Literature Evaluation Table NRS 433 GCU

Nursing Practice Problem

Pressure ulcers result from prolonged pressure on some pressure areas, such as elbows, heels, and the back of the head. The ulcers/injuries result from prolonged pressure on these areas hence decreased blood and oxygen supply that causes necrosis and wounds. Pressure ulcers are painful, can develop severe sepsis, increase healthcare costs, and lead to death (Zarai et al., 2019).

Literature Evaluation Table NRS 433 GCU

Current statistics show that pressure ulcers reduce the quality of life and patient health outcomes. Pressure ulcer development is a quality measure metric by the Agency for Healthcare Quality and Research important in evaluating care quality and patient safety.

Critically ill patients and elderly patients face significant problems with movement. This population reports the most pressure ulcers due to decreased activity and unconsciousness (Gasper et al., 2022). Elderly patients develop severe wounds that hardly heal due to old-age tissue development and repair changes. Individuals with severe injuries such as cervical vertebrae fractures have mobility issues, and repositioning may be more harmful than harmless. Usual care in these patients entails two-hourly repositioning to relieve pressure in these areas.

The standard routine may be inapplicable in most patient situations, such as neck and head injury patients, and is also severely affected by nurses’ shortage and intention to carry out the procedure. Interventions should, as ripple mattresses, help redistribute pressure in body areas automatically over time. These interventions will help redistribute pressure with minimum patient movement and improve outcomes while maintaining patient comfort.

PICOT Question: Among critically ill and elderly patients, does using ripple mattresses compared to usual care prevent pressure ulcers and improve their management?

Criteria Article 1 Article 2 Article 3
APA-formatted article citation with permalink Adibelli, S., & Korkmaz, F. (2022). Pressure injury prevention practices of intensive care unit nurses in Turkey: A descriptive multiple-methods qualitative study. Journal of Tissue Viability.



Sachs, M. B., Wolffbrandt, M. M., & Poulsen, I. (2018). Prevention of pressure ulcers in patients undergoing subacute rehabilitation after severe brain injury: An observational study. Journal of Clinical Nursing, 27(13-14), 2776-2784.  https://doi.



VanGilder, C. A., Cox, J., Edsberg, L. E., & Koloms, K. (2021). Pressure injury prevalence in acute care hospitals with unit-specific analysis: results from the International Pressure Ulcer Prevalence (IPUP) Survey database. Journal of Wound, Ostomy and Continence Nursing, 48(6), 492-503. https://



How does the article relate to the PICOT question? The article evaluates the practices in intensive care units used to prevent pressure injuries/ulcers in critical care units such as ICU and HDU. Routine care, such as two-hour repositioning, is integral in pressure ulcer prevention and nurses’ attitude, thoughts, and deliberations toward the actual practices in intensive care units. The article evaluates the prevention of pressure ulcers in patients receiving rehabilitation care after brain injury. Severe brain injury renders patients weak and reliant on the care providers for most or all of their needs. The article explores the various ways in which healthcare providers prevent pressure ulcers in these patients. Among the methods used are ripple mattresses for pressure distribution and pressure ulcers prevention The International Pressure Ulcer Prevalence Survey evaluated the pressure injury prevalence, risk factors associated with pressure ulcers, and standard prevention practices in critical care units using data from the institution’s database. The essay explores a critical part of the picot; population and evaluates the problem in critical care units.
Is the article qualitative, quantitative, or mixed methods? Justify your selection. The article uses mixed methodsThe study used descriptive statistics to collect and analyze observations and semi-structured interviews. The article utilized a qualitative method because it used an observation method to collect data and analyze the data using content analysis The article is quantitative. The study collects, analyzes, and reports data using quantitative methods.
Purpose statement The purpose of the study was to examine the thoughts, deliberations, and actual practice in pressure injury prevention in critical care units Assess the interventions by healthcare professionals in pressure ulcers prevention in individuals with severe brain injury and undergoing rehabilitation services To examine pressure injury prevalence, risk factors, and prevention practices of critically ill patients in the US using the pressure ulcer prevalence survey database.
Research question(s) Are nurses’ thoughts and deliberations in line with actual practices of intensive care units in pressure injury prevention? What efforts do healthcare professionals implement to prevent pressure ulcers in severe brain injury patients? What is the overall prevalence of pressure injuries prevalence?What is the prevalence of HAPI in critical care units in the US between 2018-2109?

What are pressure injury factors associated with more severe HAPIs in critical care unit patients?

