Evidence-Based Practice and Applied Nursing Research

O’Brien, G., Moore, Z., Patton, D., & O’Connor, T. (2018). The relationship between nurses assessment of early pressure ulcer damage and sub epidermal moisture measurement: A prospectivexplorative  study. Journal of Tissue Viability, 27, 232–237.   https://doi-  org.wgu.idm.oclc.org/10.1016/j.jtv.2018.06.004

Background or Introduction

The author of this non-experimental descriptive study extensively describes what pressure ulcers(PU) is, the negative impact the PU has on the individual emotions, physical, psychology, and social life. The research was conducted in the medical and surgical unit of a general hospital in Ireland. The prevalence of hospital-acquired pressure ulcers (HAPU) in Ireland is linked to the poor quality of care and recognized as an adverse clinical event.  The author explained the association between aging and PU development. The current PU detection tools sensitivity and specificity were compared on table 1. The study compares the relationship between nurse’s visual skin assessment (VSA) of the patient at risk of PU development and sub epidermal moisture measurement (SEM). The purpose of the study to establish whether measurement of SEM was more accurate and timely in detecting skin change when compared to visual skin assessment current “gold standard” alone.

Review of the Literature

In respect to the literature review, the authors their study on Pressure Ulcers (PU) by looking at areas that causes damages to skin tissue over bonny prominences. The literature looked at various present and passed evidence based studies on PU. The was an empirical review done by the author, for example there are studies which show how the previous researchers failed to  identify the effectiveness of  formal PU risk management practices  which is among the best methods of risk assessment  in comparison to  risk assessment based on the  Visual Skin Assessment (VSA).  In the same line, research that explores the knowledge of nurses also reveal that most employees have challenges in the knowledge about pressure staging. In this manner, the authors tend to show that this is the reason management of PU is still a problem in medical care.  From the author’s review on the visual skin assessment (VSA) they came up with the conclusion that other methods used on detecting early pressure damage should be examined. Also the authors agreed that it is important to conduct early assessment as this will act as a precursor to the prevention of skin damage due to pressure.  There will also be very important health benefits for the patient suffering PU.  While reviewing scientific studies dune on PU, the researcher agreed that Measuring the levels of Sub Epidermal Moisture (SEM) in PU is important in predicting the damage to the PU, there is also a close association between the higher levels of SEM and the development of visually detected ulcers. From the literature, the authors agreed that the elimination of avoidable hospital PU is important in the planning and management of patients at risk of developing PU. The literature review thus identified various gaps that were required to be filled especially when looking at emerging science on the management and treatment of patients with PU.

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Discussion of the Methodology

This research is a quantitative, nonexperimental descriptive study. A non-probability purposive sampling method was used to recruit the subject of the study.  The research subject had to meet the following  inclusion criteria

-Patient at risk of developing PU based on Norton score and has intact skin on admission.

-Patient without existing PUs.

-A patient who consent to participate or assented by their next kin.

In the study, the exclusion criteria, included patient that did not consent to participate in the study, those with a Norton Score that indicated they were not at risk, those without mobility and activity limitations and patients that were at risk but also had an existing PU.

Data Analysis

The data pertaining the research patient were collected for four weeks or until the patients were transferred or discharged.  Since the study was non-interventional, the research participant was on normal care and PU preventions intervention as per hospital protocol.  The patient demographic data, mobility, activity levels and Norton scores were collected on the first day. The researchers carried out SEM measurement on the sacrum and both heels daily, and the reading was recorded using the SEM scanner. All data were checked for accuracy by an independent person. The data were categorized into variables, entered into SPPS and analyzed using descriptive and statistics. Nurses, visual skin assessment (Current gold standard) were correlated with SEM measures to determine the relationship between the two variable using Pearson's correlation coefficient results.      

Researcher’s Conclusion

 From this study, it was concluded by the researcher that the feasibility of using SEM measurement is vital to the current methods of assessing early stages of PU.  From the study the researcher also concluded SEM detected damages on patients with early stages of PU thus showing that the current study supports early findings in the management and treatment of PU.

