NUR2300 Assignment: Evidence-Based Nursing Practice Report

This report delves into the application of evidence-based nursing practice to address the clinical issue of pressure injuries, particularly among elderly patients. The report begins by outlining the significance of pressure injuries and the need for effective interventions. A PICO question is formulated to guide the evidence search, focusing on the use of air mattresses to reduce the occurrence of pressure injuries. The methodology includes a search of the PubMed database, employing specific keywords and inclusion/exclusion criteria to identify relevant research articles. The report synthesizes the findings from five selected studies, including systematic reviews, observational studies, and randomized controlled trials, to evaluate the effectiveness of air mattresses in preventing pressure injuries. The analysis highlights the benefits of air mattresses in reducing the risk of pressure injuries and provides recommendations for practice change, such as implementing air mattresses for high-risk elderly patients. The report emphasizes the importance of continuous evaluation and further research to optimize patient outcomes and improve nursing care.

Running head: NURSING PRCATICE BASED UPON EVIDENCES
EVIDENCE BASED NURSING PRACTICE
Name of the student
Name of the university
Author note

1NURSING PRCATICE BASED UPON EVIDENCES
Outline of the clinical issues
Evidence based nursing practice is the approach that helps the healthcare
professionals to implement effective and evidence based interventions to improve patient
condition (Breimaier et al., 2015). As per Bender (2016), using evidence based practices,
healthcare professionals are able to make effective decisions and provide the patient in the
presence of operative care so that their health condition could be improved. Experimental
involvements are circumstances that help the healthcare professionals to retrospect upon their
past healthcare experience and then through their critical understanding ability draw parallels
between situations (Thomas, Jinks & Jack, 2015). In such situation, application of evidence
based practice and its five critical steps such as ask, acquire, appraise, apply, and assess help
them to find out interventions that could be used for the growth and development of the
healthcare processes.
One such critical condition that has been discussed in this evidence based paper is
associated with pressure injuries among patients admitted in the healthcare facilities (Becker
et al., 2017). Pressure injuries are critical condition, in which the patients suffer from shear,
frictions or major injuries in their skin due to their lack of movement of presence of bone
prominence under their skin surfaces (Alvarez et al., 2016). As per Järbrink et al. (2016),
pressure injury may appear to be one health complication that would be solved by the
movement or posture changes among the patients, however there are statistical data that
indicates towards the severity and complexity of this complication. As per the data collected
from the Australian Bureau of Statistics (2016) every 1 patients in 100 were seen to be
affected with critical risk of pressure injury and in such condition, and the rate was expected
to increase by 9.7% in upcoming years, due to increased population, rush at healthcare
facilities and inability of healthcare professionals to focus upon such complications for every
patient. Hence, this healthcare complication has been chosen or this analysis so that the care

2NURSING PRCATICE BASED UPON EVIDENCES
service receivers could be delivered with actual and evidence constructed nursing training for
the development of the evidence based nursing practice would be an effective process so that
interventions to decrease the risk of such patient’s risks could be identified (Järbrink et al.,
2016).
There are multiple researches that has been conducted so that all the aspects of
pressure injuries and associated complication could be addressed and the care service
achievers could also be provided with effective interventions. One such intervention is
application of air mattress among the patients so that their risk of pressure injury could be
decreased. This was the reason this intervention was chosen as the topic of this evidence
based nursing practice.
Clinical question
The clinical question that has been selected for this evidence based nursing practice
has been developed in PICO format so that accurate and appropriate research articles could
be selected from databases.
Population Intervention Comparison Outcome
Elderly Patients
affected with risk
of pressure injury
Application of air
mattresses
Not applying air
mattress
Reduces or
decreases the risk of
pressure injury
The question: In elderly patient does the use of air mattress versus no air mattress
decrease the occurrence of a pressure injury?