What are the differences in prevention practices in critically ill patients with no injuries compared to patients who developed superficial or severe pressure injuries?

Outcome(s) The practice measures do not necessarily conform to the evidence-based recommendations in actual ICU nursing practice due to factors such as Patient/nurse ratios. Healthcare professionals use experience and knowledge to apply interventions for pressure ulcer prevention and provide care that suits every patient’s needs. The overall pressure injury prevalence in critical care units is 14.3%, compared to the 7.78% medical-surgery showing that critically ill patients are at a high risk of pressure injuries.The prevalence of HAPI was 2.58% in medical-surgical units and 5.58% in critical care units

Critically ill patients report more severe pressure injuries than patients in other units, with the sacral-coccyx region having the highest number of PIs

Prevention interventions such as technologies in critical care units while patient repositioning by self or the nurse were the most common interventions

Setting (Where did the study take place?) Three different adult intensive units in United States Hospitals A Danish sub-acute rehabilitation ward in southwestern Denmark US healthcare facilities participating in the IPUP survey 2018/2019
Sample 40 nurses in 25 beds Four patients undergoing severe brain injury rehabilitation 41866 patients in critical care units
Method Variation sampling Convenience sampling to select Voluntary response sampling
Key findings of the study and implications for nursing practice From the study, factors affecting pressure injuries prevention practices in critical care units were support materials, skin care, nurse-patient ratio, patient health condition, interprofessional roles, and individual skin characteristics and vulnerabilities. Four themes were prominent in the study, including organization of clinical practice, professional assessment, and interactions with the patient. The study highlights the importance of clinical knowledge and shows that it is not enough for effective treatment, despite its great significance. Thus, other interventions, such as ripple mattresses, have shown thus be employed for the effective prevention and treatment of pressure ulcers. The study found gaps in pressure ulcer critical care, which are inaccurate risk quantification in this population and the potential unavoidability of PI development. Pressure ulcer development in critical care units is a problem that requires prevention and management.
Recommendations of the researcher The study recommends institutions and healthcare providers consider evidence-based approaches in ICU pressure ulcer preventive practices and the prevention of pressure ulcers. The researcher recommends that healthcare providers revisit patients’ past lives, pay attention to them, and use the details to improve outcomes. The researcher also recommends interdisciplinary extrapolation of results to in The researcher recommends institutions consult reputable databases and institutions such as the Agency for Healthcare Research and Quality and Institute for healthcare improvement to improve outcomes in critical care units
Criteria Article 4 Article 5 Article 6
APA-formatted article citation with permalink Lindhardt, C. L., Beck, S. H., & Ryg, J. (2020). Nursing care for older patients with pressure ulcers: A qualitative study. Nursing open7(4), 1020–1025.


Sharp, C. A., Schulz Moore, J. S., & McLaws, M. L. (2019). Two-hourly repositioning to prevent pressure ulcers in the elderly: patient safety or elder abuse? Journal of bioethical inquiry16(1), 17-34.


Gaspar, S., Botelho Guedes, F., Vitoriano Budri, A. M., Ferreira, C., & Gaspar de Matos, M. (2022). Hospital‐acquired pressure ulcer prevention: What is needed for patient safety? The perceptions of nurse stakeholders. Scandinavian Journal of Caring Sciences, 36(4), 978-987.


How does the article relate to the PICOT question? The article explores a critical component of the PICOT: the population. The study investigated the care interventions implemented for elderly patients and preventing pressure ulcers. The article evaluates geriatric nurses’ experiences and perceptions of pressure ulcer prevention. The article evaluates usual care (comparison for the intervention), two-hourly repositioning on elderly patient outcomes, and safety. The article evaluates the current interventions’ effectiveness and any need for change. The article weighs the benefits and demerits of the intervention and its effectiveness in preventing pressure ulcers. The article explores the problem, the first component of the PICOT. It explores the institutional, patient, and nurse-related factors necessary before intervention implementation to prevent pressure ulcers in hospital units.
Is the article qualitative, quantitative, or mixed methods? Justify your selection. The study utilized a qualitative approach, data collection was verbatim, and thematic analysis was used in qualitative analysis. The article utilizes a quantitative approach because the authors utilize numeric data to evaluate outcomes and uses descriptive statistics and inferences where the data is given in frequencies, percentages, rates, and prevalence The researchers used a qualitative method, as seen in data collection methods (semi-structured interviews) and analysis (thematic and content analysis).
Purpose statement The study’s purpose was to explore the experiences and perceptions of preventing pressure ulcers for geriatric nurses The study aimed to determine the number of elderly patients at risk for pressure ulcers, utilization of two-hourly repositioning, and the prevalence of pressure ulcers in the last week of life The study aimed to explore the perceptions of nurses’ stakeholders regarding pressure ulcer prevention practices and reality in a healthcare setting.
Research question(s) What are the geriatric nurses’ experiences and prevention of pressure ulcers in pressure ulcers prevention? Is two-hourly patient repositioning effective in preventing pressure ulcers among residents in a Residential Aged Care Facility? What are the perceptions of nurses’ stakeholders on pressure ulcer prevention and patient safety and reality in hospital settings?
Outcome(s) Nurses’ perception is an issue requiring attention. Nurses’ perceptions and experiences in geriatric care are influenced by nursing skills, the availability of nursing resources, and new nurses in the ward. Pressure ulcer prevalence does not impact pressure ulcer formation or healing. Patients who were repositioned two-hourly also developed pressure ulcers Expected outcomes were an understanding of:Pressure ulcer risk assessment

