Critical Appraisal of Research

Part 4A: Critical Appraisal of Research

 

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Full citation of selected article Article #1 Article #2 Article #3 Article #4
Bååth, C., Idvall, E., Gunningberg, L., & Hommel, A. (2014). Pressure-reducing interventions among persons with pressure ulcers: results from the first three national pressure ulcer prevalence surveys in Sweden. Journal of Evaluation in Clinical Practice, 20(1), 58–65.

 

Padula, W. V., Makic, M. B. F., Mishra, M. K., Campbell, J. D., Nair, K. V., Wald, H. L., & Valuck, R. J. (2015). Comparative effectiveness of quality improvement interventions for pressure ulcer prevention in academic medical centers in the United States. The Joint Commission Journal on Quality and Patient Safety, 41(6), 246-AP5. Coyer, F., Gardner, A., Doubrovsky, A., Cole, R., Ryan, F. M., Allen, C., & McNamara, G. (2015). Reducing pressure injuries in critically ill patients by using a patient skin integrity care bundle (InSPiRE). American Journal of Critical Care, 24(3), 199-209. Yap, T. L., Kennerly, S. M., Bergstrom, N., Hudak, S. L., & Horn, S. D. (2016). An Evidence-Based Cue-Selection Guide and Logic Model to Improve Pressure Ulcer Prevention in Long Term Care. Journal of Nursing Care Quality, 31(1), 75-81
Conceptual Framework

Describe the theoretical basis for the study

 

 

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None provided

 

 

An Evidence-Based Prevention Protocol InSPiRE protocol Innovative Cueing model
Design/Method Describe the design

and how the study

was carried out

 

A cross-sectional research design Quasi-experimental design Intervention: Before and after design Synthesis of evidence from interventions
Sample/Setting

The number and

characteristics of

patients,

attrition rate, etc.

21 county councils and 290 municipalities in Sweden.

70,000 participants in the first nationwide surveys

16,466 participants in the actual study.

 

 

Hospital inpatients from the University HealthSystem Consortium (UHC).

55 UHC hospitals

ICU in an Australian metropolitan tertiary referral hospital.

207 patients, 105 in the intervention group and 102 in the control group

3 PrU prevention interventions
Major Variables Studied

List and define dependent and independent variables

 

Dependent variable: pressure ulcer prevention.

 

Independent variable: Pressure-reducing interventions among persons with pressure ulcers

 

 

Dependent variable: Pressure Ulcer Prevention

 

Independent variable: Quality Improvement Interventions

 

 

Dependent variable: Prevention of pressure injuries in the ICU.

 

Independent variable: Interventional patient skin integrity bundle

Dependent variable: improvement of Pressure Ulcer Prevention in Long Term Care

Independent variable: Evidence-Based Cue-Selection Guide and Logic Model

 

Measurement

Identify primary statistics used to answer clinical questions

 

The prevalence of pressure ulcer among the participants following the implementation of the pressure-reducing interventions

 

The study measured the rate of pressure ulcer prevalence over time following the implementation of pressure ulcer prevention interventions.

 

To measure the effectiveness of interventional patient skin integrity bundle in preventing pressure injuries in the ICU.

To measure the effect of preventions based on the cuing model in the prevention of pressure ulcers in long term care.

Data Analysis

Statistical or

qualitative

findings

Descriptive analyses Statistical analysis of survey data The Statistical Package for the Social Sciences (SPSS) (Version 18.0, Chicago, IL, USA). Research synthesis
Findings and Recommendations

General findings and recommendations of the research

The results revealed that pressure ulcer preventive strategies, such as repositioning and use of PU, were effective in preventing and reducing the rate of pressure ulcers.

 

The study provided important evidence for the use of quality improvement interventions to prevent pressure ulcers in hospitals.

 

 

The results of the study indicated a considerable reduction of pressure injuries following the implementation of the intervention. The evidence can be used in practice to prevent injuries in ICU patients. The research revealed a considerable reduction of pressure ulcers in long term care through implementation of innovative cueing components to facilitate care. The results indicated the models that can be used in practice to support the objective.
Appraisal

Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of

use in your practice?

