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Research Critique Guidelines Part I

Use this document to organize your essay. Successful completion of this assignment requires that you provide a rationale, include examples, and reference content from the studies in your responses.

Qualitative Studies

Background of Study

1.Summary of studies. Include problem, significance to nursing, purpose, objective, and research question.

How do these two articles support the nurse practice issue you chose?

1.Discuss how these two articles will be used to answer your PICOT question.

2.Describe how the interventions and comparison groups in the articles compare to those identified in your PICOT question.

Method of Study:

1.State the methods of the two articles you are comparing and describe how they are different.

2.Consider the methods you identified in your chosen articles and state one benefit and one limitation of each method.

Results of Study

1.Summarize the key findings of each study in one or two comprehensive paragraphs.

2.What are the implications of the two studies in nursing practice?

Ethical Considerations

1.Discuss two ethical consideration in conducting research.

2.Describe how the researchers in the two articles you choose took these ethical considerations into account while performing their research.

PICOT Question and Literature Research

Qiu Sun

Grand Canyon University

Applied Statistic to health care professions

Prof. Thatcher

March 6th, 2022

Clinic issue: pressure ulcer (pressure injury)

An Ulcer of Pressure is a localized injury to the skin and underlying tissue, usually over a bony prominence, as a result of pressure alone or pressure in conjunction with shear (Dorner et al., 2009). Today, pressure ulcers rank third in terms of cost after cancers and cardiovascular diseases. This disease has a mortality rate of two to six times higher than most other diseases, with 60,000 deaths occurring every year due to this complication(Schindler et al., 2011). Inpatients are more susceptible to pressure ulcers in the tissues of the extremities and in bony extensions such as the sacrum and heel. Pressure ulcers are most often caused by low physical activity, decreased consciousness, urinary and fecal incontinence, malnutrition, and advanced age (Afzali Borojeny et al., 2011).

In the United States, pressure ulcers are estimated to cause about 2.5 million hospitalizations (Kottner & Dassen, 2010). Pressure ulcers can result in pain, reduced autonomy, increased infection and sepsis risks, more surgical procedures, long hospital stays, and higher costs for patients, families, and health care systems (Stinson et al., 2013). In addition to physical-social and self-care dysfunction, pressure ulcer patients may also experience several complications such as depression, pain, topical infection, osteomyelitis, sepsis, and even death (Senmar et al., 2017).

Despite advances in medicine, pressure ulcers remain one of the most common medical problems. There is currently no consensus on the risk factors of pressure ulcers, so identifying them is the first step in preventing an increase in their incidence (Donnelly et al., 2011). The development of counseling and prevention systems for pressure ulcers in the USA and Europe has become so important because pressure ulcers pose a major concern for patients and healthcare providers(Reddy, Gill, & Rochon, 2006).

PICOT Question

Population: patients who have developed pressure ulcer

The intervention of interest: patients who utilize pressure ulcer prevention strategies

Comparison: patients who are not been used pressure ulcer strategyies

Outcome: better or faster wound healing

Time: in the monitoring phase.


Article 1

Article 2

Article 3

APA-Formatted Article Citation with Permalink

Reddy, M., Gill, S. S., & Rochon, P. A. (2006). Preventing Pressure Ulcers: A Systematic Review. JAMA, 296(8), 974.doi:10.1001/jama.296.8.974

McInnes, E., Jammali-Blasi, A., Bell-Syer, S. E., Dumville, J. C., Middleton, V., & Cullum, N. (2015). Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews.doi:10.1002/14651858.cd001735

Schindler, C. A., Mikhailov, T. A., Kuhn, E. M., Christopher, J., Conway, P., Ridling, D., ? Simpson, V. S. (2010). Protecting Fragile Skin: Nursing Interventions to Decrease Development of Pressure Ulcers in Pediatric Intensive Care. American Journal of Critical Care, 20(1), 26?35.doi:10.4037/ajcc2011754

How Does the Article Relate to the PICOT Question?

This article is relevant to general pressure ulcer prevention strategyies among patients who suffer pressure ulcers

The aim of this systematic review is to determine the extent to which pressure-relieving support surfaces reduce the incidence of pressure ulcers compared to standard support surfaces, as well as their comparative effectiveness in ulcer prevention.

This article is relevant to determine nursing strategies associated with a lower incidence of pressure ulcers.

Quantitative, Qualitative (How do you know?)

methodological quality of randomized control trial

Randomised controlled trials (RCTs) and quasi-randomised trials

Randomized clinical trial multivariate logistic regression models

Purpose Statement

To systematically review the evidence examining interventions to pre- vent pressure ulcers.

To review which material of mattress or supportive surface can help relieve pressure ulcer

To determine effective interventions associated with low pressure ulcer incident

Research Question

Studies assessed three categories of interventions, namely those that addressed impairments of mobility, nutrition, and skin health.

