Effective Support Surface For Preventing Pressure Ulcers In Acute Care Setting

Prevalence of Pressure Ulcers in Australia

Question:

What type of support surface is the most effective in preventing pressure ulcers in patients admitted to the acute care setting? 

The Australian society is diverse as it comprises of a variety of population’s experiences regarding different diseases. One of the most prevalent conditions of illness is due to the occurrence of pressure ulcers (McInnes et al. 2015). It is a wound in which the death of the skin and the underlying tissues occurs due to the pressure which is not relieved. There are several factors that contribute to the progression of pressure ulcers. A pressure ulcer can develop within twenty four hours of the preliminary pressure. It is very painful and causes immense suffering to the patient. The patient’s quality of life gets affected. The treatments of ulcers might require surgical methods like colostomies, amputations and debridement (Demarré et al. 2013). Therefore, the healthcare sector has categorized the patients from the non-English backgrounds, as the patients who belong from the background which is culturally and linguistically diverse and particularly includes the Indigenous and migrant backgrounds.  It is quite annoying and challenging for the nursing experiences and it is quite complex for professionals of nursing to tackle the patients who are suffering from pressure ulcers and are admitted to the acute care setting in Australia (Engels et al. 2016).  The explicit and severe challenges that are experienced by the nursing professionals include barriers of language, delivery of quality care, bureaucratic system of healthcare, relationship with the patient and the nurses, together with dealing with their personal and family stress. Attaining the knowledge of treatment is considered necessary for the nurses in all the aspects.  This can be performed by the recognition on the basis of knowledge in the place of work and comprises of the sources such as health workers, the patients as well as their families, who can extensively assist in attaining the knowledge (Schoeps et al. 2016). This assessment is concerned with the nurses who face acute challenges while working with the patients suffering from pressure ulcers and includes a systematic review of significant literature.

‘What type of support surface is the most effective in preventing pressure ulcers in patients admitted to the acute care setting?’

A question of research characteristically assists to direct and guide a program of research. Hence, it has to be clear as well as focused and it should encompass the combining of the different resources for presenting the argument. Formulation of a question that is associated with research should encompass the execution of preliminary research for obtaining a general idea of the subject, based on the journals which are peer-reviewed. In order to formulate question, the framework of PICO has been utilized (Mallah et al. 2015). The PICO framework is applied in the evidence-based practice for framing the questions which are associated with the healthcare sector. It is also used to develop the strategies of literature search. The acronym of PICO is as follows:

P- Population or Patient

Challenges Faced by Nursing Professionals

I- Intervention

C- Comparison

O- Outcomes

The questions that are clear and well-focused are necessary to search the significant evidence and identify the correct resources. Hence, the framework of PICO assists in the identification of the most important elements associated with the questions and makes the statement of the question relevant (Chaboyer and Gillespie 2014). In this assessment, the comparison is not included due to lack of its scope. Therefore, the framework utilized in this assessment is PIO framework, which only considers the patient/population, intervention and outcome.

The PIO acronym utilized for this assessment is as follows:

P- Patients admitted to the acute care setting

I-Support surface

O- Preventing pressure ulcers

The development of a research question is involved with the concept of developing a research hypothesis. Predictions were made about the phenomenon of research examination which forms the research foundation. Specific predictions were made with the help of hypothesis with respect to the direction and nature of the association that exists in the between two different variables. In order to draft the Question of research in the assessment, insight was given to the research hypothesis that stated the acute challenges that are faced by the nurses while tacking the patients suffering from pressure ulcers on a daily basis. The testable and quantifiable parameters were evaluated and included the individuals of different population. At the end, the experience of the staff was taken into consideration that helped to draft the final question, integrating the other two hypotheses and resulted in the stating of the research question “What type of support surface is the most effective in preventing pressure ulcers in patients admitted to the acute care setting?” 

The process of research is initiated by having an interest in a particular or specific topic. Though, the familiarity with the subject defines the correct question of research. The scarcity of the apparent knowledge raises the question within the area of study and the importance of the research question is defined by investigational research. It is necessary to identify the boundary between the lacks of knowledge and the apparent knowledge that assists to find out the clinical doubts rationalizing the significance of the research question. In this assessment, the importance of the research question lies in the actuality that it assists to find the type of support surface is the most effective in preventing pressure ulcers in patients admitted to the acute care setting.

