Drafting a Literature Review: Pressure Ulcers

Subject: Nursing
Pages: 20
Words: 5496
Reading time:
22 min
Study level: Bachelor


A literature review is an essential component of every research. This section summarizes the current information on a selected topic, demonstrates what questions have been answered, and reveals the existing gaps. A decent literature review should form the basis of a scientific study, meaning that any information should be extracted from timely and relevant sources. That is why the previous assignment summarized and synthesized scholarly articles about using regular turning and repositioning to reduce the prevalence of pressure ulcers among older patients. At this point, it is reasonable to incorporate the literature review to identify its content. The given assignment will demonstrate that the literature review implies three major themes. They are the use of turning and repositioning, the use of repositioning in combination with other preventive measures, and the role of pressure ulcers in the health care industry. Each of them will further cover specific subthemes that will better reveal the content of the significant themes. Thus, the paper’s principal aim is to comment on the major themes and their subthemes.

The Use of Repositioning and Turning

The first theme that is extracted from the literature review refers to the use of repositioning to address pressure ulcers. Considering the DPI Project topic, it is not a surprise that it is necessary to identify what scientific studies state about the effectiveness of this method. The given theme will try to explain whether this intervention is suitable to address the issue, how to maximize its benefits, how it affects various groups of patients, and what techniques are used. As for the given literature review, 15 scholarly articles represent this theme.

Affecting Pressure Ulcers

The first subtheme focuses on whether it is justified to rely on turning and repositioning in reducing the pressure injury prevalence among older patients. The articles of this group pose a single but significant question. Atkinson and Cullum (2018), Gaspar et al. (2019), and Mäki-Turja-Rostedt et al. (2019) try to explain what pressure ulcer prevention measures can be used and which of them are the most effective. The following information will comment on the peculiarities of these sources.

The three articles above are systematic reviews, meaning that they used the same methodology. It refers to the identification of relevant studies and the analysis of their content. The differences, however, relate to the number of articles under consideration and the databases for search. Thus, Atkinson and Cullum (2018) focused on 38 studies; Gaspar et al. (2019) analyzed 26 articles; Mäki-Turja-Rostedt et al. (2019) drew attention to 18 pieces of research. Mäki-Turja-Rostedt et al. (2019) worked with the highest number of resources, including PubMed (MEDLINE), CINAHL, Web of Science Core Collection, Scopus, Cochrane Wounds Group Specialized Register, and Cochrane Central Register of Controlled Trials databases. Simultaneously, Gaspar et al. (2019) focused on the EBSCO host, PubMed, and Web of Science databases, while Atkinson and Cullum (2018) only reviewed the Cochrane Library and PubMed. A high number of databases denotes that the studies have worked with reliable sources.

The selected methodology leads to a significant limitation of the studies. It relates to the fact that the scientific articles review their studies one by one, making it challenging to compare or contrast the effectiveness of different interventions. Furthermore, these three articles have generated consolidated results, stating that turning and repositioning are insufficient prevention measures when they are used in isolation. As for the recommendations for further research, it is reasonable to identify how to maximize the effect of pressure ulcer prevention measures. The articles from this subtheme have demonstrated that turning and repositioning are popular ways to address the issue of pressure injuries. Still, they are not effective if they are used separately.

Various Repositioning Intervals

The second subtheme draws attention to the fact that there are different repositioning intervals. It refers to 2-, 3-, and 4-hourly repositioning techniques that are currently used in hospitals. Since there are a few options, it is necessary to identify how they affect pressure injury incidence. In other words, the articles from this subtheme will try to answer whether there is a significant difference between the possible repositioning intervals.

These studies have worked with various samples and utilized different methodologies to test the hypothesis above. On the one hand, Courvoisier et al. (2018) have analyzed the data of 2,671 patients, Latimer et al. (2016) drawn attention to 241 participants, while Sharp et al. (2019) investigated 80 individuals. The study by Courvoisier et al. (2018) has a cross-sectional prevalence design. An observational study that is based on semi-structured observations has been conducted by Latimer et al. (2016). Finally, Sharp et al. (2019) have undertaken a retrospective cross-sectional approach to identify the development of pressure ulcers in the long run. These pieces of research imply various samples to analyze the issue under consideration from different aspects.

