Evidence-Based Nursing Research: Pressure Ulcer Prevention Strategies

This report presents an evidence-based nursing research study focused on the prevention of pressure ulcers, a common issue among bedridden patients. The study investigates the effectiveness of two key interventions: patient repositioning and the use of air mattresses. The research problem is defined by the damage caused by unrelieved pressure on bony prominences, leading to ulcers. The report highlights the significance of the problem, emphasizing the potential complications of pressure ulcers and the importance of identifying effective preventative measures. The research question compares the efficiency of repositioning versus air mattresses in reducing the risk of pressure ulcers, framed using a PICOT question. A detailed search strategy using PubMed database is described, including keywords, Boolean operators, and truncation. Five relevant articles are summarized, evaluating the evidence on both interventions. The discussion synthesizes the findings, suggesting that repositioning is more effective and cost-effective than air mattresses. The report also includes references and an appendix with abstracts of the selected articles.

Running Head: EVIDENCE BASED NURSING RESEARCH
EVIDENCE BASED NURSING RESEARCH
Name of the student:
Name of the university:
Author note:

1EVIDENCE BASED NURSING RESEARCH
Introduction:
Pressure ulcers or bedsore among the patients that are bedridden or is not able to move on
their own is common and frequently observed. These pressure ulcers are caused due to the
unrelieved pressure of the patient over the prominences over the bony areas. To reduce the risk
of pressure ulcers among the bedridden patient, several interventions are implied which include,
repositioning of the patient, air mattress and others (Tubaishat et al., 2018). The aim of the
discussion is to evaluate the effectiveness of the repositioning of the patient over the air mattress
in reducing the risk of the pressure ulcers in the bed ridden patient. The discussion includes, the
research problem, significance of the problem and importance of research for the particular topic
in the development of the professional knowledge and the clinical practice. In order to conduct
the research, the relevant literatures are collected with the aid of the search strategy, which is
discussed in the essay. Five relevant articles are collected from PubMed and are summarized.
The essay also includes the discussion, which states about the knowledge or understanding which
is enhanced from the review. By reviewing the five different literature, the understanding about
the research problem is also enhanced which is incorporated in the essay.
Background:
Research problem:
Pressure ulcers or the bedsores are caused due to the extra pressure posed on the bony
prominences of the patient. As the patient is not able to move on their own, the pressure exerts
on the bony areas for the long time, which damages the underlying skin and tissue, causing
pressure ulcers (Mervis & Phillips, 2019). It is not assessed or heals on time; it can turn into deep

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injury associated with swelling, pus formation, pain and can also give rise to life threatening
process such as, joints infection, cancer, cellulitis and sepsis. Hence, the research is conducted to
identify the best intervention among repositioning and air mattress that aid to reduce the risk of
the pressure ulcers
Significance:
Pressure ulcers are frequently observed among the individual who are confined to the
single place whether bed or wheel chair for a longer period of time. The pressure ulcers can
cause the change in the color of the skin, pus in the skin and swelling. The area around the ulcer
turns either cooler or warmer when touched and the areas become tender. The chances of having
pressure ulcer can be reduced by repositioning of the patient (Mervis & Phillips, 2019). The
pressure ulcer is due to excessive pressure on the bony prominences for the longer period of
time, hence the repositioning of the patient at the frequent interval such as, lifting the patient,
shifting weight at the frequent intervals, elevating the bed aid to reduce the risk pressure ulcers.
Other intervention that can be used for pressure ulcers is the application of the air mattress,
which helps in reliving the pressure. With the help of the research, the most effected intervention
out of these two interventions is selected.
Research question:
The research question revolves around the strategies that can be used to reduce the
chance of the pressure ulcers among the bed ridden patients. The two most effective
interventions to reduce the risk of pressure ulcers are the repositioning of the patients and the use
of the air mattress. The research compares the efficiency of both the intervention in reducing the
development of the pressure ulcers (Kusens, 2016).

