Picot Part 2: Evidence-Based State of the Science Paper (Research Paper Sample)

Evidence-Based State of the Science Paper
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Institutional Affiliation
PICOT Question: In the critically ill elderly patient, does nurses’ knowledge of evidence-based recommendations for pressure ulcer prevention affect the incidence and prevalence of pressure ulcers?
Background
Pressure ulcers (PU) are still a major concern to hospitalized patients despite the numerous strategies developed to curb the problem(Barker et al., 2012). In fact, it is regarded among the top five causes of preventable harm to patients (Nuru, Zewdu, Amsalu &Mehretie, 2015). The risk factors of developing pressure ulcers include impaired mobility, old age (≥65 years), and pre-existing severe illness like urogenital disorders, stroke, diabetes, (Demarre et al., 2014). Pressure ulcer development is a complex, multifactorial process because it usually involves more than one of these risk factors (Demarre et al., 2014). Pressure ulcers cause a preventable burden to the patient, family and health care facilities due to the impact of health care cost, elongated hospital stay, pain and high mortality rates(Bates-Jensen & MacLean, 2007).
In the United States the cost of pressure ulcer management is estimated to be over $11 billion annually due to the increasingly high prevalence. More than 2.5 million patients in the US develop pressure ulcers each year (Barker et al., 2012). The prevalence of pressure ulcers in critical care units in the US is approximately 22% (Sen et al., 2009). As a result, various prevention and management strategies have been developed. However, as mentioned in the opening statement, despite these developments, pressure ulcers remain a major threat to hospitalized patients especially the elderly and those who are critically ill (Barker et al., 2012).Research has shown that effective pressure ulcer prevention is multifactorial. Some of the factors impacting effective prevention and management of pressure ulcers include knowledge and attitude towards evidence-based recommendations as well as the actual practice of the ulcer prevention strategies.
However, it has been reported that even though nurses may have the updated knowledge; some aspects of the recommendations are not adequately implemented (Hoviattalab, Hashemizadeh, D'Cruz, Halfens&Dassen, 2014).There is, therefore, a gap between knowledge acquisition and its actual translation to practice in relation to pressure ulcer prevention and treatment (Barker et al., 2012). This paper aims to find out whether nurses’ knowledge of evidence-based recommendations for pressure ulcer prevention affects the incidence and prevalence of pressure ulcers in the critically ill elderly patients.
The elderly and critically ill patients are among the at-risk population for development of pressure ulcers. This is due to their reduced mobility as well as sensation (Bluestein &Javaheri, 2008). This explains the high percentages of prevalence in this population. To curb the pressure ulcer threat in this population, any loopholes in the implementation of the evidence-based recommendations should be analyzed and be acted upon. It can be argued that the knowledge and attitude of the nurses on the evidence based prevention strategies impacts on their actual application. Unless one has the correct knowledge, they cannot effectively practice the recommended prevention strategies.
Literature Search
The literature search was conducted using a combination of three search phrases-‘pressure ulcers incidence’ ‘nurses knowledge’ and ‘evidence-based prevention’ in the Wiley Online Library. A total of 5458 search results came up including journal articles, books and databases. However, only 700 were journals. The articles were included if they were published in English between the year 2005 and 2015 and if the journals were peer-reviewed.Following this criterion, the results were narrowed down to 88. The author skimmed through the abstracts in search of the three key words and thus remained with only 20 articles. Of these, 5 articles were eligible for inclusion in this review because the aspect of nurses’ knowledge/attitude versus the incidence of pressure ulcers was addressed. In addition, the interventions partly involved enhancing the nurses’ knowledge.
State of the Science Summary
As described in the literature search section, the strategy yielded 5 study articles for the analysis and summary. Out of the five analyzed articles; four had an intervention phase in their methodology section while one was a cross-sectional study without any intervention. The rationale for including the cross-sectional study was to provide a glimpse of comparison between the articles with intervention and those without. It is also worth mentioning that the four intervention-studies applied almost similar evidence-based interventions. The major components in each of the four studies focused on improving nurses’ knowledge and attitude towards PU prevention as well as providing a strict practice protocol for the prevention and management of pressure ulcers. On the other hand, the fifth study aimed at assessing nurses’ knowledge and attitudes towards pressure ulcer evidence-based prevention and the corresponding prevalence.
