HNN021 Nursing: Annotated Bibliography on Pressure Injury Prevention

This annotated bibliography evaluates three research articles focusing on interventions to prevent pressure injuries (PI) in hospital settings. The review highlights the effectiveness of specialty linens in reducing PI rates, particularly in high-risk intensive care patients, and emphasizes the importance of evidence-based practice in nursing. It contrasts the limited effectiveness of repositioning systems with the comprehensive approach of using care bundles combined with active surveillance. The bibliography concludes that while specialty linens and care bundles show promise, adherence to care bundle elements and cost considerations are crucial for successful implementation in clinical practice. Desklib offers a variety of study tools and resources to support students in understanding and applying these concepts.

Running head: ANNOTATED BIBIOLOGRAPHY
Annotated bibliography
Name of the student:
Student no.:
Word count:

1ANNOTATED BIBLIOGRAPHY
Annotated bibliography
1. Annotated bibliography for first article
Aim: The main aim of the research by Knibbe et al. (2018) was to assess the operational
feasibility of using repositioning system in reducing reduce pressure ulcer in immobilized bed
ridden patients.
Study design: Research was done in two Flemish nursing homes using case-series based study
design. Reposition system was fixed in six beds for four months and a randomized rotation
schedule was used as a strategy to ensure that all nurse experienced the system for 4 weeks. The
compliance with the individual repositioning protocol was judged based on international
guidelines. Training was also given to staffs in the setting regarding the use of repositioning
system. To ensure optimum data quality, all staffs were explained about data collection process
and a researcher was recruited to monitor data collection activities.
Setting: Two Flemish nursing homes were the setting for the study
Sample: The number of patients participating in the study was 13 and the median age was 86
years. Total sample size was 35,
Results: Assessment of skin condition of patient was done twice a week and it was found that
repositioning system resulted in no changes in skin problem. No incidence of reduction skin
problems or new issues of skin problem was found. The main reason behind this is that all areas
of high bed-skin interface were relieved due to regular positioning. Risk assessment of patient
using the Braden scale revealed that 10 out of 13 patients were at risk of developing pressure

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ulcer and four were diagnosed with pressure ulcer prior to the research. The study showed that
single intervention like repositioning system is not effective in preventing pressure ulcer.

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2. Annotated bibliography for second article:
Aim: The aim of the study Freeman et al. (2017) was to investigate about the effectiveness of
speciality linens on controlling pressure injury rates in high risk patients. The specialty linen was
made up of a fabric that addressed the microclimate around the patient.
Study design: By the use of retrospective analysis method, the effect of speciality linen on 24
beds in cardiovascular intensive care unit (CVICU) and 20 beds in surgical intensive care unit
(SICU) was assessed.
Setting: The 24- bed CVICU and a 20-bd SICU unit were the main research setting. After giving
education to staffs regarding the use of the speciality linens, the effect of specialty linen on unit-
acquired pressure injuries was evaluated by the review of patient charts admitted to both units
from April 2014 to October 2015. Excel spreadsheet gave information about the key variables
measured which included patient history, patient demographics and pressure injury assessment
outcome.
Sample: As two different setting was used, the samples in both setting differed. Patient with
vascular, cardiac and thoracic adult patients were found in CVICU and had patients with
extensive nose, ear or throat surgery, kidney and liver transplants, and other urologic operations
were admitted in SICU.
Key findings: The study revealed reduction in pressure injury rates evidence by a decrease in
rate from 7.7% before the intervention to 5.3% after the intervention. This data was the
combined outcome for both the units. The analysis of the two units was done separately too.
Review of rates for SICUs revealed the use of specialty liner was accompanied with a decrease
in total unit-acquired pressure injuries from 7.52% to 4.74%. In case of CVICU, total acquired

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rate reduced from 7.96% to 6.03%. The study proved speciality linen as an effective intervention
in the prevention and management of pressure injuries in clinical setting. However, to ensure
application in real setting, the effect of the intervention should be evaluated in other settings also.

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3. Annotated bibliography for the article by Frank et al. (2017):
Aim: Frank et al. (2017) aimed to investigate about the effectiveness of active surveillance and
prevention bundle on reducing pressure injury (PI) rates in a pediatric hospital.
Research design: The PI prevention bundle included five elements and it was implemented in
selected hospitals that came under the SPS network. All participating hospital had to apply the
bundle to high-risk patients. Bundle compliance was defined by completion of all the 5 elements
of the bundle. Three step approach was used to identify and prevent PI which included
conducting active surveillance, implementation of the PI prevention bundle and deployment of a
wound ostomy team. Severe pressure injuries, deep tissue injuries and pressure injuries were the
primary outcome that was measured after the intervention. In addition, Email based survey was
also conducted to judge the compliance rate for each hospital and the hospital unit which
achieved maximum compliance rate.
Setting: 33 children’s hospital selected by SPS Learning Network was the main sample setting
Sample: The sample for the study included paediatrics patients and staffs at the selected
hospital.
Results/findings: Some of the important results coming from the study was that implementation
of the PI bundle was associated with increase in stage 2 pressure injuries, decrease in stage 3
pressure injuries and reduction in stage 4 injuries. Reduction in rate of deep tissue injuries was
also observed. Relation was also found between rate of PI and adherence to the recommended
bundle elements. The participant group achieving highest bundle compliance rate were found to
have the lowest PI rate. The study revealed that use of bundle is effective in reducing progression

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of PI to more severe injuries. The combination of PI bundle along with active surveillance helped
in achieving desired results for patients suffering from PI.

