Advanced Levels of Clinical Inquiry and Systematic Reviews

Advanced Levels of Clinical Inquiry and Systematic Reviews

Pressure ulcers (PUs) are skin lesions caused by prolonged friction in areas of the body where a patient’s weight exerts increased mechanical pressure, such as the sacrum, trochanters, scapulae, or shoulder blades), heels, and elbows. An increase in the number of these occurrences and their consequences affects patients’ and their families physical and emotional health, as well as their quality of life, hospital costs, and healthcare system expenditures. PUs cannot be completely avoided, but they can be greatly reduced by using well-established, high-quality, evidence-based methods. One of the many EBP measures to prevent PUs is repositioning. When a person is repositioned, pressure is redistributed from one area of the body to another. This study is looking to see if repositioning in critically ill patients can help reduce pressure injuries.

Clinical Issue Keywords

The Walden Library’s appropriate research databases, which include a number of nursing-related magazines, were extremely helpful in my search for studies on my topic. I searched for keywords such as “frequency,” “schedule,” “turn,” “reposition,” “hour,” “pressure ulcer,” “hospital-acquired pressure ulcers,” “sores,” and “inpatients” using the Boolean operators AND and OR. As demonstrated, quotation marks were used in these search phrases to ensure that search results produced articles that contained the entire phrase (Bramer et al., 2018). Web of Science, CINAHL, Scopus, Pubmed, ScienceDirect, the Cochrane Library, and Proquest databases was used to find articles published between 2015 and 2021. The study included articles that primarily focused on preventing hospital-acquired PUs, repositioning frequency, or repositioning of bed-bound adult patients.

PICOT Problem

How does repositioning adult bed-bound patients at frequent intervals accompanied by conventional care reduce the rate of developing PUs over a three-month period compared to conventional care alone?

P- adult bedridden patients

I- repositioning at regular intervals with standard care.

C- only conventional care

O- lessens the development of pressure ulcers

Three months T

Articles Chosen

The study by Jocelyn et al. (2017) sought current evidence on the repositioning frequency of bed-bound adult patients in order to inform future repositioning practices used by healthcare organizations. Their scoping review of available evidence revealed inconclusive evidence supporting the impact of repositioning on lowering the patient incidence of PU. Only two of the eight scoping review studies found significant differences between intervention and control groups. The study’s strength is that it uses current evidence to demonstrate that repositioning alone cannot be used in clinical settings to prevent PU. The study will be useful in my PICOT because it will guide me on the best repositioning degree and frequency.

Sharp et al. (2019) conducted a retrospective cross-sectional study of eight medical records from residents over the age of 65 who died between 2011 and 2014. According to the findings, 91% of residents in their final week of life were considered at risk of a PU, and 96% of those at risk were moved twice a day, seven days a week. In clinical practice, a PU risk screening technique did not protect vulnerable residents in the control group, which included those who were moved 24 hours a day, every day. The golden hour guideline for PU risk requires a timely assessment by medical practitioners so that at-risk residents can receive an APAM within an hour. This prompt action reduces the likelihood of a new PU and sleep disruption. The study’s methodology—a retrospective cross-sectional survey of eight medical facilities—is its strength, as it increases the generalizability of results. This research will aid my PICOT in determining an effective repositioning frequency that does not interfere with the subjects’ sleep patterns.

Latimer et al. (2015) conducted a prospective observational study to determine the frequency of patients turning in three continuous nursing shifts and the factors predicting the frequency of repositioning. The study’s findings on the frequency of repositioning revealed that subjects with mobility issues received more frequent repositioning. The other finding was that participants preferred the HOBE position of 1-45 degrees of positioning across all three shifts. This finding was supported by other studies that found patients preferred a HOBE position of 1 to 90 degrees. A HOBE of 30 degrees or more typically increases the risk of PU in patients due to the increased friction and weight that the buttocks and sacrum must bear. Because RCTs have strict inclusion criteria and protocols, observational studies like this one have a high level of reliability and validity. These findings are very informative and will aid in determining the best HOBE position to subject the study participants to in order to prevent pressure ulcers.