On the other hand, appropriate literature reviews represent the second part of this subtheme. The studies by Jocelyn Chew et al. (2017), Tayyib and Coyer (2016), and Tran et al. (2016) have identified 10, 25, and 353 articles, respectively. The scientists have searched many relevant databases to extract the materials for their studies. In addition to that, Pechlivanoglou et al. (2018) have attempted to compare the cost-effectiveness of various repositioning intervals based on the data extracted from a clinical trial. These multiple approaches demonstrate that the articles consider the given subtheme from different points of view.

Some of these studies imply limitations, and it is necessary to consider them. On the one hand, the limitations refer to small sample sizes. The articles by Jocelyn Chew et al. (2017) and Sharp et al. (2019) are suitable examples. On the other hand, Pechlivanoglou et al. (2018) offer a vital limitation because the researchers did not consider the economic benefits that could arise from the absence of injuries among nurses. The presence of these issues does not mean that the studies are irrelevant or not empirical; it only mentions that additional research is necessary to test their findings.

As for the results, they can be divided into two groups. The first one includes the studies by Courvoisier et al. (2018) and Pechlivanoglou et al. (2018). Courvoisier et al. (2018) admit that 2-hourly and 3-hourly intervals are better than 4-hourly ones, while Pechlivanoglou et al. (2018) stipulate that repositioning patients every three hours is the most cost-effective option. At the same time, the other articles that represent the given subtheme indicate that there is no significant difference between various repositioning intervals. Thus, further research is necessary to identify whether it is possible to maximize the prevention measures’ effect with additional options.

The subtheme is of significance to the theme and overall project. It shows that various repositioning and turning intervals are a sensitive topic in the research field. However, there is insufficient evidence that any of these frequencies is substantially better than the others. In conclusion, it means that reducing repositioning and turning intervals is not sufficient to reduce the incidence of pressure ulcers among older patients.

The Impact of Repositioning and Turning on Patients with Specific Health Conditions

It is sad to say that pressure ulcers are usually comorbidities that develop against the background of other diseases. Typically, this health issue is the most acute for individuals who spend much time in prone or sitting positions. That is why it is reasonable to identify research pieces that would determine whether turning and repositioning are useful for people with particular health conditions. Thus, Aljezawi and Tubaishat (2018) try to answer whether these interventions are effective for cancer patients, while Chitambira and Evans (2018) attempt to assess the effect of repositioning for stroke patients with pusher syndrome. The following details will explain how these scientists answer these research questions.

Since the two studies pursue similar objectives, it is not a surprise that they imply some similarities regarding their methods and samples. The article by Aljezawi and Tubaishat (2018) is a multicenter, cross-sectional study of 110 individuals, while Chitambira and Evans (2018) have conducted a quality improvement initiative with 140 adults. The two research pieces make their participants subject to two-hourly repositioning and analyze the prevalence of pressure injuries following the interventions.

The articles of the given subtheme imply some limitations that deserve attention. On the one hand, Aljezawi and Tubaishat (2018) suffer from a consideration that is caused by the design of their study. It relates to the fact that incidence studies only measure the outcome of interest at a single point of time, which slightly narrows the research’s scope. On the other hand, the study by Chitambira and Evans (2018) is limited by a short intervention period. The scientists have analyzed the intervention’s effect after two months, which can be insufficient to depict the real impact.

Irrespective of the interventions, it is necessary to comment on the articles’ findings. Even though the studies have some features, they have arrived at entirely different results. Thus, Chitambira and Evans (2018) stipulate that repositioning stroke patients with pusher syndrome and placing pillows reduce pressure ulcer incidence. Further research is necessary to identify whether this intervention is useful for individuals with other health conditions. Simultaneously, Aljezawi and Tubaishat (2018) admit that regular repositioning does not guarantee that a cancer patient will manage to avoid pressure injuries. The authors state that they will keep looking for ways to minimize the prevalence of pressure injuries among cancer patients.

