Week 10 Assignment: Article Critique: Prevention of Pressure Ulcers/ Injuries

Week 10 Assignment: Article Critique: Prevention of Pressure Ulcers/ Injuries

Week 10 Assignment: Article Critique: Prevention of Pressure Ulcers/ Injuries

A brief, 1- to 2-paragraph overview of the study that you selected. (Topic: Hospital Acquired Pressure Injury Prevention)
An explanation of two to three strengths of the study and support for your selection (i.e., why is this a strength). Be specific.
An explanation of 2–3 weaknesses of the study and support for your selection (i.e., why is this a weakness). Be specific.
Note: The strengths and weaknesses that you identified should be in relation to design, sampling, data collection, statistical analysis, results, and discussion of the study that you selected.

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An explanation of proposed changes you would recommend to improve the quality of the study, capitalizing on the strengths and improving on the weaknesses that you identified in the study. Be specific and provide examples.
A final summary of the implications of this study for nursing practice.
Consider the research design used in your selected article. Ask yourself the following questions:
Is the design appropriate for the study? Why or why not?
Would a different design provide better results? Why or why not?

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Article Critique: Prevention of Pressure Ulcers/ Injuries

            Pressure injuries in the hospital setting are a quality improvement matter and their occurrence has to be prevented at all costs. When pressure injuries occur, the implication for the provider is that the nursing care offered at the facility is not up to standard and that is why the pressure ulcers have occurred in the first place. Pressure ulcers occur to patients that do not have enough mobility and are bed-ridden. Examples of these patients are those that are critically ill and are in intensive care units (Ahtiala et al., 2018; Ayello, n.d.). As such pressure injuries are a prevalent worry among patients who have been in the hospital for a long time, and they disproportionately impact the elderly. The ensuing bed sores are a hospital quality issue that must be addressed in order to improve patient outcomes. When a bedridden patient is not shifted periodically, sustained pressure on bony prominences inhibits blood flow to the afflicted areas. This might cause the sufferer a great deal of agony and anguish (Gaspar et al., 2019). As stated above, nurses must therefore identify patients who are at risk for pressure injuries and prevent them as soon as possible to avoid complications. In this, their attitude matters a lot (Etafa et al., 2018). In order to make sure that pressure ulcers do not occur nurses carry out pressure ulcer risk assessment and put in place evidence-based strategies that have scholarly support for efficacy in preventing the occurrence of the injuries (Melnyk & Fineout-Overholt, 2019). The purpose of this paper is to choose an article that addresses the prevention of pressure ulcers and critique it in its methodology, sampling, and overall validity and reliability.

Overview of the Study Selected

            The study selected for this critique is a systematic review on the effectiveness on hospital-acquired pressure ulcers prevention by Gaspar et al. (2019). The unavoidable increase in the expense of treatment and hospitalization caused by pressure ulcers that do not heal rapidly is one of the most noticeable difficulties linked with pressure ulcers. The dilemma puts clinicians’ ability to adapt their practices to the ever-changing care environment to give proper care to patients who are both at risk of pressure injuries and have previously been subjected to corresponding ulcers to the test (Gaspar et al., 2019). To put it another way, health professionals must transition from standard practice to evidence-based practice, or EBP. As a result, one of the most pressing issues facing the health-care business in general and the nursing profession in particular is how to prevent pressure injuries and its more severe sequelae. Different clinical contexts generate a wide range of pressure injury epidemiology choices, making it more difficult to generalize previous findings and identify the best treatments for preventing ulcer-related problems.

            The study by Gaspar et al. (2019) is a level I evidence study because it is a systematic review of other studies. It entailed a detailed analysis of research published between 2009 and 2018 (systematic review). Articles published in English, Portuguese, French, and Spanish met the inclusion criteria. The evaluation also includes studies on the occurrence of pressure injuries. The total number of publications reviewed in the final sample was 26. Following the application of filtering algorithms, these were the final highly specialized articles picked. A preliminary search of research databases turned up 258 papers on pressure ulcers and their prevention in the hospital setting.

