Comparing Pressure Ulcer Prevention Methods

The assignment provides a detailed analysis of two studies that investigated the effectiveness of different pressure ulcer prevention methods. The first study compared the incidence of pressure ulcers among aged patients in nursing homes who used two different repositioning regimens. The second study examined the effects of three types of mattresses on skin structure and function after loading. The assignment also discusses the benefits of a systematic approach to research, including reduced bias and increased efficiency.

Evidence Based Nursing Research
(Author’s name)
(Institutional Affiliation)

Student Name: Student Number:
Abbreviated PICO Worksheet and Search Strategy
Brief description of the problem or topic:
Bedbound patients are at a high risk of developing Pressure Injuries. Research is continuously being undertaken to find the best way of preventing
these. Two methods of preventing pressure injuries are performing regular 2hrly repositioning and turning, and the use of alternating air mattresses. AP Population/Patient/
Problem
Relative and the elderly resident
I Intervention Regular 2hrly repositioning and turning
C Control/Comparison Alternating air mattresses
O Outcomes Prevention of Acquired pressure area
Write out your question:
For elderly residents in aged care, is performing regular 2hrly repositioning and turning or the use of alternating air mattresses is more effective in the
prevention of acquired pressure area?
Identify □ Cochrane Library □ PubMed/MEDLINE □ JBI COnNECT+ (Joanna Briggs) □ CINAHL with Full Text
Keywords Search Terms Alternative terms/synonyms
P Relative and the elderly resident Next to kin, family member, residents family
I Regular 2hrly repositioning and
turning
2hrly turn,2/24 PAC, q2h PAC
C Alternating air mattresses Air mattress, hospital air bed
O Reduction in the number of
Acquired pressure area
Bed sores, Pressure ulcer, decubitus ulcers
Search filters or □ Age The elderly □ Language: English only □ Publication years <5years □ Other peer
reviewed

Running head: Evidence based nursing research 3
Bergstrom, N., Horn, S., Rapp, M., Stern, A., Barrett, R., & Watkiss, M. (2013). Turning
forUlcer ReductioN: A Multisite Randomized Clinical Trial in Nursing Homes. Journal
Of The American Geriatrics Society, 61(10), 1705-1713.
Level of Evidence: Systematic review
Justification using the 5 components
The study was conducted to determine the required frequency of positioning in nursing
homes residents who are at high risk of developing pressure ulcer when they care on high-
density foam mattresses. Different repositioning groups were used according to the repositioning
intervals which include a two-hour group, three-hour group, and four-hour group. The
participants were from the United State of America and Canada who were at the age over 65
years and at risk of developing pressure ulcers. The participants were located randomly using
skin stratification method and repositioning schedule for three weeks where blinded assessors
assessed the skin integrity weekly. The results showed that there was no significant difference of
pressure ulcers incidents in relation to different repositioning groups over the three weeks in
participants using high-density mattresses when the repositioning is done consistently and their
skin monitored.

Evidence based nursing research 4
Gillespie, B., Chaboyer, W., McInnes, E., Kent, B., Whitty, J., & Thalib, L. (2014).
Repositioning for pressure ulcer prevention in adults. Cochrane Database Of Systematic
Reviews22 (1) 108-109
Level of Evidence: Systematic review
Justification using the 5 components
The study was conducted to review the effects of repositioning to prevent pressure ulcers,
to determine the most effective method and ascertain the cost and resources necessary for
implementation. The search methods were from an electronic database where two authors
independently performed the study selection. Three systematic reviews and a study representing
502 participants from acute and chronic settings were selected. The study found that
repositioning was an important component when it comes to pressure ulcer prevention and
treatment. The reposition frequency and the positioning for ulcers prevention had great
uncertainty in terms of evaluation but did not mean that the intervention was not effective. The
evidence showed that there was no difference between the 30-degree tilt and a 90-degree stand in
relation to repositioning frequency. The repositioning using 30-degree tilt in three hours
frequency was found less costly and more effective than 90-degree tilt in every six hours.