This subtheme has a particular meaning for the entire project. Firstly, it proves that pressure injuries are a widespread problem that requires specific interventions. Secondly, the subtheme has revealed that individuals with specific health conditions are more subject to suffering from the given issue because they spend much time in sitting and prone positions. Thirdly, while the two studies’ results are controversial, Chitambira and Evans (2018) have demonstrated that repositioning can be effective when used together with additional interventions. This idea is significant because it shows a possible way to maximize the positive effect of regular repositioning and turning.

Repositioning Techniques and Approaches

The fourth subtheme refers to the idea that various repositioning techniques and approaches to this intervention can lead to better patient outcomes. Repositioning and turning effectiveness is supposed to increase when medical professionals follow specific strategies to make decisions and take action. That is why the articles of this subtheme try to address appropriate research questions. Thus, Krapfl et al. (2017) analyze the effectiveness of incremental positioning, Oomens et al. (2016) focus on tilting to combat pressure ulcers, and Sving et al. (2016) consider whether it is reasonable to use turning schedules. These research questions prove that these scientists try to find the best repositioning and turning strategy.

In an attempt to answer the questions above, the researchers have utilized different methodologies and worked with various samples. Firstly, the study by Krapfl et al. (2017) is a literature review that has searched three databases, including CINAHL, EMBASE, and PubMed, to identify relevant articles. As a result, the scientists have extracted five research pieces that focused on the effect of incremental positioning. Secondly, Oomens et al. (2016) selected 14 volunteers and analyzed magnetic resonance imaging (MRI) of their sacral areas. It was necessary to determine how tilting would affect individuals’ skin. Thirdly, the article by Sving et al. (2016) is a quasi-experimental, pre-and post-test study of 506 patients. The scientists implemented different turning schedules and assessed their impact on participants’ health.

The studies under consideration imply some limitations that deserve attention. As for the article by Krapfl et al. (2017), the researchers only focused on five studies, which can make it insufficient to generate conclusions based on small sample size. Oomens et al. (2016) explain that their work is limited since they considered the sacral area alone. It means that their intervention could have a different impact on other body parts. Furthermore, Sving et al. (2016) used questionnaires to identify wheat nurses thought of their intervention. A limitation relates to the fact that the researchers included pre-test data in post-test questionnaires, which could promote biased answers.

The results of this subtheme are also controversial, depending on the study. On the one hand, Oomens et al. (2016) stipulate that tilting is an effective intervention to reduce pressure injuries. However, further research is necessary to determine how this strategy affects other body parts. On the other hand, Krapfl et al. (2017) and Sving et al. (2016) conclude that their interventions are not sufficient to decrease the prevalence of pressure ulcers among older patients. This fact denotes that the authors should follow other study designs to test whether their hypotheses are influential under different conditions.

The findings of the given subtheme support the overall tendency that has been identified throughout the theme exploration. It relates to the fact that there is controversial evidence regarding the effectiveness of repositioning and turning in preventing pressure ulcers. These three studies have demonstrated that the same is true for various repositioning techniques and approaches. Even though the findings are controversial, it is possible to extract one typical issue. Many articles demonstrate that managing pressure injuries is a complex task that requires a comprehensive approach. In other words, turning and repositioning should be accompanied by additional steps or measures to increase the opportunity of achieving the desired objectives.

Repositioning and Turning Together with Other Interventions

According to the information above, it is not a surprise that the second theme refers to the use of repositioning and turning with other interventions to combat pressure injuries. This topic is requested in the research field, and scientists do their best to assess various additional measures’ effectiveness. The possible interventions include the use of mattresses and pillows, continuous bedside pressure mapping (CBPM) systems, and electronic devices. Eleven articles represent the given theme and are subdivided into appropriate subthemes.

