Analysis of Patient Repositioning and Pressure Ulcer Risk: Report

This report examines the effectiveness of patient repositioning in preventing pressure ulcers, a significant challenge in healthcare due to associated costs and patient morbidity. The report critiques a primary research article focusing on monitoring interface pressure in at-risk patients. It details the search strategy, research critique using a Randomised Controlled Trial (RCT) approach, and the quantitative research methodology employed. The report analyzes sampling methods, ethical considerations, and statistical analysis techniques used to assess the impact of repositioning interventions. Findings highlight the limitations of the study, including a small sample size, and discuss the importance of ethical considerations, data analysis methods, and the context of the research. The report concludes with key points and suggestions for improving repositioning practices to mitigate pressure ulcer risks, emphasizing the need for further research and ethical considerations in healthcare settings.

Evidence and Research in
Practice

Table of Contents
Background .....................................................................................................................................1
Search Strategy ...............................................................................................................................1
RESEARCH CRITIQUE.................................................................................................................3
Design and methods.....................................................................................................................3
Sampling......................................................................................................................................4
Ethics ...........................................................................................................................................5
Analysis........................................................................................................................................5
Research Context ............................................................................................................................6
Summary of key points and Suggestions.........................................................................................7
CONCLUSION ...............................................................................................................................8
REFERENCES................................................................................................................................9
.......................................................................................................................................................11

Background
To explore an area of difficult practices in health and social care, the topic which has
been chosen under present report is “Pressure ulcers in bed ridden patients”. The reason behind
this is to measure the effectiveness of repositioning practices, which is an ongoing challenge in
terms of cost, morbidity, length of stay and mortality (Bullock and et. al., 2018). Pressure ulcers
today, are higher at risk that causes cost problem for bedridden and hospitalised patients.
Because to manage one-full thickness ulcer, it can cost over $70,000 for an individual, while
more than $17 billion can be spent on treatment of pressure ulcer annually (Shaw, 2018). In this
regard, repositioning patients in regular manner help in reducing interface pressure, as well as
prevent them from pressure ulcers also. However, it is considered as standard of care, but still it
doesn't relieve on entire areas of at-risk tissue (Farley-Ripple and et. al., 2018). Therefore, to
make an argument on this practice, I have chosen an article “Patient Repositioning and pressure
ulcer risk – Monitoring interface pressure of at-risk patients”, which is given by Matthew and et.
al., (2013). This primary article allows a researchers to understand the feelings of participants
and their viewpoints on given topic.
Search Strategy
For searching matter on chosen topic, keywords include interface pressure, decubitus
ulcer, ulcer prevention, risk of pressure ulcer, standards of care and more. For refining these
keywords searching terms, a number of SEO tools can be used, such as Google's Webmaster
Tools, Ahrefs, Woorank, Buzz Stream and more. In this regard, I have employed the right SEO
(Search Engine Options) tool i.e. HubSpot's Website Grader, to gather relevant and specific
content on given topic “Pressure ulcers in bed ridden patients”. This tool helps in identifying
and sorting the contents to prepare a report on a specific topic. On seeing the importance of given
scenario, limited primary articles are explored, that are published between 2011 to 2018. This
would help in gathering recent information on measuring the effectiveness of repositioning
strategy, for ulcer prevention. Using this tool, I have used Prisma Flowchart to find articles on
the same topic on Google Scholar, where key words that I have types is 'concept of repositioning
the patients and its effectiveness in prevention of pressure ulcers'. So, records that have identified
by database searching are near about 225. After then, I have filtered the key words by necessities
of repositioning the patients, it helps in removing the duplicate articles and filtered 225 articles to
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100 and repeating the same process until it reduced to 8 only. So, I have reviewed these eight
articles to find the most effective one where only primary activities has done to evaluate the
result. So, only one article I have found that fits with demand of my research paper which is -
“Patient Repositioning and pressure ulcer risk – Monitoring interface pressure of at-risk
patients”.
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RESEARCH CRITIQUE
Basically, critique is said to be a term which means to judge a particular value that a
literature document having. There are many research appraisal tools that can be utilised by me
for critiquing the article and these are : Randomised Controlled Trial (RCT), Cohort, Diagnostic,
Case control Studies, Economic Studies, Other Quantitative, Qualitative, Mixed Methods and
Systematic Reviews (Moore & Cowman, 2015). Here, I have considered Randomised Controlled
Trial (RCT) for performing the quantitative research as this would directly help me out in pulling
out favourable outcomes in regards to the chosen research investigation within the article i.e.
quantitative. With the help of this, it will be easy for me to pull out favourable outcomes that are
more credible, rigour and relevant as well. Basically, the reason that came in front i.e. this
approach (methodological checklist tool) is much more easy to understand then other types of
tools, that are being utilised by professionals within health sector (Mervis & Phillips, 2019).
Along with this, I have analysed that this also contains a number of pros and cons as well
considering an article which was developed as a quantitative research and these are :
Comparative (Pros): It is said that, considering this approach particularly will help
healthcare providers in comparing a particular treatment to another one, which was developed
establishing the superiority in specified time frame (Farley-Ripple and et. al., 2018). Away with
this, another benefit of considering this study design can make causal inferences, i.e. it is the
strongest empirical evidence of a treatment's efficacy.
