NRS 433 Week 5 Research Critiques And PICOT Statement Final Draft

NRS 433 Week 5 Research Critiques and PICOT Statement Final Draft

Prepare this assignment as a 1,500-1,750-word paper using the instructor feedback from the previous course assignments and the guidelines below.

Research Critiques and PICOT Question Guidelines –Qualitative and Quantitative Studies Example

The nursing problem of interest is pressure ulcers in critical care units. Pressure ulcers develop when patients sleep on one side and result from decreased blood and nutrient supply to the area. Pressure ulcers affect elderly and critically ill patients due to their mobility problems. The routine practice to prevent ulcers is 2-hourly patients turning, but the practice is partially effective, and patients pressure ulcers despite routine turning.

Complications of pressure ulcers include infections, leading to gangrenous tissues, especially in the sacrum and calcaneus regions (Mitchel et al., 2018). The current staff shortage, the bulkiness of the routine practice, and the effects of routine turning cause an increasing demand for practice changes. The proposed change uses ripple mattresses, timed technologies that change pressure from interconnected air pockets.

In addition, ripple mattresses relieve pressure to form the areas, routinely promoting circulation and preventing pressure ulcers. The desired outcomes are improved pressure ulcer healing and decreased pressure ulcer development. Staff knowledge and attitude towards the new intervention will significantly influence its success.

The revised PICOT question is: “Among critically ill and elderly patients, does using ripple mattresses compared to usual care prevent pressure ulcers and improve their management?”

Background of Studies

Sach et al. (2018) evaluated interventions by nurses to prevent pressure ulcers in patients undergoing subacute rehabilitation after severe brain injury. The purpose was to determine professionals’ intent and effort to pressure ulcers. The research questions aimed to determine if nursing professionals implement interventions recommended in national guidelines and by large organizations. The study established that national guidelines and recommendations are hardly implemented in healthcare institutions.

Gasper et al. (2018) evaluated the perception of nursing professionals of pressure ulcer prevention and reality in healthcare facilities. The purpose was to determine how nurses perceive pressure ulcer prevention, driven by the high burden of pressure ulcers. The research questions focused on determining nurses’ knowledge and practices implemented to prevent pressure ulcers and the causes of underutilization of available evidence-based strategies to prevent pressure ulcers.

Gasper et al. (2018) will help understand factors affecting pressure ulcer prevention, hence their management. Sachs et al. (2018) outline factors associated with pressure development and poor outcomes and thus inform nursing interventions. Sharp et al. (2019) evaluated the link between 2-hourly repositioning and the development of PUs in the last two weeks of life of residents at an elderly care facility.

The research questions it answered were “Do routine practices of two-hourly patient repositioning prevent pressure ulcers?” and Is two-hourly patient repositioning and restrain safe or elderly abuse?” The aim was to establish a relationship between routine practice and desired outcomes to recommend practices to improve pressure ulcer prevention efforts. The research helped understand the implications and effectiveness of routine nursing practices, two hourly patients turning.

Van Gilder et al. (2021) evaluated the overall pressure ulcers prevalence and healthcare-acquired pressure ulcers based on HAPIs. The aim was to determine the burden of PIs in care centers. The study questions focused on determining the most common PI locations, Braden scores in HAPIs, and areas with the highest burden. Sharp et al. (2019) and Van Gilder et al. (2021) discuss the prevalence and incidences of pressure ulcers.

How Do These Four Articles Support the Nursing Practice Problem You Chose?

Sachs et al. (2018) evaluated the gap between the development of pressure ulcer prevention and its implementation. It also validates the pressure ulcers problem existence. Gasper et al. (2018) also support the problem’s existence in all healthcare settings, with the highest prevalence in critical care settings. The article also shows the importance of nurses in pressure ulcer prevention. Nurses are tasked with patient turning, which is often not done, leading to pressure ulcers.

harp et al. (2019) will help show the effectiveness of t routine practices, an essential component of the PICOT, while Van Gilder et al. (2021) will help validate the existence of the pressure ulcer burden in critical care settings. Sharp et al. (2019) recommend ripple mattresses and other interventions as effective interventions to promote quality patient outcomes. The two articles will help evaluate routine practices and recommend changes, such as ripple mattresses, to routine practices to reduce pressure ulcer prevalence.