Continuous Bedside Pressure Mapping (CBPM) Systems

The first subtheme addresses the issue that repositioning charges nurses with responsibility. It relates to the fact that many individuals forget to move to avoid pressure injuries because of various reasons. That is why it is nurses’ task to either remind them of the necessity or to reposition the patients by themselves. In this case, medical professionals need assistance to cope with the assignment successfully, and CBPM systems can be useful in this case. It is so because these systems help nurses determine when patients start experiencing excessive pressure and when it is necessary to reposition them. The articles by Gunningberg and Carli (2016) and Gunningberg et al. (2017) address this topic. Whether the use of CBPM systems can prevent pressure ulcers is the research question of the two studies.

The scientists have utilized different approaches to answer the question above. On the one hand, Gunningberg and Carli (2016) have conducted a prospective and quantitative study of 19 registered nurses and 33 assistant nurses, where the medical professionals assessed the effectiveness of CBPM. On the other hand, the work by Gunningberg et al. (2017) is a pragmatic randomized controlled trial of 190 patients, including control and intervention groups. CBPM systems were applied to the intervention group to test whether the given intervention has the potential to protect older patients from pressure injuries.

It is reasonable to discuss the limitations of the two studies. Gunningberg and Carli (2016) explain that their study’s limitation is that they did not consider the development of pressure ulcers in different patients. Simultaneously, the survey by Gunningberg et al. (2017) was limited because their intervention was not blinded to medical professionals and participants. Another challenging fact was that CBPM systems were a new technology that could save and process all pressure records for investigation. These issues demonstrate that there can be disputes regarding whether the studies’ findings will apply to the population under normal conditions.

Since the articles have utilized various approaches, it is not a surprise that their results are different. Since Gunningberg and Carli (2016) focus on what nurses think of CBPM systems, the researchers conclude that this intervention leads to optimized repositioning, which is useful to reduce pressure ulcers. Further research is necessary to investigate the patients’ perception of CBPM systems. The article by Gunningberg et al. (2017) addresses this issue and concludes that the application of the CBPM systems does not lead to any significant improvement regarding pressure injury prevalence. It means that further research is necessary to test whether the blinded intervention will have the same impact on patient health.

The given subtheme has demonstrated that there is insufficient evidence that the use of CBPM is effective in reducing pressure ulcers. Even though nurses mention that this intervention has many benefits regarding the issue under consideration, the studies did not prove this hypothesis. It denotes that regular notifications of the necessity to change the patients’ position is convenient for medical professionals but does not improve the situation with pressure injuries among older patients. Consequently, further research is necessary to identify what additional interventions significantly maximize the effect of repositioning and turning, which will lead to fewer pressure injuries.

Specific Mattresses and Pillows

This subtheme will consider whether specific mattresses and pillows are sufficient to reduce pressure on individuals’ skin and protect them from pressure ulcers. Three studies are included, and they are the works by Jiang et al. (2020), Powers (2016), and Sauvage et al. (2017). These pieces of research try to answer research questions of whether mattresses and pillows effectively reduce the pressure ulcer prevalence and mattresses of what type are better.

The scientists have tested their hypotheses on different sample sizes and with the help of different methodologies. For example, Jiang et al. (2020) have conducted a multicenter, open-label, and comparative study with 1,204 participants. This fact has allowed the researchers to compare the effectiveness of viscoelastic foam and air pressure redistribution mattresses. In turn, Powers (2016) has selected 59 participants and investigated whether the standard of care (SOC) using pillows is better than a patient positioning system (PPS) in a nonrandomized study. Finally, the article by Sauvage et al. (2017) is a randomized, controlled, superiority, parallel-group, open-label, multicenter study of 76 patients. The scientists have compared the effectiveness of alternating pressure air mattresses (APAM) and viscoelastic foam mattresses (VFM).

The studies under consideration imply some limitations that can affect their results. Jiang et al. (2020) admit that their article is limited since their intervention period only was seven days. Simultaneously, small sample sizes are a significant limitation of the studies by Sauvage et al. (2017) and Powers (2016). Furthermore, Powers (2016) stipulates that nonrandomized group allocation could be a barrier, but further analysis of the groups did not reveal any essential demographic differences within the sample population. The presence of these limitations is a warning sign that these scientists can conduct additional research to eliminate the effect of outside phenomena on the scientific findings.

