Evaluation of Evidence: Preventing Pressure Injuries in Elderly Care

This report evaluates the evidence for preventing pressure injuries in elderly residents of aged care facilities, focusing on the impact of increased mobilization through walking on the reduction of pressure ulcers. The introduction highlights the prevalence of pressure injuries, the difficulties in treating them, and the importance of preventative measures. The background section discusses existing preventative strategies like repositioning and pressure mattresses, while also emphasizing the need for improved methods. The research question, framed in the PICO format, investigates whether walking for ten minutes every two hours can prevent pressure injuries. The search strategy outlines the databases (Medline and CINAHL), search terms, Boolean operators, and inclusion/exclusion criteria used to identify relevant articles. The report summarizes five selected articles, including their hierarchy of evidence and key findings, which support the use of patient repositioning to prevent bedsores in aged care residents. The discussion section reflects on the search process, challenges encountered, and limitations of the evidence, emphasizing the need for further research in specific intervention areas. The report concludes by providing a list of references used in the evaluation.

Running head: ASSESSMENT 3: EVALUATION OF EVIDENCE 1
EVALUATION OF EVIDENCE.
(Author’s name)
(Institutional Affiliation)

EVALUATION OF EVIDENCE 2
Introduction.
Pressure ulcers are highly common in aged care facilities due to the existence of risk
factors such as chronic diseases, malnutrition, and age-related issues(Sharp, Schulz Moore, &
McLaws, 2019). A pressure injury normally has features such as localize injuries underlying skin
tissues over the bony prominence areas of the body such as ankle and hip regions. Pressure
injuries commonly occur to patients who are bed-bound and thus treatment of such wounds
especially in aged patients is often difficult. One way of preventing pressure injuries in these
facilities is by increasing patients mobilization to relieve pressures at affected regions(Gillespie
et al., 2014). Patient mobilization helps to relieve pressure at affected parts of the body thus
improving the life quality of patients. Therefore, health care providers should look for more
reliable and most useful strategies that support patient mobilization specifically in aged care
residents where such interventions might be limited. This study seeks to evaluate the most
available evidence that supports how increasing mobilization in elder people through assisting
them to walk for at least ten minutes every two hours daily can help to prevent pressure injuries.
The study will include a search strategy of the various evidence and discuss how it has an impact
on understanding evidence-based practice.
Background.
For a long period, many aged care facilities are usually at risk of bedsores despite the
existence strategies such frequent repositioning at two hours and four hours intervals and use of
pressure mattress(Yap, Kennerly, Bergstrom, Hudak, & Horn, 2016). Although a good deal of
health care providers understands these risks, little has been done to change to other prevention
methods that can work. According to the study by Yap et al 2018, pressure ulcers can start
developing in patients while sitting, sleeping in one position for a long time or leaving a patient

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in any other position for a longer period. Therefore, improving mobilization to patients is an
effective intervention that can highly reduce such incidences thus improving the life and quality
of aged patients(Bergstrom et al., 2014). There are various ways in which health care providers
can improve patients mobilization in aged care facilities. The most commonly used methods
include turning of patients two-hourly in different possible positions to relieve pressure at target
areas. Evidence shows that patient repositioning reduces risks for pressure injuries development
in aged patients(Yap et al., 2018). Other methods of reducing pressure injuries include the use of
high-density form mattresses that can be combined with patient reposition to provide better
results. However, despite the use of these interventions, patients still develop bedsores and thus
better strategies need to be employed(Bergstrom et al., 2014). Walking patients for ten minutes
every two hours or at a similar time per day can highly help to improve patients mobilization
wholly and thus reliving pressures to the risk areas such as ankles, hips, and elbows. Besides, this
strategy help in improving other physical and physiological functions thus allowing the body to
function in a way there is a reduced risk for development of complete immobilization or leading
to bed-bound patients(Yap et al., 2018). In this regard, checking the best available evidence that
can prove increase mobilization of patients minimizes risks for pressure ulcers development can
help to improve clinical practice, guidelines, and recommendations that can be used to improve
health and welfare of aged care patients.
Research Question and PICO.
In elder people living in aged care facilities, could a walk for ten minutes every two hours daily
prevent the risk of pressure injuries?
P- aged patients in residential facilities.
I-Walking for ten minutes per in ever two hours per day

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C- Other bedsore prevention strategies like two-hourly repositioning.
O- Patients will demonstrate reduced risks for bedsores development.
Search Strategy.
Databases.
The search strategy for the evidence articles was performed on Medline and CINHAL databases
as they have proved to provide more reliable, accurate and evidenced-based academic journals
and research thus they will be more suitable to address the research question.
Search terms.
The search terms for this study include pressure ulcers, prevention, aged care residents/ facilities,
walking, positioning, and control.
Boolean Terms
The Boolean terms used while searching for the articles in the databases include AND, OR.
Inclusion and Exclusion Criteria
The inclusion criteria for the articles included all articles that are not more than five years old to
provide the most current evidence, journals that are only systematic reviews, meta-analysis,
clinical trials, and random control trials to provide a high hierarchy of evidence. All other articles
were excluded through the search process. In addition, only the free full-text articles were
included in the search process. Other than that, only articles related to the research question were
included. Journals from other region were included to allow the research process to be more
globally other than locally. Articles which are more than five years old were excluded from the
results as they could provide information that is out of current practice. The exclusion criteria
also excluded all articles that were irrelevant to the research question, websites articles, those
that did not have a title, authors or publication dates as they could not be validated.

