The Impact of Using Pressure Mattresses in the Prevention of Pressure Ulcer in Acute Care Patients

Running head: CLINICAL QUESTION 1
The impact of using pressure mattresses in the prevention of pressure ulcer in acute care patients
Outline of Clinical Issue
Pressure ulcers are localized injuries to the skin or the underlying tissue which develops
as a combination of pressure or shear. This problem affects the patient’s wellbeing and quality of
life to the patients while at the same time the cost associated with this problem in Australian
public hospitals has been estimated to exceed AU$1.8 billion per annum (Nguyen, Chaboye, &
Whitty, 2015). Despite the existence of evidence-based approaches for the management of
pressure ulcers, there are increased cases of pressure ulcers which call for the need to assess the
barriers faced by nurses during the implementation of evidence-based pressure ulcer prevention
strategies. There are different ways that nurses use to prevent pressure ulcers but the use of a
pressure mattress has been regarded as the best strategy for preventing pressure ulcers in acute
care patients.
According to Serraes & Beeckman (2016), pressure mattresses are specifically designed
to prevent bedsores and keep the patient healthy. The design of the mattress is to increase
comfort through high-level pressure support on different body parts. The mattresses contain air
pockets that place pressure on the main pressure points of the body to reduce the development of
sores. Two types of mattresses are used in clinical settings for prevention purposes, static/
reactive mattresses, alternating or active mattresses, and hybrid or combination mattresses. The
static mattress has multiple pressure-relieving foams that allow the distribution of the patient’s
weight over the surface lowering the pressure and reducing the risk of developing sores. On the
other hand, the airflow mattress has lateral air cells redistributes the pressure when the patient
lies on a dynamic surface. This study analyses the use of pressure mattresses in relieving
pressure and the development of sores on the body by creating comfort and distribution of the
body.
Clinical Question
The impact of using pressure mattresses in the prevention of pressure ulcer in acute care patients
Population: patients admitted in acute care situations who spend most of their time in bed or
wheelchair.
Intervention: use of pressure mattress
Comparison: effectiveness of using pressure mattress to prevent pressure ulcer
Outcome: pressure mattress in the prevention of pressure ulcers
Evidence Search
The purpose of this search was to find the best articles on the topic that were done using
the systematic review method or used randomized controlled trials since these are regarded as the
best sources of evidence for the study. Randomized controlled trials offer a good level of
evidence since they entail the use of two patient groups, one is the general group and the other is
a control group that is used to measure the effects of the treatment (Bhide, Shah, & Acharya,
2018). In most cases, the participants in the study are blinded to increase the efficiency and
reduce bias in the study. On the other hand, systematic reviews offer the highest level of
evidence that is developed from a review of previous studies that have been done on the topic
(Armstrong, Hall, Doyle, & Waters, 2011). By comparing the findings from different studies,
systematic reviews offer the highest level of evidence that can be used in any study.
The initial search revealed 739 items which included all the articles that were found on
the topic this gave a wide range of materials that needed to be refined. When the filters were
advanced to include article attributes for Medline journals and open access, the search led to 309

CLINICAL QUESTION 2
articles on the topic. The refinement was further done narrowing down to only studies that dealt
with pressure ulcer prevention using mechanical forms which led to 65 studies. From these
studies, 22 studies were found on the topic which had to be reviewed one by one using their
abstract to determine the method of study which led to 7 articles that entailed the use of pressure
mattresses to prevent pressure ulcers. This has been shown in the PRISMA table in the appendix.
Literature Synthesis of Best Evidence
Malbrain, et al. (2010) study presented the importance of pressure redistribution support
surfaces to prevent pressure ulcer in critical care patients. The mechanism of the mattress allows
distribution of the body on the surface of the mattress allowing the loading and off-loading the
tissues of the body allowing body pressure to be reduced which allows the patient to feel better.
Since pressure healing only occurs when the pressure on the affected area is reduced or
eliminated, then the role of the mattress is to allow equal perfusion of the body. Meaume &
Marty (2018) study also reported that for patients lying for over 15 hours, it is important to use
support surfaces that offer the best comfort for the patient which will allow distribution of
pressure in the body. Just turning the patient regularly to prevent the accumulation of pressure, it
is important to ensure that the patient achieves maximum comfort. The design of the mattress is
to provide comfort from the specific body parts that can easily develop sores from body
pressure.
Shi, Dumville, & Cullum (2018) study reports that the use of pressure mattresses reports
a significant decrease in pressure ulcer surfaces in most patients. This is because the design of
the mattress allows the ulcers to improve by providing and balancing pressures on the surface.
The mechanism of healing is through reducing the pressure that the body exerts on the damaged
skin area. The design of the mattress is to specifically offer relief to the patient. Pressure
mattresses are designed with air cells that deflate and inflate on different parts of the body to
allow the sores to heal by themselves. This design is similar to the mechanical movement of the
patient while sleeping on the mattress which provides comfort to reduce the development of
sores. This leads to reduced pressure in body parts with less padding like shoulders, elbows,
heels, and hips. Further, Colin, et al. (2012) add that these mattresses offer a support surface that
allows and increases air circulation which prevents the development of sores. The mattress is
designed to offer quality sleep for the patient which is an important component of preventing
pressure sores. This leads to optimal immune function which addresses the response of the body
to pressure ulcers. There are different types of pressure mattresses which have all been designed
to provide comfort and relieve pressure to the patient.
According to the study by Nixon, et al. (2016) pressure mattresses offer an effective way
of preventing and treating pressure ulcers but there are different types of mattresses that exist
which require different use and patient monitoring methods. In this case, the nature of the patient
setting determines the pressure ulcer challenges that they face which requires the need for
assessing the limitations in different kinds of literature on the use of mattresses. This is because
there are different risk factors like diabetes that can exacerbate the likelihood of the patient
developing pressure ulcers. In most cases, these mattresses have been used to offer the best
comfort to the patient that allows pressure distribution and even healing of existing pressure
ulcers. This has been supported by Meaume & Marty (2018) who argued that the pressure
mattress use in clinical situations is the best way based on the findings of this study which
reported a low incidence of pressure ulcers in high-risk patients.
In addition to that Tsuchiya, et al. (2016) suggests that the selection of the pressure-
relieving mattress depends on factors like mobility, results of the skin assessment and the level of