At this point, it is reasonable to comment on the research results. Firstly, Jiang et al. (2020) mention that the viscoelastic foam and air pressure redistribution mattresses are effective pressure injury prevention methods, but there is no significant difference between the two. According to the authors, further research is necessary to assess the mattresses’ effect for different repositioning intervals. Secondly, Powers (2016) concludes that the use of pillows is not sufficient to reduce the pressure injury prevalence. It is reasonable to conduct a randomized study to investigate the given issue. Thirdly, Sauvage et al. (2017) admit that the APAMs are more effective compared to the VFMs. It is reasonable to involve a larger sample size to test the reliability of these results.

The results of this subtheme are of significance for the major theme and overall project. It is so because the articles have demonstrated that pillows are not sufficient to minimize pressure injuries, while both viscoelastic foam and air pressure redistribution mattresses can cope with the task. In addition to that, it has been mentioned that APAMs are better at decreasing the prevalence of pressure ulcers among older patients. It means that regular repositioning can be more effective if patients use specific mattresses that reduce pressure on individuals’ skin and muscles.

Electronic Devices

This subtheme refers to the issue that appropriate electronic devices can improve the effect of repositioning and turning to reduce pressure injury incidence. Many articles address this topic, including the works by Edger (2017), Knibbe et al. (2018), Minteer et al. (2019), Pickham et al. (2019), Richardson et al. (2017), and Stinson et al. (2018). The studies try to answer the research question of whether various electronic devices, including automatic repositioning systems, wearable patient sensors, accelerometers, and others, can decrease the prevalence of pressure injuries.

These studies represent an array of various methodologies and sample sizes. Edger (2017) has conducted a prospective before-and-after study with 717 patients to test a repositioning device’s impact. Knibbe et al. (2018) were subjecting 13 patients to an automatic repositioning system for four weeks to analyze how an automatic repositioning system will influence their skin. Minteer et al. (2019) have attempted to analyze two sensor devices that imply no contact with the patient skin to track ten individuals’ movements. The study by Pickham et al. (2019) is a randomized clinical trial that includes 1,312 participants to evaluate the use of a wearable patient sensor. Richardson et al. (2017) have conducted a quality improvement program that took place in four adult critical care units with 88 beds in total to test the use of technical and non-technical interventions. Finally, Stinson et al. (2018) have analyzed the findings of two recent articles with at-risk cohorts, including 21 participants in total. The study has assessed the use of accelerometers and interfaces pressure mapping systems.

Numerous limitations influence the generalizability of the studies that represent the given subtheme. The works by Knibbe et al. (2018), Minteer et al. (2019), and Stinson et al. (2018) are affected by small sample sizes. This fact makes it impossible to affirm that their results will have the same impact on the entire population. The study by Edger (2017) is limited because of a nonrandomized design. This issue can lead to the fact that the results are only applicable to a particular population layer. As for Pickham et al. (2019), they acknowledge that attention should be paid to the issue that different study units could generate mixed results. Finally, a specific design makes the article by Richardson et al. (2017) limited because temporal changes can affect the results irrespective of the interventions under investigation. The information above demonstrates that the findings should be interpreted through the lens of these limitations.

The results of this subtheme can be divided into two groups. Fistly, Stinson et al. (2018) admit that accelerometers and interface pressure mapping systems are not effective in preventing pressure injuries. It is so because these technologies do not promote the regular repositioning of older patients. Secondly, the other articles demonstrate that appropriate electronic devices lead to frequent repositioning, which decreases the pressure ulcer prevalence among older patients. For example, a suitable repositioning device reduces pressure injury incidence from 1.3% to 0% (Edger, 2017). Knibbe et al. (2018) admit that an automatic repositioning system leads to recovery from pressure ulcers. Furthermore, Minteer et al. (2019) have concluded that sensor devices accurately track patient movements, while Pickham et al. (2018) have demonstrated that wearable sensors lead to lower pressure ulcer rates. Finally, Richardson et al. (2017) argue that technical and non-technical interventions should be used together to achieve the best results. In this subtheme, additional research may be needed to assess the effectiveness of these electronic devices together with various repositioning intervals.

