University Nursing Report: Evidence-Based Practice for Pressure Ulcers

This nursing assignment report focuses on evidence-based practices for managing pressure ulcers, a significant clinical issue affecting patient care. The report begins by outlining the clinical problem and its importance, emphasizing the need for effective therapeutic interventions over medicinal approaches. The student conducted an evidence-based search using PubMed, employing keywords and Boolean operators to gather relevant research articles published between 2014 and 2019. The search yielded five articles, including systematic reviews, descriptive qualitative studies, a quasi-experimental study, and a cross-sectional study. The report synthesizes the findings from each article, highlighting the effectiveness of interventions such as polarization light, repositioning, mobilization therapies, risk assessment, static mattresses, and staff education in reducing pressure ulcer incidence and improving patient outcomes. The report concludes with recommendations for practice change, emphasizing the importance of education and training for healthcare professionals to improve their knowledge and implementation of evidence-based interventions, ultimately leading to better patient care and reduced risks associated with pressure ulcers. The report also addresses frequent position changes, skin cleanliness, and the use of medicated pillows and air mattresses as key interventions. Further, it discusses the use of Negative Pressure Wound Therapy.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the student
Name of the university
Author note

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Outline of the clinical issue
Clinical experiences are situations that help the nursing professionals to understand
critical aspects of healthcare while providing care to patients (Missen, McKenna& Beauchamp,
2016). Clinical nursing problems are the critical conditions, in which it is important that the
nursing professionals implement critical care so that these conditions could be treated effectively
(Sving, Högman, Mamhidir and Gunningberg, 2016). One such critical condition is pressure
ulcers in patients. As per Qaseem, Humphrey, Forciea, Starkey and Denberg(2015), pressure
ulcers arecritical conditions due to which majority of the patients are unable to lead effective
lifestyle or develop and also increase the cost of living. If the pressure ulcer related conditions
are not treated effectively, then it would create critical conditions such as poor nutrition and
hydration condition, increased lack of sensory conditions, immortality and critical health
conditions (Haugland&Giske, 2016). As per the Australian bureau of statistics, more than 70%
of patients that have been admitted in the healthcare facilities suffer from moderate to severe
pressure ulcer related conditions and in such condition, they should be provided with critical
healthcare interventions so that they could overcome these health conditions.
Therefore, the primary aim of this paper is to develop an effective evidence based search
so that the appropriate research articles could be found and through the help of that evidence
search, critical articles could be collected and a literature synthesis could be developed. Further,
thorugh these practice chances, this paper would help to identify the aspects that would develop
further recommendations for the changes that need to be taken for the practice.
Clinical question
Population Intervention Comparison Outcome

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patients
suffering from critical
pressure ulcer condition
Usage of
therapeutic intervention
compared to
medicinal interventions
improved
conditions
The question: does the evidence based therapeutic interventions helps the patients
suffering from pressure ulcer to obtained improved condition compared to medicinal or
pharmaceutical intervention?
Evidence search
To collect latest evidences for the identification of therapeutic interventions to overcome
the critical health complications of pressure ulcers in patients who are being admitted to
healthcare facilities, an evidence based search strategy would be conducted. The scientific
database of Pub Med would be used for this purpose asSving et al. (2016) mentioned this
database 40 one of the leading and accurate database for scientific evidences. To collect recent
and accurate databases, key words such as “therapeutic intervention”, “pressure ulcer”,
“improvement”, and “effective intervention” and through the usage of Boolean operators (AND,
OR, NOT), these keywords would be searched in permutation and combinations to find out
several accurate and appropriate research articles. Multiple inclusion and exclusion criteria
would be implemented in the search process and the search results would be refined using
publication years (2014 to 2019), research type (primary or secondary), higher or lower level of
evidence (as per the NHMRC hierarchy of evidences) so that refined and relevant research
articles could be selected for this analysis.

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The five research articles that were included after conduction of evidence based search
included two systematic reviews, one descriptive qualitative study, a quasi experimental study
and a cross sectional research process. These research articles were included in the NHMRC
hierarchy of evidences as level of evidence 1, level of evidence 4, and level of evidence 3
respectively.
Literature synthesis of best evidence
The first evidence collected from the search evidences is conducted by Tayyib and Coyer
(2016) so that the complication related to Hospital‐acquired pressure ulcers (HAPUs) could be
effectively overcome and the quality of care could be eliminated. This paper identified all the
aspects so that the incidences and prevalence of this health condition could be controlled. There
are multiple research evidences that were collected from this research process, such as
polarization light, repositioning and mobilization therapies, nutritional aspects and
implementation of support surfaces would help the patient to overcome the HAPU related
complications. These results are reliable and valid as there are multiple research processes found
repositioning and mobilization therapy to be effective in providing patients with HAPU in
effective relief. Therefore, application of this could be easily help the patients that are suffering
from moderate to severe pressure ulcer conditions. Therefore, the research article by Tayyib and
Coyer (2016) helped to identify effective therapeutic intervention for the patients with pressure
ulcers.
The second research article, by Qaseem, Humphrey, Forciea, Starkey and
Denberg(2015), whereas identified that proper risk assessment of patients that are admitted in
healthcare facility helps the patients by reducing their risk of critical health complications.

