Evidence-Based Nursing Research: A Clinical Issue and Appraisal Report

This report presents an evidence-based nursing research assignment, focusing on the clinical issue of pressure ulcer prevention. The study addresses the question of whether frequent patient repositioning helps prevent pressure ulcers, incorporating PICO elements (Problem, Intervention, Comparison, Outcome). It justifies the application of Evidence-Based Practice (EBP) in a case scenario involving a newly graduated nurse, emphasizing the importance of EBP in gathering authentic information and selecting best clinical practices. The report includes recommendations from three relevant articles, suggesting redistribution of pressure, increased nurse training, and the effectiveness of regular repositioning. Part B provides a clinical appraisal of two articles, detailing their methodologies, findings, and strengths, highlighting factors contributing to pressure ulcer development, such as immobility and spinal cord injuries, and the cost of treatment. The report concludes by synthesizing the findings and emphasizing the importance of EBP in improving patient outcomes and nursing practices within healthcare settings.

Running Head: Evidence-Based Nursing Research
EVIDENCE-BASED NURSING RESEARCH

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Table of Contents
Introduction................................................................................................................................3
Part A: Clinical issue..................................................................................................................3
Part B: Clinical appraisal............................................................................................................7
Conclusion................................................................................................................................11
Reference list............................................................................................................................12
Appendices...............................................................................................................................17

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Introduction
Evidence-based nursing practice refers to selection of best solutions to healthcare issues
based on available authentic resources regarding same issue through prolonged research
process. It is the best way to select best clinical practice for healthcare issues. In this study,
issue and related question are being formed based on provided case scenario. Importance of
answering framed question is being discussed on the basis of existing literature. Best clinical
practices related to present situation are being included as recommendations. Three articles
are being reviewed to figure out potential practices to current situation. In addition, this paper
is focusing on summarization of two articles that are related to selected issue.
Part A: Clinical issue
● Issue and question
Issue is lack of knowledge in nurses regarding importance of frequent repositioning for
preventing pressure ulcer.
Question: Does frequent repositioning of patient helps in preventing pressure ulcer?
PICO (Problem, Intervention, Comparison and Outcome) elements are present in this above
mentioned question. Here, Problems is Pressure ulcer, Intervention is frequent repositioning
of patient. In this case, comparison indicates comparison of repositioning, massaging and
other prevention measure. Expected outcome is prevention of pressure ulcer.
● Justification
a. Critical justification of application of Evidence-Based Practice process in current
situation of case study
In the provided case scenario, it can be noticed that newly graduated nurse have limited
knowledge and she is being influenced by her colleague regarding provision of care. This

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kind of practice may cause harm to the patient. As opined by Boltz et al. (2016), it is
important to consider Evidence-based Practice (EBP) in this case in order to gather proper
knowledge regarding importance of repositioning of patient to prevent pressure ulcer.
Application of EBP may provide opportunity to nurses for gathering authentic as well as
effective information regarding best clinical practices to prevent pressure ulcer in patients.
White et al. (2016) have argued that consideration of EBP helps healthcare professionals such
as nurses to provide their best care to patients. In this case, EBP practice may unveil other
alternative practices that can be considered to prevent pressure ulcer.
Searching key terms in authentic databases allow nurses to conduct secondary research in
order to collect evidence of practices related to their identified issue (Brinkhof et al. 2016). In
this given situation, the nurse has made decision based on suggestion of her colleague. This
kind of decision cause harm to patient. However, Chaboyer et al. (2017) have contradicted
that application of EBP can help this nurse to understand importance of repositioning.
Positive aspects of repositioning can be understood with consideration of available secondary
information. Previous researchers have mentioned findings of their research and this
information may enrich knowledge of concerned nurse (Black et al. 2015). In addition, nurses
may recall EBP identified in case of handling similar case in future. As argued by Sharp,
Moore & McLaws (2019), it is important for nurses to understand roles and responsibility of
them their workplace. EBP can provide clear knowledge about roles as well as responsibility
of nurses within hospitals. EBP is helpful in providing safe and healthy environment for
patients by concerned nurses within healthcare organizations.
b. Importance of answering question
Above mentioned question has been framed based on identified issue from the provided case
scenario. As mentioned by Sving et al. (2016), nurses need to take initiative to gather
information regarding cases they handle if they have limited knowledge related to the case.