Evidence based nursing research 5
McInnes, E., Jammali-Blasi, A., Bell-Syer, S., Dumville, J., & Cullum, N. (2012). Preventing
pressure ulcers—Are pressure-redistributing support surfaces effective? A Cochrane
systematic review and meta-analysis. International Journal Of Nursing Studies, 49(3),
345-359.
Level of Evidence: Randomized controlled trials (RCTs)
Justification using the 5 components
The study was performed by Cochrane Wound Group where randomized control trials
and quasi-randomized trials either published or non-published were assessed to show the effects
of support surfaces on pressure ulcers. The Cochrane risk of bias tool was used to compare and
summarize each setting and the methodological quality. A group of 16, 285 participants were
identified in 53 eligible trials. The analysis showed that about 95 % of participants using hospital
air form mattress had a reduce evidence of developing pressure ulcers as compared to other
normal hospital mattresses. The study concluded that there is a good evidence that higher
specification form mattress in the operative settings are highly effective in preventing pressure
ulcers. However, there was no sufficient evidence to conclude the value of the mattresses in
terms of cushions, protectors and the materials to use.
Moore, Z., Cowman, S., & Conroy, R. (2015). A randomised controlled clinical trial of
repositioning, using the 30° tilt, for the prevention of pressure ulcers. Journal Of Clinical
Nursing, 20(17-18), 2633-2644.

Evidence based nursing research 6
Level of Evidence: Randomised controlled trial (RCT)
Justification using the 5 components
A cluster randomized controlled trial was conducted to determine the incidence of
pressure ulcers among aged patients in nursing homes who were using two different
repositioning regimens. Twelve nursing homes were selected with 99 participants who were
reposition using three hourly 30-degree tilt of positioning. The second group of 114 participants
used the six hourly 90 degrees rotation and normal prevention routines for four weeks. All data
analysis was intended for the treatment of all participants. All participants were Irish and white
men were about 65% were over 80 years old. The results showed that, repositioning patients who
are a higher risk of pressure ulcers at three hourly using 30-degree tilt reduces incidences of
pressure ulcers.
Tomova-Simitchieva, T., Lichterfeld-Kottner, A., Blume-Peytavi, U., & Kottner, J. (2017).
Comparing the effects of 3 different pressure ulcer prevention support surfaces on the
structure and function of the heel and sacral skin: An exploratory cross-over trial.
International Wound Journal12 (1) 28-83.
Level of Evidence:
Justification using the 5 components
The study was conducted to measure the effects of the three types of mattresses in
relation to sacral and heel characteristics after two hours loading which include active air
mattresses, reactive gel mattresses and basic form mattresses. Fifteen healthy participants all
around sixty six years old were included. The skin surface temperatures, the extent of skin water
loss elastic function, epidermal hydration, skin roughness and recovery, as well as erythema,

Evidence based nursing research 7
were measured at preloading, at the beginning of the loading and 30 minutes post loading on the
three different mattresses. The form mattresses showed that there was the high increase in skin
temperatures, skin water loss, and erythema after loading indicating that they had higher risks of
skin occlusion and deformation. The formed group showed there was a decrease in mean
roughness which made the skin to flatten. The study concluded that the type of surface support
influences the functions and structure of the skin.
Reflection:
The systematic approach has proven to provide a more reliable data since it is obtained
from available evidence from various research questions. Based on the evidence available,
systemic approach tend to give definitive answers to particular questions about a disease,
preventions, clinical procedures and the need for certain therapeutic methods. This is because the
systematic approach is more specific about the exact search terms and resources to obtain the
data. In addition, Systematic reviews tend to minimize biases when it comes to scientific
reasoning and conclusions due to their practical advantages. Furthermore, systemic reviews
provide and identify a gap of knowledge that calls for more studies and research. Other than that,
systematic approach tends to take shorter time when doing the whole research as compared to
field work. However, systematic reviews can take longer periods where evidence is not enough.
References

Evidence based nursing research 8
Clarke, M., & Li, Y. (2014). Editorial for issue 3 of 2014, Journal of Evidence Based
Medicine. Journal Of Evidence-Based Medicine, 7(3), 153-153.
Current Research in Translational Medicine. (2016). Current Research In Translational
Medicine, 64(1), 1.
Lund, H. (2014). From evidence-based practice to evidence-based research – Reaching research-
worthy problems by applying an evidence-based approach. European Journal Of
Physiotherapy, 16(2),65-66.
The 10th International Congress on Complementary Medicine Research in 2015 (ICCMR 2015).
(2015). Integrative Medicine Research, 4(1), CO1.