According to the framework of health service for the patients admitted to the acute care setting in Australia, it has been discovered that a large number of individuals are suffering from pressure ulcers. These figures are expected to increase further in future as well as present challenges for the providers of healthcare service with respect to requirements of support and devices that are safe in terms of all the aspects (Fleming 2015). Because of the larger diversity populations residing in Australia, a variety of challenges come into view for the professionals of nursing that are persuaded by the appropriate responses and individual goals of health. The explicit factors of challenging include the cultural, environmental, spiritual, social, economic and emotional that intertwines across the diverse profiles of healthy in a variety of ways to influence the behavior of the patients together with their family members and verify the role of the nursing professionals in supporting the treatment and providing care (Lachenbruch et al. 2016)..

Formulating a Research Question Using PICO Framework

The challenges that are faced by the nurses while providing care to the pressure ulcer patients of different backgrounds encompass the patients together with their families. The major challenges comprises of communication, assessment, restrictions of working with the interpreters and the provision of holistic care. Privacy and education are the issues that were associated with the patients. Aggression and visiting were the issues with the family members of the patients who are admitted to the acute care setting. Types of workers of health, obligation of the health officials as well as flexibility of the organization are the issues with the system of healthcare (Huang et al. 2015).  The willingness of commitment and the stipulation of care are the keys to the care of the patients who are admitted to the acute care setting. The nurses have a conventional sight of the patient.

In order to improve the proficiency of the nurses with respect to the care of the patients with ulcers and provide them the treatments like static support surfaces and dynamic support surfaces to a much more extent. Experience could assist the nurses in this aspect by developing knowledge within the episodes of care by facing inconsistent challenges. By means of a proper training along with education, the development of understanding and knowledge of care for the patients who are suffering from pressure ulcers is essential (Barry and Nugent 2015).

The search strategy is initiated with the searching of a database from which the data is gathered in a structured manner. The available data is arranged in terms of a model that supports the processes and it requires collection of information. In this assessment, the collected of data has been done with the help of PubMed. It is a free search engine along with the accessing of the MEDLINE database of references and abstracts. The database is maintained by the United States National Library of Medicine in association with the National Institutes of Health for retrieval of information.

The next step of the search strategy is involved with the identification of the keywords. This assessment utilized the PIO strategy for the database search string along with its implementation. Appropriate keywords were utilized in variety of combinations as indicated by the framework for searching the database and extracting the research articles that are required for answering the articles of research. The identification of relevant keywords was performed by utilizing the PICO framework and it assisted comprehensively to combine the appropriate search terms with respect to the research articles.

The role of connecting words has been played by the Boolean operators that are positioned between the search terms to narrow or expand the search. In this assessment, the Boolean operators utilized are AND, NOT and OR. AND helps to find the citations that are comprised of all of the specific keywords. NOT assists to find the citations that contain specific keywords. OR helps to find the citations that contain either of the keywords that are specific. A stepwise guide to use the Boolean operators and keywords  for searching the selected database is search string. The search strings like? and * have been utilized on a trial and error basis for searching the appropriate articles.

The PIO Framework for This Research

Truncation was utilized for expanding the process of search as it helped in the identification of variations in the words. The symbols utilized for the search were?,*and $ as nurs*for retrieving nurse and nurses. In the search process, abbreviations used was PPU for patients with peptic ulcers. Wildcards were utilized for trying different spellings for patient skin colour and color were searched with the ? symbol. These all were implemented on a trial and error basis but could not retrieve relevant results of the search. 

Table: Searched Keywords

P Population  / Problem	I Intervention	O Outcome
Patients with Pressure Ulcers Acute challenges Communication challenges Responsibility of the Nurses Capabilities	Support surface Nursing knowledge proficiency Professional ethics Moral values	Patient care Patient compliance Patient contentment Efficient care Respect and dignity

A detailed account of the search strategy and the results has been provided in the appendix. 

The appropriate research articles retrieved by means of the search keywords have been provided below.