Sachs et al. (2018) and Gasper et al. (2018) did not have control or intervention groups. Sachs et al. (2018) study population was critical care patients, resembling the interest population for this study. Gasper et al. (2018) utilized nurses for their study. Nurses are not among the interest population but are vital implementers of the chosen intervention.

Sharp et al. (2019) and Van Gilder et al. (2021) are non-experimental and hence do not have intervention or control groups. However, Van Gilder et al. (2021) use data from acute hospital settings, and Sharp et al. (2019) study subjects were individuals from residential aged care facilities. The project’s interest population is critically ill and elderly patients, hence the similarities between these studies. The information is thus relevant based on the populations used.

Method of Studies:

Sachs et al. (2018) utilized a qualitative, non-participant observational study. Sharp et al. (2019) conducted a retrospective cross-sectional analytical survey design, while Van Gilder et al. (2018) conducted an observational cross-sectional cohort study. Gasper et al. (2018) conducted an in-depth qualitative interview. The interviewer must have adequate knowledge, unlike a non-participant observational study. The in-depth interview is also more comfortable for the interviewer and the subjects.

The non-participant observational study method is easy, less time-consuming, and thus less costly. The method is limited by data collection and entry bias because the professionals understand they are being watched. In-depth reviewers are professionals and require skills among the interviewers. Coleman (2019) notes that in-depth interviews’ major limitation is their dependence on the interviewer’s questions, questioning style, and choice of subjects.

Observational cross-sectional cohort studies which are well-designed produce high-quality results. However, they are limited by the need for large population size and long-duration follow-up, making them cumbersome and expensive. Retrospective analytical surveys rely on already collected data; hence, they are less time and cost-consuming. However, most of the data is collected for other purposes; hence, many missing data links for analytical surveys (Talari & Goyal, 2020). In most cases, addressing these biases and limitations is possible through well-designed studies.

Results of Studies:

Sachs et al. (2019) identified four themes in pressure ulcer prevention: professionalism, patient involvement, the feasibility of practices, and professional pride. These factors affect the utilization of evidence-based pressure ulcer prevention strategies that are available.

According to Gasper et al. (208), factors associated with the various themes were; communication “interest, responsibility, autonomy, leadership, and prioritization,” competence “Braden scale operationalization, undergraduate degree education, continuous professional education, missing care, and reliability of patient records and clinical characteristics,” opportunity theme,” understaffing, health policies, EHRs and clinical language used, access to appropriate resources (equipment and staff), teamwork, and specialist availability.”

Sharp et al. (2019) show that 34% of the 80 residents die with at least one pressure ulcer despite the two-hourly repositioning intervention. 38% of patients were restrained and sustained injuries besides Pus; among them, 72 had dementia. Van Gilder et al. (2022) show a high burden of pressure ulcers in healthcare facilities. Data revealed that 8.87% of patients had a pressure ulcer, and 2.51% had a HAPI. Med-Surg units had the lowest prevalence of 7.78% PI and 1.875 HAPIs, while CCUs had the highest prevalence of 14.32% PI and 5.85% HAPIs. Critical care patients also had the most severe PUs, and the most affected body region was the coccyx.

Implications to Nursing Practice

Sachs et al. (2018) show the various factors to address before implementing change interventions. It also implies that PU prevention interventions should be prioritized to achieve desired outcomes. Gasper et al. (2018) show that growth opportunities such as resource mobilization (such as bedding), EHR, teamwork, and specialist utilization can be mobilized to help manage the current problem.

