Critical Appraisal of Research on Pressure Ulcer Prevention: Module 4

This assignment presents a critical appraisal of four peer-reviewed articles focused on the prevention of pressure ulcers. The evaluation includes an analysis of the conceptual frameworks, designs, methods, samples, and major variables studied in each article. The assignment involves completing an evaluation table, a levels of evidence table, and an outcomes synthesis table, as per the assignment brief. The studies examine the effectiveness of alternating pressure air mattresses, repositioning schedules, and static air mattresses with heel flotation zones in preventing pressure ulcers among debilitated patients. The appraisal assesses the strengths, risks, and feasibility of each study, ultimately identifying best practices such as regular repositioning and the importance of a healthy diet in preventing pressure ulcer formation. The assignment also synthesizes the findings to offer recommendations for healthcare settings, emphasizing collaborative approaches and patient-centered care.

Running Head: Evidence-Based Project
EVIDENCE-BASED PROJECT

2
Evidence-Based Project
Table of Contents
Part 4A.......................................................................................................................................3
Part 4B......................................................................................................................................13

3
Evidence-Based Project
Part 4A
Full citation
of the
selected
article
Article #1 Article #2 Article #3 Article #4
Ansari, M.T.,
Buckley, D.I.,
Butler, M., Soh,
C. S. (2014).
The refinement
of topic for
systematic
review: Lesson
and
recommendation
from the
effective health
care program.
Journal of
Clinical
Epidemiology,
67(4), 425-432.
DOI:10.1016/j.jc
linepi.2013.10.0
23
Callaghan, R., &
Stephen-
Haynwa, J.
(2017). A 100
patient clinical
evaluation of
alternating
pressure
replacement
mattress in
home-based
setting, British
Journal of
Nursing,
26(Sup20), S54-
S56.Doi:
10.12968/bjon.2
017.26.Sup20.S5
4
Colemenero et
al. (2014).
Comparison of
two
repositioning
schedule for the
prevention of
pressure ulcers
in patients on
mechanical
ventilation with
alternating
pressure air
mattress.
Intensive Care
Medicine,
40(11),1679-
1687. Doi:
10.1007/s00134-
014-3424-3
Fletcher, J.
(2014).
Development
and preliminary
evaluation of a
static air
mattress with a
heel floatation
zone. Wound
UK, 10(4), 68-
75. Retrieved
from Retrieved
from
http://
academicguides.
waldenu.edu/
library.

4
Evidence-Based Project
Conceptual
Framework
Here main
theoretical basis
is systematic
reviews that are
conducted by the
agency for
healthcare
research and
quality. Input
was gathered
through PICOTS
and another
analytical
framework.
Evidence-based
research has
been done in this
study.
Prevention and
effective
management of
pressure ulcer
can be achieved
through the
application of
alternating
pressure air
mattress. In this
study, dual
professional
APAM for
patients are
examined at
high-risk state of
pressure ulcers.
Repositioning of
patients is very
essential that
helps in
management and
prevention of
pressure ulcers.
In this study, the
main theoretical
basis is confined
within
repositioning for
patients under
mechanical
ventilation.
Collaboration
between
healthcare staff
and direct
healthcare
services is
essential for
modification of
a mattress. This
can help to
provide
protection to
patients and help
them to heel.
Design/ A working 100 patients Pragmatic and 30-bed mixed

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Evidence-Based Project
Method group has been
formed with four
experts from the
Evidence-based
Practice centers.
They are
experienced in
refinement and
they discussed
the topic to get
the agreement.
were taken
following a pilot
study of 10
patients. They
were evaluated
for 83 days with
alternating
pressure
replacement
mattresses.
open-label
randomized trial
has been done
by repositioning
eligible patients
in 2 and 4 hours.
medical ward
has been taken
and replacement
if mattresses
have been done
to collect data.
Evaluation of
data has taken
place after this.
Sample/
Setting
4 investigators
with experience
in refining
100 patients,
who are being
treated in their
own homes
165 patients
repositioned in 2
hours and 164
patients
repositioned for
4 hours
26 patients of a
medical ward
with 30-bed
Major
Variables
Dependent
variable:
Systemic review
Independent
variable: The
refinement of
topic
Dependent
variable: Risk of
pressure
ulceration
Independent
variable:
Alternating
Dependent
variable:
Prevention of
pressure ulcer
Independent
variable: Two
repositioning
Dependent
variable: Heel
protection from
pressure ulcer
Independent
variable: Static
air mattress with

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Evidence-Based Project
pressure air
mattresses
schedule heal floating
zone
Measurement 33 items were
generated that
were
consolidated to
17 items later for
discussion.
Process of
developing
method guidance
was followed.
Observational
study was
followed by the
selected
respondents.
open-label
randomized
clinical trial was
followed in this
article.
Observational
study was
conducted to
gather
information
about the subject
area and collect
data.
Data Analysis Different
requirement of
topic refinement
like transparency
eliminating bias
are some
essential
qualitative
findings.
Impact of
regular
repositioning of
patients was
found effective
and described
through
statistical data.
Pressure ulcer
grade II formed
in 10.3% of
[atients in 2-
hour group.
13.4% of
patients suffered
pressure ulcers
in the 4-hour
group.
26 sets of data
were collected in
this section of
the study.
Findings and
Recommendat
Methodologicall
y rigorous and
Pressure
redistribution
2 and 4 hours of
reposition did
Clinical staff
must work