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Further, it also mentions the usage of static mattresses as well as advanced static overlays for the
patients that are with high risk of pressure ulcer so that their risk of health complications could
be effectively reduced. These results are valid or reliable because application of these mattresses
and overlays have been found effective by researchers Qaseem, Humphrey, Forciea, Starkey and
Denberg(2015) and it improved the patient condition by 47%. Therefore, application of these
interventions would be effective in reducing the risk of pressure ulcer.
The third research articles that have been included in the research paper after
development of evidence based search is the research conducted by Sving, Fredriksson,
Gunningberg andMamhidir(22017), in which they conducted an descriptive qualitative study so
that thorugh the interview of nursing professionals, they could be provided with effective care.
The researchers found that application of pressure reducing equipment and application of bedside
support, feedback and discussions were important for the growth and development of
applications so that the patients could be provided with effective and developed care.
The fourth research article that has been included in the evidence based search is the
research article conducted by Sving, Högman, Mamhidir andGunningberg, (2016), as per which,
it is the unit-tailored and multi-faceted intervention that is implemented in the care process so
that the patients could be provided with effective care that are suffering from pressure ulcer. The
research paper mentioned a descriptive qualitative study approach. The method of this study
design included interviews of five focus-group nursing personnel and five first-line managers.
These interviews were conducted at five different Swedish hospital units.The findings of this
research article mentioned that majority of the patients that suffered from this health
complication were treated and cared by nursing professionals that do not have effective
knowledge of treating such complication thorugh therapeutic interventions. This finding

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indicated to the fact that with effective training and education, the nursing professionals would
be able to care for critical conditions and they would be able to reduce the risk of critical care for
the patients that are suffering from pressure ulcers. Therefore, these findings seemed relevant
and accurate for the application in the care facilities. Therefore, these accurate and relevant
interventions could be easily applied upon the healthcare situations so that patients with pressure
ulcer related risk factors could be treated effectively (Milliken& Grace, 2017).
The fifth research article on the other hand, was a cross sectional study so that the
preventive measures implemented in the healthcare facilities of Sweden could be analyzed and
its effectiveness could be easily identified (Gunningberg, Sedin, IAndersson&Pingel, 2017). This
research paper was able to identify interventions that could be used by the healthcare facilities so
that they could treat the pressure ulcer and affected health complications. Further, it was found
that majority of the patients that were suffering from critical healthcare complications were
found to be effective in decreasing the risk of health complication on the patient’s healthcare.
Interventions such as floating heels and sliding sheets were able to identify aspects and provide
the patients with effective care so that they could provide the patient’s with critical healthcare
interventions.
Therefore, from all of these evidences collected from the evidence based search strategy
were able to identify the aspects that would be important for the growth and development of
therapeutic interventions so that patients and risk of pressure under could be prevented and all
the patients could improve their critical health complications without any fail. Both of the
systematic review articles were able to identify higher level of evidence and hence through these
research findings, it was evident that application of therapeutic interventions is effective in

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reducing the patient’s critical situations so that they could maintain improved patient outcomes
and therefore were able to answer the question developed in clinical question section.
Recommendations for practice change and research
As the previous sections mentions that application of evidence based articles could help
to reduce the risk factors of pressure ulcer related condition, these research findingsare important
in developing some crucial and critical aspects of pressure ulcer treatment. This research article
also found that the improper and inadequate knowledge of the healthcare professionals were one
of the critical reasons due to which majority of the patients were unable to overcome their critical
conditions. In such condition, it should be mentioned that the primary reason of such
complication is factors related to the organisation and the individual health care professional that
might act as barriers to evidence-based practice and research utilization. Therefore, in such
condition it may interfere with the critical health complications of the patients as well as the
nursing professionals. Therefore, the primary strategy that would help to reduce or facilitate the
evidences would be application of education or training sessions with the nursing professionals.
As per Milliken and Grace (2017), educational and training session with healthcare professionals
would help them to understand the critical and crucial aspects of pressure ulcer treatment and
they would be able to implement effective treatment intervention for the pressure ulcer affected
patients. This is an important aspects so that they could be provided with effective and critical
care to the patients. Further, after application of educational and training sessions for the
patients, the nursing professionals would help the patient to understand the complication they are
suffering from. Hence, while concluding this paper, it would be mentioned that though the
application of effective and evidence based nursing practice multiple effective and develop
interventions were found that would help the patients to overcome their critical health

