Pressure Ulcer Prevention: Contributing Factors and Prevention Report

This report focuses on pressure ulcer prevention in healthcare settings, starting with a research question that investigates the contributing factors influencing pressure ulcer prevalence. It emphasizes the role of evidence-based practice in integrating research into clinical settings. The report includes a literature review exploring factors such as intrinsic and extrinsic elements that contribute to pressure ulcer development, drawing on studies that identify risk factors and their impact. The methodology outlines a quantitative case-control study design, data collection methods using EMRs, and data analysis techniques, including descriptive statistics and logistic regression. Ethical considerations are addressed, highlighting the importance of ethical research conduct and potential emotional risks. The report aims to provide insights for the assessment of contributing factors for pressure ulcer prevalence and aid in risk assessment for early detection and prevention, with the potential to update nurses on best practices. The student's work also addresses the validity, potential obstacles, and advantages and disadvantages of the case control study, ensuring a comprehensive understanding of the topic.

Running head: PRESSURE ULCER PREVENTION
Pressure ulcer prevention
Name of the Student
Name of the University
Author note

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Table of Contents
3. Research question and its purpose...............................................................................................2
4. Literature review..........................................................................................................................3
5. Methodology, data collection and analysis method.....................................................................6
6 Validity.........................................................................................................................................8
7. Ethical considerations..................................................................................................................9
9. Reflection.....................................................................................................................................9
References......................................................................................................................................10
8. Appendix....................................................................................................................................12

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3. Research question and its purpose
3.1 “Contributing factor that impact pressure ulcer prevalence in health care setting”.
3.2 The role of evidence-based practice (EBP) is to integrate evidence of best research into
clinical practice and enhance patient values. EBP is important as it is aimed at providing the
most effective care that is available that is based on best evidence (Aasekjær et al. 2016). In
nursing, the role of EBP is to ensure clinical practice that based on best available evidence so
that patients are benefitted (Melnyk et al. 2014). In the present clinical question, contributing
factors that impact pressure ulcer (PU) prevalence in the hospital settings is studied based on best
available evidences.
Six steps are involved in EBP that help nurses to gain knowledge that enhances their
clinical judgment and augment the nurses in clinical decision-making process. The first step
involves the framing of clinical question that involves converting the need for information about
diagnosis, prevention, therapy and causes like contributing factors that affect PU prevalence i n
the clinical healthcare setting (McKeon and McKeon 2015). Second step involves the search for
the best evidence through information retrieved from databases that are most likely to answer
through keywords, concepts and Boolean operators. The third step involves the critical appraisal
of the evidence by assessing and evaluating the strengths and weaknesses of evidence. The
fourth step involves the integration of evidence with the clinical expertise to make the best
clinical decision for the patients and ensure safety (Hurlburt et al. 2014). The fifth step involves
the evaluation of outcomes of EBP practice decision in terms of achieved expected outcome,
barriers that hinder practice change or implementation of intervention. Lastly, the dissemination
of evidence in the organization and can be achieved through posters, conferences, manuscripts,
online media and posters.

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3.3 The results of the study will contribute to EBP and future studies for the prevention of PUs
by early detection and evaluation of the factors that contribute to PU prevalence in the healthcare
settings. The assessment of factors that contribute to PU can be helpful for the early risk
assessment and development of interventions that can aid in reducing PU prevalence in hospital
settings.
3.4 When there is better, assessment of contributing factors, PU can be prevented as well as
reduce the incidence and prevalence of PU in healthcare settings. Evaluation of PU contributing
factors can help nurses in assessing the high and low risk patients. This can aid in enhancing
patient safety and in providing the best quality of care to patients and in gaining knowledge for
the effective decision-making process for effective practice changes. The implementation of
strategies for PU risk assessment and prevention can be helpful in adding information to the
existing knowledge for better clinical judgment and develop critical thinking skills in decision-
making process.
3.5 One member of multidisciplinary team that can contribute to the present research study is
infection control nurse. The participation in the process is to collect and analyse the data on the
incidence of hospital acquired PUs and barriers that led to the failure of prevention strategies and
investigation of possible resources in response to the PU incidence in the hospital setting.
4. Literature review
4.1 Many factors contribute to the PU development that implies physical, social and emotional
overloads for the healthcare professionals, patients and families. It reduces the quality of life and
increase in healthcare burden due to long hospitalization durations leading to high morbidity and
mortality rates.