The study provides results that can be used in practice to prevent pressure ulcers. However, the study lacked adequate preventive strategies to inhibit pressure ulcers. The study does not involve any risk in its implementation in practice. The study provided evidence of effective quality improvement interventions for the prevention of pressure ulcers. However, health care organizations can only apply the findings as part of a quality improvement bundle. The research provides strong evidence for the use of interventional patient skin integrity bundles in the prevention of pressure ulcers. However, the findings are limited to the ICU. The evidence can be used in similar settings to achieve positive outcomes. The study provides important findings regarding the use of innovative cuing and other interventions to prevent pressure ulcers. However, the findings are limited to past interventions and in long term care. The results can be integrated into regular care for hospitalized and institutionalized patients to prevent pressure ulcers.
General Notes/Comments The study provides critical data for the implementation of pressure ulcer preventive interventions in hospitalized patients.

 

 

The study provides important findings on the implementation of quality improvement interventions in the prevention of pressure ulcers in hospitalized patients. The study provides feasible evidence for the prevention of pressure ulcers using interventional patient skin integrity bundle. The study provides evidence-based proposals to improve long-term care in the prevention of pressure ulcers.

Levels of Evidence Table

 

Use this document to complete the levels of evidence table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

 

 

Author and year of selected article Article #1 Article #2 Article #3 Article #4
 

Bååth, C., Idvall, E., Gunningberg, L., & Hommel, A. (2014)

 

 

Padula, W. V., Makic, M. B. F., Mishra, M. K., Campbell, J. D., Nair, K. V., Wald, H. L., & Valuck, R. J. (2015). Coyer, F., Gardner, A., Doubrovsky, A., Cole, R., Ryan, F. M., Allen, C., & McNamara, G. (2015). Yap, T. L., Kennerly, S. M., Bergstrom, N., Hudak, S. L., & Horn, S. D. (2016).
Study Design

Theoretical basis for the study

 

A cross-sectional research design

 

 

 

Quasi-experimental design Intervention: Before and after design Synthesis of evidence from interventions
Sample/Setting

The number and

characteristics of

patients

21 county councils and 290 municipalities in Sweden

70,000 participants in the first nationwide surveys

16,466 participants in the actual study.

Hospital inpatients from the University HealthSystem Consortium (UHC).

55 UHC hospitals

ICU in an Australian metropolitan tertiary referral hospital.

207 patients, 105 in the intervention group and 102 in the control group

3 PrU prevention interventions
Evidence Level *

(I, II, or III)

 

Level III

 

Level II Level I Level V
Outcomes

 

 

 

The overall prevalence of pressure ulcers was lower after the intervention, which proves effectiveness.

 

Fifty-three (96%) of the 55 hospitals used quality improvement interventions for PU prevention. The intervention was effective in reducing the rate of pressure ulcers. The cumulative rate of pressure injuries was lower in the intervention than the control.

 

The research revealed considerable reduction of pressure ulcers in long-term care through implementation of innovative cueing components to facilitate care.
General Notes/Comments The study provides critical data for the implementation of pressure ulcer preventive interventions in hospitalized patients.

 

 

 

 

 

The study provides important findings on the implementation of quality improvement interventions in the prevention of pressure ulcers in hospitalized patients. The study provides feasible evidence for the prevention of pressure ulcers using interventional patient skin integrity bundles. The study provides evidence-based proposals to improve long term care in the prevention of pressure ulcers.

* Evidence Levels:

 

  • Level I

Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

 

  • Level II

Quasi-experimental studies, a systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis

 

  • Level III

Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis

  • Level IV

Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence

  • Level V

Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence

Outcomes Synthesis Table

 

Use this document to complete the outcomes synthesis table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

 

 

Author and year of selected article Article #1 Article #2 Article #3 Article #4
 

Bååth, C., Idvall, E., Gunningberg, L., & Hommel, A. (2014)

 

Padula, W. V., Makic, M. B. F., Mishra, M. K., Campbell, J. D., Nair, K. V., Wald, H. L., & Valuck, R. J. (2015). Coyer, F., Gardner, A., Doubrovsky, A., Cole, R., Ryan, F. M., Allen, C., & McNamara, G. (2015). Yap, T. L., Kennerly, S. M., Bergstrom, N., Hudak, S. L., & Horn, S. D. (2016).
Sample/Setting

The number and

characteristics of

patients

21 county councils and 290 municipalities in Sweden, 70,000 participants in the first nationwide surveys and 16,466 participants in the actual study. Hospital inpatients from the University HealthSystem Consortium (UHC).

55 UHC hospitals

ICU in an Australian metropolitan tertiary referral hospital.

