Comparison Cohort Study

Pressure ulcers are a major health issue that can be essentially preventable. Nurses assess skin integrity and identify pressure ulcers and implement preventative measures in order to treat and avoid prolonged stays in hospitals. There are many important risk assessment tools and skin assessment education that can aid nurses’ knowledge concerning pressure ulcers. The European Pressure Ulcer Advisory Panel acknowledged the necessity for healthcare professionals to be well-informed about how to take an organized approach to guiding and recording pressure ulcer risk assessment. Evidence implies that if these elements, such as, assessment scale, clinical judgement, and complete skin assessment are in place, it can reduce the development of
a pressure ulcer (Joseph & Clifton, 2013).
How important is turning verses the use of redistribution devices?
In patients with nutritional imbalances, the patient is predisposed to developing a pressure ulcer quicker than in a healthier patient. Evaluating which methods to use, according to supportive literature, will guide nurses to implement the appropriate care and treatment for the patient. A comparison cohort study was conducted in order to evaluate two methods for turning and positing and the effects it has on pressure ulcer development. Two methods of positioning were evaluated specifically with the use of pillows (standard of care) to patient positioning system (PPS). Sixty patients from a neurointensive/trauma unit were used for this particular study. A random assignment of patients was designated to one of two teams per standard bed placement practices. Patients who already had a prior pressure ulcer were not included in this study. Evaluation of pressure ulcers were performed on a daily basis and information was collected on the number of staff members that were required to turn the patients. The patients that were turned with standard of care pillows was designated
to one team and patients that were turned using the patient positioning system were designated to another group. A documentation sheet was displayed in each room for nursing documentation in order to keep track of when the patients were pulled up in the bed. The patient positioning system included a low-friction glide sheet with handles in order to lessen the labor needed to turn the patient. This glide sheet included an antishear strap to avoid the patient from sliding off of the bed. Limitations to this particular study contained a small sample size and the use of nonstandardized pillows. Results of this study supported the use of the patient positioning system for prevention of hospital acquired pressure ulcers. No nurse was physically injured during the data collection time (Powers, 2016).
As part of our evidence-based practice in the management of pressure ulcers, registered nurses’ awareness and views in hospital settings are continuously studied. In the Journal of Clinical Nursing, 2012, the purpose of the study was to describe the nurses’ performance and their insight on pressure ulcer prevention. The design of this particular study was descriptive and nine registered nurses in three hospital wards partook in the study. Their practices were studied carefully in a nurse-patient care situation with patients who were at risk of developing pressure ulcers. Methods used were both qualitative and quantitative. This research study took place in hospitals in Sweden. In Sweden, registered nurses are accountable for the care that is delivered to the patients and they work closely with assistant nurses at the bedside. The conclusion of this study showed lack of prevention methods. No risk assessment devices or tools were used and very little care plans were identified. It was discussed that the registered nurses relied on their nursing assistants to implement the pressure relief measures (Sving, Gunningberg, Hogman, & Mamhidir, 2012). How is this particular study pertinent to clinical practice? “Evidence-based pressure ulcer prevention is fundamental to patient safety” (Sving et al., 2012, p. 1293).
Evidence-based practice offers a great opportunity for nurses to educate and add importance to patient contribution.
It incorporates the greatest available scientific data in addition to experimental evidence so that we can become well informed critical thinkers and make educated decisions in the deliverance of patient care (Dearholt & Dang, 2012). When discussing the relevance of patient repositioning and turning, pressure ulcers result when pressure is increased on the skin and subcutaneous tissues surpasses the confined capillary pressure, which then, compromises the blood flow causing ischemia and reduced oxygen delivery (Peterson, Gravenstein, Schwab, VanOostrom, & Caruso, 2013). “Managing one full-thickness ulcer can cost up to $70,000 and over $17 billion is spent on pressure ulcer treatment annually in the United States” (Peterson et al., 2013, p. 477). Peterson et al., 2013 discuss that it is unanimously decided that pressure-distributing devices cannot replace patient repositioning care and it will be further explained in detail. Their particular study implemented a descriptive and observational design which takes place in a university-affiliated hospital with 170 intensive care beds from 2007-2009. Twenty-three participants were enrolled in the study from a convenience sample of 20 in intensive care and 3 in transitional care. Informed consents had been obtained. As part of this study, a sensor was placed underneath the patient that extended from the lower
back to the mid-thigh in order to confirm data collection from the perisacral region. Measurements were recorded every 30 seconds as the patient lied in bed and had their routine care which comprised of lateral turning by the patient’s nurse. Wedges or pillows that were used were placed beneath the device in order to allow for constant measurement of pressures on the skin. The patients were monitored for four to six hours and the patients were observed during supine, left and right turns every two hours. The outcome of the study provides unbiased support that patient repositioning when done routinely, reduces the chances of pressure ulcers in areas that are commonly at risk. However, additional research is crucial to determine how pressure mapping can be utilized in order to improve at risk tissue in the prevention of pressure ulcers (Peterson et al., 2013).