Sharp et al. (2019) show that two-hourly repositioning is not an effective intervention in pressure ulcer development, hence the need for change. It also shows that dementia patients are prone to pressure ulcers, hence the need to develop interventions to control them with restraint. Van Gilder et al. (2021) validate the existence of a nursing problem and the need to develop effective interventions for the problem. The result implies that the burden is higher in critical care areas compared to the medical-surgical units, hence the need for more attention to the ICU.

Ethical Considerations

There are various ethical considerations in research. One of the ethical considerations is informed consent. Research subjects must be aware of the research interventions, and information must be fully disclosed to the patients to help them make participatory decisions. Coercion, misinformation, and failure to disclose some information in research amount to malpractice. Another ethical consideration is the ethical review of studies. Internal review boards must review and approve research to ensure it meets the basic standards of research and that it complies with the local, state, and federal regulations in research (Glaszio et al., 2021).

Sharp et al. (2019) and Van Gilder et al. (2019) used secondary data for their study; hence, there was no need for an informed concept. Informed consent applies only to primary research interventions. Sachs et al. (2018) and Gasper et al. (2018) used nurses in their research studies. Both studies obtained through participants’ verbal and written and informed concepts. All these studies were reviewed by internal review boards by the relevant institutions.

Sharp et al. (2019) were reviewed by the UNSW Australia Human Research Ethics Committee HC, number HC14163. Van Gilder et al. (2021) were reviewed by the Institutional Review Board at Wound, Ostomy and Continence Nurses Society. The researchers in the other articles also ensured that their respective institutions reviewed and approved their studies before conducting and disseminating the data. Thus, these articles met the ethical considerations in research.

Outcomes Comparison

The project’s anticipated outcomes are decreased prevalence and improved management of pressure ulcers. The desire is to prevent pressure ulcers and their complications. All these four articles show that routine practices are ineffective in preventing pressure development because the PU developed is still high in healthcare facilities. Sachs et al. (2018) state that the current interventions and recommended practices are hardly implemented, hence the need to lay strategies to enhance their utilization.

Gasper et al. (2018) note that the interventions developed should be supported by the parent institutions to ensure they achieve the desired results. Sharp et al. (2019) and Van Gilder et al. (2021) show that the prevalence of pressure ulcers is high in the elderly and critical care units, hence the need for developing evidence-based interventions to manage the problem.

Proposed Evidence-Based Practice Change

The PICOT question intends to improve the nursing practice problem of pressure ulcer management. The problem affects populations such as critically ill and elderly patients. The PICOT attempts to remedy the problem by evaluating an evidence-based practice and how it can replace the routine practice of two-hourly patient turning.

The articles show a current burden in critical care settings, with a high prevalence rate of 14% in critical care units (Van Gilder et al., 2021). They also show that evidence-based practice recommendations exist, but they are hardly implemented, leading to high-pressure ulcers prevalence. Knowledge, supporting infrastructure, and policies will help manage the pressure ulcer problem (Gasper et al., 2018). Thus, the PICOT, research problem, and articles contain interrelated themes.

The research articles evaluate the problem’s existence, contributing factors, current evidence-based strategies to manage the problem, and the effectiveness of ripple mattresses in preventing and managing pressure ulcers. Ripple mattresses are effective in pressure ulcer prevention because they routinely relieve pressure areas by changing the pressure of air pockets, preventing pressure ulcer development (Shi et al., 2022). The intervention roll-out should entail staff education and the development of policy regulations for ripple mattresses. Actions such as mandatory inspection of the mattresses’ use and vigorous assessment of their use will increase their utilization and interaction in the organizational culture.

Conclusion

This paper analyzed nursing practice problems, four nursing articles, and a PICOT statement to establish their relationship. The paper analyzed four articles, their methods, their relationship to the practice problem and the PICOT, and ethical considerations, and proposed an ethical, evidence-based change. The change will entail changes in practice and policies regulating pressure ulcer prevention. Insights from the article show the considerable burden of pressure ulcers and create the need for developing pressure ulcer management interventions in the healthcare setting-critical setting. Nurses are vital in the project’s evolvement and implementation in the selected healthcare setting.