EBP

Comparison of Silicone Foam Dressings Versus Pressure Reduction Techniques

Student Name

Minnesota State University, Mankato

NURS 320-W 02 Critical Inquiry and Evidenced-Based Practice for RNs

Dr. Ellen Vorbeck

Date: mm/dd/year

Comparison of Silicone Foam Dressings Versus Pressure Reduction Techniques

Pressure injuries can have significant negative consequences for patients including infection, reduced quality of life, disability and even death (Campbell, et al., 2020). Pressure injuries are also very costly for patients and healthcare systems, estimated to average between $37,000-$70,000 per patient (Walker, et al. 2015). In patients who were both immobile and incontinent, Gray & Guiliano found the “prevalence of facility-acquired pressure injury in the sacral area remained statistically significant” compared to patients who were continent (2018, p. 65). Placing a silicone foam dressing over the sacrum is a common preventative practice in patients with stage 1 pressure injuries, but does research support this intervention when incontinence is involved? It is important to utilize evidence-based research to determine if this is the best practice to prevent skin breakdown in this population, as they have increased vulnerability to pressure injuries.

Background

The first step toward preventing pressure injuries is thorough assessment. The Agency for Healthcare Research and Quality (AHRQ) recommends inspecting skin for the following: temperature, color, moisture, turgor and integrity. They advise utilization of assessment tools such as the Braden Scale to standardize skin assessments and determine patient risk for skin breakdown (Berlowitz, et al., 2014). There are two main types of skin breakdown in the pelvic area, pressure injuries and incontinence-associated dermatitis. Pressure injury is defined by Campbell et al., as “localized damage to the skin and/or underlying tissue, usually over a bony prominence” (2020, p. 30). When a patient is determined to be at risk for developing pressure injury through a Braden score or other scale, pressure reduction techniques are utilized to prevent breakdown. Pressure reduction techniques vary by hospital but typically include turning and repositioning, placing pillows to cushion bony prominences, and utilizing pressure-reducing mattresses. In contrast, incontinence-associated dermatitis (IAD) is defined by Gray & Guiliano as “erythema and edema of the surface of the skin, sometimes accompanied by serous exudate, erosion or secondary cutaneous infection” specifically found in patients who are incontinent of bowel and/or bladder (2018, p. 63). Though these two conditions are separate, incontinence is found to worsen the risk of developing pressure injuries. In their multivariate analysis on immobility, incontinence and pressure injury, Gray & Guiliano found that the presence of IAD significantly increased the likelihood of developing a pressure injury (2018.) Some of the prevention strategies overlap between these conditions, such as preventing moisture and pressure reduction techniques.

Research Problem Statement

With this known link between IAD and pressure injury, it is important for clinicians to determine the best interventions to prevent skin breakdown in populations where both are present. This paper is comparing the use of silicone foam dressings in this population, versus pressure reduction techniques alone.

Research Purpose

The purpose of this paper is to determine whether silicone foam dressings prevent skin breakdown more effectively than pressure reduction techniques alone, in hospitalized patients who have stage 1 pressure injuries and incontinence.

Research Question

In individuals with both incontinence and stage 1 pressure injuries, how does a silicone foam dressing compared to pressure reduction techniques affect skin integrity within a hospital stay?

Research Utilization Model

The Johns Hopkins Nursing Evidenced-Based Practice Model (JHNEBP) is an appropriate research model to use for this research focus as it was developed to make incorporating evidence more manageable for nurses during clinical practice. This makes it well suited to research and implementation within a hospital system. Melnyk and Fineout-Overholt (2019) describe the three main steps: Practice Question, Evidence, and Translation. First, the question is developed and refined, a leader is determined, and an interdisciplinary team is formed. Then, evidence is screened, rated, and summarized. This phase ends with specific recommendations determined by the strength of the research. Recommendations can be one of four options such as changing the practice immediately because the evidence is strong, considering a pilot or research study, or if there is little evidence, continuing research or ending the project. Finally, the results of the study are integrated into practice (Melnyk & Fineout-Overholt, 2019, pp. 413-414).

While utilizing this model, the interdisciplinary team should be composed of bedside nurses, managers, WOC nurses and hospitalists. The research obtained will guide the interdisciplinary team in answering the research question and determining the best way to disseminate this research into clinical practice in the hospital setting. Figure 1 visually depicts the JHNEBP model utilized in this research project.

Figure 1

The Johns Hopkins Nursing Evidence-Based Practice Model