            The study’s independent variable was preventative measures, while the dependent variable was the occurrence of pressure injuries. There was no explicit conceptual framework in place for the investigation. This was implied, and it was that there are evidence-based, practical procedures or treatments that may be used to prevent pressure ulcers. Randomized controlled trials, or RCTs (n = 6) were the most prevalent study design among the articles chosen and examined. Staff education, the use of support structures, and positioning with early mobilization of the bed-ridden patient were shown to be the most common evidence-based therapies. Prophylactic dressings, repositioning and early mobilization, skin care, firm support surfaces, using risk assessment tools like the Braden scale, and staff education and training are all evidence-based approaches for preventing pressure injuries. This is according to Gaspar et al. (2019), Ness et al. (2018), and Tayyib and Coyer (2016).

Strengths of the Study

            This study by Gaspar et al. (2019) had a number of strengths. The first of these is that it is a systematic review, a fact that places it at the top of the pyramid of evidence in terms of value. In the hierarchy of evidence, systematic reviews and meta-analyses as well as randomized controlled trials are the topmost studies that provide the highest level of evidence to support particular interventions. This is derived from the fact that a systematic review benefits from the fact that the various studies are primary studies and have been conducted in various geographical areas with different methodologies. If like in this study by Gaspar et al. (2019) there is geographical inclusion, he result of the systematic review is even better representative since different parts of the world have been represented. Again, if majority of the reviewed studies are randomized controlled trials as in the case of this article by Gaspar et al. (2019); then the evidence is the highest possible. RCTs are experimental in nature and are the best for establishing causality anywhere.

            The other strength of the study by Gaspar et al. (2019) as alluded to above is that majority of the n=26 studies systematically reviewed were randomized controlled trials. It has been established that their exact number was n=6. Randomized controlled trials on their own are part of the studies that have the highest evidentiary value at level I of evidence. If therefore a systematic review is done of studies that are already level I then the evidence that results has very high value and accuracy. That Gaspar et al. (2019) chose to have or include more RCTs is therefore one of the most significant strengths of this study compared to any others.

            The third and last strength of this study by Gaspar et al. (2019) is the fact that in its inclusion criteria it considered geographical inclusion. Assuming that only studies that were published in English were to be included, the systematic review would have only reflected the situation as it is with regard to pressure ulcers in English-speaking countries. This would have meant that the findings are biased towards the United States, Australia, and the United Kingdom. The inclusion of studies that were published in French, Spanish, and Portuguese means that the results and findings of this particular study by Gaspar et al. (2019) are valid and representative. They can then be generalizable without having to worry about them being skewed.

Weaknesses of the Study

            Like every other study, the study by Gaspar et al. (2019) also has a few weaknesses. There is no study that is 100% strong and that does not have any flaw. One of the identified weaknesses of this systematic review is that its sample of studies that were reviewed is quite small. As stated above, these were only n=26. If the sample had been a little bit larger of say n=45; the strength of the results would have been even greater. A lager sample size is always associated with better reliable and valid results in research. Of importance also to note on this point is that of this small sample, only n=6 articles were about randomized controlled trials (RCTs). That leaves a whole n=20 articles that were not RCTs. This huge difference in methodology of the articles that were reviewed in this systematic review means that there is a possibility that the outcome of the review was diluted by the lack of sufficient numbers of RCTs addressing the matter of pressure injury prevention in healthcare settings.