This subtheme is of significance for the major theme and the whole project. It refers to the fact that the studies above have demonstrated that the use of electronic devices can improve the effectiveness of repositioning in combating pressure ulcers. Even though some research pieces state that particular types of technology do not result in positive outcomes, it means that medical professionals and establishments should make efforts to choose the most suitable interventions. In conclusion, it is reasonable to invest in selecting the best device to maximize the effect of repositioning and reduce pressure injuries among numerous individuals.

Pressure Injuries in the Health Care Industry

The third theme presents the most generalized information on pressure ulcers and includes the smallest number of articles. This theme is necessary for the given project because it allows us to understand common concepts of how health care can address the issue and what challenges the problem brings to the medical industry. That is why four studies will explain how pressure ulcers develop, what nurses think of this problem, and what the first essential phenomenon to start combating pressure injuries is.

Pressure Ulcer Development

Since the DPI Project aims to assess the effectiveness of various pressure ulcer prevention and management methods, it is impossible not to draw attention to the theoretical background of this medical condition. It is a complex issue that implies an adverse impact on numerous patients. That is why it is necessary to understand how pressure injuries emerge. In the given literature review, this subtheme is represented by Greenwood and McGinnis’s (2016) study. The researchers attempt to answer the question of what prerequisites lead to pressure ulcer development.

There is no doubt that a specific methodology is needed to cope with the aim mentioned above. Greenwood and McGinnis (2016) have decided to rely on the investigation of previously completed root cause analyses (RCAs). The authors have identified 32 RCAs that were performed during January-October 2014. The selected material was then coded to enable convenient content analysis and avoid possible biases. Greenwood and McGinnis’s (2016) task was to investigate those RCAs’ findings to identify essential themes and learning points. This methodology demonstrates that these authors have approached the issue from a scientific point of view.

It is possible to mention that the given study does not imply any limitations. As Greenwood and McGinnis (2016) admit, their study’s primary consideration is that it only focuses on patient factors that result in pressure ulcers. It denotes that the article does not draw attention to the creation of systems and organizational explanations of the issue, which leads to two consequences. On the one hand, the researchers present a comprehensive review of what factors result in pressure injuries. On the other hand, this information is insufficient to develop systems of how to protect patients from this problem.

It is not a surprise that pressure ulcer prerequisites are multiple. Greenwood and McGinnis (2016) have managed to identify many of them, including mobility, nutrition, perfusion, staffing, skin condition, and others. Even though it is a typical case that many factors cause a pressure injury, it is still possible to state which of them are the most common. According to Greenwood and McGinnis (2016), they are poor nutrition and tissue perfusion. Thus, further research is needed to determine what organizational and systems issues also contribute to the creation of pressure ulcers. This information will help develop an effective intervention strategy to improve the situation.

These details demonstrate that pressure injuries represent a severe issue in the health care industry. Numerous patients suffer from them, and many factors cause them. Thus, this subtheme is useful to understand that there is no single intervention that could solve the problem and protect individuals from pressure ulcers. That is why when a medical organization intends to minimize pressure injury incidence, it should implement a comprehensive approach that will address various aspects of the problem.

Nurses’ Perception

When it comes to preventing or managing pressure ulcers, it is challenging to overestimate medical professionals’ role in achieving the desired outcomes and reducing the pressure injury prevalence. It is so because nurses and others are responsible for turning patients or promoting them not to stay in one position for an extended period. The articles by Gunningberg et al. (2018) and Hommel et al. (2017) represent the given subtheme. These studies pose the research questions of what nurses think of pressure mapping systems and how they evaluate a turning approach.

