Literature Support
The importance of the issue is evidenced by numerous research works devoted to it. For instance, Balzer et al. (2014) conduct research to determine patients characteristics that impact their choices in the assessment of pressure ulcers and appropriate care. They come to the conclusion that the overall care dependency and patients capabilities are the main factors that should be considered while providing care (Balzer et al., 2014). Van Rijswijk and Beitz (2015) are also interested in the issue as they investigate the effectiveness of different methods to prevent ulcers. They conclude that the use of algorithms and decision processes might be helpful in preventing this problem and improving the state of patients who might suffer from ulcers due to their limited mobility (Van Rijswijk & Beitz, 2015). Moreover, Briggs et al. (2013) continue the investigation of the issue by estimating the prevalence of unattributed pressure areas associated with pain and ulcers.
In the course of the research, they find out that both patients with PUs and without them report a significant pain prevalence which means that the problem remains topical and there is a significant need for intervention to improve the situation in the sphere and help patients with ulcers recover. At the same time, Rodrigues et al. (2016) state that health workers possess the information needed to provide care for patients with ulcers. Moreover, their competence and knowledge of the prevention of pressure ulcers might be used to choose among the most efficient strategies that should be used to guarantee a complete recovery and avoid the further development of the issue. The problematic character of the question and its negative impact on the overall state of patients health is touched upon by Ahtiala, Soppi, Wiksten, Koskela, and Gronlund (2014).They assume that the appearance of ulcers in three months term could be avoided if appropriate preventive measures are used (Ahtiala et al., 2014). However, in several cases, the choice of wrong approaches to care creates an incident resulting in a significant deterioration of the situation and state of a patient. In such a way, the choice of method to treat patients with ulcers becomes a central dilemma for the healthcare sector (Ahtiala et al., 2014). This perspective on the issue is supported by Allen (2012) who states that turning and repositioning of patients might be a good alternative to other methods because of its proven efficiency and positive results reported by other patients.
In the course of the investigation, the author finds out that other methods including pressure-redistributing support surfaces demonstrate a lower level of efficiency. Cogan et al. (2016) revolve around the same issue. Interviewing nurses who work with hospitalized critically ill adult patients, the researchers acquire data indicating that the convenience and efficiency of different methods to provide care to this category varies. However, regarding the outcomes and reported improvement of patients states, repositioning remains one of the most efficient approaches to working with ulcers and preventing their appearance. The significance of this health problem and the necessity of prevention of ulcers is discussed by Kelly and Puurveen (2013). Analyzing the data from 60 hospitalized patients, they conclude that pressure ulcers are more probable to appear in those individuals who are not provided with an opportunity to change their body position or move (Kelly & Puurveen, 2013). In such a way, the method that includes these aspects could be considered the most efficient one.
Kapp, Miller, and Donohue (2013) also try to determine the most efficient approach to minimize risks and avoid the appearance of pressure ulcers. Discussing the results of using compression stockings and comparing them to other methods, they presuppose that specialists should give preference regarding the peculiarities of a particular case; however, repositioning remains one of the most efficient approaches characterized by enhanced outcomes and patients satisfaction. Assessing ulcer risk and factors that might stipulate their appearance, Low, Vasanwala, and Tai (2014) are sure that critically ill patients belong to the risk group as they are deprived of an opportunity to move or change their body position. In such a way, repositioning becomes a fundamental activity for them as it helps to restore blood circulation. Mackie, Baldie, McKenna, and OConnor (2014) conduct their own study to collect credible data related to the appearance of pressure ulcers and nurses approaches to the delivery of care. They discover that nurses prefer to choose among methods the efficiency of which is proven by positive outcomes and include repositioning and movements. Delving into the issue, Papanikolaou (2013) assesses the views of senior community nurses and their experiences related to the issue of pressure ulcer preventative care for older people with limited mobility.