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Print screen of the search strategy.
The search process was done on the internet using a personal computer and on the school library.
Data was searched on the two databases identified above. During the search process, a
combination of key terms were searched using an advanced search strategy available on the
database. Various filters like age of the articles, type of articles, region, relevancy to the search
terms and others as described in the inclusion and exclusion criteria were used in order to
produce only relevant data. Below is an example of how the search was done for some articles
using specific terms with pictures.
Use of search terms Pressure ulcers and Prevention in Medline databases
Pressure ulcers AND prevention
First, the terms were imputed into the database using the advanced search.
The results were shown as below.

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312 articles were found which fitted most of the inclusion criteria as noted in the above picture.
When a more relevant additional term was added using a Boolean term AND with AGED
CARE as an additional search term, 137 articles were shown as in the below picture.

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From the results, most relevant articles were selected for the research. Other more searches were
done on CINHAL and Medline as demonstrated by the three pictures. Additional searches were
done as examples below using Boolean terms AND, OR in the two selected database in order to
look for more results.
Example of a Search string used
1. Pressure ulcer AND prevention
2. Pressure injuries AND control
3. Aged care facilities AND pressure ulcers
4. Positioning AND pressure ulcers
5. 1 OR 2
6. 2 OR 4
7. 1 AND 3
8. 3 AND 4
Summary Table for the Five Articles selected.
Authors and year published. Hierarchy of evidence Summary
Gillespie, B. M., Chaboyer, W.
P., McInnes, E., Kent, B.,
Whitty, J. A., & Thalib, L.
(2014)
Systematic review This article aimed to review
how evidence says about
repositioning patients help in
pressure ulcers prevention in
adults. The results showed that
patient repositioning is crucial
and it has been used to prevent
bedsores in many hospitals
Yap, T. L., Kennerly, S. M.,
Bergstrom, N., Hudak, S. L.,
& Horn, S. D. (2016)
Systematic review This review was conducted to
determine a proper appropriate
model that can be used to
provide effective methods for
pressure ulcer control in long
term care.
Bergstrom, N., Horn, S. D., Random Control Trials This random control trial was

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Rapp, M., Stern, A., Barrett,
R., Watkiss, M., & Krahn, M.
(2014)
conducted to check how
frequent patients should be
repositioned to prevent
bedsores in aged care
residents.
Sharp, C. A., Schulz Moore,
J.S., & McLaws, M. L.
(2019)
Cross-sectional survey This survey was conducted to
check if two-hourly
repositioning was effective in
preventing bedsores. The study
showed that other extra
methods need to be added for
effective prevention.
Yap, T. L., Kennerly, S. M.,
Horn, S. D., Bergstrom, N.,
Datta, S., & Colon-Emeric, C.
(2018)
Random Control Trials This study was conducted to
evaluate the best methods and
precipitating factors that can
be used to prevent bedsores.
Discussion.
The above search strategy enabled me to understand how to analyze the most suitable
articles that demonstrate high levels of evidence that can be used to address the research
question. The inclusion and exclusion of criteria was the most suitable method that made it easy
for me to identify the articles to be used. However, most of the search terms like walking could
not provide relevant articles. Therefore, I came to understand that certain search terms and
literature can not be found on the databases since they have not been addressed thus creating a
gap for further studies. During the search process, various difficulties were encountered such as a
combination of words that will produce more suitable results and selecting the most suitable
articles for the research. Furthermore, various selected articles were disbanded as they could not
provide any relevant information. I had to scan almost fifteen articles by reading their abstracts
to see if they respond to the research question. This made me conclude that evidence-based

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studies are limited when it comes to various specific interventions and therefore there is a need
for health care providers to venture into more research in areas that have gaps of evidence.

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10
References.
Bergstrom, 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.
Ontario Health Technology Assessment Series.
Gillespie, B. M., Chaboyer, W. P., McInnes, E., Kent, B., Whitty, J. A., & Thalib, L. (2014).
Repositioning for pressure ulcer prevention in adults. Cochrane Database of Systematic
Reviews. https://doi.org/10.1002/14651858.CD009958.pub2
Sharp, C. A., Schulz Moore, J. 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. https://doi.org/10.1007/s11673-018-9892-3
Yap, T. L., Kennerly, S. M., Bergstrom, N., Hudak, S. L., & Horn, S. D. (2016). An evidence-
based cue-selection guide and logic model to improve pressure ulcer prevention in long-
Term care. Journal of Nursing Care Quality.
https://doi.org/10.1097/NCQ.0000000000000128
Yap, T. L., Kennerly, S. M., Horn, S. D., Bergstrom, N., Datta, S., & Colon-Emeric, C. (2018).
TEAM-UP for quality: A cluster randomized controlled trial protocol focused on
preventing pressure ulcers through repositioning frequency and precipitating factors.
BMC Geriatrics. https://doi.org/10.1186/s12877-018-0744-0