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PICOT question:
“In an elderly bedridden patient with a high risk of pressure ulcers (P), how does
repositioning the patient (I) compared to applying air mattress (C) reduce the development of
pressure ulcer (O)?”.
Significance of the research question in the development of the professional knowledge and
the clinical practice:
As the research question revolves around the two interventions that is the application of
the air mattress and the repositioning of the patient, therefore with the help of the research the
professional knowledge regarding the strategies that can be used to reduce the pressure ulcer is
enhanced. This knowledge can be implied for the faster recovery of the patient from the ulcer or
will also aid in reducing the risk of ulcer in the bed ridden patient (Boyko, Longaker & Yang,
2018). It will help the nurse to provide appropriate intervention in providing quality care to the
patient in the future clinical practice.
Search strategy:
Databases are considered as the library from where the articles which are mostly relevant
to the research question are selected. There are several databases that can be used to collect the
literature. The database used in this essay to search literature is PubMed. PubMed is considered
as one of the most frequently used database to search for the relevant literature, as it comprises
more than 29 million references for the literature related to the biomedical field from MEDLINE,
online books and life science journal (Vinkers, Tijdink & Otte, 2015) Therefore, it is considered
as the one of the most appropriate database to collect the literature in order to answer the
research question.

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There are millions of literatures or evidence available associated with a single topic,
hence in order to search for the most relevant articles related to the research question, multiple
search strategies are used. Search strategy is termed as the strategy used in the database to get the
most relevant articles (Bramer et al., 2018) . The search strategy that is used in this essay to get
the most relevant articles is as follows:
Different key words are used such as, “pressure ulcers”, “bed sores”, “air mattress”,
“cushion”, “positioning”, “repositioning”, “reducing”, “minimizing”, “shifting”, “bed ridden”,
“patient”, “wheel chair”, “unable to move”. The key words or the combination of the key words
are used to get the most appropriate literature.
The combinations of the key words are given with the help of the Boolean operators.
Boolean operators are considered as a tool which enhances the quality of the literature search
with the help of AND, OR and NOT. It helps in broadening of the research or in narrowing of
the search (McGowan et al., 2015). The key words used for Boolean search like, “pressure
ulcers”, OR “bed sores”, AND “air mattress”, OR “cushion”, AND “positioning”, OR
“repositioning”, AND “reducing”, OR “minimizing”, AND “shifting”, AND “bed ridden”, AND
“patient”, AND “wheel chair”, OR “unable to move”.
Apart from these truncation (*) and wildcards (#) are also used to narrow down he search
by using the symbol at the after the key words such as position*, it will provide all the result
which includes, Positioning, positioned and position. The time limit for the search is set from
2014 to 2019 to get the evidence from the currently published literature.
According to the McInnes et al., (2015), pressure ulcers in the old age that have lost their
moving ability is common. In this article the researcher has conducted a Cochrane systematic

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review in order to evaluate the effectiveness of the frequent positioning in reducing the risk of
the pressure ulcer. The aim of the paper is to establish the extent to which the support such as
pressure relieving support to reduce the incidence rate of the pressure ulcer. From the result of
the article it can be concluded that the pressure relieving approach such as frequent repositioning
is more effective in reducing the risk of pressure ulcer over any other method. According to
Tayyib and Coyer (2016), positioning and repositioning schedule is considered as one of the
most effective method to reduce the risk of the pressure ulcer in the bed ridden patent. The aim
of the article is to collect the evidence of the most effective strategy to reduce bedsores by the
help of semi meta-analysis. The result states that positioning and repositioning schedule is most
effective. A cross sectional survey has been conducted by Sharp, Moore and McLaws, (2019), to
evaluate the effectiveness of the repositioning of the patient in the pressure ulcer. In order to do
that, 80 respondents over the age of 65 years are selected. The result states that repositioning the
patient for about two hours a day reduces the risk of ulcer and it can be used with pressure air
mattress. The aim of the study conducted by Woodhouse et al., (2015), is to compare the
efficiency of the repositioning with the air mattress. In order to do that, 10 respondents were
selected to compare the effect of the two interventions. From the result it can be stated that
repositioning is more cost effective as well as more effective for bedsores. A Cochrane review
has been conducted by Bradford (2016), to assess the efficiency of the repositioning in the
pressure ulcer prevention. By conducting the research, it is found that, repositioning is most
effective as well as more commonly used for the pressure ulcer as compared to air mattress.
Discussion:
By reviewing the literature related to the research question which is evaluation of the
effectiveness of the repositioning of the patient in reducing the risk of getting affected with the

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pressure ulcers or bed sores, information regarding the intervention is assessed. In the essay, the
search strategy has been implied to get the most related literature. From the above essay,
professional knowledge regarding the different interventions which is repositioning and air
mattress is gathered which helps to provide quality care to the patient, who has been suffering
from moving disability in future clinical practice.
The review helps in comparing the two interventions which is used to reduce the pressure
ulcers in the bedridden patient. After reviewing the literature, it can be stated that repositioning
is more effective than the mattress or the cushion in reducing the chances of the pressure ulcer
and is also more cost effective.

