Evidence-Based Practice for Repositioning in Pressure Ulcer Prevention

Part – A
Introduction
The pressure ulcer management across the health care settings proves highly
problematic for professional nurses, particularly during the post-operative phase across the
surgical ward. The assessment by (Wong, Amin, & Dumville, 2016) considers repositioning
as a recommended pressure-relieving measure that substantially reduces the risk of the
patient’s pressure ulcer in the inpatient and surgical wards. Contrarily, the study by prioritizes
air mattress over two-hourly repositioning measure in the context of reducing the risk of
pressure ulcers for the admitted patients (Sharp, Schulz Moore, & McLaws, 2019). The
systematic analysis by Gillespie, et al. (2014) reveals the patient repositioning measures at
90º and 30º tilts as the standard conventions warranted to minimize the frequency of pressure
ulcers in bed-confined patients. Repositioning measures are widely utilized in clinical
practice; however, the repositioning frequency remains debatable unsubstantiated in the
context of evidence-based clinical literature. Physical inactivity and immobility are the
precursors of patients’ pressure ulcers in hospital settings (Bhattacharya & Mishra, 2015).
The pressure sores include non-blanching erythematous patches and blisters or decubitus
ulcers that develop under the impact of sustained pressure over the skin and resultant
reduction in tissue oxygen tension. These outcomes necessitate the patients’ repositioning
with the core objective of minimizing oxygen tension across the immobile skin locations.
Furthermore, patients’ age, physical activity level, gender, bed-confinement/immobility level,
and disease type determine their repositioning frequency in the hospital setting (Latimer,
Chaboyer, & Gillespie, 2015). These outcomes reveal substantial evidence-based gaps related
to the standardized patient repositioning and eventual pressure ulcer reduction in the patients
of various age groups and disease conditions. Accordingly, the presented paper thoroughly
explores EVB (evidence-based practice) process in the context of determining the true
essence of the patients’ repositioning for their pressure ulcer reduction in the hospital setting.
The critical appraisal of the selected evidence-based articles is based on evaluating pressure
injury development causes in patients affected with spinal cord injury and the impact of
hydrocolloid dressings utilization for pressure ulcer frequency reduction in the health care
settings.
Clinical Issue

The most critical issue in the presented case study is based on the pressure ulcer
prevention through 2-hourly patient repositioning measure in the surgical ward or another
inpatient unit. The following PICO question effectively addresses the pressure ulcer
prevention concern for the admitted patients.
P: Surgically intervened/bed-confined/immobile/physically less active/inactive/admitted
patients across surgical wards or inpatient settings
I: 2-hourly repositioning
C: Absence of repositioning
O: Pressure ulcer prevention
PICO Question: Does 2-hourly repositioning of surgically
intervened/bed-confined/immobile/physically less active/inactive hospitalized patients reduce
their frequency of decubitus/pressure ulcers to a greater extent than the pressure ulcer
frequency of the patients who do not receive repositioning support from professional nurses?
Databases Utilized During Search Strategy
The search approach effectively utilized three databases including CINAHL
(EBSCO_Health, 2019), Cochrane database of systematic reviews (Cochrane_Library, 2019),
and PubMed/Medline (PubMed.Gov, 2019), in the context of exploring relevant articles
related to the relevance of 2-hourly repositioning in pressure ulcer reduction.
Search Limits
The search limits were based on the articles’ publication dates between 01-Jan-2007
to 31-Dec-2014. The content type included systematic reviews and randomized controlled
trials.
Search Terms
The following search terms were categorically utilized in accordance with the selected
PICO question.
1. Repositioning
2. Pressure ulcers
3. Decubitus ulcers
4. Pressure ulcer prevention

5. Regular turning
6. 2-hourly repositioning
7. 3-hourly repositioning
8. 4-hourly repositioning
9. Pressure ulcer lesions
The evidence-based search strategies in the presented context retrieved the following
three articles related to patients’ repositioning and a corresponding reduction in pressure ulcer
frequency.
Reddy, M. (2011). Pressure ulcers. BMJ Clin Evid, 1-43. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3217823/
Article Relevance
The systematic review by (Reddy, 2011) is substantially relevant to the answerable
question since its systematic review provides the safety and effectiveness of regular
turning/repositioning intervention in the context of minimizing the frequency of pressure
ulcers in hospital patients affected with a poor skin condition and reduced immobility.
Practice Recommendations
The systematic review by (Reddy, 2011) does not recommend any standard
repositioning regimen in the context of preventing decubitus ulcer progression in hospitalized
patients. The study outcomes provide weak evidence in relation to the pressure ulcer
prevention capacity of 90degree supine/lateral and 30degree tilt repositioning approaches for
elderly patients in the hospital setting. The findings of the systematic review do not provide
substantial evidence related to the effectiveness of the patient repositioning interventions as
compared to the standard ulcer prevention strategies across the clinical practice environment.
However, the study outcomes substantiate the need for further investigation in the context of
evaluating the effectiveness of the patient repositioning with other standard approaches
(including surgery, low-pressure supports, topical medication, pressure relieving surfaces,
and foam mattresses) for pressure ulcer prevention. The study outcomes do not
fundamentally support the sole administration of 2-hourly patient repositioning interventions
for pressure ulcer prevention inside the hospital setting.
Bergstrorm, N., Horn, S. D., Rapp, M., Stern, A., Barrett, R., Watkiss, M., & Krahn, M. (2014).
Preventing Pressure Ulcers: A Multisite Randomized Controlled Trial in Nursing Homes.