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complications associated with pressure ulcer. Pressure ulcers which are also referred as bed sores
developed due to the exertion of toomuch pressure in the skin. These bed sores often lead to the
development of infections around the skin. Pressure ulcer occurs due to a constant, chronic
pressure on the skin. This pressure, in turn, causes a damage of the underlying tissue around the
skin. Pressure ulcers exert an inadmissible impact on health care structure, care providers as well
as most specifically on patients. The proper prevalence statistics of pressure ulcer remains
obscure. However, the pressure ulcers can be prevented by various different methods. There are
numerous and diverse intervention strategies to treat pressure ulcer. Numerous strategies may
include surgical repair, proper cleaning of the pressure ulcer affected area, ultrasound therapy,
hyperbaric oxygen therapy and electrical stimulation.
Frequent position changing- In case of a patient suffering from pressure ulcer, frequent
position changing is one of the most important key interventions. In order to reduce the pressure
ulcer frequent position changing of the patient helps immensely. Frequent position changing
exerts a less pressure on the skin of that particular pressure ulcer patient, thereby reducing the
sec=verity of pressure ulcer.
The patient suffering from pressure ulcer has to keep his or her skin always clean and
dry. This, in turn, increases the rate of cutaneous circulation of that particular pressure ulcer
patient.
Proper medicated pillows and air mattresses also play an inadmissible role to reduce the
severity of the pressure ulcer.
Negative Pressure Wound Therapy or Vacuum Assisted Closure Therapy- This therapy is
noninvasive therapy. This therapy was developed by the researchers of Wake Forest University

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School of Medicine, Winston-Salem, NC. This therapy can be used to treat different kinds of
acute, chronic, sub-acute non healing, infectious wounds of the pressure ulcer patients. The
V.A.R (C) therapy comprises of an open cell foaming, evacuation tubing, a vacuum therapy
pump and a canister for fluid storage. A continuous feedback technology loop has also been
associated with this V.A.R (C) therapy (Santamaria et al., 2015). This therapy helps to reduce
pressure ulcers by exudating the excessive tissue fluid from the particular affected (pressure
ulcer) area and prevents accumulation of infectious materials around the ulcer. The negative
wound pressure therapy also helps in the formation of granulation tissues. Granulation tissues are
much more effective in reducing the severity of pressure ulcer.

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References
Gunningberg, L., Sedin, I. M., Andersson, S., &Pingel, R. (2017). Pressure mapping to prevent
pressure ulcers in a hospital setting: A pragmatic randomised controlled
trial. International journal of nursing studies, 72,
53-59.DOI:10.1016/j.ijnurstu.2017.04.007
Haugland, B. Ø.,&Giske, T. (2016). Daring involvement and the importance of compulsory
activities as first-year students learn person-centred care in nursing homes. Nurse
education in practice, 21, 114-120.DOI: https://doi.org/10.1016/j.nepr.2016.09.001
Milliken, A., & Grace, P. (2017). Nurse ethical awareness: Understanding the nature of everyday
practice. Nursing ethics, 24(5), 517-524. DOI:
https://doi.org/10.1177%2F0969733015615172
Missen, K., McKenna, L., & Beauchamp, A. (2016). Registered nurses’ perceptions of new
nursing graduates’ clinical competence: A systematic integrative review. Nursing &
health sciences, 18(2), 143-153. DOI: https://doi.org/10.1111/nhs.12249
Qaseem, A., Humphrey, L. L., Forciea, M. A., Starkey, M., &Denberg, T. D. (2015). Treatment
of pressure ulcers: a clinical practice guideline from the American College of
Physicians. Annals of internal medicine, 162(5), 370-379. DOI: 10.7326/M14-1567
Santamaria, N., Gerdtz, M., Sage, S., McCann, J., Freeman, A., Vassiliou, T., ... & Knott, J. (2015). 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. https://doi.org/10.1111/iwj.12101

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Sving, E., Fredriksson, L., Gunningberg, L., &Mamhidir, A. G. (2017). Getting evidence‐based
pressure ulcer prevention into practice: a process evaluation of a multifaceted
intervention in a hospital setting. Journal of clinical nursing, 26(19-20), 3200-3211.DOI:
10.1111/jocn.13668
Sving, E., Högman, M., Mamhidir, A. G., &Gunningberg, L. (2016). Getting evidence‐based
pressure ulcer prevention into practice: a multi‐faceted unit‐tailored intervention in a
hospital setting. International wound journal, 13(5), 645-654. DOI:
https://doi.org/10.1111/iwj.12337
Tayyib, N., & Coyer, F. (2016). Effectiveness of pressure ulcer prevention strategies for adult
patients in intensive care units: a systematic review. Worldviews on Evidence‐Based
Nursing, 13(6), 432-444. DOI: https://doi.org/10.1111/wvn.12177

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Appendix
Search history and results