The first study with an intervention phase was conducted by Baldelli&Paciella (2008) in the Stony Brook University Medical Center. The purpose of this study was to determine the effect of creating and implementing a pressure ulcer prevention bundle on incidence and prevalence of pressure ulcers (Baldelli&Paciella, 2008). The study was carried out in 6 phases and in each phase about 35 nurses participated. The second of the four studies was conducted in an academic tertiary care facility in Canada and aimed at determining the effect of implementing a planned pressure ulcer prevention strategy on the epidemiology of Heel pressure ulcers (Campbell, Woodbury & Houghton, 2010). Campbell & associates (2010) had a sample of 27 health care providers and 40 patients. The other study conducted by Sving and colleagues (2014) showed how a multifaceted unit-tailored intervention using evidence-based PU prevention impacts on the incidence and prevalence of PU. The sample size was relatively large as the total number of nurse participants was 275 while patient participants were 506. The last intervention-based study was carried out by Gill (2015) and its purpose was to reduce hospital acquired PU in the ICU using an evidence-based pressure ulcer prevention strategy. However, the article did not specify the sample size. The fifth study included in this review assessed nurses’ knowledge and attitudes towards pressure ulcer prevention guidelines and determine the correlation between knowledge and compliance to the guidelines (Demarré et al., 2011). In this article, the sample included nurses and nursing home residents. The number of participating nurses was 145 while a total of 615 residents were included in the study.
Findings
Four of the studies analyzed herein were categorized as Level IIbevidence, with the exception of the study by Svingand associates (2014) which was classified as category IIa because it employed a quasi-experimental design while the others were more of quality improvement projects (Practicing Chiropractors’ Committee on Radiological Protocols (PCCRP), 2006). All the articles included in the review supported the conclusion that implementation of an evidence-based ulcer prevention strategy improves the nurses knowledge of PU prevention and reduce the prevalence and incidence of pressure ulcers.
With an evidence level of II and such consistent results it is correct to infer that the articles were appropriate for the PICOT question. Others may find an exception from the study by Demarre and colleagues (2011) because the study had no intervention phase thus distancing it from the other four studies. However, the results of this study (insufficient knowledge corresponding to high prevalence of pressure ulcers) indirectly supports the results from the other four studies.
As stated earlier, all the studies positively associated nurses’ knowledge and attitude to correct practice of the pressure ulcer guidelines. Correct practice of the prevention strategies was in turn associated with a decrease in prevalence and incidence of pressure ulcers. The study by Baldelli&Paciella (2008) concluded that the Pressure Ulcer Prevention Bundle enhanced the quality of care to patients by decreasing pressure ulcer incidence and prevalence rates and enhancing knowledge of prevention strategies. This also the case in the study by Campbell, Woodbury & Houghton, (2010) which reported that after implementation of the program the incidence of Heel Pressure Ulcers was at 0% which is a statistically significant reduction as it lies below the lower limit of 95% CI (8-18%). In the study carried out by Sving and colleagues (2014), the results indicated that there was a significant increase in nurses’ knowledge post-intervention. Even though the reduction in prevalence was not statistically significant, it can be indirectly associated with the improved knowledge because the attitude was constantly high pre- and post-intervention. The last study by Gill (2015) also concluded that an evidence-based pressure ulcer prevention strategy is associated with a decrease in PU incidence and prevalence rates.
Conclusion
Pressure ulcers are a major concern to hospitalized patients because they are associated with many negative patient outcomes including, longer hospitalization time, pain and treatment costs. There is the need to implement evidence-based strategies that effectively prevent the occurrence of PU in hospitals and nursing homes. However, the success of the s...