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Engels et al. (2016) conducted a retrospective chart review for the determination of
factors that contribute to PU development among patients undergoing surgical procedures being
the main research aim. The study design is retrospective data collection in an integrated, tertiary
healthcare setting in southeastern United States. This comprised of four community hospitals in
variety of locations with 600 acute care beds and out of 25,300 surgical procedures, 2,093
surgeries lasted for more than three hours. The findings of the study revealed that there are
consistent contributing factors that affect PUs prevalence in patients who underwent surgical
procedures that lasted for more than three hours. Intrinsic factors include advancing age,
presence of co-morbid conditions, medications, low body mass, systemic blood pressure,
haemoglobin, albumin levels, poor nutritional status and decreased blood pressure. Extrinsic
factors comprised of environmental and physical factors include friction, shear and moisture,
positioning, length of stay, blood loss, arterial pressure and body temperature. However, the
study design was a limitation as the results obtained from this study do not old enough strength
as compared to other form of studies. Another limitation of this paper is that data collection
where they obtained conclusions that contribute to the PU development following surgery. The
findings suggest that PU development is due to systemic and extrinsic factors that contribute to
PU prevalence and early detection of these factors can be helpful in early risk identification and
its assessment.
Coleman et al. (2013) also studied the identification of risk factors that are predictive for
PU development in adult populations as their main research aim. For this study, a systematic
review of primary research was conducted and papers that recommended methods for the
identification of observational risk factors. After the reviewing of 5642 abstracts, 365 studies
were selected and out of which 54 fulfilled the criteria. The result findings suggested that most

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important contributing factors in the PU development are mobility, skin pressure and ulcer
status. The strength of this study is that it is the first systemic review that studied the risk factors
in PU development. The strength of this study is that the included studies had a detailed quality
assessment that can be identified for the for the result interpretation. However, the major
limitation of this study is that the description variables are in large numbers, which has an impact
on the interpretation and meta-analysis where there is a need for minimum data set. From this
study, it can be concluded that both intrinsic and extrinsic factors work together for the
development of PU.
Coleman et al. (2014) also studied the risk factors that are associated with PU
development and incidence. The paper was aimed at developing an evidence-based risk
assessment framework for the identified risk factor. These risk factors highlighted in the study
are immobility, skin status, perfusion, skin moisture, nutrition, sensory perception and com-
morbid conditions like diabetes. As there were limitations in the previous studies regarding risk
assessment tools and lack of agreement in the identification of risk factors. The key findings
showed that Risk Assessment Framework could do pressure ulcer risk assessment in te clinical
practice.
The above evidence showed that identification of the associated risk factors that
contribute to PU development could be helpful in the early identification and prevention of PU.
The studies highlighted the intrinsic and extrinsic factors that are the determining factors in the
incidence and prevalence of PU.

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5. Methodology, data collection and analysis method
5.1 The data required for the present study will be based on standards like risk assessment, skin
assessment pressure redistributing devices, care planning and repositioning.
5.2 Based on these standards, data will be collected in the hospital. The study design for the
present research is quantitative mainly a case control design that is best suited for the
identification of contributing factors in studying PU prevalence. The data collection will be done
on risk factors and tissue tolerance constructs (Yang et al. 2014).
5.3 The research will take place in the ICUs in a hospital comprising of 250 beds and 3 ICUs;
surgical, cardiovascular trauma ICUs. Braden scale will measure the activity, mobility and
sensory perception for the exclusive measurement of construct of pressure. Braden scale
subscore will measure the shear or friction and moisture being the extrinsic factors in tissue
tolerance. The inclusion criteria comprised of patients admitted to ICU between 18 to 60 years of
age being the case subjects and control subjects will be ICU admissions from the age 18 to 60
years of age. The exclusion criteria comprised of the CPR, stage one PU development within 48
hours and discharge from ICU prior to the visual PU development and ICU stay more than 48
hours. The matching criteria comprising of same ICU within 90 stays, absence or presence of
ventilator use and ICU length of stay where the controls in ICU for the same number of days.
5.4 The data will be collected from the cases using EMRs. For the case subjects, the medical
number, ICU length of study and ventilator use in the data management form. After the
identification of control subject, the ICU and medical records will be entered that indicates the
match. Data will be collected from the EMR that provide all patient information and variables
identified in the study.

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5.5 Questions are required for the improvement of health promotion programs and best practice
in the nursing.
What are the intrinsic factors that are taken into consideration during care planning for
the patient?
What are the intrinsic considerations that are taken into consideration during patient care
planning?
How often the skin assessment is done for the patients?
5.6 Data analysis for the present study will be using SPSS software for the investigation of
patient data collected in terms of the identification of determinants for the systematic patterns.
Descriptive statistics for the summarization of variables for each patient groups. Logistic
regression analysis will be used for the generation of both adjusted and unadjusted associations
of each PU risk factor with PU prevalence. Multiple hierarchical logistic regression will be used
for the generation of adjusted odds ratios. Braden scale will be used for the analysis of adjusted
and univariate analyses (Gelman et al. 2014).
5.7 The potential uses of data are to update the nurses regarding the assessment of contributing
factors for PU prevalence and aid in risk assessment for the early detection and prevention.
5.8 The Data Collection Policy in Australia, Health as a statutory requirement for data collection.
6 Validity
6.1 The physical variables comprises of the patient medical information that comprises of
medical history, hospital stay and reason for admission. The economic variables comprise of the