1. Alanen, J. and Muli, R., 2015. ASSESSMENT TOOLS FOR PRESSURE ULCERS.
2. Barker, A.L., Kamar, J., Tyndall, T.J., White, L., Hutchinson, A., Klopfer, N. and Weller, C., 2013. Implementation of pressure ulcer prevention best practice recommendations in acute care: An observational study.International wound journal,10(3), pp.313-320.
3. Gillespie, B.M., Chaboyer, W.P., McInnes, E., Kent, B., Whitty, J.A. and Thalib, L., 2014. Repositioning for pressure ulcer prevention in adults.The Cochrane Library.
4. Lawrence, P., Fulbrook, P. and Miles, S., 2015. A Survey of Australian Nurses’ Knowledge of Pressure Injury/Pressure Ulcer Management.Journal of Wound Ostomy & Continence Nursing, 42(5), pp.450-460.
5. McInnes, E., Jammali-Blasi, A., Bell-Syer, S., Dumville, J. and Cullum, N., 2012. Preventing pressure ulcers—Are pressure-redistributing support surfaces effective? A Cochrane systematic review and meta-analysis.International journal of nursing studies,49(3), pp.345-359. 

Article No.	Reference	Study Design	Population P	Intervention I	Outcomes O
1.	Alanen and Muli (2015)	Survey questionnaire	Survey conducting nurses with six ethnic groups of patients in the US in 15 focus groups of patients with pressure ulcers	Assessment of the cultural and ethnic preferences among the patients with pressure ulcers and the influence of the nursing intervention	Nurses face acute challenges and dilemma while caring for the patients with pressure ulcers
2.	Barker et al. (2013)	Qualitative study	20 nurses in 4 focus groups with 5 –7 participants in each group	Patterns of Communication between the nurses and the patients with pressure ulcers who are admitted to the acute care setting	Cultural and linguistic factors directly affect the beliefs of the nurses for pain treatment for the patients having pressure ulcers
3.	Gillespie et al. (2014)	Qualitative survey	120 students of nursing with 60 junior and 60 senior nursing students	Question-based research was performed to gather the experience of the nursing students regarding the nursing intervention for pressure ulcers	Summing up the student experiences for proficiency and improving their knowledge for their future profession
4.	Lawrence et al. (2015)	Survey questionnaire	20 nurse managers involved in nursing practice	Exploration of the perception of the nursing managers involved in the care of  patients suffering from pressure ulcers	Language barriers have been identified as the most important and complex problem in the patient – nurse association
5.	McInnes et al. (2012)	Systematic review of literature	Advanced practice nurses providing cancer care to the patients having pressure ulcers	Decision making for cancer care is influenced by the cultural belief systems	Requirement of nursing education program for addressing the needs of the patients having pressure ulcers who are admitted to the acute care settings.

This research assessment has enhanced my understanding regarding the evidence-based practice for nursing. The identification of related research articles and writing a research question has helped me enormously in understanding the challenges that are faced buy the professionals of nursing. It has helped me to discover the ways to deal with the challenges that are faced by the nurses in acute care and long-term settings for the care of the patients having pressure ulcers. Besides this, I have learned the methods of database search by utilizing the key features of Abbreviation, Boolean, Wildcard and truncation. I have developed a comprehensible knowledge of the process of inclusion as well as exclusion of the key search words and finding out the appropriateness of the searched literature. My understanding has intensified and my skills have been enhanced concerning the search string for the literature that explains the profile of nursing care for the patients suffering from pressure ulcers, who are admitted to the acute care settings.

The experiences of the nurses with these patients sought for the knowledge required to offer care oriented around an individual and conventional viewpoint. The nurses faced a number of challenges and quandaries with the patients as well as their families while working with these patients (Flood et al. 2015). For accommodating the patients who are suffering from pressure ulcers, it was considered that adequate knowledge and guidance is necessary. To prepare the future nursing professionals to face this challenges efficiently, they should be exposed to the present situation and train them to make them capable enough to face these acute challenges. Besides all these, the healthcare system should enhance its flexibility, the number of health workers must be augmented and interpreters should be easily available (Ozyurek and Yavuz 2015).  Sometimes the issue of communication gap arises as a hurdle in the treatment and care of the patients and as a result, the relationship of the patient and the nurse is never developed. An improper communication leads to gaps in the process of treatment and care and it sometimes becomes critical if the patients are suffering from long-term diseases (Cullum et al.  2013). 