3NURSING PRCATICE BASED UPON EVIDENCES
Evidence search
To collect recent and latest research articles and to understand the effectiveness of the
air mattresses to overcome the risk of critical health complication associated with pressure
injuries, an evidence based practice should be conducted. In this process, scientific database
Pub Med would be selected. This database includes more than 40,000 of scientific research
articles throughout the years and hence, search keywords of selected clinical question in this
scientific database would help to identify accurate research papers. In this database, the
keywords that were used for the identification and collection of research scholarly journals,
are “pressure injury”, “air mattress”, “health improvement” and “reduced risk of pressure
injury”. Further, these key terms would be searched with Boolean operators such as AND,
OR and NOT so that through permutation and combination, accurate research articles could
be collected. Further, to sieve through accurate research scholarly journals, with several
inclusion and exclusion criteria would be applied in the evidence based search process, so
that accurate research articles could be collected and analysed to understand the effectiveness
of the process. The inclusion criteria that would be selected for this analysis is the application
of publication year 2014 to 2019, research articles with highest level of evidences, research
articles that are peer reviewed and contains proper data analysis process so that accuracy of
the intervention could be judged. Further, research articles that do not contain proper data
analysis, articles that are not full text or are descriptive, and research articles that are not peer
reviewed were eliminated from the search process. The search strategy PRISMA graph and
the search history of the database has been provided in the appendix section of this
assignment.
All the five research articles that has been selected for this analysis is inclusive of two
systematic review articles, one observational study, one cross section study, and one
randomised control study. After analysing these research articles under the NHMRC

4NURSING PRCATICE BASED UPON EVIDENCES
hierarchy of evidences it was seen that all the articles included in this research scholarly
journals, included were of evidence level 1, 2 and 3.
Literature synthesis of best evidence
The primary evidence that has been collected for the critical appraisal is the research
process conducted by McInnes et al. (2015) in which the primary aim of the researcher was to
understand the effect of the pressure-relieving support surfaces to reduce the health
complication associated with pressure injury compared to the other interventions. To identify
the effectiveness of it, the researchers conducted a systematic review and search research
articles from databases such as MEDLINE, EMBASE and CINAHL and The Cochrane
Central Register of Controlled Trials (CENTRAL).The research article included research
papers that are randomised control trail, quasi-randomised trials so that all the bias related
risks could be modified and the patient could be provided with accurate and effective
research processes. After the completion of the process, it was seen that usage of air
mattresses or alternative pressure mattresses are cost effective as well as effective
interventions that could be used by the healthcare professionals to reduce the risk of pressure
injury among the patients at post-operative process or the patient that are suffering from the
risk of postoperative pressure ulcer incidence. Further, as the paper provided a detailed and
bias free analysis of the intervention, this could be implemented in the healthcare facilities to
treat the patients and their critical health complication.
Another research article that has been selected for the analysis is the research
conducted by Sauvage et al. (2017), in which the primary aim of the researchers was to
analyse the effectiveness of the Axtair One, among the elderly patients so that they could
provide their patients with effective ability and comfort so that they could overcome their risk
of developing pressure ulcers or injuries. In this condition it should be known that Axtair One
is an air mattress or an alternating pressure air mattress which is available in viscoelastic

5NURSING PRCATICE BASED UPON EVIDENCES
foam mattress form so that the patient could be provided with effective care to overcome
their risk of pressure ulcer condition. The researchers conducted a randomised control trail
and compared this with that of the critical health complication so that they could identify the
benefit and risk of this intervention upon the patients of pressure ulcer. The future implication
of this intervention could be understood from the fact that application of this intervention
helps to decrease the risk of potential harms associated with this health condition.
The third research article that has been selected for this data synthesis is based upon
the application of air mattresses in the elderly patients living at the resident sites. As per
Sharp, Moore and McLaws (2019), it was mentioned that the healthcare professionals at
residential units has always implemented repositioning aspects to avoid the risk of pressure
ulcer. Despite that the patients has been observed to develop severe pressure related
conditions. To understand the effectiveness of the selected research aim, the researchers
conducted a cross sectional survey with the patient so that the effectiveness of the
interventions could be identified. It was seen that application of repositioning was not able to
prevent the occurrence of pressure injury of the patients and hence, it was mentioned that
application of air mattress could help the patient to prevent the risk of critical risk of pressure
injury. This research finding helped to understand and compare between two health
interventions and hence, it was seen that application of this mediation could help the patient
to overcome their risk of critical health complication. Therefore, this paper provides a
detailed analysis of the situations that could help the patient to overwhelm their critical health
difficulty related to pressure ulcers. Therefore, this was the critical health complication that
was associated with this critical condition.
The fourth research scholarly journal that has been selected for the analysis is the
research paper conducted by Meaume and Marty (2018) as per which, the primary aim of the
researcher was to comprehend the efficiency of the alternating-pressure mattress overlay

