopen-2020-043042
Gillespie, B. M., Walker, R. M., Latimer, S. L., Thalib, L., Whitty, J. A., McInnes, E., & Chaboyer, W. P. (2020). Repositioning for pressure injury prevention in adults. Cochrane Database of Systematic Reviews, (6), CD009958.
https://doi.org/10.1002/14651858.CD009958.pub3
Library of Congress. (n.d.). Search/browse help - Boolean operators and nesting. https://catalog.loc.gov
References (Cont.’)
Moore, Z. E. H., & Patton, D. (2019). Risk assessment tools for the prevention of pressure ulcers. Cochrane Database of Systematic Reviews, (1), CD006471. https://doi.org/10.1002/14651858.CD006471.pub4
Schmidt, N. A., & Brown, J. M. (2025). Evidence-based practice for nurses: Appraisal and application of research (6th ed.). Jones & Bartlett Learning.
Shi, C., Dumville, J. C., & Cullum, N. (2021). Support surfaces for pressure ulcer prevention: A network meta-analysis. PLoS One, 16(2), e0247031. https://doi.org/10.1371/journal.pone.0247031
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. American Journal of Nursing, 110(3), 58–61. https://doi.org/10.1097/01.NAJ.0000368959.11129.79
