Clinical Governance Report: Pressure Injuries and PICOT Question

This report delves into the clinical problem of pressure injuries, a significant challenge in healthcare, particularly for immobilized patients in nursing homes and hospitals. It explores the risks associated with immobility and the development of pressure ulcers, emphasizing the need for evidence-base...Read More

Contents
Introduction......................................................................................................................................1
Potential clinical problem................................................................................................................1
Clinical Question.............................................................................................................................3
Conclusion.......................................................................................................................................4
References........................................................................................................................................5

Introduction
Preventing the pressure injuries in healthcare sectors, has been always a major challenge, on
both caregivers and patients. As a whole, due to epidemiology of pressure injuries which is
varied by clinical setting including potentially preventable condition. Nurses should use
Evidence based practice while taking care of patient. Evidence based practice means delivery of
health care that can be justify with the best evidence from patient care data and studies with
clinical expertise and patient preference and values in terms of their individual needs for well-
being ( Ellen Fineout-Overholt et. al., 2011). The risk of development related to pressure ulcers
or injuries might interfere with functional recovery of patient and can be complicated by pain or
any kind infection, which result in longer stays in hospitals. The present report is made to
describe potential clinical problem associated with “Pressure Injuries”, with formation of PICOT
question on same, to analyse its description.
Potential clinical problem
Patients in hospitals or homebound in long-term care facilities like nursing homes are facing
issues regarding mobility, due to health condition or age. To provide them care, health care
professionals generally avoid to encourage to move by own manner, in order to reduce risks
related with fallen during movement. But it increases risk of pressure injuries which is
considered as one of the biggest challenge for nurses or other medical practitioners. For the first
step of the evidence based practice nurses may have asked question to lay the ground work for
evidence based practice for example in case of injured patients who are not able to move and lie
on bed for longer period, are on higher risk of causing ulcers, back pain and more, due to
increase pressure on body (Melnyk et. al., 2010). This would also put a great impact on lives of
bed-ridden patients in terms of pressure ulcers on their body, as well as on ability of nurses for
rendering appropriate care to them. Evidence of presence of the pressure ulcers on patients, who
lie on bed for longer period, indicates the poor overall prognosis. This may contribute for
premature mortality within some patients. Considering some evidence based reports, it has been
analysed that pressure injuries are mostly seen in elderly populations; those who have less level
of nutrition or long-time ill (Thomas &Gregory, 2014).
A pressure injury is generally, localized skin damage or might be underlying soft tissue. This
kind of injury can be developed as intact skin, might be as an open ulcer and sometime results in
1