People at high risk of developing pressure ulcers should use higher-specification foam mattresses rather than standard hospital foam mattresses.

Effective nursing care with targeted interven- tions can reduce the incidence of pressure ulcers.


Examed difference approaches: reposition on the special mattress, incontinence care, skin care, nutritional supplement all benefit for decrease or prevention pressure ulcer

higher-specification foam mattresses show more evidence to prevent pressure injury

In this multisite study, we focused on determining the incidence of pressure ulcers among critically ill and injured infants and children, comparing the characteristics of patients with and without pressure ulcers, and identifying prevention strategies associated with fewer pressure ulcers.


(Where did the study take place?)

Participants from acute care, long term care, rehab, and mixed setting

Participants who have hight risk of pressure ulcer or some of them have pressure ulcer



The 59 selected studies enrolled a total of 13 845 patients: 9397 (67.9%) in acute care, 2367 (17.1%) in LTC, 333 (2.4%) in re- habilitation, and 1748 (12.6%) in mixed settings

People receiving health care who were deemed to be at risk of developing pressure ulcers, in any setting, total of included trials to 59 , in comparison 1, participant including


5346 patients in pediatric inten- sive care units in whom pressure ulcers did and did not develop were compared


Based on whether the intervention being evaluated addressed mobility, nutrition, or skin health impairments, RCTs were divided into three categories.

Randomised controlled trials (RCTs) and quasi-randomised trials .

Trials that evaluated the following interventions included:

1. ?Low-tech? CLP support surfaces

2. ?High-tech? support surfaces

3. Other support surfaces

The 29 separate preventive measures evaluated in this way were entered into the multivariate logistic regression models described above in order to determine which preventive measures had the greatest influence on pressure ulcer development..

Key Findings of the Study

Re-position on the special mattress, skincare, nutritional supple all affectively reduce incident happen

High special supportive surface show show more benefit for preventing pressure ulcer

Infants and chil- dren sink into low?air loss beds and specialty beds in turning mode, increasing occipital friction and shearing. Pressure ulcers were more likely in children who remained in the pediatric intensive care unit at least 4 days

Some of the pressure ulcers in our patients were related to devices.

Strategies associated with less frequent development of pressure ulcers included use of specialty beds, egg crates, foam overlays, gel pads, dry-weave diapers, urinary catheters, disposable under-pads, body lotion, nutrition consultations, change in body position every 2 to 4 hours, blanket rolls, foam wedges, pillows, and draw sheets

Recommendations of the Researcher

The in-complete reporting in the RCTs may have influenced our assessment. In future studies, the interventions required to prevent pressure ulcers specifically among high-risk populations should be defined. There are several risk factors for pressure ulcers, including being bedridden or chairbound, being unable to reposition without assistance, difficulty ambulating, history of stroke, fecal incontinence (which is highly related to immobility), low body weight, lymphopenia, difficulty feeding independently, impaired nutritional intake, nonblanchable erythema of intact skin (ie, stage 1 pressure ulcer), and dry sacrum.

The study also found that people who used sheepskin overlays for their mattresses tended to develop fewer pressure ulcers. In contrast to high-specification constant low-pressure or alternating-pressure support surfaces, there is little evidence that alternating-pressure mattresses can prevent pressure ulcers more effectively than alternating-pressure overlays.

These patients may benefit from targeted nursing interventions to reduce pressure ulcers. We plan to conduct a prospective randomized clinical trial to confirm that specific nursing interventions improve outcomes. During the study, critical care nurses will have access to a set of interventions that can significantly reduce pressure ulcer risk in critically ill children and infants


Article 4

Article 5

Article 6

APA-Formatted Article Citation with Permalink

Medical Advisory Secretariat (2009). Community-based care for chronic wound management: an evidence-based analysis. Ontario health technology assessment series, 9(18), 1?24.

Lavall?e, J. F., Gray, T. A., Dumville, J., & Cullum, N. (2019). Preventing pressure ulcers in nursing homes using a care bundle: A feasibility study. Health & social care in the community, 27(4), e417?e427.

Soban, L. M., Kim, L., Yuan, A. H., & Miltner, R. S. (2017). Organisational strategies to implement hospital pressure ulcer prevention programmes: findings from a national survey. Journal of nursing management, 25(6), 457?467.

How Does the Article Relate to the PICOT Question?

Managing pressure ulcers with a multidisciplinary wound care team significantly increases wound healing

Assessed pressure ulcer prevention strategies in nursing home

Programs designed to prevent pressure ulcers include nursing interventions such as risk assessments, as well as organizational strategies such as policies and performance monitoring to embed these interventions into routine care.

Quantitative, Qualitative (How do you know?)

Randomized controlled trials and Controlled clinical Trials

Quantitative and qualitative data were analyzed using descriptive statistics

A cross-sectional survey ,Descriptive statistics

Purpose Statement

To determine the effectiveness of a multidisciplinary wound care team for the management of chronic wounds.