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Evidence-Based Project
ions accurate
systematic
reviews required
for refining of
topic.
surface must be
selected based
on level of
mobility, clinical
judgment, risk
and pressure
damage grade.
not reduce
events of
pressure ulcer.
collaboratively
for protecting
patient’s heel
from pressure
ulcer.
Appraisal Strength:
Experienced
investigators
Risk: Sharing of
biased
knowledge
Feasibility:
Experience of
investigators
helps to draw
agreement.
Strength: Larger
sample has
allowed
reviewing
different aspects
related to the
research topic
Risks: Risk of
failure and harm
to patients
Feasibility:
Practical
experiment that
generated
evidence
Strength: Two
repositioning
schedule has
been studied.
Risks:
Possibility to
harm patients
Feasibility:
Practical
experiment that
generated
evidence
Strength: Both
staff and patients
were considered
for data
collection
Risks: Incorrect
data shared by
respondents
Feasibility:
Evidences are
provided.
General
Notes/Comm
Previous
literature could
Evidence of
previous
Experiment is
well-structured
Broad research
has shed light on

8
Evidence-Based Project
ents be reviewed to
get more
authentic
answers
literature could
be reviewed to
get more
accurate result
and conducted
with accuracy.
different
perspectives
Author and
year of
selected
article
Article #1 Article #2 Article #3 Article #4
Ansari, Buckley,
Butler, Soh
(2014)
Callaghan, &
Stephen-
Haynwa, 2017
Colemenero et
al. (2014)
Fletcher, 2014
Study Design A group of
workgroup
members
experienced in
topic refinement
has generated a
list of questions
and policies
An
observational
study was
conducted on
100 patients that
are followed by
a pilot study of
10 patients. This
Open-label
randomized
clinical trial was
done to fulfill
the objective of
comparing the
effectiveness of
repositioning in
Observational
study of 30
patients was
done to find the
impact of static
air mattress with
heel flotation
zone.

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Evidence-Based Project
relevant to
refinement
process.
study was done
regarding
evaluating
alteration of
pressure
replacement
mattress.
every 2 and 4
hours. This
prevents
pressure ulcer
formation.
Sample/
Setting
4 workgroup
members were
selected for this
purpose. No
patients were
involved.
100patients
were selected in
their homes.
164 patients for
the 4-hour group
and 165 patients
for the 2-hour
group were
selected who
were receiving
mechanical
ventilation
support.
26 sets of data
were collected
from patients.
They have high
risk of pressure
damage.
Evidence
Level *
(I, II, or III)
Level IV Level I Level I Level I
Outcomes Accurate,
relevant and
methodologicall
y correct
systematic
Surfaces of
pressure
redistribution
need to be
selected based
Repositioning
frequency
cannot reduce
events of
Clinical staff
needs to work
collaboratively
to prevent
pressure ulcer on

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Evidence-Based Project
reviews can be
used to refine
topic
on holistic
assessment of
patient
pressure ulcer heels of patients
General
Notes/Comm
ents
Quality could
be improved by
analyzing
previous
researches
Good quality
research
Good quality
research
Good quality
research
Author and
year of
selected
article
Article #1 Article #2 Article #3 Article #4
Ansari, Buckley,
Butler, Soh
(2014)
Callaghan, &
Stephen-
Haynwa, 2017
Colemenero et
al. (2014)
Fletcher, 2014
Sample/
Setting
No patients
were involved.
100 patients
were selected
those who are
receiving home-
based care.
165 patients for
a 2-hour group
and 164 patients
for the 4-hour
group were
26 sets of data
were collected
from patients
who are risk-
prone to

11
Evidence-Based Project
selected. They
are having
mechanical
ventilation
support.
pressure ulcer.
Outcomes Systematic
review can be
used in refining
topic if it is
relevant with
correct
methodology
Holistic
assessment of
patient needs to
be done for
selecting surface
of pressure
redistribution
Different
reposting
schedule cannot
prevent incident
of pressure ulcer
Clinical staff
needs to work
collaboratively
while providing
air mattress with
heel floating
zone to patient
Key Findings For refinement,
different
analytical
frameworks like
PICOTS can be
used.
Transparency
and elimination
of bias are
essential for
refinement.
Regular
repositioning
and proper diet
can prevent
pressure ulcer.
Pressure ulcer
formation rate is
high for those
patients who are
turned every 4
hours.
Staff must work
collaboratively
by analyzing
needs of
patients.

12
Evidence-Based Project
Appraisal and
Study Quality
Experienced
investigators
have shared
knowledge that
is authentic and
it is an average
quality of study.
Experiment has
made this
research more
authentic and
good quality
Experimental
data is the
evidence of
conclusion and it
is good quality
research.
Experimental
data is the
evidence of
conclusion in
this good quality
research.
General
Notes/Comm
ents
More accurate
outcome could
be gained by
reviewing
previous
research findings
Good quality
research
Good quality
research
Good quality
research
Part 4B
From the above appraisal, the best practice which is selected is regular repositioning of
patients and maintaining a healthy diet. As stated by Callaghan & Stephen-Haynwa (2017),
risk assessment and clinical judgment can be used to take the proper steps to eliminate

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Evidence-Based Project
pressure ulcer formation. Regular repositioning and proper, mobility helps to eliminate the
formation of pressure ulcers in different body parts like sacrum and elbow. Moreover,
repositioning of patients can be done in every 2 hours. In the study of Colemenero et al.
(2014), it was found that pressure ulcer formation and growth reduces if repositioning occurs
in every 2 hours. Pressure ulcer formation is comparatively lower than those patients who are
repositioned in every 4 hours. Hence, maintaining a proper diet, adopting the strategy of
repositioning of patients and increasing frequency of repositioning are some of the best
practices that can be adopted in a healthcare setting.