            The other weakness that has been identified for this systematic review by Gaspar et al. (2019) is the fact that the inclusion criteria was for studies that were published within the previous 10 years. With the speed at which scholarly evidence is being published, including studies that were published ten years before means that inevitably obsolete material or evidence will be included in the systematic review. The best that could have happened was for the authors and researchers to decide to search widely but only for articles that were published within the past five years. A five-year period is a reasonable space of time during which a change in evidence cannot make a very big difference. This reasoning is taken from the fact that after new evidence is presented or recommended by the various dissemination methods, it takes time for translation into practice to occur. A five year period is therefore enough for this process such that if some other evidence emerges it will be incorporated without running the risk of using obsolete information.

Proposed Changes to Improve the Quality of the Study

            Some of the proposed changes that I would recommend for the improvement of the quality of the study by Gaspar et al. (2019) are:

• To include more randomized controlled trials (RCTs) in the final sample of the studies that have met the inclusion criteria and that will be reviewed systematically. The reason for this has already been explained above in that RCTs are themselves level I articles. For this reason, including them makes the evidentiary value of the systematic review stronger.
• To make the sample larger by including more studies, preferably RCTs. Bigger samples give room for better validity and reliability. This would have been the case with Gaspar et al. (2019).
• To include for review only those studies that were published within the last five years. This is to avoid the unfortunate event in which information and evidence that is obsolete is incorporated into the systematic review. This would be very misleading and will have consequences on practice and patient safety.

Implications of the Study for Nursing Practice

            To summarize the implications of the systematic review by Gaspar et al. (2019) for nursing practice; it would be safe to say that these are significant. First, the problem of pressure sores is still a global healthcare quality phenomenon. Implementing the recommendations for prevention would therefore ensure that patients save on the cost of hospitalization and morbidity and mortality rates are reduced. The other implication that is important is that when nurses practice in an environment in which outcomes are good, they get motivated and experience better job satisfaction. Reducing pressure ulcers will thus in itself help improve quality further by having happy and motivated nurses who are eager to work. The study design of a systematic review was very appropriate. The reason is that this is he design that gives the highest level of evidence at level I on the pyramid of evidence. There is no other design that would have provided better results except RCTs. However, these have already been incorporated into the review.

Conclusion

            The article by Gaspar et al. (2019) is a systematic review that also incorporates RCTs. It is a good article that has more advantages than it has flaws. For this reason, it is recommended to guide practice since the evidence-based measures recommended in it for the prevention of pressure ulcers are valid and effective. 

References

Ahtiala, M., Soppi, E., & Tallgren, M. (2018). Specific risk factors for pressure ulcer development in adult critical care patients: A retrospective cohort study. EWMA Journal, 19(1), 35–42

Ayello, E.A. (n.d.). Using pressure ulcer risk assessment tools in care planning. Agency for Healthcare Research and Quality (AHRQ). https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/pressure_ulcer_prevention/webinars/webinar5_pu_riskassesst-tools.pdf

Etafa, W., Argaw, Z., Gemechu, E., & Melese, B. (2018). Nurses’ attitude and perceived barriers to pressure ulcer prevention. BMC Nursing, 17(1), 14. https://doi.org/10.1186/s12912-018-0282-2

Gaspar, S., Peralta, M., Marques, A., Budri, A., & Gaspar de Matos, M. (2019). Effectiveness on hospital-acquired pressure ulcers prevention: A systematic review. International Wound Journal, 16(5), 1087-1102. http://dx.doi.org/10.1111/iwj.13147

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4^th ed. Wolters Kluwer.

Ness, S. J., Hickling, D. F., Bell, J. J., & Collins, P. F. (2018). The pressures of obesity: The relationship between obesity, malnutrition and pressure injuries in hospital inpatients. Clinical Nutrition, 37(5), 1569–1574. https://doi-org.ezp.waldenulibrary.org/10.1016/j.clnu.2017.08.014

Tayyib, N., & Coyer, F. (2016). Effectiveness of pressure ulcer prevention strategies for adult patients in intensive care units: A systematic review. Worldviews on Evidence-Based Nursing, 13(6), 432–444. https://doi-org.ezp.waldenulibrary.org/10.1111/wvn.12177