The nurses possess sympathy for the patients and have an optimistic attitude towards facing the acute challenges associated with the care of the patient. In order to enhance the effectual treatment of the patients, the nurses reveal the readiness to augment their knowledge for learning the cultural diversity (Moore et al. 2014). They strive constantly to attain the capability to work within the perspective of the patient. They work on the efforts to become more well-informed and aware that makes easy the communication with the patient population together with their families. Since this investigational learning occurred in a variety of workplaces, there were possibilities of spreading of the erroneous cultural information (Barry and Nugent 2015). This raised the actuality that there is a necessity of programs of staff improvement that provide opportunities to the nurses as well as the nursing managers to talk about the concerns of patient care (Lachenbruch et al. 2016).

As the worldwide mobility of the population of patient’s increases in the facilities of acute care in Australia, its population has become more ethnically diverse than ever. The professionals of nursing staff are required to work with the patients (Schoeps et al. 2016). Consequently, it is becoming gradually more challenging to the nurses to provide acute care to the individuals who are suffering from pressure ulcers and provide them with support surface such as static or dynamic support surfaces depending on the condition of the patient (Engels et al. 2016). The recognition of the experiences of the nurses for the caring of the patients who are in the acute care settings has a noteworthy contribution towards the knowledge of nursing (Chaboyer and Gillespie 2014). This can be performed by the recognition on the basis of efficient knowledge in the place of work and comprises of the sources such as health workers, the patients as well as their families, who can extensively assist in attaining the knowledge in an efficient manner.  

References

Barry, M. and Nugent, L., 2015. Pressure ulcer prevention in frail older people. Nursing Standard, 30(16), pp.50-60.

Chaboyer, W. and Gillespie, B.M., 2014. Understanding nurses’ views on a pressure ulcer prevention care bundle: a first step towards successful implementation. Journal of clinical nursing, 23(23-24), pp.3415-3423.

Cullum, N., Ciliska, D., Haynes, B. and Marks, S. eds., 2013. Evidence-based nursing: an introduction. John Wiley & Sons.

Demarré, L., Verhaeghe, S., Van Hecke, A., Grypdonck, M., Clays, E., Vanderwee, K. and Beeckman, D., 2013. The effectiveness of three types of alternating pressure air mattresses in the prevention of pressure ulcers in Belgian hospitals. Research in nursing & health, 36(5), pp.439-452.

Engels, D., Austin, M., McNichol, L., Fencl, J., Gupta, S. and Kazi, H., 2016. Pressure Ulcers: Factors Contributing to Their Development in the OR.AORN journal, 103(3), pp.271-281.

Fleming, E., 2015. An exploration of the patient and family or carer experience of implementing the pressure ulcer prevention care bundle (known as SSKIN) within a regional quality improvement collaborative.

Flood, K.L., Booth, K., Pierluissi, E., Danto-Nocton, E.S., Kresevic, D.M. and Palmer, R.M., 2015. Acute Care for Elders. In Geriatrics Models of Care(pp. 3-23). Springer International Publishing.

Huang, L., Woo, K.Y., Liu, L.B., Wen, R.J., Hu, A.L. and Shi, C.G., 2015. Dressings for Preventing Pressure Ulcers: A Meta-analysis. Advances in skin & wound care, 28(6), pp.267-273.

Lachenbruch, C., Ribble, D., Emmons, K. and VanGilder, C., 2016. Pressure Ulcer Risk in the Incontinent Patient: Analysis of Incontinence and Hospital-Acquired Pressure Ulcers From the International Pressure Ulcer Prevalence™ Survey. Journal of Wound Ostomy & Continence Nursing,43(3), pp.235-241.

Mallah, Z., Nassar, N. and Badr, L.K., 2015. The effectiveness of a pressure ulcer intervention program on the prevalence of hospital acquired pressure ulcers: Controlled before and after study. Applied Nursing Research, 28(2), pp.106-113.