6NURSING PRCATICE BASED UPON EVIDENCES
(APMO) due to which they suffer from critical health complications associated with the
occurrence of pressure ulcer (PU). The primary aim of the paper hence decided to identify the
effectiveness of the alternating-pressure mattress overlay in decreasing the risk of pressure
ulcer among the patients that are suffering from the risk of pressure ulcers and hence, the
researchers conducted an effective prospective observational study in three of the primary
rehabilitation centres so that the with application of alternating-pressure mattress overlay in
the pressure ulcer or injury related condition could be effectively understood. The research
successfully identifies the fact that application of the alternating-pressure mattress overlay
related mattresses helps the elderly patients admitted in the care facility with interventions
that effectively reduces their risk of critical health complications. Similarly, the fifth research
article also identified effective results of dissimilar support surfaces in lessening of the
pressure ulcer related occurrences among the patients associated with critical conditions. Fir
this aspect Shi, Dumville and Cullum (2018) also conducted a systematic review so that they
could overcome the critical risk of personal bias and hence, they develop systematic review
process and identifies the aspects due to which the decision making process become difficult.
Through the analysis of 65 research articles in the process, they found that application of air
mattress or other surface related complication could help the patient to overwhelm their risk
of dangerous well-being complaint associated with pressure injury.
Therefore, all these five research articles help to understand a holistic approach of the
care interventions that could help the patient to overcome their risk of pressure injury if
applied in their healthcare process of elderly patients.
Recommendations for practice change and research
The detailed and critical analysis of the research articles that were collected and
analysed for this research article were collected from the literature search process, help to
identify the holistic aspects that would help to understand the effectiveness of the process.

7NURSING PRCATICE BASED UPON EVIDENCES
However,, thorugh the proper analysis of the aspects identified in these five articles
highlights few aspects that could be implemented in the healthcare facilities so that the
patients could overcome their serious well-being difficulties related with pressure ulcer.
These aspects could be included in the following recommendation section so that while
implementing non-therapeutic interventions for pressure injury condition, the patient should
be provided with air mattress so that their risk of pressure injury could be reduced effectively.
The first recommendation would be implementing the air mattress for the elderly
patients that are highly connected with the risk of pressure ulcers (Järbrink et al., 2016). This
help the patients to reduces their prevalence and incidence of pressure injury and they would
be able to overcome the risk factor. Further, implementation of this intervention in small
scale would help the hospital authority to understand the effectiveness of the processes
(Becker et al., 2016). The second recommendation would be helping the patient with
repositioning with the presence of air mattress so that both these therapeutic interventions
could help the patient to overcome their risk of pressure injury. Hence, through the
development of these interventions, they would help the patients to provide them comfort and
overcome their risk of pressure injuries.

8NURSING PRCATICE BASED UPON EVIDENCES
References
Alvarez, O. M., Brindle, C. T., Langemo, D., Kennedy-Evans, K. L., Krasner, D. L.,
Brennan, M. R., & Levine, J. M. (2016). The VCU Pressure Ulcer Summit. Journal
of Wound, Ostomy and Continence Nursing, 43(5), 455-463.doi;
https://doi.org/10.1097/WON.0000000000000255
Becker, D., Tozo, T. C., Batista, S. S., Mattos, A. L., Silva, M. C. B., Rigon, S., ... & Duarte,
P. A. (2017). Pressure ulcers in ICU patients: Incidence and clinical and
epidemiological features: A multicenter study in southern Brazil. Intensive and
Critical Care Nursing, 42, 55-61. Doi; https://doi.org/10.1016/j.iccn.2017.03.009
Bender, M. (2016). Conceptualizing clinical nurse leader practice: an interpretive
synthesis. Journal of Nursing Management, 24(1), E23-E31.DOI:
https://doi.org/10.1111/jonm.12285
Breimaier, H. E., Heckemann, B., Halfens, R. J., & Lohrmann, C. (2015). The Consolidated
Framework for Implementation Research (CFIR): a useful theoretical framework for
guiding and evaluating a guideline implementation process in a hospital-based nursing
practice. BMC nursing, 14(1), 43. Doi: https://doi.org/10.1186/s12912-015-0088-4
Gray, J. R., Grove, S. K., & Sutherland, S. (2016). Burns and Grove's The Practice of
Nursing Research-E-Book: Appraisal, Synthesis, and Generation of Evidence.
Elsevier Health Sciences. Retrieved from: https://books.google.co.in/books?
hl=en&lr=&id=oD_UDAAAQBAJ&oi=fnd&pg=PP1&dq=evidence+based+nursing+
practice&ots=yjY_R1pqgM&sig=NowNConZML-ZTD6CFXs5rgRPLRY
Järbrink, K., Ni, G., Sönnergren, H., Schmidtchen, A., Pang, C., Bajpai, R., & Car, J. (2016).
Prevalence and incidence of chronic wounds and related complications: a protocol for