painful condition (Anon, 2017). Prolonged pressure injury that often result in tolerance of soft
tissue for shear and pressure, are also affected by level of nutrition in body, perfusion,
immobility, co-morbidities, chronic wounds and soft tissue condition (Bhattacharya & Mishra,
2015).
However, a number of interventions have been taken to reduce such risks that arise due to
pressure injuries. It includes pressure-relieving devices, Hyperbaric oxygen therapy,
Electromagnetic therapy, risk assessments, Standard mattress, negative pressure wound therapy,
air beds and more to provide relief from actual injury arise due to prolonged pressure injuries
(Thomas, & Compton, Gregory 2014). All such therapies and medications processes are quite
effective in reducing impact of prolonged pressure or other kinds of factors that increases risks of
pressure injuries. It helps nurses and other associated practitioners to provide good care to
patients and support them, in prevention of occurrence of such issues. But it increases cost of
treatment for hospitals and also it refers to go beyond the affordability of those patients who
belong from lower middle class or poor background (Bhattacharya &Mishra., 2015). Therefore,
major group of people, who belongs from such population are on higher risk arise from
prolonged pressure injuries. Along with this, it also increases stress and put challenges on nurses
and medical team to provide proper care to such patients, without using high-cost treatment
procedures, which directly impact on desired health outcomes negatively. Therefore, to improve
healthcare practices and quality of patient outcomes, especially in case of prolonged pressure
injuries, it is essential to integrate EBP (Evidence based practices) in clinical practices. This
would help in making correct decisions for nurses about care treatment to support people to
prevent themselves from bedridden ulcers or other problems of pressure injuries.
Clinical Question
To provide better nursing care to the patient and to get maximum outcomes it is important to
determine real clinical issue and it must be in an answerable question. PICOT format is the most
used format in nursing care. And if question is asked in PICOT format then the search for the
evidence in clinical practice is significantly streamlined (Melnyk et. al., 2010). PICOT format is
systematic approach to get best evidence based available answer from the healthcare database
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(Fineout-Overholt & Stillwell, 2019). Therefore, to conduct evidence based practices on such a
case, a clinical question has been framed by using PICOT framework –
Clinical question: Among immobilised patients in nursing home[RT1] and hospital, how
does the repositioning is affecting /influencing the rate of pressure injuries compared to No
Repositioning?
This question has been chosen to analyse on cost cutting therapies that could aid healthcare
industry to overcome from challenge of pressure injuries.
PICOT Format –
Population Immobilised Patients
Intervention Repositioning
Comparison No repositioning
Outcome Rate of pressure sores
Time During hospitalisation
From above stated discussion on clinical problem based on evidences, it has evaluated that
however, a number of therapies, medications and interventions have been taken to help patients
to overcome from major risks of pressure injuries (Bernadette Melnyk and et. al., 2009). But still
due to higher cost of treatments of such procedures, it is difficult for healthcare sectors to
provide the same to each patient on minimum cost, because a number of critical cases into
hospitals on regular basis, where patients get admitted and stay in hospitals for longer period.
Among them, major population are unable to pay for getting such highly effective treatment that
prevents them from risk of pressure injuries (Lyder Courtney and Elizabeth, 2008).
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Conclusion
It has been concluded from all the report that beside various treatments, procedures,
therapies and medical technologies introduced, still, that aid healthcare providers to utilise
number of interventions for preventing people from pressure injuries development. The purpose
of the essay is to describe a clinical problem and develop a PICOT question based on this
problem. It includes repositioning and some fewer steps that might be easy for preventing
patients from serious causes of pressure injuries. Prevention of pressure injuries can also help to
reduce the extra time and workload on the hospital and nursing homes facilities. For
understanding importance and effectiveness of repositioning, a question is put to conduct further
research in present report clinical practices, for resolving actual problem of pressure injuries.
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References
Anon., A. (2017). Pressure ulcers get new terminology and staging definitions. Nursing
Management (USA), 48(1), 46-50.
Bhattacharya, S., & Mishra, R. K. (2015). Pressure ulcers: Current understanding and newer
modalities of treatment. Indian journal of plastic surgery : official publication of the
Association of Plastic Surgeons of India, 48(1), 4–16.
Echt, D. S., M.D., Liebson, P. R., M.D., Mitchell, L. B., Peters, R. W., M.D., Obias-Manno, D.,
Barker, A. H., M.D., . . . Richardson, D. W., M.D. (1991). Mortality and morbidity in
patients receiving encainide, flecainide, or placebo. The New England Journal of
Medicine, 324(12), 781-788.
Fineout-Overholt, E. B., Gallagher-Ford, L., Mazurek Melnyk, B., & Stillwell, S. (2011).
Evidence-Based Practice, Step by Step: Evaluating and Disseminating the Impact of
an Evidence-Based Intervention: Show and Tell. AJN, American Journal of
Nursing, 111(7), 56-59.
Fineout-Overholt, E.B., Ellen & Stillwell, S.(2019), in Evidence-based practice in nursing &
healthcare : a guide to best practice, by Melnyk, Bernadette Mazurek, and Fineout-
Overholt, Ellen, Fourth edition, Philadelphia, Wolters Kluwer, ,33-54
Lyder, CH & Ayello EA.(2008) Pressure Ulcers: A Patient Safety Issue. In: Hughes RG, editor.
Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD):
Agency for Healthcare Research and Quality (US); Chapter 12
Melnyk, B. M., Fineout-Overholt, E. B., Stillwell, S. M., & Williamson, K. (2010). Evidence-
Based Practice: Step by Step: The Seven Steps of Evidence-Based Practice. AJN,
American Journal of Nursing, 110(1), 51-53.
Melnyk, B. M., Fineout-Overholt, E. B., Stillwell, S. M., & Williamson, K. (2009). Evidence-
Based Practice: Step by Step: Igniting a Spirit of Inquiry. AJN, American Journal of
Nursing, 109(11), 49-52.
Stillwell, S. B., Fineout-Overholt, E. M., Melnyk, B. M., & Williamson, K. (2010). Evidence-
Based Practice, Step by Step: Asking the Clinical Question: A Key Step in Evidence-
Based Practice. AJN, American Journal of Nursing, 110(3), 58-61.
Thomas, M., & Compton, MD, Gregory A. (2014). Pressure Ulcers in the Aging Population A
Guide for Clinicians (1st ed. 2014. ed., Aging medicine
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Criteria High
Distinction
Distinction Credit Pass Fail
Structure and Writing style 10%
 The essay is structured in a logical sequence so that the content flows
(headings may be used to develop the structure of the paper)
 The essay ends with a cogent, defendable conclusion that summarise the
discussion within the body of the paper.
 Writing style
 The essay is written with clear sentence structure, clarity of argument and
precision of expression and the spelling and grammar are correct
Structure
and Writing
style 10%
Fulfils the
technical
aspects of the
task.
Very well-
structured
with all
components
present as
outlined in
assessment
details.
Systematicall
y and
logically
organised.
Flawless
grammar,
spelling and
sentence
structure
The overall
paper, from
introduction
to
conclusion,
flows
extremely
well
Adheres to
word count
+/- 10%
Well-
structured
with all
components
present as
outlined in
assessment
details.
Systematical
ly and
logically
organised.
Excellent
grammar,
spelling and
sentence
structure
Adheres to
word count
+/- 10%
Generally
well-
structured
with all
components
present as
outlined in
assessment
details.
Evidence of
systematic
organisatio
n of
content.
Minimal
errors in
spelling,
grammar, or
syntax so the
paper is easy
to read.
Adheres to
word count
+/- 10%
Adequately
structured
as outlined
in
assessment
details but
one or two
components
need further
development
.
Structures
may make it
difficult to
read, but it
adequately
communicat
es
information.
Problems
evident with
grammar,
spelling, and
sentence
structure but
the paper is
mostly easy
to read
Adheres to
word count
+/- 10%
Inadequate
structure
as outlined
in
assessmen
t details
with poor
organisatio
n of
component
s.
No clear
flow,
rambling,
repetitive,
difficult to
read and to
understand
the
meaning.
Includes
significant
errors in
spelling,
grammar,
and syntax,
so the intent
of the paper
is difficult to
determine.
Over/under
the word
limit
(-/+10%)
6

