Spring Arbor University NUR 551: Literature Review on Pressure Ulcers

This assignment presents a literature review and critical thinking exercise based on a randomized controlled trial (RCT) examining the effectiveness of soft silicone multi-layered foam dressings in preventing sacral and heel pressure ulcers in trauma and critically ill patients (the Border Trial). The assignment identifies the independent and dependent variables, PICO components (Patient, Intervention, Comparison, Outcome), and determines the study's experimental design. It explores the use of randomness and blinding in the study, the statistical tests employed (Fisher's Exact Test), and the significance of the results. The review also discusses the potential clinical implications of the findings, such as the benefits of silicone dressings in reducing hospital stays. The assignment references the original research paper by Santamaria et al. (2013) and summarizes the findings and analysis performed, providing a comprehensive overview of the study's methodology and conclusions. The assignment uses the provided assignment brief which details the course information and context for the assignment.

Running head: LITERATURE REVIEW
Literature review and Critical Thinking exercise
Student Name
University Name
Author Note

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A randomised controlled trial of the effectiveness of soft silicone multi-layered foam
dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill
patients: the border trial (Quantitative Study)
1. What are the independent and dependant variables in the study? What are the
PICO components?
In the study, the dependant variables are length of stay of the patient, the
physiological variables like temperature, heart rate, MAP mmHg and ATS. The
independent variables in the study is observed to be admission classification to the
emergency department.
P – Patients admitted to the emergency department with major trauma and/or critical
illness of pressure ulcer
I – Mepilex Border Sacrum dressing to the sacrum and Mepilex Heel dressing to the
heel of the individual
C – Usual Intervention for pressure ulcer
O – Intervention group showed lesser length of stay in the hospital for proper
recuperation
2. Is this study experimental or non-experimental?
The following research study selected is an experimental study in which the variables
are manipulated by the author. Hence, in this study, the variables like length of stay,
mechanical ventilation and the way in which the patient is admitted in the hospital on
the grounds of critical illness or major trauma are all manipulated by the author
depending upon the type and duration of the intervention is given to the population.
The interventions were provided in a random manner which generated results that had
changed from the incidence rate which, in turn, showed that they had changed and
were manipulated by the author to understand their relationship.

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3. How, if at all, was randomness used in this study?
The intervention in the study was divided in two parts – control group and trial group.
The patients who had fulfilled the eligibility criteria were randomly allocated to the
two of the groups. The control group received the usual pressure intervention of ulcer
measures while the trail group received a Mepilex Border Sacrum dressing applied to
the wound of the ulcer for their appropriate recuperation. A computer generated set of
numbers which were randomly allocated to the groups were inserted in numerous
envelopes which the patients were asked to pick up and be allocated to one of the
research groups. The emergency department (ED) nurse had undertaken the duty to
screen the patients on the basis of the inclusion criteria and then were provided with
envelopes.
4. How, if at all, was blinding used in this study?
In the research study, the author has failed to specify whether the patients had been
told about them being a relevant part of the research that is being conducted with the
help of them. However, from the type of the research study, it can be inferred that the
patients had little knowledge about the interventions that were given to them because
it was randomly allocated to them. A computer generated number was allocated to
each of the members and then were asked by the patients to pick one of the numbers
without the prior knowledge of the intervention group they are being allocated.
Hence, in a way, it can be understood that there was blinding executed on the
participants in the research. However, the author of the research failed to make it clear
to the readers about such a possibility.
5. Did the researchers use any statistical tests? If yes, were any of the results
statistically significant?

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The researchers had conducted the analysis of the study by the help statistical analysis
methods to analyse the data that has been collected from the patients. The Fishers
Exact Test was undertaken by the researchers for appropriate analysis of the data
collected. It is one of the easiest methods to be implemented by the authors when the
size of the sample for the research study is small and is valid for most of the sample
sizes incorporated by the authors. It helps in generating a relationship between the
control intervention and the trial group intervention. The results are presented in the
form of tables which are easily comprehendible by the readers. In the research study,
there are two tables which has helped the analysts in coming to appropriate
conclusions.
6. If the results of this study are valid and generalizable, what might be some of the
uses to which the findings could be put in clinical practice?
The prevention measures that have been undertaken by the researchers in their study,
one of the control groups received the usual pressure ulcer intervention. However, the
trial group received Mepilex Border Sacrum dressing was applied to analyse the
health outcome for the patients receiving it. The results achieved from the research
showed that the patients who had received the trial intervention, the length of stay in
the hospital was lesser when compared with the results of the patients receiving usual
intervention. Hence it can be implied from this, that when this silicone dressing is
incorporated into the healthcare system by the hospital, the health outcome of the
patient will be increased significantly. The patients admitted to the emergency
department with complains of pressure ulcers, should be administered silicone
dressing immediately such that a greater health outcome is achieved.

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References
Santamaria, N., Gerdtz, M., Sage, S., McCann, J., Freeman, A., Vassiliou, T., … Knott, J.
(2013). A randomised controlled trial of the effectiveness of soft silicone multi-
layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma
and critically ill patients: the border trial. International Wound Journal, 12(3), 302–
308.