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This approach may help them to select best clinical practice. It has been observed that the
concerned nurse has limited knowledge regarding repositioning. Due to this reason, she has
taken incorrect action that can cause occurrence of pressure ulcer in patient. It can be stated
after being influenced by Zhang, Sun & Yue (2015), answering this question may influence
nurses to conduct research on present situation and they may be able to gather authentic
information regarding repositioning.
Through searching of answer to this question, nurses will be able to identify alternative
practices that may support in prevention of pressure ulcer. As suggested by Hansen &
Fossum (2016), nurses need to evaluate advantages of all practices in order to select the best
one. This approach of nurses is potent to help in enriching knowledge regarding techniques to
prevent pressure ulcer in patient with spinal cord injury. In order to answer this question,
nurses will assess PICO elements of this question such as problem, intervention, comparison
of available solutions and expected outcome (Cortes et al. 2018). On another hand, they will
be able to identify gaps in their care giving practice and will be able to rectify their mistakes
in future.
● Searching databases
It is important to use authentic databases for searching EVP for present scenario to gather
authentic information (Hoviattalab et al. 2015). Databases used in searching strategies are
mentioned below,
1. CINAHL
2. PubMed
3. MEDLINE
Research limit must be set wisely for gathering authentic information (Florindez et al. 2019).
During the research current literature based on prevention of pressure ulcer have been
considered. Literature published within past 5 years has been considered while searching.

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Search terms used: Prevention of pressure ulcer, best nursing practice to prevent pressure
ulcer, importance of reposition to prevent pressure ulcer, roles and responsibilities of nurses
in prevention of pressure ulcer.
● Recommendation
Recommendation from article 1
This selected article is relevant to present case scenario as it has discussed challenges faced
by healthcare professionals in preventing pressure ulcer and potential solutions to mitigate
identified challenges (Dealey et al. 2015).
From the discussion of this article, it is recommended to redistribute pressure among all body
parts to maintain equal level of pressure in all body parts. Nurses need to spread the loads
manually to incorporate this recommendation. On another hand, nurses can use active
therapy. Active therapy refers to limiting the time period that each body part is in contact
with any kind of support. [Referred to Appendix 1]
Recommendation from article 2
This chosen journal article is relevant to this study as it has discussed perception of
experienced nurses towards prevention of pressure ulcer (Roberts et al. 2016).
As per the findings of this article, it is recommended that healthcare organizations need to
train their nurses to increase awareness regarding preventive measures of pressure ulcer.
Effective communication with nurses may help to convey information regarding prevention
of pressure ulcer. [Referred to Appendix 2]
Recommendation from article 3
This article can be considered as relevant as this paper has discussed impact of dressing on
regular basis on prevention of pressure ulcer (Black et al. 2015)
After studying the findings of this article, it is recommended that turning and repositioning
may help to reduce pressure duration on particular body part. Repositioning in every 2-3