CLINICAL QUESTION 3
the site at risk. This means that clinical settings will have different types of pressure mattresses
which can yield different results. McInnes, Jammali-Blasia, Bell-Syerb, Dumville, & Cullum
(2012) study also reported that there is a range of different low-pressure mattresses that can be
used in the treatment of pressure ulcers. This means that there is a need for further research to
determine the way these mattresses can be used to completely treat pressure ulcers. This study
reports that few studies offer evidence-based guidelines on the effectiveness of using the
pressure mattress. This is because the increasing number of patients at the risk of developing
pressure ulcers has gone up due to the varying number of patients who are admitted in clinical
settings. This is also seen in Malbrain et al. (2010) study which highlighted that despite the
preventive care being implemented, ICU patients still develop pressure injuries. The varying
nature of studies on the use of pressure mattress to prevent pressure mattress shows that they are
effective in offering support surfaces that reduce the effects of pressure on the body. The role of
the mattress is to achieve equal distribution of the body and allow airflow in specific parts that
can lead to the development of pressure ulcers.
Recommendations for practice change and research
Despite the fact the innovation of pressure mattresses offers the best therapeutic
conditions for patients who spend most of their time in one position, it is evident that there is still
a high number of patients suffering from pressure ulcers. This calls for the need for research on
the clear role that reactive support surfaces like mattresses offer. This is because different studies
have proposed different ways of preventing pressure ulcers in critical patients (Tsuchiya, et al.,
2016). This is because the level of evidence in most studies that have been done of the topic is
relatively weak which means that there are no strong assumptions on the topic that can be used to
draw specific conclusions. Thus thorough research needs to be done on a larger number of
patient populations to capture the different challenges in the implementation of the study
method.
Another issue is the limited existence of the pressure mattresses on the market, which
creates the gap of availability and affordability. In this case, most patients may lack the ability to
afford this mattress while the studies that have been done may have failed to capture varying
demographic profiles of patients. This implies that it can be easier if alternative forms of
pressure-relieving surfaces can be proposed which are easy to afford so that most patients can
benefit from the process.
Further, there are other pressure ulcer prevention methods like fluidized therapy which
are effective in reducing the sores. From the studies, McInnes, Jammali-Blasia, Bell-Syerb,
Dumville, & Cullum (2012) suggests that there is no comparison of the effectiveness of pressure
mattresses with other methods so that their effectiveness can be ranked on a scale. This implies
that even though they are effective, there is a need for proper research to adequately compare
their effectiveness with other study methods to propose the best method using an evidence-based
approach.
Malbrain, et al. (2010), Nixon, et al. (2016) and Colin, et al. (2012) studies have also
raised the need to analyze the relative merits of different interventions that relate to the use of
pressure mattresses in pressure ulcer prevention. Thus future research needs to focus on
addressing the deficiencies that are reported in the studies. Further, these studies relied heavily
on previous studies which had several limitations. Thus further research will be effective in
assessing the challenges of using pressure mattresses and how this can be addressed to improve
clinical outcomes.

CLINICAL QUESTION 4
Therefore, pressure mattresses offer an alternative way of preventing and treating
pressure ulcers among patients in critical care situations. The pressure mattress acts by relieving
the body from the pressure that it exerts on specific points that create the sores. This mattress
offers mechanical therapy options that replacing turning the patient around creating comfort to
the patient. However, there is limited literature on the effectiveness of the mattresses since most
of them are not widely available in the market. This review calls for the need for further research
to address the limitations of different studies on the topic.