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Implications for nursing practice:
As the incidence of pressure injuries (PI) creates additional burden for patients and staffs,
annotated bibliography of three research journal article was done to evaluate intervention to
prevent PI hospitals. From the review of the summary of three journal articles, many important
findings has been obtained that may inform clinical practice. The significance of the findings of
Freeman et al. (2017) is that it proved the utility of using specialty linens in preventing PI. The
reliability of the intervention is further enhanced by the fact that intervention was implemented
on high risk patients in the intensive care unit. As PI rate declined significantly in high risk
people, future nursing staffs can consider using this preventive method in clinical setting.
Nursing staff can be educated or informed about the benefits of using specialty linens while
caring for patients with PI. The main advantage of speciality linen is that it affects the extrinsic
factor like microclimate surrounding patient to reduce PI rate. This knowledge might facilitate
increased us of specialty linen to promote health of those people who are at high risk of PI.
However, the use of only single intervention of speciality linens is not effective as the specialty
linen did not reduced all posterior PIs.
All nurses have the professional obligation to utilize the principles of evidence based
practice to provide high quality care. To ensure that the best evidence in applied in practice,
comparison of the result with other study is necessry to identify reliability of the research articles
(Ellis, 2016). The reliability of the findings given Freeman et al. (2017) is understood from the
fact that other evidence also exist that reports about similar findings for the utility of specialty
linen to treat PI. A randomized controlled trial investigating about the impact of silk like fabric
compared to standard hospital linens of pressure ulcer revealed that use of silk like fabric
technology can reduce the burden of PI (Coladonato et al., 2015). Hence, nursing practice get the

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advantage of applying the intervention in high-risk patients to control PI rate. Several techniques
can be used to disseminate the posiive effect of intervention to nursing staffs such as via radio
announcement Integrative review on nursing strategies to prevent PO also revealed the positive
effect of the fabric on treatment of PI (Benevides et al., 2012). Therefore, nurses can use the
second article to find best preventive steps to control and reduce rate of PI. However, cost
involved in implementing the intervention might be one of the barriers to implementation of the
intervention and this must be considered by hospital administrator or managers.
After conducting annotated bibliography of the three research papers, the research article
by Knibbe et al. (2018) has been found to be of little relevance to nursing practice because the
use of repositioning system was not effective in reducing PI. The sample size of the study was
small and the evidence is not found effective in informing nursing practice. In contrast, study by
Frank et al. (2017) is considered the most useful preventive measure as it includes all actions that
can prevent PI. The use of care bundle with active surveillance includes all elements that is
necessary to prevent PI. This evidence would inform nurse about the best practice steps to
maintain health and promote recovery of patient with PI. However, adherence to the care bundle
is one factor that can have an impact on outcome of patient. In such case, training needs of the
practice nurses needs to be considered to promote compliance with the bundle elements. This
will increase the likelihood of achieving higher reduction in PI rates. Nurses in practical setting
will also get the opportunity to improve continuous professional development by learning about
ways to achieve maximum compliance with the bundle element (Chaboyer et al., 2015).

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References:
Benevides, J. L., Coutinho, J. F. V., Tomé, M. A. B. G., do Amaral Gubert, F., de Castro, T. B.,
& de Oliveira, S. K. P. (2017). Nursing strategies for the prevention of pressure ulcers in
intensive therapy: integrative review. Journal of Nursing UFPE on line-ISSN: 1981-
8963, 11(5), 1943-1952.
Chaboyer, W., Bucknall, T., Webster, J., McInnes, E., Banks, M., Wallis, M., ... & Cullum, N.
(2015). INTroducing A Care bundle To prevent pressure injury (INTACT) in at-risk
patients: a protocol for a cluster randomised trial. International journal of nursing
studies, 52(11), 1659-1668.
Coladonato, J., Smith, A., Watson, N., Brown, A. T., McNichol, L. L., & Clegg, A. (2015).
Griffin, T., McPhail, L. & Montgomery, TG (2012). Prospective, Nonrandomized
Controlled Trials to Compare the Effect of a Silk-Like Fabric to Standard Hospital
Linens on the Rate of Hospital-acquired Pressure Ulcers. Ostomy Wound Management,
58 (10), 14-31. Pflegerische Interventionen zur Dekubitusprophylaxe auf einer
Intensivpflegestation, 85.
Ellis, P. (2016). Evidence-based practice in nursing. Learning Matters.
Frank, G., Walsh, K. E., Wooton, S., Bost, J., Dong, W., Keller, L., ... & Brilli, R. J. (2017).
Impact of a Pressure Injury Prevention Bundle in the Solutions for Patient Safety
Network. Pediatric Quality & Safety, 2(2), e013.

10ANNOTATED BIBLIOGRAPHY
Freeman, R., Smith, A., Dickinson, S., Tschannen, D., James, S., & Friedman, C. (2017).
Specialty linens and pressure injuries in high-risk patients in the intensive care
unit. American Journal of Critical Care, 26(6), 474-481.
Knibbe, N. E., Zwaenepoel, E., Knibbe, H. J., & Beeckman, D. (2018). An automatic
repositioning system to prevent pressure ulcers: a case series. British Journal of
Nursing, 27(6), S16-S22.