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hours can be considered as effective standard for preventing pressure ulcer. Its approach of
nurses can effectively help in preventing pressure ulcer. [Referred to Appendix 3]
Part B: Clinical appraisal
Article 1:
Literature review: This article has different collected information regarding pressure ulcers.
This ulcers increase complication of problems and that even caused deaths (Cortes et al.
2018). Different data regarding cause of pressure ulcers are described well in literature
review portion of this article. According to data represented in this review around 60% of
pressure, ulcers are developed in chronic care units (Latimer, Chaboyer & Gillespie, 2015).
Moreover, it is also stated in the literature review that risk factor increases by 74% due to
some essential factors like immobility and alteration of patients. In the literature review, it is
also mentioned that onset of pressure ulcer not only impacts life of patients but also impacts
on quality of treatment provided by a care center. Moreover, in this part of article different
treatment of pressure ulcers are discussed that increases knowledge of readers. This includes
using conventional way of treatment and skin protectors. Moreover, benefits of using
conventional treatment and hydrocolloid dressings are also discussed in this part of study.
Method: In this article, a retrospective cohort study was carried out to gain desired objectives.
Main population of this study is adult patients with cardiovascular problem. Different data are
collected from 1461 records of patients those are aged about 18 years of age. Eligible
population is those patients who are over 18 years of age and hospitalized in intensive care
units with intact skin. Risk level is analyzed through the help of Braden scale in this research
design. Time of pressure ulcer occurrence and development are analyzed and degree of
complication is evaluated. Different socio-demographic information is collected from

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different clinical records of the care organization. For analyzing data, bivariate analysis was
performed using different tools like t-test and chi-square test.
Findings: it was found that patients who are given hydrocolloid and conventional treatment
are similar risk-prone than only conventional treatment. It can be seen that different factors
like immobility of patients and incontinence are some reasons that increase risk factor of this
problem. However, systematic evaluation of pressure ulcer through Braden scale and
implementation of cure practices can reduce complication of patients.
Article 2:
Literature review: Main theme of discussion of this study is pressure ulcers in the patients of
spinal cord injuries (Florindez et al. 2019). Annual rate of pressure ulcers among spinal cord
injuries is 20 to 31% (Jocelyn Chew et al. 2018). Annual cost of treatment ranges from
$20000 to $200000 (Noble & Sweeney, 2018). These complications arise more to medically
underserved adults and due to lack of proper assessments. Different causes are discussed well
in literature review section that can help to build a clear idea about the topic. However,
detailed information and collection of various evidences are missing in this section.
Method: Qualitative study has been adopted in this case and secondary design of study has
been framed. Main population of study is patients, who are suffering from spinal cord
injuries. Data has been collected from treatment notes and other clinical records. Analysis of
data is done by analyzing treatment notes. 25 patients are selected finally for conducting this
research. Different information like education, economic condition, age, nature of disease is
collected for conducting this research. Near about 1800 treatment notes are evaluated that are
generated from different nurses and doctors.
Findings: It has been found that different other factors like diabetes, previous history of
pressure ulcers increase risk factor of this problem among spinal cord injury patients. Other
factors like lack of knowledge of management, issues regarding supply and equipment and

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not following prescribed bed rest are other causes of pressure injuries among patients
suffering from spinal cord injuries.
Summary of articles
Article 1:
It can be seen that in article 1, different factors are analyzed and supported by collecting data
from previous research (Cortes et al. 2018). Different factors that cause pressure ulcers are
analyzed in a proper way. This is a main strength of this article because reader can achieve
detailed knowledge about the topic. Information regarding occurrence of pressure ulcers and
factors that increases severity of these injuries are discussed well and supported by data.
Pressure ulcer occurrence rate in hospitals ranges from 2.2% and 10% (Yap et al. 2016).
Annual cost of treating pressure ulcers ranges from 2.2 to 3.6 billion USD. A large group of
population was selected in this article that comprises of adults of different age groups. This is
another essential strength that has increased the chance of achieving unbiased error-free
results. In addition, different stages of pressure ulcer development are analyzed in a proper
way. Time and nature of pressure ulcer from stage 1 to stage 4 are recorded. It was found that
patients that are protected with hydrocolloid and conventional care method have same risk of
infection as patients protected with only conventional care. Moreover, infection rate in
elbows, heels are greater in patients those who are protected with hydrocolloid and
conventional care. Limitations of the study are not mentioned that can be pointed out as a
weakness of this article. In addition, ethical practice is also not mentioned in this study.
Article 2:
In this article, a qualitative analysis regarding pressure injury is done and main population
study was patients suffering from spinal cord injuries (Florindez et al. 2019). Pressure injury
is very much prevalent among patients suffering from spinal cord injuries. Collection of
detailed information about participants like nature of disease, age, and education level is