Content & Critical Analysis 80%
 The essay question or the topic/ issue has been discussed
 The essay content has clear links to clinical governance or practice
development at a healthcare setting
 Demonstrates depth of understanding of the topic and significant issues
Critical analysis
 The essay demonstrates a high degree of critical thoughts and insight by:
 Providing justification/rationale for the argument/ discussion
 Demonstrating they have reflected on the complex issues surrounding the
topic/question
Discussing the topic from different perspectives, thereby providing a balanced
argument/ discussion
Knowledge
and
understandi
ng of
concepts:
(5%)
The essay
begins with a
clear
statement
that identifies
the aim/
purpose and
the structure
of the
assignment
at an
exceptional
standard
The essay
begins with
a clear
statement
that
identifies the
aim/
purpose and
the structure
of the
assignment
is at a high
standard.
The aim/
purpose and
the structure
of the
assignment
is
adequately
stated.
The aim/
purpose and
the structure
of the
assignment
is stated but
needs more
clarification.
The aim/
purpose
and the
structure of
the
assignmen
t has not
been
stated.
Limited or
inadequate
foundation
for the
essay
Demonstrate
s knowledge
and
understandi
ng of
identification
of a potential
clinical
problem
(30%)
Presents a
comprehensi
ve
description of
the identified
clinical
problem and
its
significance
is provided.
Rich in
content. Full
of critical and
evidence-
based
thought,
insight and
analysis.
Shows
thorough
knowledge
and
understandi
ng of the
chosen topic
is evident.
Presents a
clear and
concise
description
of a
potential
clinical
problem.
Discussion/
ideas are
Shows
evidence of
relevant and
sound
knowledge
and
understandi
ng of the
topic.
Adequate
description
of a
potential
clinical
problem is
provided.
Discussion/
ideas are
Shows basic
knowledge of
the topic but
not a
thorough
understandin
g of some
key
concepts.
The potential
clinical
problem
needed more
depth and
robust
discussion in
relation to
the clinical
problem
Inadequate
level of
knowledge
of the
chosen
topic for
discussion
with few
concepts
thoroughly
understood
Inadequate
to no
description
of a
potential
clinical
problem.
7

Discussion/
ideas are
supported
with relevant
extensive
literature
showing
evidence that
the student
has read
widely
beyond set
readings with
evidence well
integrated.
supported
with strong
depth of
evidence-
based
information,
thought and
insight and
analysis
evident
supported
with relevant
literature
and
evidence is
integrated
adequately.
Discussion/
ideas are
supported
with relevant
literature, but
evidence is
integrated at
a basic level.
Formulate a
review
question to
yield the
most
relevant and
best
evidence
using PICOT
format
(30%)
Presents a
comprehensi
ve review
question
using the
PICOT
format.
Presents a
comprehensi
ve synthesis
and expands
on why the
review
question is
important for
the
development
of clinical
practice or
professional
knowledge or
research
review
question
well
formulated.
Presents
more
detailed
description
of why the
review
question is
important
for the
developmen
t of clinical
practice or
professional
knowledge
or research
review
question
stated is
relevant,
researchabl
e, and
significant.
PICOT
clear and
accurate
and
relevant to
the clinical
problem
identified
Presents an
adequate
justification
for the
selection of
this
question
and its
relevance
to clinical
practice,
professional
knowledge,
and
research
review
question
stated but
needs
further work.
Some
elements of
PICOT
unclear/
inaccurate
Presents
limited
description
of why the
review
question is
important for
the
development
of clinical
practice or
professional
knowledge
or research
Review
question is
inadequate
ly stated or
missing.
No
connection
/ relevance
between
the clinical
problem
and the
clinical
question.
Rationale
for the
selection of
the clinical
question
missing
Critical
Analysis:
A
sophisticated
analysis is
The
assignment
shows a
Shows
evidence of
analysis
The
assignment is
limited to
The
assignment
is generally
8