The researcher finds out that the most popular methods are affordable, evidence-based, and manageable (Papanikolaou, 2013). For this reason, specialists might give their preference to repositioning and similar approaches to eliminate the problem. Periyasamy, Anand, and Ammini (2013) conduct their study among patients with diabetes who might also suffer from the high risk of pressure ulcers. In the course of the research, the authors proclaim that particular diseases might complicate the case and result in the increased speed of ulcers development. Under these conditions, the creation of an appropriate solution becomes crucial. Finally, Tubaishat, Papanikolaou, Anthony, and Habiballah (2017) investigate the problem of chronic ulcers and their impact on the state of patients. During the blind randomized controlled trial, they come to the conclusion that compression stoking treatment remains efficient among this group of patients. However, its combination with repositioning and other methods might demonstrate even better results.
In such a way, the given literature evidences an enhanced significance of pressure ulcers and methods to avoid their appearance and development. The majority of the authors state that the efficiency of a treatment depends on the peculiarities of a patient and the combination of measures used by nurses to assist individuals in their recovery. However, repositioning demonstrates stable positive results which should be considered by investigators.
Research Approach
The character of the investigated issue and PICO question stipulates the choice of the research design and methodology that should be used to collect relevant and credible data and discuss it. Nevertheless, to analyze the efficiency of repositioning and compare it to pressure-redistributing support surfaces, a quantitative approach should be used. It will help to make a conclusion and discuss the problem.
As for the research design, the quasi-experimental method should be explored. This choice is preconditioned by the peculiarities of this approach and its applicability. A significant part of investigations devoted to this issue also adheres to the quasi-experimental research design which evidences the correctness of our choice and a wide array of opportunities for the assessment.
Nevertheless, quasi-experiment is also known as a non-randomized controlled trial introduced with the primary aim to investigate the impact a particular intervention might have on a group of participants. In such a way, a researcher acquires an opportunity to monitor alterations among individuals and record the most important data related to the research question (LoBiondo-Wood & Haber, 2013). The ability to choose a needed group of patients is an integral part of quasi-experiments. Moreover, this research methodology provides the investigators with an opportunity to chose an appropriate sampling size.
In such a way, using the quasi-experimental research method, we acquire an opportunity to compare the impact repositioning, and the use of pressure-redistributing support surfaces have on patients by creating two groups and comparing their results. This serves as the leading rationale for the choice.
Thus, one of the apparent advantages of this approach is the opportunity to monitor alterations among participants and their states to compare final results and determine the efficiency of the interventions mentioned above (LoBiondo-Wood & Haber, 2013). Moreover, a researcher can choose groups meeting specific requirements needed to gather information or ensure that the planned intervention will be investigated appropriately.
Therefore, several disadvantages should be taken into account when choosing this methodology. First, quasi-experiments might need an extensive amount of time to conduct research and attain the result. Second, a researcher might fail to achieve objectivity by choosing inappropriate control groups that will deteriorate final results and distort data.
Sampling Method
As it comes from the research question, the target population is comprised of hospitalized adult patients who have severe diseases and are limited in their abilities. In such a way, they belong to the risk group characterized by the high probability of the appearance of pressure ulcers. In such a way, all adult patients regardless of their gender or ethnicity could be included in the research.
As far as we are interested in the investigation of the way the suggested interventions impact individuals from the described target population, random or probability sampling should be used. It contributes to the enhanced objectivity of collected data and ensures that unbiased results will be acquired at the end of the experiment.
The desired sample size is about 100 participants. They should be divided into two groups to compare the impact repositioning, and pressure-redistributing support surfaces might have on patients. Each group should be comprised of 50 patients suggested different methods of treatment. This sampling procedure will help to acquire data needed to compare the efficiency of measures and conclude about their future use.
The given sampling procedure provides investigators with the chance to work with objective data collected during the research. Additionally, random sampling helps to decrease the probability of mistakes and attain credible results that could be later used in different discussions of the issue (LoBiondo-Wood & Haber, 2013). Second, the distribution of patients into two comparatively large groups helps to meet the basic requirements of the project.