Ethical limitations (Cons): Specifically, the negative aspect of considering this tools is
that it mainly requires appropriate clinical equipoise. That means, an individual may not ethically
randomise patients until and unless equal support is given in clinical community.
Design and methods
In the given article, quantitative research methodology is being utilised was used
permitting the researcher to compute the conclusion in numerical terms so that effectively right
amount of information could effectively be carried out in specified time frame (Shaw, 2018).
Basically, approach that I have utilised in the primary research article approach as it
continuously allowed me and all the participants to deliver the numeric data, related to the
number of cases that came in front of providers related to pressure ulcers, and the individuals
(patients) who were being served with the repositioning treatment related strategy (Bullock and
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et. al., 2018). Considering this type of investigation, it could easily be said that correct
information (in numbers) in regards to Bedridden patients who are at risk of pressure ulcers will
be carried out in specified time frame. Considering the PICO Questions that I have built were
pressure ulcers, turning a patient, pressure mattresses and bedridden patients who are at risks are
said to be some of open ended questions (De Meyer and et. al., 2017). In present context, I have
found that all of these questions mainly carried some disadvantages and advantages and these are
: they allow for the participant to respond spontaneously, thus avoiding bias that may result from
suggesting responses to individuals. On the other hand, there is particular a major disadvantage
as well and i.e. subsequent analysis and participant response mainly consumes time and they stay
difficult as well (Fabbruzzo-Cota and et. al., 2016). I also found that, it will be required to collect
the data, considering the appropriate information in regards to the chosen topic. On the other
hand, in a negative sense if it is thought, then the whole process is said to be lengthy in nature,
because ample number of issues majorly takes place in specified time frame.
Sampling
In present context, non-probability sampling strategy where the method has been taken
into consideration i.e. convenience sampling in order to recruit participants (23 respondents).
Basically, authors of chosen article have conducted their study on 23 patients who were being
considered as the individuals that were dealing with pressure ulcers. Along with this, they have
utilised mixed methodology that has helped in pulling out favourable outcomes in specified time
frame in regards to the chosen subject and i.e. Patient repositioning and pressure ulcer risk—
Monitoring interface pressures of at-risk patients. Including this, quantitative investigating
research is being utilised that will help in pulling out favourable numbers considering the
specified aim. This would also help researchers in hitting targets in regards to the chosen topic.
Sample bias can arise when the actual sample does not adequately reflect the spectrum of
characteristics in the target population (Krupp and Monfre, 2015). This information is necessary
to allow the reader to estimate the magnitude of bias and leads us to question the integrity of the
findings. Common practice to reduce interviewer bias is to use investigators who are not
involved within the area being researched.
Away with this, data collection approach that was considered i.e. deductive as it is one of
the crucial approach, where reliability and validity of method is very important as this gives the
research findings credibility (Tayyib, Coyer & Lewis, 2016). In present context, I can say that if
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other approaches like probability sampling techniques has been taken into consideration, it is
may be possible that I would have taken this whole outcome to a wrong way. Therefore, it can be
said that on the chosen topic i.e. Patient repositioning and pressure ulcer risk—Monitoring
interface pressures of at-risk patients, convenience sampling was being taken into consideration.
This has helped me in looking into the subject in much more appropriate and in effective manner
as well. In here, different number of formulas in regards to the quantitative investigation was
being utilised so that to pull out effective and efficient results in a short span.
Ethics
Under the article, I have evaluated that researchers have properly maintained the ethics
while conducting report on selected participants. Mallah, Nassar and Badr (2015) define ethical
consideration as an important part of research, when voluntary participation of respondents is
included, to collect primary research. It describes a set of moral standards, principles, rules that
governs a profession. Hereby, as present article is completely primary based, therefore,
considerations of ethical states that researchers haven’t harm the principal morale, i.e. privacy as
well as anonymity of participants are properly protected. Along with this, confidentiality of
information has also been maintained, by signing an informed consent with participants (Tayyib,
Coyer & Lewis, 2015). Feedback of chosen 23 respondents on repositioning practices of
prevention of pressure ulcers, has also been interpreted in honest way, by the researchers of
present article. This primary article also received an institutional review board approval, where
all participants are provided informed consent. Investigation of this support was funded and
supported by the University of Florida College of Medicine & Engineering, Department of
Anaesthesiology and Health Service Research & Development, with declaration of no competing
interests. All of these evidence shows trustworthiness and ethical consideration to the study
(Woodhouse and et. al., 2015). However, participants have not informed publication of this data
so, this point reflects ethical dilemma of given study.
Analysis
The researchers under given primary article has maintained the credibility, via utilisation
of statistical analysis, where for analysing data, quantitative approach has been chosen by using
descriptive and observational study. It focuses on collecting data from at a tertiary care, where
participants are invited to enrol in study during regular care at hospitals (Boyko, Longaker and
Yang, 2018). Visual inspection and anatomically aligned the images of data recorded about
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pressure profile, help in comparing the result of chosen participants from each other, regarding
risk of same. Usage of statistical tools like ANNOVA, Wilcoxon Rant Test help in interpreting
data more efficiently, to conclude result. However, chosen sample of 23 respondents only
describes the limitation of data, because generalisation of such information creates difficulties
for further and appropriate findings.