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funding and social variables comprises of communication between the researcher and
participants.
6.2 The language barrier and funding are two obstacles for the research study. For overcoming
language barrier, medical interpreters are required for the language translation. For overcoming
funding problem, during the planning of proposal, the strategic planning of budget should be
done so that there is no issue for funding.
6.3 The advantage of case control study is that it can be used for the study of the PU with long
latency period between exposure and disease progression like PU. It is cost effective and less
time-consuming (Yin 2013).
6.4 The disadvantage of case control study is that it has subject to selection bias, information on
exposure is subjected to observational bias and do not allow any calculation of prevalence and
incidence (DiMaggio 2013).
6.5 Consideration must be given to the results of the study along with rigour of the research.
6.6 Rigour can be studied for the study where the researchers can help to enhance quality if the
research and in quantitative research, rigour and validity can be done through reliability and
validity measurement (Johnston 2014).
7. Ethical considerations
7.1 The research should be conducted ethically that is critical by adhering to the standards or
norms that distinguishes between the acceptable and unacceptable behaviour. The emotional
need of participants’ family and friends comprises of emotional risks that can be overcome by
educating them about the purpose of the research or else they might get anxious.

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7.3 While researching, Professional Standards of Practice include ANMC Code of Conduct,
ANMC Code of Ethics, NMBA Enrolled nurse standards for practice and NMBA Regulatory
Authority Standards for Practice.
7.4 Australian Code for the Responsible Conduct of Research and National Health and Medical
Research Council (NHMRC)
7.5 National Statement on Ethical Conduct in Human research
7.6 The researchers must act in the best interest of the participants and maintain confidentiality
and respect the autonomy of participants and ensure safety during the condition of research under
duty of care.
7.7 The patients personal details should not be disclosed to others and maintain confidentiality.
9. Reflection
For the proper work and collaboration during research, there should be proper coordinated work,
empathy for each other and strong relationship building, trust and effective collaboration
between the teammates.

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References
Aasekjær, K., Waehle, H.V., Ciliska, D., Nordtvedt, M.W. and Hjälmhult, E., 2016.
Management Involvement—A Decisive Condition When Implementing Evidence‐Based
Practice. Worldviews on Evidence
‐Based Nursing, 13(1), pp.32-41.
Coleman, S., Gorecki, C., Nelson, E.A., Closs, S.J., Defloor, T., Halfens, R., Farrin, A., Brown,
J., Schoonhoven, L. and Nixon, J., 2013. Patient risk factors for pressure ulcer development:
systematic review. International journal of nursing studies, 50(7), pp.974-1003.
Coleman, S., Nelson, E.A., Keen, J., Wilson, L., McGinnis, E., Dealey, C., Stubbs, N., Muir, D.,
Farrin, A., Dowding, D. and Schols, J.M., 2014. Developing a pressure ulcer risk factor
minimum data set and risk assessment framework. Journal of advanced nursing, 70(10), pp.2339-
2352.
DiMaggio, C., 2013. Introduction. In SAS for Epidemiologists (pp. 1-5). Springer New York.
Engels, D., Austin, M., McNichol, L., Fencl, J., Gupta, S. and Kazi, H., 2016. Pressure ulcers:
factors contributing to their development in the OR. AORN journal, 103(3), pp.271-281.
Gelman, A., Carlin, J.B., Stern, H.S., Dunson, D.B., Vehtari, A. and Rubin, D.B., 2014. Bayesian
data analysis (Vol. 2). Boca Raton, FL: CRC press.
Hurlburt, M., Aarons, G.A., Fettes, D., Willging, C., Gunderson, L. and Chaffin, M.J., 2014.
Interagency collaborative team model for capacity building to scale-up evidence-based
practice. Children and Youth Services Review, 39, pp.160-168.
Johnston, A., 2014. Rigour in research: theory in the research approach. European Business
Review, 26(3), pp.206-217.

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McKeon, P.O. and McKeon, J.M.M., 2015. Evidence-Based Practice or Practice-Based
Evidence: What’s in a Name?.
Melnyk, B.M., Gallagher‐Ford, L., Long, L.E. and Fineout‐Overholt, E., 2014. The
establishment of evidence‐based practice competencies for practicing registered nurses and
advanced practice nurses in real‐world clinical settings: proficiencies to improve healthcare
quality, reliability, patient outcomes, and costs. Worldviews on Evidence
‐Based Nursing, 11(1),
pp.5-15.
Yang, J., Zaitlen, N.A., Goddard, M.E., Visscher, P.M. and Price, A.L., 2014. Advantages and
pitfalls in the application of mixed-model association methods. Nature genetics, 46(2), pp.100-
106.
Yin, R.K., 2013. Case study research: Design and methods. Sage publications.