Introduction
Pressure ulcers that are formed due to a long stay in the supine position are common preventable hospital-acquired health conditions that may result in serious complications (Bly, Schallom, Sona, & Klinkenberg, 2016). This problem is prevalent in intensive care units (ICUs) where patient mobility is often limited, and many of them can hardly estimate their health status. Pressure ulcers bring discomfort to both the junior medical personnel and patients, and the search for relevant methods to combat this issue is an essential task.
In order to analyze appropriate solutions to the problem of pressure ulcers in ICU patients, this review of the appropriate academic literature is conducted. The purpose of this work is to review recent literature and address the following PICO question: in those patients with pressure ulcers who undergo treatment in intensive care units (P), how effective is the use of specific preventive measures (I) compared to standard care principles (C) in reducing the consequences of the problem (O)?
Current sources have important information regarding approaches to preventing the development of this ailment and measures to eliminate it. The standard preventive procedure is patient positioning, but it tends to have considerable limitations (Behrendt, Ghaznavi, Mahan, Craft, & Siddiqui, 2014). ICU patients still develop pressure ulcers since it can be hard to ensure patients’ correct position during their hospital stay.
The focus of this review is on preventive measures that are not confined to patient positioning, but include additional components. Some attention is also paid to the factors contributing to the development of pressure ulcers.
Methods
This brief literature review includes six primary studies published in peer-reviewed journals during the past five years. It is essential to analyze the most recent findings as they are associated with the use of innovative strategies and the most advanced technology. Overall, 25 articles were considered during the selection process, but only six of them met the inclusion criteria. In addition to the publishing date, inclusion criteria were the type of the research (primary or secondary), type of the preventive strategy (non-standard), and the hospital department (intensive care unit). The keywords utilized included pressure ulcer, intensive care unit, and prevention. Such databases as CINAHL, PubMed, EBSCO, and Google Scholar were used to locate the most appropriate articles.
Results
The reviewed studies are characterized by the use of the quantitative design that ensures the identification of the current trends and covers large groups, which is an important strength. Behrendt et al. (2014) conduct a controlled study to identify whether a continuous pressure ulcer mapping device is a valuable technique. The results obtained by Behrendt et al. (2014) confirm the effectiveness of the implementation of a continuous bedside pressure mapping device to prevent the development of the disease. The data were compared in two groups, and the outcome of the intervention among the target patients was more positive.
Bly et al. (2016) conduct a chat review for ten months and observe variables related to the issue of pressure ulcers. Bly et al. (2016) who review patients in ICUs argue that their model that is applied for the purpose of finding correlations between specific variables and the development of pressure ulcers is relevant. 345 people were selected as the participants of this research, and “the model of pressure, oxygenation, and perfusion” was applied to them to prove the study’s objective (Bly et al., 2016, p. 156).
The purpose of the study by Hyun et al. (2014) is to determine whether there is a connection between weight and the development of pressure ulcers. The data collected are divided into four categories based on participants’ mass index. Overweight influences pressure ulcers significantly, which supports the authors’ hypothesis (Hyun et al., 2014). Hyun et al. (2014) apply a data collection technique based on the assessment of variables relevant to the body mass index.
Serra et al. (2015) review the information obtained as a result of the assessment of patients with hypoalbuminemia in ICUs, analyzing two target groups of participants. The authors resort to the definition of ulcers mentioned in the NPUAP / EPUAP classification system. The intervention performed by Serra et al. (2015) aims at identifying the effect of albumin administration in relation to the problem. The statistics of 73 patients are analyzed, and the diagnosis of hypoalbuminemia is the key data collection criterion. The findings demonstrate the success of the intervention, and its strength is that medical intervention for the target population has no potential limitations. The only weakness is that not all patients with a propensity for pressure ulcers can participate in such a program.
Smit, Harrison, Letzkus, and Quatrara (2016) conduct a chat review based on demographic statistics. The goal of the work by Smit et al. (2016) is to determine whether there are demographic factors that affect the problem. According to the findings, the crucial factors that should be taken into account are “the administration of vasopressor support and patient length of stay” (Smit et al., 2016, p. 38). The information is collected among men and women in equal proportions. The weakness of the study is that too many different variables are included in the study. The major strength is the large number of target group participants.
