NUR 551: EBP Question Development on Pressure Ulcer Management

This assignment focuses on developing an Evidence-Based Practice (EBP) question related to pressure ulcer prevention and management within Intensive Care Units (ICU) and trauma units. The student identifies the clinical problem of pressure ulcers, highlighting their negative consequences on patients, families, hospitals, and the economy, including increased costs and health complications. The assignment emphasizes the importance of addressing this problem to improve patient outcomes, reduce healthcare costs, and enhance the efficiency of healthcare professionals. It reviews current practices, such as patient turning and the use of alternating air mattresses. The assignment then formulates a specific EBP question, focusing on the effectiveness of five-layer silicon bordered dressings in reducing pressure ulcers in the heel and sacral regions within ICU and trauma settings, utilizing the PICO framework to define the population, intervention, comparison, and outcomes. The assignment includes references to support the arguments and evidence-based practices discussed.

Running head: EBP QUESTION DEVELOPMENT 1
EBP QUESTION DEVELOPMENT
Author’s name
Institutional Affiliation

EBP QUESTION DEVELOPMENT 2
1. What is the problem?
Despite the existence of various methods of pressure ulcer prevention, bedsores have
remained among the most clinical challenges in Intensive Care Units(ICU) and trauma units in
the hospital. Poor management of pressure ulcers has various negative consequences on the
patient and their families, hospital, general population and even at the national level(Krupp &
Monfre, 2015). One major negative effect of Pressure ulcers in patients is that it affects both
patients' psychological and physical functions in various ways. This includes decrease thought of
self-worth due to damage to self-image, pain, risks for nosocomial infections due to increased
hospitalization and disabilities(Krupp & Monfre, 2015). Chronic pressure ulcers can even affect
patients' cardiovascular and immunological functions leading to further preventable
complications(Krupp & Monfre, 2015). In addition, pressure ulcers increase cost on patients and
their families due to prolonged hospitalization, increase the cost of care at the local and national
levels as elated to high workload on nurses and physicians, long working hours and other
tangible resources used during care delivery(Call et al., 2013). A survey was conducted between
the years 1990 and 2001 concerning pressures ulcer prevalence found that the United States has
the longest large scare scale prevalence that ranges between 9.2% and 15 % as compared to
countries such as the United Kingdom and Germany(Dealey et al., 2013). Additionally, the cost
of pressure ulcer management in the United States of America is large of which it is estimated to
be around 15 billion dollars annually(Black et al., 2014). This demonstrates the magnitude of the
problem and how it is affecting the economy of the United States. Therefore, effective methods
of pressure ulcer management need to be established to combat this clinical problem.

EBP QUESTION DEVELOPMENT 3
2. Why is the problem important and relevant? What would happen if it were not
addressed?
Pressure ulcer prevention and management are significant to nurses, doctors, patients and
the nation as a whole making it the topic of interest that needs to be addressed. Effective
prevention and management of bedsores increase nurses’ and doctors’ working efficiency,
reduce workload and long working hours and promote better working conditions(Black et al.,
2014). This, in turn, increases their working moods, reduces absenteeism and promotes job
satisfaction thus enhancing the delivery of high-quality care to patients(Krupp & Monfre, 2015).
Other than that, understanding the proper management of bedsores increases nurses’ clinical
skills and advances their careers. On the other hand, prevention of pressure ulcers reduces the
cost of care to patients and hospital, promotes patients’ well-being, and reduce both related
morbidity and premature mortality rates(Krupp & Monfre, 2015). In this regard, the clinical
problem identified requires immediate attention that needs to be addressed to provide proper
management techniques that reduce the cost of care and at the same time enhancing the quality
and safe care to patients.
Failure to address this clinical challenge may lead to health care delivery problems that
affect the national economy and well-being of patients(Dealey et al., 2013). Poor pressure ulcer
management increases the cost of care that utilizes billions of money annually. This money can
be used in the development of other economically advantaged projects that can boost the
economy of the whole nation if pressure ulcers are managed effectively(Dealey et al., 2013).
Other than that, failure to address this topic will lead to increase dependency ratio due to
disabilities, a low number of active human resources, dissatisfaction among health workers and
high cost of care that will only increase poverty levels.