9NURSING PRCATICE BASED UPON EVIDENCES
a systematic review. Systematic reviews, 5(1), 152. Doi;
https://doi.org/10.1186/s13643-016-0329-y
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). doi: 10.1002/14651858.CD001735
Meaume, S., & Marty, M. (2018). Pressure ulcer prevention using an alternating-pressure
mattress overlay: the MATCARP project. Journal of wound care, 27(8), 488-494. doi:
10.12968/jowc.2018.27.8.488.
Sauvage, P., Touflet, M., Pradere, C., Portalier, F., Michel, J. M., Charru, P., ...&Scherrer, B.
(2017). Pressure ulcers prevention efficacy of an alternating pressure air mattress in
elderly patients: E²MAO a randomised study. Journal of wound care, 26(6), 304-312.
doi: 10.12968/jowc.2017.26.6.304.
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. doi: 10.1007/s11673-018-9892-3
Shi, C., Dumville, J. C., & Cullum, N. (2018). Support surfaces for pressure ulcer prevention:
a network meta-analysis. PloS one, 13(2), e0192707. doi:
10.1371/journal.pone.0192707
Thomas, J., Jinks, A., & Jack, B. (2015). Finessing incivility: The professional socialisation
experiences of student nurses' first clinical placement, a grounded theory. Nurse
education today, 35(12), e4-e9. DOI: https://doi.org/10.1016/j.nedt.2015.08.022

10NURSING PRCATICE BASED UPON EVIDENCES
Appendix 1
Search history collected from Pub Med
Links to the articles
Article 1: https://www.ncbi.nlm.nih.gov/pubmed/26333288
Article 2: https://www.ncbi.nlm.nih.gov/pubmed/28598759
Article 3: https://www.ncbi.nlm.nih.gov/pubmed/30671872
Article 4: https://www.ncbi.nlm.nih.gov/pubmed/30086253
Article 5: https://www.ncbi.nlm.nih.gov/pubmed/29474359

11NURSING PRCATICE BASED UPON EVIDENCES
PRISMA diagram

Running head: NURSING PRCATICE BASED UPON EVIDENCES
Data summary table
SEARCH QUESTION/TOPIC:
Author
(s) (date)
Study Design
Question Domain
Key information Validity Check
(eg bias)
Author’s
Results/Findings
Author’s
Conclusions
Reviewer
Comments
(Your appraisal)
Evidence Source
No. ___
McInnes
et al.,
2015
Purpose:
The purpose of the
paper is to evaluate
the effectiveness of
air mattress in
reducing the
pressure injuries as
compared to the
other standard
surfaces.
Design: systematic
review
Level: 1A
Domain:pressure
injuries and its
intervention.
P:
people suffering
from pressure
injuries
I:
pressure
relieving
support surfaces
C:
standard support
surfaces
O:
low incidence
rate of pressure
injuries
The research article
is stated to be valid
as it is a systemic
review of the
randomized
controlled trials
and the finding of
the research is
accurate and
applicable.
Foam support
surfaces reduces the
risk of pressure ulcer
by causing adverse
skin changes.
Individuals who are
at the higher risk of
getting pressure
ulcer and injuries
should use
specification foam
mattresses.
The paper provides
with the information
about the
effectiveness of air
mattresses in
reducing pressure
injuries and hence
answers the PICO
question.

1NURSING PRCATICE BASED UPON EVIDENCES
Evidence Source
No. ___
Sauvage
et al.,
2017
Purpose:
The purpose of the
article is to compare
pressure air mattress
with viscoelastic
foam mattress for
the treatment of the
pressure injuries.
Design: randomised
controlled trial
Level: 1b
Domain: comparison
of the intervention
P:
Bedridden
patient over the
age group of 70
years.
I: Alternating
pressure air
mattress
C: Viscoelastic
foam mattress
O:
Reducing the
risk of pressure
ulcer.
The method used is
the paper is the
randomised control
trial, which is one
of the most
effective method
and has low bias.
Hence the paper is
considered to be
valid.
The risk of pressure
ulcer in bedridden
patient is 7.57 less if
alternating pressure
air mattress is
provided instead of
viscoelastic foam
mattress.
Alternating pressure
air mattress was is
superior to
viscoelastic foam
mattress for the
prevention of
pressure ulcer in the
elderly patients.
The article provides
a detailed answer of
the PICO question
and states that air
mattress is effective
in reducing pressure
injuries.