Even though the articles above focus on various topics, they have utilized similar methodologies. The studies by both Gunningberg et al. (2018) and Hommel et al. (2017) imply semi-structured interviews of managers, physicians, nurses, and others. The researchers have selected several appropriate professionals and made them provide answers. When it comes to the methodologies, it is rational to describe a slight difference regarding sample sizes. Hommel et al. (2017) have worked with 39 individuals, while Gunningberg et al. (2018) have chosen 50 medical professionals. This information demonstrates that the authors have utilized appropriate approaches to find answers to their research questions.

At this point, it is reasonable to comment on the articles’ limitations. Since this subtheme includes two studies with almost identical designs, one can conclude that the limitations are also similar. It relates to the fact that the two articles rely on personal interviews that result in some considerations. For example, the quality of findings directly depends on the trustworthiness of the information provided by the participants. In other words, if medical professionals fail to present credible information, the research results will imply some doubts. That is why the two articles have provided their sample sizes with convenient conditions to eliminate the effect of any biases and stimulate individuals to present trustworthy information.

Similar methodologies have resulted in similar results of the studies under consideration. According to Hommel et al. (2017), nurses believe that regular turning is an effective intervention to reduce pressure injury prevalence. Gunningberg et al. (2018), in turn, admit that nurses highly appreciate the use of pressure mapping systems to stimulate repositioning and turning of patients. These two articles have demonstrated that qualified medical professionals positively evaluate the interventions under analysis. However, further research is necessary to determine whether this positive attitude is justified. It means that further studies should assess how regular turning and pressure mapping systems influence patients’ health and pressure ulcer development.

This subtheme has demonstrated that the issue of pressure injuries gathers the attention of multiple medical professionals. They understand the importance of the problem and have some opinions concerning the current interventions to improve the situation. The two articles have revealed that nurses and other medical staff positively assess regular turning and pressure mapping systems. They admit that these actions can improve patient outcomes and help them avoid pressure ulcers. As for the current project, these conclusions demonstrate that nurses are involved in pressure ulcer prevention. However, the studies also show that these individuals are a suitable way to assess the preliminary effectiveness of various interventions. In other words, it is not reasonable to rely on nurses’ opinions to predict whether a particular strategy can minimize pressure injuries.


As has been mentioned above, nurses play a significant role in managing patients with pressure ulcers and preventing this problem. That is why different articles considered what nurses and other medical professionals thought of specific interventions. However, it is also necessary to state that nurses’ qualifications and skills can influence whether patients are at risk of having pressure injuries. The article by Woodhouse et al. (2019) addresses this topic and focuses on nurses’ training. Thus, the researchers pose the question of whether written guidance is an effective method to reduce the incidence of pressure ulcers.

To answer the question above, the researchers needed a suitable methodology. Woodhouse et al. (2019) have conducted a pre-test post-test study with twelve participants. Specific attention was drawn to ensure that the participants imply various work histories, experiences, and medical knowledge. The authors made the participants review the 30° side-lying technique guidance and asked them to reposition a healthy volunteer. After that, two nurse researchers measured turn angles using a handheld inclinometer device with a 0.5° resolution (Woodhouse et al., 2019). This fact allowed the researchers to identify whether the guidance review led to any improvements concerning a repositioning technique.

The given article has a single limitation that could influence the credibility of its results. It refers to small sample size, but Woodhouse et al. (2019) have addressed this issue. The researchers drew attention to ensure that the study participants were of various experience levels and expertise. That is why one can suppose that the following findings imply a decent reliability level. As for the results, Woodhouse et al. (2019) conclude that the guidance review increased a repositioning quality. Simultaneously, the study has demonstrated that a guide with visual manifestations of repositioning techniques is a useful way to promote nurses’ training and increase their skills. Further research is necessary to test whether the effect is the same for a larger cohort of medical professionals.


The literature review has demonstrated that pressure injuries and their prevention methods are an essential topic in the research field. The studies under consideration consider the issue from multiple sides, which allows understanding in detail how it emerges and affects older patients. Thus, the literature review has generated a single essential thought. Since many factors result in the development of pressure injuries, a comprehensive intervention is needed to address the situation and protect people from this health condition.


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