Lavallée, J. F., Gray, T. A., Dumville, J., & Cullum, N. (2018). Barriers and facilitators to

                preventing pressure ulcers in nursing home residents: A qualitative analysis informed by

                 the Theoretical Domains Framework. International Journal of Nursing Studies, 82,

                 79–89. https://doi-org.wgu.idm.oclc.org/10.1016/j.ijnurstu.2017.12.015

Background or Introduction

There authors of this qualitative research investigated the barriers and facilitators to the prevention of pressure ulcers in the nursing home residents. The qualitative analysis of the research was also done based on the theoretical dormains framework. According to background of the study, it looked at the issues of Pressure Ulcers diagnosis and the damages it causes to the patient’s skin and underlying tissue. Various past studies have also shown that Pressure Ulcers can lead to immobility, cause pain and delay patient recovery. From the background of the study, the author also found that the elder group of patients were at most risk of delayed recovery, they were also most likely to develop Pressure Ulcer (PU), including those that are seriously ill, in the end PU was responsible for reduced or impaired mobility and poor nutrition, meaning nursing home residents might also be at risk. For this reason, purpose of the study is to investigate, the different pressure context in regard to ulcer prevention within nursing homes. The qualitative study was also very important in finding out the barriers and facilitators to evidence based practices to the prevention and treatment of PU patients.

Review of the Literature

From the literature review, the researchers defined Pressure Ulcers as an area of localized damage to the patient’s skin or other underlying tissues due to pressure and shear.  The researchers also found that some of the risk factor associated with PU included but not limited to poor mobility, increasing age, multi-mobility, poor nutrition, however the high end of risk continuum, which was the main concern for the paper was putting many nursing home residents with multiple risk factors.  From the empirical literature, the researcher revealed that in Mar of 2017, Approximately 7388 of individuals across different healthcare centers in England suffered Pressure ulcers in the 24 within the 24 hrs. period within which time the data was reported.

The major part of the literature is based on the England Nursing homes and private organization all of which follow the national guidance in respect to the care of patients with pressure Ulcers. According to the sources from National Health Institute for Healthcare Excellence on pressure ulcers, caregivers, including nursing homes are allowed to work independently which little input from the NHS community nurses. However, nursing homes are required to make referrals for patients with Pressure Ulcers to a NHS tissue viability nurse, whose role in the treatment plan would be to provide advice regarding clinical practices like prevention of pressure ulceration and not implement care or show how it needs to be conducted.

Further in the literature review, the researcher also highlighted studies that show pressure ulcers is a burden to many patients and lead to distress and loss of independence. Pressure ulcers is also presents negative impact to the health of patients and health related quality of life.

The literature review also made use of theoretical understanding on the attitudes, behaviors and belief of home nursing staff and effects it has in prolonged cure or behavior change of patients with Pressure Ulcers. Various theories were also utilized as a tool for analyzing and influencing behavior change to motivate fast treatment for patients like the Health Belief Model and the theory of Planned Behavior.  By using the various theory domains, the researchers aimed at exploring the perception of home nursing staff in regard to treatment, the barriers and factors leading to the pressure ulcers prevention practices in a nursing home setting.  With respect to the literature review, the study also expanded existing knowledge through the data collection and analysis in the theory of behavior change as a way of informing the future development of a tailored for of pressure ulcer prevention and intervention.

Discussion of the Methodology

Since this study was about provision of care and treatment, the researcher conducted a qualitative study. Data was collected through semi structured interviews where participants were healthcare assistants, nursing home nurses and managers. Other participants were the nursing manager’s fom the North Wes of England.  It was important that the researcher developed an interview guide using the various theoretical domains as it advised the objective of the study, which was to investigate the barriers and facilitators to pressure ulcer prevention in nursing home residents.

Data Analysis

The data analysis was done using a framework analysis and various domains were identified as salient based on their potential strength and frequency of their impact. Analyzed data revealed the high level of enthusiasm for improving knowledge and skills on prevention of pressure ulcers by nursing home staff.  It showed that nursing home staff were motivated to share information with their colleagues regarding care for PU, the managers allocate time to share evidence based practices and that the nursing home staff remained on duty to discuss the consultation with other staff.

There were however concerns over insecurity, intimidation, inconsistency and inaccuracy when it comes to categorization of Pressure ulcer, measurement and referrals.

Researcher’s Conclusion

The conclusion was confirmed as follows:

•         There is need for intervention in support of nursing home care staff during their pressure ulcer prevention practices as there is still lack of knowledge of care, categorization and support for behavior change.

•         The theoretical domains framework is important in enhancing and designing the right intervention on the prevention and treatment of Pressure Ulcers within a Home nursing environment.