EBP QUESTION DEVELOPMENT 4
3. What is the current practice?
Several current prevention and management practices are used in the prevention of
pressure ulcers in hospitals. One of them includes the use of a patient turning technique(Boyko,
Longaker, & Yang, 2016). In ICU and Trauma units, patient turning is done after every two
hours to reduce the pressure at the prominent areas thus reducing the chances of patients
developing bedsores(Boyko et al., 2016). This technique is effective and has been reported to
help in many hospitals(Boyko et al., 2016). Secondly, evidence has shown that pressure ulcers
can be reduced using alternating air mattresses and surfaces that do not promote bedsores.
Finally, dressings have been proven to be an adjunct to bedsore prevention. To be specific, the
use of five-layer silicon bordered dressings has proven to be effective in the reduction of
pressure ulcers when combined with the above two pressure prevention practices(Santamaria et
al., 2013). In this regard, patients are normally dressed immediately before being admitted to the
ICU or at trauma units.
4. How was the problem identified?
(Check all that apply)
__√__Safety and risk management concerns
__√__Quality concerns
__√__Unsatisfactory patient, staff, or organizational outcomes
____Variations in practice within the setting
____Variations in practice compared to a community standard
____Current practice that has not been

EBP QUESTION DEVELOPMENT 5
5. Name each PICO component
P (population, patient or problem) = ICU and Trauma patients
I (Intervention) = use of five-layer silicon bordered dressings technique
C (comparison with other interventions) = Other interventions such as normal
dressings, patient turning and use of alternating air mattress
O (outcomes are qualitative or quantitative measures to determine the success of the
change) = At the end of the research period patient will demonstrate a significant
decrease in the number of patients with bedsores and only a few and low non-
complicated√ pressure ulcers will be seen.
6. State your EBP question.
How effective is the five-layer silicon bordered dressings technique when applied in the heal and
sacral regions in reducing pressure ulcers in the ICU and trauma units?

EBP QUESTION DEVELOPMENT 6
References.
Black, J., Clark, M., Dealey, C., Brindle, C. T., Alves, P., Santamaria, N., & Call, E. (2014).
Dressings as an adjunct to pressure ulcer prevention: Consensus panel recommendations.
International Wound Journal. https://doi.org/10.1111/iwj.12197
Boyko, T. V., Longaker, M. T., & Yang, G. P. (2016). Review of the Current Management of
Pressure Ulcers. Advances in Wound Care. https://doi.org/10.1089/wound.2016.0697
Call, E., Pedersen, J., Bill, B., Black, J., Alves, P., Brindle, C. T., … Clark, M. (2013).
Enhancing pressure ulcer prevention using wound dressings: What are the modes of action?
International Wound Journal. https://doi.org/10.1111/iwj.12123
Dealey, C., Brindle, C. T., Black, J., Alves, P., Santamaria, N., Call, E., & Clark, M. (2013).
Challenges in pressure ulcer prevention. International Wound Journal.
https://doi.org/10.1111/iwj.12107
Krupp, A. E., & Monfre, J. (2015). Pressure Ulcers in the ICU Patient: an Update on Prevention
and Treatment. Current Infectious Disease Reports. https://doi.org/10.1007/s11908-015-
0468-7
Santamaria, N., Gerdtz, M., Sage, S., Mccann, J., Freeman, A., Vassiliou, T., … Knott, J. (2013).
A randomized controlled trial of the effectiveness of soft silicone multi-layered foam
dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill
patients: The border trial. International Wound Journal,12(3), 302–308. https://doi.org/
10.1111/iwj.12101