To determine, the implementation bundle effective on pressure ulcer

To describe the presence and operationalization of organizational strategies to support implementation of pressure ulcer prevention programs across acute care hospitals in a large, integrated healthcare system.

Research Question

Multidisciplinary team can help manage Chronic wounds

assessed the feasibility of implementing our pressure ulcer prevention care bundle in a nursing home setting.

Assess the presence and operationalization of organizational strategies to support implementation of pressure ulcer


The percentage of persons and/or wounds completely healed. Reduction in healing time, improved quality of life, and pain management.

According to this study, a pressure ulcer prevention bundle is acceptable to nursing home staff and can improve care provision. Participants reported an increase in their motivation to provide more comprehensive care.

Organizational strategies that support pressure ulcer prevention program implementation (policy, oversight committee, wound care specialist, staff education, performance data, and performance improvement activities) were reported at high levels


(Where did the study take place?)

Nursing home

Nursing home



Population includes persons with pressure ulcers (anywhere) and/or leg and foot ulcers

In 2007, control Group 119, experimental 127.

Harrison et al, 2005: before 78, after 180

Vu et al, 2007 : 176 residents (342 wounds)

collected data for 462 resident bed days prior to implementing the bundle; collected data for 1,181 resident bed days during the intervention phase

achieved 97% response rate (N=116/120)


Randomized controlled trials and Controlled Clinical Trials (CCT), The intervention includes a multidisciplinary (two or more disciplines) wound care team, The control group does not receive care by a wound care team

For 5 weeks before implementing the bundle, we collected quantitative data on nursing home staff pressure ulcer prevention behaviors, as well as pressure ulcer incidence rates. After implementation, we collected data for an additional 9 weeks.

The bundle comprised three evidence-based elements: support surfaces, skin inspection, repositioning

A cross-sectional survey of key informants at all VHA acute care hospitals was conducted via email to assess pressure ulcer prevention programs. Surveys were sent to 124 nurse leaders

Key Findings of the Study

Using a multidisciplinary wound care team, we’ve been able to reduce the pain and the need for daily wound care. And significantly increases wound healing

Before the implementation of this period, five new pressure ulcers were recorded, and repositioning was the only documented way to prevent pressure ulcers.

Following implementation, no new pressure ulcers developed. Documented prevention strategies included repositioning, skin inspection, and checking support surfaces.

For the year October 1, 2013 to September 31, 2014, the aggregated mean HAPU rate for acute care hospital medical/surgical units was 1.02% (range 0?3.1%)

Recommendations of the Researcher

Evidence for these outcomes is low to very low, so further research will likely have a big impact on how confident we are in the estimate of effect.

Further research is needed to enhance adherence and/or documentation to further investigate a bundle’s potential for preventing pressure ulcers in nursing homes.In spite of low completion rates of the bundle (or the documentation of this), feedback from participants indicates that the bundle was easy to follow, facilitated continuity of care, and resulted in comprehensive pressure ulcer prevention.

Nurse leaders and committees and quality improvement teams play important roles in operationalizing patient safety initiatives such as pressure ulcer prevention.


Afzali Borojeny, L., Albatineh, A. N., Hasanpour Dehkordi, A., & Ghanei Gheshlagh, R. (2020). The Incidence of Pressure Ulcers and its Associations in Different Wards of the Hospital: A Systematic Review and Meta-Analysis. International journal of preventive medicine, 11, 171.

Dorner BD, Posthauer ME, Thomas D. European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Role of Nutrition in Pressure Ulcer Healing Clinical Practice Guideline. 2009

Donnelly, J., Winder, J., Kernohan, W. G., & Stevenson, M. (2011). An RCT to determine the effect of a heel elevation device in pressure ulcer prevention post-hip fracture. Journal of wound care, 20(7), 309?318.

Kottner, J., & Dassen, T. (2010). Pressure ulcer risk assessment in critical care: interrater reliability and validity studies of the Braden and Waterlow scales and subjective ratings in two intensive care units. International journal of nursing studies, 47(6), 671?677.

Reddy, M., Gill, S. S., & Rochon, P. A. (2006). Preventing pressure ulcers: a systematic review. JAMA, 296(8), 974?984.

Schindler CA, Mikhailov TA, Kuhn EM, Christopher J, Conway P, Ridling D, Scott AM, Simpson VS Am J Crit Care. 2011 Jan; 20(1):26-34; quiz 35.

Stinson, M., Gillian, C., & Porter-Armstrong, A. (2013). A literature review of pressure ulcer prevention: weight shift activity, cost of pressure care and role of the OT. British Journal of Occupational Therapy, 76(4), 1-10.

Senmar, M., Azimian, J., Rafiei, H., Habibollahpour, M., & Yousefi, F. (2017). The incidence of pressure ulcer in old patients undergoing open heart surgery and the relevant factors. Journal of Preventive Epidemiology, 2(2), e15-e15.

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