2NURSING PRCATICE BASED UPON EVIDENCES
Evidence Source
No. ___
Sharp,
Moore
&McLaw
s 2019
Purpose:
To determine the
effectiveness of the
pressure air mattress
over two hour
repositioning.
Design: cross
sectional survey
Level:2
Domain:pressure
injuries intervention
P: elderly
patient aged 65
years and above
I:
pressure air
mattress
C:
Two hour
repositioning.
O:
Reduced
incidence of
pressure injuries
By reviewing the
method and the
level of evidence,
it can be stated that
the soundness of
the paper is high.
The biasness of the
paper is also low
and hence is
considered to be
valid .
The findings of the
article suggests that
Two hour
repositioning is
ineffective in
preventing the
occurrence of the
pressure injuries as
compared to
pressure air mattress.
Two hour
repositioning is
effective but only for
a shorter period of
time, in order to
provide proper
treatment
alternating pressure
air mattress is
preferred over.
From the article, it is
analysed that both
air mattress and two
hour repositioning is
effective to prevent
pressure ulcers, but
the effectiveness of
pressure mattress is
more than that of the
two hour
repositioning.
GUIDE
Author (date): include all authors and date of publication
Study design: include purpose, study design , domain, and level of
evidence (LOE) using JBI
Key information: include population/patients (P), intervention (I),
comparison (C), outcomes measured (O)
Validity check: include issues with methodology, rigour, potential for bias
–eg validity, reliability
Results/Findings: include generally favourable or unfavourable,
specific outcomes of interest, estimates of experimental effect, if
appropriate
Author Conclusions: author’s interpretation of findings; include
limitations, implication for practice and research) if appropriate
Reviewer Comments: include potential for bias, weaknesses and
strengths of study design, applicability
SEARCH QUESTION/TOPIC:
Author
(s) (date)
Study Design
Question Domain
Key information Validity Check
(eg bias)
Author’s
Results/Findings
Author’s
Conclusions
Reviewer’
Comments
(Your appraisal)

3NURSING PRCATICE BASED UPON EVIDENCES
Evidence Source
No. ___
Meaume,
& Marty,
(2018)
Purpose:
The primary
objective of the
paper is to appraise
the incidence of the
pressure injuries in
the patient lying
around 15-20 hours
around a day on the
alternating-pressure
mattress overlay.
Design:
Observational study
LOE: 3
Domain: nursing
care for pressure
injuries
P:
Bedridden
patients
I:
alternating-
pressure
mattress overlay
C:
Normal beds
O:
Reduced
incidence of
pressure ulcer
Observational
study provides the
primary data which
is more accurate
and reliable that
the secondary data.
Along with that,
the method of the
paper is also of
high quality, hence
the soundness of
the paper is high
and is considered
to be valid.
The findings of the
article suggests that
in case of alternating-
pressure mattress,
patient satisfaction is
high and incidence
rate of pressure ulcer
is low.
The incidence rate of
pressure ulcer is low
in the patient who
have participated in
the research. Hence,
alternating-pressure
mattress is
recommended in
case of patient
having high risk of
infection.
The article argues
that the patient who
are at the high risk of
having pressure
ulcer such as
bedridden patient
should be provided
with alternating-
pressure mattress
instead of normal
bed.

4NURSING PRCATICE BASED UPON EVIDENCES
Evidence Source
No. ___ Shi,
Dumville,
&
Cullum,
(2018)
Purpose:
To determine the
effectiveness of
different types of
support surfaces.
Design:
Meta-analyses
Level: 1
Domain: clinical
intervention of
pressure ulcer
P:
Bedridden
patient
I:
Powered active
air-surfaces
C:
standard
hospital
surfaces.
O:
Prevention of
pressure ulcer
It is a meta-
analyses study,
which means that
the rate of biasness
is less and the level
of evidence is also
1, hence the study
is said to be valid.
The findings of the
article states that the
powered active air
surfaces and the
powered hybrid air
surfaces reduces the
rate of pressure ulcer.
Air pressure support
surfaces are more
effective as
compared to the
standard surface of
the hospital but is
less conformable
than that
The article aims to
assess the efficiency
of the different
support surfaces and
the result suggests
that the air
surfaces are more
effective.
GUIDE
Author (date): include all authors and date of publication
Study design: include purpose, study design , domain, and level of
evidence (LOE) using JBI
Key information: include population/patients (P), intervention (I),
comparison (C), outcomes measured (O)
Validity check: include issues with methodology, rigour, potential for bias
Results/Findings: include generally favourable or unfavourable,
specific outcomes of interest, estimates of experimental effect, if
appropriate
Author Conclusions: author’s interpretation of findings; include
limitations, implication for practice and research) if appropriate
Reviewer Comments: include potential for bias, weaknesses and
strengths of study design