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References:
Boyko, T. V., Longaker, M. T., & Yang, G. P. (2018). Review of the current management of
pressure ulcers. Advances in wound care, 7(2), 57-67.
Bradford, N. K. (2016). Repositioning for pressure ulcer prevention in adults: a Cochrane
review. International journal of nursing practice, 22(1), 108-109.
Bramer, W. M., de Jonge, G. B., Rethlefsen, M. L., Mast, F., & Kleijnen, J. (2018). A systematic
approach to searching: an efficient and complete method to develop literature searches.
Journal of the Medical Library Association: JMLA, 106(4), 531.
Kusens, N. (2016). U.S. Patent Application No. 15/148,151.
McGowan, J., Sampson, M., Salzwedel, D. M., Cogo, E., Foerster, V., & Lefebvre, C. (2016).
PRESS peer review of electronic search strategies: 2015 guideline statement. Journal of
clinical epidemiology, 75, 40-46.
McInnes, E., Jammali‐Blasi, A., Bell‐Syer, S. E., Dumville, J. C., Middleton, V., & Cullum, N.
(2015). Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic
Reviews, (9).
Mervis, J. S., & Phillips, T. J. (2019). Pressure ulcers: prevention and management. Journal of
the American Academy of Dermatology.
Sharp, C. A., Moore, J. S. S., & McLaws, M. L. (2019). Two-Hourly Repositioning for
Prevention of Pressure Ulcers in the Elderly: Patient Safety or Elder Abuse?. Journal of
bioethical inquiry, 16(1), 17-34.

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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.
Tubaishat, A., Papanikolaou, P., Anthony, D., & Habiballah, L. (2018). Pressure ulcers
prevalence in the acute care setting: a systematic review, 2000-2015. Clinical nursing
research, 27(6), 643-659.
Vinkers, C. H., Tijdink, J. K., & Otte, W. M. (2015). Use of positive and negative words in
scientific PubMed abstracts between 1974 and 2014: retrospective analysis. Bmj, 351,
h6467.
Woodhouse, M., Worsley, P. R., Voegeli, D., Schoonhoven, L., & Bader, D. L. (2015). The
physiological response of soft tissue to periodic repositioning as a strategy for pressure
ulcer prevention. Clinical Biomechanics, 30(2), 166-174.

9EVIDENCE BASED NURSING RESEARCH
Appendix:
Author
and Date
Aim/Objective Methodolog
y
Level of
Evidence
Major Findings
McInnes
et al.,
2015
To establish the extent
to which the support
such as pressure
relieving support to
reduce the incidence
rate of the pressure
ulcer
Cochrane
systematic
review
Level 1  Pressure relieving approach
such as frequent repositioning is
more effective in reducing the
risk of pressure ulcer over any
other method
Tayyib
and
Coyer,
2016
To collect the evidence
of the most effective
strategy to reduce
bedsores
Semi
meta-
analysis
Level 2  Positioning and repositioning
schedule is more effective than
any other method.
Sharp,
Moore
and
McLaws,
2019
To evaluate the
effectiveness of the
repositioning of the
patient in the pressure
ulcer
Cross
sectional
survey
Level 1  Repositioning the patient for
about two hours a day reduces
the risk of ulcer and it can be
used with pressure air mattress
Woodhou
se et al.,
2015
To compare the
efficiency of the
repositioning with the
air mattress
Randomiz
ed control
trial
Level 1  Repositioning is more cost
effective as well as more
effective for bedsores
Bradford,
2016
To assess the
efficiency of the
repositioning in the
pressure ulcer
prevention
Cochrane
review
Level 1  Repositioning is most effective
as well as more commonly used
for the pressure ulcer as
compared to air mattress