Research Critiques and PICOT Question Guidelines of Pressure Ulcers

Introduction

Problem

The phenomenon of pressure ulcers is unfortunately common in a significant portion of hospital patients. Due to immobility and the related issues, patients often suffer from pressure ulcers, which complicate the treatment process, contribute to comorbid issues and nosocomial infections, and increase the length of the hospital stay. Therefore, addressing the problem of pressure ulcers should be seen as an issue of high urgency and importance. Moreover, the introduction of pressure mapping in bedridden patients, which is viewed as the possible solution in this research, implies the need to educate nurses about the approaches to pressure mapping. Consequently, appropriate training techniques will need to be introduced into the context of healthcare.

PICOT

“In patients who are in hospital stay, what is the effect of continuous bedside pressure mapping on the incidence of hospital-acquired pressure injuries compared with repositioning every two hours within one year of implementation?”

Research Critiques

Background

In order to introduce an effective management approach for a specific healthcare issue, especially the one as complicated as the problem of pressure ulcers, a proper background must be established, with full-fledged research on the topic. Each of the studies under analysis introduces a coherent overview of the issue at hand, providing clear indications of the concern and the reasons for the introduction of an intervention.

However, some of the studies selected for the analysis have provided greater scope for the problem. Namely, the research by Hartmann et al. (2016) has introduced the opportunity to consider different frameworks of addressing pressure ulcers, pressure mapping being one of the possible solutions., Focusing on nurse education and the opportunity to teach the nursing staff to address the issue of pressure ulcers, the specified research has broadened the context of the analysis. Indeed, the issue of nurse education and the promotion of innovative solutions for preventing the appearance of pressure ulcers in patients is an important part of addressing the current scenario (). Thus, the study that sheds light on the available opportunities for teaching nurses to tend to the needs of patients with pressure ulcers, particularly, by applying proper pressure mapping techniques, contributes to the solution.

Results

The results of each of the studies considered in this review prove that the introduction of pressure mapping as the intervention suggested in the PICOT question allows for a significant improvement in the quality of care. Namely, the qualitative articles under analysis have allowed distilling five categories that could be of potential use for further analysis. These include the need for continuous coaching and education, the incorporation of pressure mapping into the list of nursing guidelines, the development of innovative practices, their ease of use, and opportunities for updating the model in the future (Gunningberg et al., 2018).

Likewise, the quantitative article written in collaboration between Gunningberg and Carli (2016) indicates that the inclusion of pressure mapping contributes vastly to the drop in the appearance of pressure ulcers in bedridden patients. Specifically, the research proves that the proposed approach based on mapping has contributed to the 59,7% increase in the knowledge score regarding the management of patients’ needs in nurses (Gunningberg & Carli, 2016). Consequently, there is reason s to believe that the introduction of pressure mapping could assist in addressing the challenges faced by patients in the hospital setting, particularly, the problem of ulcer development.

At the same time, the second quantitative article has shown that the suggested intervention may have its problems. Indeed, as the results of the study conducted by Gunningberg et al. (2017) shows that the introduction of mapping may fail unless nurses are aware of the strategies for performing the specified intervention and have the necessary skills to carry out the required steps. Therefore, the outcomes of the study prove that there is an urgent need to promote training among nurses so that they could implement mapping properly and introduce the needed assistance to patients accordingly.

Furthermore, the qualitative studies under analysis have indicated the importance of introducing techniques for reducing pressure ulcers and teaching nurses to apply the respective techniques accordingly. Namely, the issue of pressure mapping has been outlined as the available solution in the paper by Gunningberg et al. (2018). Furthermore, the study by Hartmann et al. (2016) has provided a roadmap for educating nurses about the application of appropriate frameworks, including pressure mapping, to the context of the hospital environment. As a result, the opportunity for transitioning from the theoretical perspective on pressure mapping to its practical use has been created.

Ethical Considerations

Remarkably, all four of the studies address the ethical concerns directly and unambiguously, allowing the results to remain uncompromised. The issue of patient consent has been addressed by the authors fully, which means that the outcomes of the analysis can be applied to other healthcare settings without the fear of them having been received unethically. Moreover, the concerns regarding the management of personal data have also been addressed properly, preventing the tiniest threat of data leakage. Thus, the key ethical considerations have been taken into account properly.