Swafford, Culpepper, and Dunn (2016) develop a program based on staff education. The authors use a common database of patients and consider various cases related to the issue of pressure ulcers (Swafford et al., 2016). The purpose of the research by Swafford et al. (2016) is to identify how staff education influences the effectiveness of pressure ulcer prevention. Information about patients was collected, and in parallel, staff training was performed. As the author’s remark, personnel education is the successful way of combating the problem considered (Swafford et al., 2016). The strength of the study is the orientation not only on patients but also on medical employees.
Discussion
Based on the results of the assessment, the reviewed academic papers carry useful information regarding the resolution of the pressure ulcer problem in patients in ICUs. It is noteworthy that the researchers whose works are reviewed stress the need to develop and implement interventions that could address the exact needs of ICU patients. The value of the studies under analysis is the use of diverse approaches to address the issue.
The developed interventions also imply the provision of training to medical staff, which is regarded as a key to solving the problem. The strength of such studies is significant since the search for solutions can save patients from severe discomfort. One of the weaknesses of the studies is a comparatively small sample size that ranges between 73 and 422 participants. Further studies should involve larger samples and cover more communities and even states. Another weakness that can undermine the validity of the findings is the focus on several variables in some studies.
This literature review suggests that the focus on quantitative designs can be seen as their weakness as qualitative data could help understand the factors that contribute to the development of pressure ulcers in patients. Therefore, qualitative studies can shed light on nurses’ attitudes toward the efficiency of interventions and major obstacles to their successful implementation. It can be beneficial to develop interventions that target specific groups of people, such as obese patients, older individuals, or patients with certain health conditions.
Conclusion
The review of academic articles on the control of pressure ulcers in patients in ICUs suggests that work is needed in this direction. Different variables may be taken into account, and both medical interventions and innovative technologies can be applied. Further work may be related to the search for new techniques based on the modern models of care. Medical personnel should be responsible for the problem and take appropriate actions to protect patients.
It is also evident that nursing professionals need further training to makes sure that innovative strategies are effective. Nurses should become agents of change and try to adopt some of the most effective instruments that are widely discussed in academia. The discussion of the burden of pressure ulcers is another important aspect that should become an indispensable element of the nursing staff’s regular meetings. The attention to the problem can help nursing practitioners to improve the quality of care they provide and enhance patient safety and satisfaction, as well as reduce financial losses.
References
Behrendt, R., Ghaznavi, A. M., Mahan, M., Craft, S., & Siddiqui, A. (2014). Continuous bedside pressure mapping and rates of hospital-associated pressure ulcers in a medical intensive care unit. American Journal of Critical Care, 23(2), 127-133. Web.
Bly, D., Schallom, M., Sona, C., & Klinkenberg, D. (2016). A model of pressure, oxygenation, and perfusion risk factors for pressure ulcers in the intensive care unit. American Journal of Critical Care, 25(2), 156-164. Web.
Hyun, S., Li, X., Vermillion, B., Newton, C., Fall, M., Kaewprag, P.,… Lenz, E. R. (2014). Body mass index and pressure ulcers: Improved predictability of pressure ulcers in intensive care patients. American Journal of Critical Care, 23(6), 494-501. Web.
Serra, R., Grande, R., Buffone, G., Gallelli, L., Caroleo, S., Tropea, F.,… de Franciscis, S. (2015). Albumin administration prevents the onset of pressure ulcers in intensive care unit patients. International Wound Journal, 12(4), 432-435. Web.
Smit, I., Harrison, L., Letzkus, L., & Quatrara, B. (2016). What factors are associated with the development of pressure ulcers in a medical intensive care unit? Dimensions of Critical Care Nursing, 35(1), 37-41. Web.
Swafford, K., Culpepper, R., & Dunn, C. (2016). Use of a comprehensive program to reduce the incidence of hospital-acquired pressure ulcers in an intensive care unit. American Journal of Critical Care, 25(2), 152-155. Web.