207 patients, 105 in the intervention group and 102 in the control group

3 PrU prevention interventions
Outcomes

 

 

The overall prevalence of pressure ulcers was lower after the intervention, which proves effectiveness. Fifty-three (96%) of the 55 hospitals used quality improvement interventions for PU prevention. The intervention was effective in reducing the rate of pressure ulcers. The cumulative rate of pressure injuries was lower in the intervention than the control.

 

The research revealed a considerable reduction of pressure ulcers in long-term care through implementation of innovative cueing components to facilitate care.
Key Findings

 

The results of the study revealed that pressure ulcer preventive strategies such as repositioning and use of PU were effective in preventing and reducing the rate of pressure ulcers. Most quality improvement interventions are effective in reducing the development of pressure ulcers among hospitalized patients.

 

The cumulative rate of pressure injuries was lower in the intervention than the control.

 

The study revealed the effectiveness of the 3 PrU prevention interventions in the prevention of pressure ulcers among hospitalized patients.
Appraisal and Study Quality

 

The article is based on valid and reliable research design to establish the efficacy of pressure ulcer preventive interventions in hospitalized patients. The study provided feasible findings that can be used in practice to prevent PU among hospitalized patients. The research provides strong evidence for the use of interventional patient skin integrity bundles in the prevention of pressure ulcers. The study provides important findings regarding the use of innovative cuing and other interventions to prevent pressure ulcers.
General Notes/Comments  

The study provides critical data for the implementation of pressure ulcer preventive interventions in hospitalized patients.

 

 

 

 

 

 

The study provides important findings on the implementation of quality improvement interventions in the prevention of pressure ulcers in hospitalized patients. The study provides feasible evidence for the prevention of pressure ulcers using interventional patient skin integrity bundle. The study provides evidence-based proposals to improve long-term care in the prevention of pressure ulcers.

 

 

 

 

 

 

 

 

Part 4B

Critical Appraisal of Research

A pressure ulcer is a common health care issue affecting hospitalized individuals, especially in the intensive care unit and other settings where patients are immobilized. Researchers have explored evidence-based interventions that can be useful in the prevention of pressure ulcers among at-risk patients. The findings from the four reviewed articles reveal the effectiveness of well-implemented interventions in the prevention of pressure ulcers or pressure injury, especially in hospitalized patients.

The studies have focused on the prevention of pressure ulcers among hospitalized patients. For example, Bååth, Idvall, Gunningberg, and Hommel (2014) explored the use of heel protection/floating heels and sliding sheets as part of the care bundle in the prevention of pressure ulcers in patients. The intervention is part of the repositioning goal of patients to reduce pressure and prevent injury. The study also revealed a positive impact on people who already have pressure ulcers because the mechanisms prevent development of more wounds.

Further research comparing two groups revealed similar effectiveness in the use of preventive interventions. Coyer et al. 2015) conducted an experimental study that showed a lower incidence of pressure ulcers among patients in the experimental group compared to those in the control group. The experimental group received the InSPiRE protocol, a preventive intervention for pressure ulcers. In another study, Padula et al. (2015) explored the impact of five quality improvement interventions in the prevention of pressure ulcers. Notably, interventions that include environmental modifications, repositioning, and regular assessment are effective in achieving the objective.

Studies support the findings that a single strategy, such as repositioning is less effective in preventing pressure ulcers. As a result, Yap, Kennerly, Bergstrom, Hudak, and Horn (2016) revealed the importance of numerous PrU prevention strategies implemented by multidisciplinary teams. Therefore, the best practice in the prevention of pressure ulcers should be multimodal, integrating evidence-based interventions in the care bundle for hospitalized patients in the ICU and long-term care. Evidence-based interventions have proven successful after a proper assessment of patient risks and matching the intervention to the needs of a particular patient. For example, the responses that are necessary before the development of pressure ulcers might be ineffective among patients who already have injuries. However, proper implementation can help patients to achieve positive outcomes.

Research shows some of the practical approaches that can be applied as part of the care bundle in preventing pressure ulcers. For example, caregivers can use various strategies, such as repositioning, dietary changes, and proper sleeping positions, to reduce the pressure for patients hospitalized for extended periods, including in ICUs. Hospitals can also include pressure redistributing devices to prevent injuries. However, implementation of the interventions should follow a careful assessment of risk to determine the most suitable method.

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