Analyse the
impact of
clinical
governance
on efficiency
and practice
standards
(10%)
made using
ideas and
principles
beyond those
introduced in
NURS2006.
resourceful
and
imaginative
analysis
using ideas
and
principles
beyond those
introduced
in
NURS2006.
using ideas
and
principles
introduced in
NURS2006.
description
with some
discussion
using ideas
and principles
introduced in
NURS2006.
descriptive
and
uncritical
and includes
frequent
unsupported
facts
and
opinions.
Some
inaccuracy
in the
material.
The
conclusion
demonstrate
s an
understandi
ng of
identifying a
clinical
problem and
asking a
clinical
question
(5%)
Insightful and
skilful
conclusion
with reference
to the future
implications of
the potential
clinical
problem.
The
conclusion
provides a
concise and
a focused
review of the
content and
its impacts.
Reference
the future
implications
of the
potential
clinical
problem.
The
conclusion
brings the
review to an
appropriate
close,
summarising
the content
and
references
future
implications.
A generic
conclusion is
made with
limited focus
and reference
to the future
implications
of the
potential
clinical
problem.
A vague and
unsupportab
le
conclusion
with little to
no focus on
the overall
merit or
implications
of the
potential
clinical
problem.
Referencing 10%
 The referencing style used throughout the paper is congruent with the College
of Nursing and Health Sciences
 The reference list is accurate (ie no missing page numbers, volumes, correct
title etc), complete (ie no reference is the body of the paper are missing from the
reference list) and consistent.
 The references cited are contemporary (ie less than 10 years old unless seminal
paper)
 Primary references are used predominantly (ie the original reference has been
sited rather than a secondary source)
 There is evidence in the paper that the student has searched widely for
information related to the topic/ issues
 The student has acknowledged all the sources of information
 Direct quotations are only used to make crucial points or to support the
discussion/ argument
Located,
evaluated,
and
Located,
evaluated,
and
Located,
evaluated,
and
Located and
collated partly
relevant
Frequent
errors in
APA (6th)
9

synthesised
highly
relevant
information
from quality
peer
reviewed,
relevant,
and current
evidence
sources.
Accurately
and
consistently
adhered to
APA (6th)
referencing
conventions
in both in
text
referencing
and the
reference
list with no
errors.
synthesised
relevant
information
from peer
reviewed,
relevant, and
current
evidence
sources.
Clear
evidence of
wide and
relevant
reading.
Almost
always
accurately
and
consistently
adhered to
APA (6th)
referencing
conventions
in both in text
referencing
and the
reference list.
incorporated
a range of
quality peer
reviewed,
relevant, and
current
evidence
sources.
Accurately
adhered to
APA (6th)
referencing
conventions
in both in text
referencing
and the
reference
list.
information
from the topic
and current
evidence
sources.
Attempt made
to adhere to
APA (6th)
referencing
conventions
in both in text
referencing
and the
reference list,
but some
referencing
omissions or
inaccuracies
noted.
referencing
style for
reference
list and in
text
referencing
Substantial
lack and
Inadequate
use of
quality peer
reviewed,
relevant,
and current
evidence
sources.
Overall
comment
Thank you, Riddhi, for submitting Assignment 1 of NURS 2006.
Overall, there was basic understanding demonstrated of what was required
for this assessment.
The essay identified a clinical problem but was superficially discussed and
there is significant superfluous information included and understanding of the
clinical problem was not clearly demonstrated. The difficulties in constructing
sentences and many grammatical errors made it difficult to understand the
meaning being conveyed especially when describing the clinical problem.
The connection between the clinical problem and the review question not
clear, with no clear rationale for the need to address this question.
The PICOT question will need further work (see feedback in the essay).
Referencing was largely incorrect and will need improvement. There appears
to be some use of old references. You will need to use the correct APA
format both intext and in the main reference list. And remember to and add to
your list all the references used in the essay.
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Academic writing issues significantly affected this essay, particularly, issues
with how to correctly structure a sentence. I strongly suggest you engage
with SLC and Studiosity to improve on your academic writing skills.
The Online Learning Lounge enables you to make an appointment to interact
with a learning advisor for assignment planning, writing, and referencing. It
can be accessed via this link:
https://flo.flinders.edu.au/course/view.php?id=63022
You can also access Studiosity, for free writing feedback,24/7 through this
link:
https://students.flinders.edu.au/study-support/slc/studiosity
See additional feedback in the essay.
Name of
marker
Ray TINI Date 24/08/20 Grade: FAIL
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