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strength of this article. Moreover, secondary study has been conducted that can help to gather
in-depth knowledge about research area. Cross-case secondary analysis has helped the
researchers to gather detailed knowledge about causes of pressure ulcers among patients who
are suffering from spinal cord injuries. Different cases are analyzed and then 25 cases are
selected by researchers. Then these 25 cases are selected for further analysis. This has helped
to gather in-depth knowledge about the study area. This can be identified as another essential
strength because different causes like history of pressure ulcers, diabetes and lifestyle can be
identified in detailed way. Different issues for pressure injuries are identified in this study,
which includes lack of elementary knowledge, not following prescribed bed rest and
immobility. Deficit in equipment and supply is another cause that is identified in this study.
However, poor literature review is a weakness of this study as detailed knowledge from
previous studies is not accumulated. Moreover, ethical way of practice is not mentioned in
this study that is another essential weakness.
Relevance of articles
These articles can be considered as essential evidence for clinical practice. It can be seen that
different factors that cause pressure ulcers are described well with the help of supporting
information. In the first article different practice for avoiding pressure, ulcers are compared
and it was found that different factors like negligence and lack of mobility are causes of
pressure ulcers. Hence, this article is relevant for gaining knowledge regarding causes of
pressure ulcer. It was seen that in spite of application of conventional and hydrocolloid care
pressure ulcers occurred. This can be avoided by mobilizing the patient every two hours.
Hence, this article can be used as evidence in order to reduce impact of pressure ulcers. Risk
of pressure ulcer is high among patients who are suffering from spinal cord injuries and
another chronic disease (Simonetti et al. 2015).

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The second article is also relevant because different causes of pressure ulcers are discussed in
this article in a detailed way. Risk of pressure ulcers increase if a patient is having diabetes
and history of this problem. However, risk factor can be reduced if proper steps like
application of treatment process using equipment and taking bed rest by following
prescription are done. Moreover, this article also suggests that rudimentary knowledge is very
essential in order to prevent this disease that occurs in a clinical setting. This factor increases
relevance of this article. In the second article, it is also mentioned that inactivity of patients is
a major cause that increases risk factor.
Conclusion
From the entire discussion of this paper, it can be concluded that application of EBP is
important to provide best quality medical support to patient. Issue has been identified from
the given case study regarding lack of knowledge in nurses regarding importance of
reposition to prevent pressure ulcer. It has been recommended that patient with spinal cord
injury must be repositioned every two hours. This clinical practice may help in prevention of
pressure ulcer in patients and hospital authorities may be able to provide healthy and safe
care to patients for their speedy recovery. Reviewing available literature based on best
practice for prevention of pressure ulcer may help concerned nurses to understand their roles
as well as responsibilities.

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Reference list
Black, J., Clark, M., Dealey, C., Brindle, C. T., Alves, P., Santamaria, N., & Call, E. (2015).
Dressings as an adjunct to pressure ulcer prevention: consensus panel
recommendations. International wound journal, 12(4), 484-488. Retrieved from:
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Boltz, M., Capezuti, E., Fulmer, T. T., & Zwicker, D. (Eds.). (2016). Evidence-based
geriatric nursing protocols for best practice. Springer Publishing Company. retrieved
from:
http://lghttp.48653.nexcesscdn.net/80223CF/springer-static/media/samplechapters/
9780826171665/mobile/9780826171665_Frontmatter.html
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. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5792240/pdf/wound.2016.0697.pdf
Brinkhof, M. W., Al-Khodairy, A., Eriks-Hoogland, I., Fekete, C., Hinrichs, T., Hund-
Georgiadis, M., ... & Reinhardt, J. D. (2016). Health conditions in people with spinal
cord injury: contemporary evidence from a population-based community survey in
Switzerland. Journal of rehabilitation medicine, 48(2), 197-209. Retrieved from:
https://www.ingentaconnect.com/content/mjl/sreh/2016/00000048/00000002/
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