Care providers’ pressure ulcers monitoring

Pressure ulcer risk profiles development; and

Effective interventions in patient safety improvement

Setting (Where did the study take place?) The geriatric ward of Odense University Hospital. A Residential Aged Care Facility The study was conducted in a nursing focus group using senior researchers
Sample Six nurses in the geriatric ward of Odense University hospital 80 patients aged 65 and above 11 participants
Method Convenience sampling Random Sampling of the medical records of the residents Convenience sampling (nurses who consented to the study)
Key findings of the study and implications for nursing practice From the study, all the nurses agreed that pressure ulcer prevention in the geriatric ward is crucial. In the theme of experiences, nurses admitted most interventions are ineffective, and it is challenging to balance pressure prevention measures such as tow-hourly repositioning From the study, 91% of the residents were turned two hourly, and 34% developed pressure ulcers. 72% of the residents had behavioral concerns, and 38% were restrained due to behavioral concerns. Two-hourly repositioning and subsequent restraining is unlawful, breaches patient rights, and does not prevent pressure ulcers. Among the participants, the mean years of experience were 15.82 years. 62% had specialized training in wound care and pressure ulcer prevention, 36% were policymakers, and 27% were directly involved in making policies that affect pressure ulcers.In thematic analysis, the most common factors implicated in pressure ulcer prevention and management include “Understaffing/nursing hours, health policies, electronic health records systems, and clinical language used, access to appropriate equipment and resources, teamwork and clinical support specialist on tissue viability/wound care.” Any interventions to manage pressure ulcers in institutions must consider these factors
Recommendations of the researcher The research highlighted the need for awareness creation on preventing and managing pressure ulcers in geriatric care. The researcher also recommends researching and implementing effective interventions such as bedside teaching, close observations and patient evaluation, and environmental modifications. The researcher recommends care providers eliminate two-hourly patient repositioning. To prevent pressure ulcers, the researchers also recommend providing other interventions, such as air/ripple mattresses. Healthcare providers and institutions should enhance institutional, behavioral change in ‘awareness/knowledge/competence, motivation and opportunity” to improve the care delivered.

Literature Evaluation Table NRS 433 GCU References

Zarei, E., Madarshahian, E., Nikkhah, A., & Khodakarim, S. (2019). Incidence of pressure ulcers in intensive care units and direct costs of treatment: Evidence from Iran. Journal of tissue viability28(2), 70-74.

Sharp, C. A., Schulz Moore, J. S., & McLaws, M. L. (2019). Two-hourly repositioning for prevention of pressure ulcers in the elderly: patient safety or elder abuse? Journal of bioethical inquiry16(1), 17-34.

Literature Evaluation Table NRS 433 GCU Guidelines.

For this assignment, provide a synopsis of the review of the research literature. Using the “Literature Evaluation Table,” determine the level and strength of the evidence for each of the eight research articles you have selected. The articles should be current (within the last 5 years) and closely relate to the PICOT question developed earlier in this course. The articles may include quantitative research, descriptive analyses, longitudinal studies, or meta-analysis articles. A systematic review may be used to provide background information for the purpose or problem identified in the proposed capstone project.

PICOT question

(P) type two diabetes

(I) physical activities

(C) pharmacologic therapy

(O) blood glucose

(T) three months.

Also Read: GCU NUR550 PICOT Research Proposal