Conclusion

All of the four studies provide sufficiently detailed conclusions, leaving room for further analysis of the problem and creating options for improvements in the current level of healthcare quality. Specifically, the outcomes of the analysis in each case indicate strongly that the incorporation of the approaches based on pressure mapping into the hospital setting will allow reducing the extent of pressure ulcers development in patients. Overall, every study is linked directly to the PICOT question established above in a very specific and objectively direct way.

While one of the papers has demonstrated that the pressure mapping approach may fail in certain contexts where nurse education rates are low, the general focus on pressure mapping as the substitute for the current framework appears to be promising. Furthermore, some of the studies, such as the one by Hartmann et al. (2016), detail the need to introduce training options for nurses so that pressure mapping strategies could be applied effectively in the target context. Therefore, the overview of the existing research of the subject matter points to the end to incorporate pressure mapping into the current set of standards for handling pressure ulcer issues.

Application to Practice

In the context of the practical use of the articles mentioned above, it is crucial to establish that the outcomes of the articles inform the strategies that can potentially be used to manage the health issue of bedside pressure mapping. Indeed, looking closer at the reviewed studies, one will recognize the fact that each of the articles contributes to the improvement of the current practices. Moreover, most of the studies clearly agree that the current bedside approach, namely, the use of bedside mapping, could use major adjustments due to the lack of efficacy. Namely, the incorporation of the strategies based on the principles of pressure mapping has been proven by Gunningberg et al. (2017)to produce an especially positive effect on bedridden patients, which is why the reason for introducing the proposed intervention into the nursing practice has been located successfully.

Moreover, the research by Gunningberg et al. (2017) has demonstrated that the necessity to incorporate nurse training into the practice of reducing the propensity toward pressure ulcers in patients is critical. Therefore, the quantitative studies under analysis have provided the direction in which further research of the subject matter should develop, namely, the creation of instructions to which staff members could adhere. Thus, gradual improvement in patient outcomes and a rapid increase in the nurse performance efficacy is expected to be observed in the target setting.

In turn, the qualitative articles mentioned above have also given further impetus for the management of the issue of pressure ulcers. Addressing the PICOT question by considering the possibilities that the inclusion of pressure mapping offers in terms of addressing pressure ulcers, both articles indicate that there is a lack of effective strategies against pressure ulcers in the inpatient context, which is why the emphasis should be placed on their prevention in the specified setting. In addition, the studies point to the positive responses toward bedside mapping in both patients, thus proving that the described approach has a tangible potential in the hospital context. Moreover, the qualitative research in question also indicates that the use of bedside mapping will require developing new skills in nurses since most of the nursing staff tends to respond rather ambivalently toward the proposed solution. Therefore, the articles at hand provide extensive information for further evidence-based practice in the healthcare environment, as well as the management of the clinical issue at hand. By integrating the principles of bedside mapping and teaching nurses to apply to the hospital context, one will be able to improve the existing nursing practice to a significant degree.

References

Gunningberg, L., Bååth, C., & Sving, E. (2018). Staff’s perceptions of a pressure mapping system to prevent pressure injuries in a hospital ward: A qualitative study. Journal of Nursing Management, 26(2), 140-147.

Gunningberg, L., & Carli, C. (2016). Reduced pressure for fewer pressure ulcers: Can real‐time feedback of interface pressure optimize repositioning in bed? International Wound Journal, 13(5), 774-779.

Gunningberg, L., Sedin, I. M., Andersson, S., & Pingel, R. (2017). Pressure mapping to prevent pressure ulcers in a hospital setting: A pragmatic randomized controlled trial. International Journal of Nursing Studies, 72, 53-59.

Hartmann, C. W., Solomon, J., Palmer, J. A., & Lukas, C. V. (2016). Contextual facilitators of and barriers to nursing home pressure ulcer prevention. Advances in Skin & Wound Care, 29(5), 226.