Research Context
Peterson et. al. paper on patient repositioning and pressure ulcer risk reveals that at-risk
areas of patients for pressure ulcer formation includes skin-area which is exposed to a number of
pressure thresholds (Tayyib, Coyer and Lewis, 2016). To determine whether repositioning of
patients helps in prevention of pressure ulcers for high-risk patients, researchers of this article
have assessed the effectiveness of same in terms of relieving at-risk tissue, especially at
perisacral area, by using the interface pressure mapping (Razmus, 2018). For this purpose, they
have conducted study on 23 bedridden patients who are at higher risk for pressure ulcer
formation. The interface pressures has recorded in every 30 seconds during routine repositioning
care, which was provided in every 4 to 6 hour. So, it has been evaluated that there was a lack of
repositioning interventions, that is mainly used for partially explaining if pressure ulcer
mitigation strategies fail or success in prevention of ulcers.
It has been calculated through statistical methods like Wilcoxon Rank Test, that for every
position at-risk areas (centimetre squares), which is experienced by every patient, is different
from other areas. If a bedridden patient will momentarily roll from one side then back during a
repositioning, under such case pressure profile might indicate that certain tissue areas will relieve
(Tayyib and Coyer, 2016). This shows a dearth of systematic reviews about each area of patient
who are at higher risk of pressure ulcer, due to long stay on bed. Research design in the form of
descriptive and observational study, helps researchers to apply a number of statistical measures
like one-tailed test to check hypothesis (Merriam and Grenier, 2019). To measure interface
pressure risk, XSENSOR Technology has been used which is a pressure mapping system, aid
researchers in obtaining relevant data and draw appropriate conclusion. But if they apply same
method on a large sample i.e. near about on 80 to 100 patients, then it will provide more
appropriate result. Other limitations of this primary article includes tissue interface pressure,
which is failed to measure capillary pressure and internal tissue (Usher and et. al., 2018). Making
adjustment in patient’s movement lead to causes errors within tracking areas that are exposed to
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prolonged pressure of ulcers. It has raised questions on accuracy and effectiveness of result
outcomes. Therefore, it has been determined that relieving at-risk tissue consider as a necessary
part for pressure ulcer prevention, but healthcare organisations are needed to improve the
repositioning practice.
Despite the key result obtained by researchers proves effective but they fail to determine
the way pressure mapping can be used, for developing better patient repositioning techniques
(Krupp and Monfre, 2015). The contents provided by the authors include their viewpoints only,
there was no reviews are provided as per University of Florida and other departments who have
supported and provided funds to researchers. So, this factor shows ineffectiveness of research
outcomes. Along with this, present research is also not done systematically or ethically, because
authors have not informed the participants about publication of this article.
Summary of key points and Suggestions
Repositioning the patients refers to be the most essential practice as it helps in dealing with
the pressure which results due to ulcers. it is very essential for health care providers to remain
aware about the tissue of human body which relieve effectiveness of their repositioning
interventions as this help ensure success of various strategies which they use to provide treatment
to patients. One area which can be further investigate by researchers in this field is pressure
mapping (Powers, 2016). With help of this service providers can develop more effective
repositioning techniques and can better deal with risk tissue which help in prevent pressure under
ulcer formation. proper research is required in order to study the various aspects of ulcers in
order to develop effective solutions and to provide better care to patients. Major area that require
to be study by the service providers is the study of various kind of tissue of human body as
through this they can provide proper treatment to patients. In order to improve the practice about
repositioning patients to prevent them for pressure ulcers, it is recommended to professionals and
other care takers to concern on some main aspects. It includes – while repositioning the patients,
they must ensure that ankles, elbows and knees of patients will not be resting on top of each
other. Head and neck of individuals must be in line with spine and should not stretched. Along
with this, comfort of patients also need to be checked after repositioning, to reduce occurrence of
pressure ulcers. As turning patients on beds in every two hours, keeps blood flowing properly
and reduce the occurrence of pressure ulcer risk. Therefore, it is essential for care takers to
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inform patients about ongoing practice, so that engagement of them to do carefully can be
gained.
CONCLUSION
It has been concluded from this article that risk of Pressure ulcers, which is also called
decubitus ulcers, pressure sores or bedsores, is higher for patients of age 65 years and above. But
patients at younger age with neurologic impairment or severe illness are also susceptible. It is
ranges in severity i.e. from reddening of the body skin to severe, deep craters or indentation in
skin with exposed bone or muscle. Pressure ulcers leads to significantly threaten the health and
well-being state of patients, due to long stay on bed with limited mobility. Therefore,
repositioning of patients in every two hours refers to the effective practices, for preventing
themselves from pressure ulcers at-risk. But for this process, careful planning and proper
assurance of patients’ comfort need to be done by care takers or medical staff.
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