The final study included in this review is Cortés et al. (2021) .’s proposed randomized controlled trial, which sought to determine how the frequency of repositioning can prevent pressure ulcers in ICU patients. The researchers will look at 22 ICUs with 150 patients each who will be randomly assigned to either a high level of repositioning or standard care. Because the study has yet to be completed, the results are only projected. The authors predict that once the intervention is implemented, the number of bedsores acquired during ICU admission will be reduced. The secondary outcome is a lower risk of PU and postural change-related complications. RCTs are powerful because they have high internal validity (Booth & Tannock, 2014). The impact of this study on my PICOT is that it will increase my understanding of the efficacy of interventions aimed at preventing PUs in my chosen patient population.

Strategies for Improving Database Search Rigor and Effectiveness

Using Boolean operators to improve the rigor and efficacy of database searches is one method. This can be accomplished by using “OR” synonyms in multiple searches (Henry, 2015). It’s a good idea to run several searches, each with a different set of words. To broaden your search, include synonyms for the word “OR” in the same search field. If you’re stumped on a synonym for a search term, look at the search results. You can use keywords or search terms from other sources’ titles or abstracts.

Another possibility is to use the database’s native language. It is critical to becoming familiar with database searching standards and properties (Henry, 2015). Keywords or search phrases found in the database’s topic terms or subject headers may be used. In databases, tags are used to group articles that address the same topic. Inserting topic phrases or headers into your search will increase the number of relevant and specific results.

References

Booth, C. M., & Tannock, I. F. (2014). Randomized controlled trials and population-based observational research: partners in the evolution of medical evidence. British journal of cancer, 110(3), 551-555

Cortés, O. L., Herrera-Galindo, M., Villar, J. C., Rojas, Y. A., del Pilar Paipa, M., & Salazar, L. (2021). Frequency of repositioning for preventing pressure ulcers in patients hospitalized in ICU: protocol of a cluster randomized controlled trial. BMC nursing, 20(1), 1- 10.https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-021-00616-0

Henry, P. (2015). Rigor in qualitative research: Promoting quality in social science research. Res J Recent Sci ISSN, 2277, 2502. https://doi.org/10.7416/ai.2015.2035

Jocelyn Chew, H. S., Thiara, E., Lopez, V., & Shorey, S. (2018). Turning frequency in adult bedridden patients to prevent hospital‐acquired pressure ulcer: A scoping review. International wound journal, 15(2), 225- 236.https://proqualis.net/sites/proqualis.net/files/Turning%20frequency%20in%20adult %20bedridden%20patients%20to%20prevent%20hospital-acquired%20pressure%20ulcer %20A%20scoping%20review..pdf

Latimer, S., Chaboyer, W., & Gillespie, B. M. (2015). The repositioning of hospitalized patients with reduced mobility: a prospective study. Nursing open, 2(2), 85- 93.https://onlinelibrary.wiley.com/doi/pdf/10.1002/nop2.20

Sharp, C. A., Moore, J. S. S., & McLaws, M. L. (2019). Two-Hourly Repositioning for Prevention of Pressure Ulcers in the Elderly: Patient Safety or Elder Abuse? Journal of bioethical inquiry, 16(1), 17-34.https://link.springer.com/article/10.1007/s11673-018- 9892-3

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EVIDENCE-BASED PROJECT, PART 2: ADVANCED LEVELS OF CLINICAL INQUIRY AND SYSTEMATIC REVIEWS.

FALL PREVENTION is the chosen clinical issue of interest. 

To Prepare:

Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.

Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.

Use the keywords from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically appraised topics (evidence syntheses), and critically appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search for and find the best evidence available.

Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.

The Assignment (Evidence-Based Project)

Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews

Create a 6- to 7-slide PowerPoint presentation in which you do the following:

Identify and briefly describe your chosen clinical issue of interest. (Fall Prevention).

Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.

Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.

Provide APA citations of the four relevant peer-reviewed articles at the systematic review level related to your research question. If there are no systematic review-level articles or meta-analyses on your topic, then use the highest level of evidence from a peer-reviewed article.

Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples. Include speaker note