At the same time, there is a certain disadvantage as sample selection bias might occur. It will distort final data and deprive researchers of an opportunity to acquire credible results and contribute to the further analysis of the issue.
Finally, all participants will be guaranteed that their rights and confidentiality will be protected during the experiment. Their personal data will remain anonymous, and participation will be voluntary. These are the central aspects that guarantee the preservation of patients rights and consideration of ethical issues.
References
Ahtiala, M., Soppi, E., Wiksten, A.,Koskela, H., & Gronlund, A. (2014). The occurrence of pressure ulcers and risk factors in a mixed medical-surgical ICU — A cohort study. Journal of the Intensive Care Society, 15(4), 340-343. Web.
Allen, B. (2012). Effects of a comprehensive nutritional program on pressure ulcer healing, length of hospital stay, and charges to patients. Clinical Nursing Research, 22(2), 186-205. Web.
Balzer, K., Kremer, L., Junghans, A., Halfens, R., Dassen, T., & Kottner, J. (2014). What patient characteristics guide nurses’ clinical judgment on pressure ulcer risk. A mixed methods study. Nursing Studies, 51(5), 703-716.
Briggs, M., Collinson, M., Wilson, L., Rivers, C., McGinnis, E., Dealey, C., …Nixon, J. (2013). The prevalence of pain at pressure areas and pressure ulcers in hospitalized patients. BioMed Central, 12(19), 1-6.
Cogan, A., Blanchard, J., Garber, S., Vigen, C., Carlon, M., & Clark, F. (2016). Systematic review of behavioral and educational interventions to prevent pressure ulcers in adults with spinal cord injury. Clinical Rehabilitation, 31(7), 871-880. Web.
Kelly, R., & Puurveen, G. (2013). Pressure ulcer risk assessment: A “Proxy Braden” scale in the resident assessment instrument–home care (RAI-HC). Home Health Care Management & Practice, 25(6), 264-273. Web.
Kapp, S., Miller, C., & Donohue, L. (2013). The clinical effectiveness of two compression stocking treatments on venous leg ulcer recurrence: A randomized controlled trial. The International Journal of Lower Extremity Wounds, 12(3), 189-198. Web.
LoBiondo-Wood, G., & Haber, J. (2013). Nursing research: Methods and critical appraisal for evidence-based practice (8th ed.). New York, NY: Mosby.
Low, L., Vasanwala, F., & Tai, C. (2014). Pressure ulcer risk assessment and prevention for the family physician. Proceedings of Singapore Healthcare, 23(2), 142-148. Web.
Mackie, S., Baldie, D., McKenna, E., & OConnor, P. (2014). Using quality improvement science to reduce the risk of pressure ulcer occurrence – A case study in NHS Tayside. Journal of Patient Safety and Risk Management, 20(6), 134-143. Web.
Papanikolaou, P. (2013). What factors do senior community nurses (Grade 7) consider in the provision of effective pressure ulcer preventative care in older aged patients? Journal of Research in Nursing, 19(3), 213-223. Web.
Periyasamy, R., Anand, S., & Ammini, A. (2013). Prevalence of standing plantar pressure distribution variation in north Asian Indian patients with diabetes mellitus: A study to understand ulcer formation. Proceedings of the Institution of Mechanical Engineers, Part H. Journal of Engineering in Medicine, 227(2), 181-189. Web.
Rodrigues, G., Vasconcelos, J., Melo, F., Vigolvino, L., de Sousa, A., Santos, I., …Correia, A. (2016). Knowledge and opinions of nursing professionals about pressure ulcers prevention. Intervention Archives of Medicine, 9(101), 1-13.
Tubaishat, A., Papanikolaou, P., Anthony, D., & Habiballah, L. (2017). Pressure ulcers prevalence in the acute care setting: A systematic review, 2000-2015. Clinical Nursing Research. Web.
van Rijswijk, L., & Beitz, J. (2015). Pressure ulcer prevention algorithm content validation: A mixed-methods, quantitative study. Ostomy Wound Management, 61(4), 48-57.