Pressure Ulcers In Older Adults - The Impact Of Repositioning And Nutrition

Pressure Ulcers in Older Adults – The Impact of Repositioning and Nutrition

Student Name:

Faculty Name:

Background of Nursing Practice Problem (one paragraph; no more than 250 words):

Skin impairment remains a common problem among older adults. In this population, a decrease in mobility associated with aging processes contributed to compromises in the skin integrity, resulting in suffering. Some compromises to the skin integrity witnessed in older adults include skin dryness and epidermal thickening. However, in hospitalized patients, pressure ulcers are one of the most common complaints of compromise to skin integrity reported in older adults. Several interventions have been used to prevent pressure ulcers among hospitalized geriatrics. Patient repositioning and nutritional interventions are effective in reducing pressure injuries. However, it is unclear if the implementation of changing the position of the patient every 2 hours would affect skin impairment among older adults with impaired mobility (Asiri, 2023).

PICO(T) Question: Use the PICOT question developed in Topic 1 Discussion Question (DQ) 2 and refine it as needed.

PICO(T) Question Template
P	Population	Older adults with impaired mobility
I	Intervention	Q2H turns
C	Comparison	Balance diet
O	Outcome	Effect on skin impairment
T	Timeline (optional)	A single hospital stay
Intervention
In older adults with impaired mobility (P), how does __Q2H turns_ (I) compared to a balanced diet (C) affect skin impairment (O) within a single hospital stay (T)?
Problem Statement
It is not known if changing the patient’s position every 2 hours (I) would affect skin impairment (O) among older adults with impaired mobility (P).

Criteria	Article 1	Article 2	Article 3	Article 4
APA Reference Include the permalink, or working link used to access the article	Ledger, L. J., Worsley, P. R., Hope, J., & Schoonhoven, L. (2023). Patient perceptions and understanding of pressure ulcer risk in the community: Empirical research qualitative. Journal of Advanced Nursing, 79(9), 3312–3323. https://doi.org/10.1111/jan.15637	Li, Z., Marshall, A. P., Lin, F., Ding, Y., & Chaboyer, W. (2022). Registered nurses’ approach to Pressure Injury Prevention: A Descriptive Qualitative Study. Journal of Advanced Nursing, 78(8), 2575–2585. https://doi.org/10.1111/jan.15218	Sharp, C. A., Schulz Moore, J. 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://doi.org/10.1007/s11673-018-9892-3	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). https://doi.org/10.1186/s12912-021-00616-0
Purpose/Aim of Study	To explore patient’s perceptions and understanding of their risk status for pressure ulcers and how information is communicated between a nurse and patient in the home setting.	To explore approaches used by registered nurses to prevent pressure injury among older patients under inpatient care.	To measure the success of 2-hourly patient repositioning in preventing pressure injuries among hospitalized older patients.	To evaluate the efficacy of hourly repositioning of patients under critical care in preventing pressure ulcers.
Research question(s)	What are the patients’ perceptions of their pressure ulcer risk?	What approaches do RNs use to prevent pressure injuries among older patients under inpatient care?	Does 2-hourly repositioning of hospitalized older adults prevent pressure ulcers?	Does hourly repositioning of patients admitted into the ICU reduce pressure ulcers in patients admitted into the ICU?
Design Is the article qualitative, quantitative, or mixed methods? Explain how you determined the type of research design.	Qualitative study. The study sought descriptive data from participants.	Qualitative study designs. The study sought descriptive data from participants.	A quantitative study utilizing cross-sectional designs. The large sample size used in the study is synonymous with quantitative designs.	The article is a quantitative study. Randomized controls are quantitative.
Setting Where did the study take place? What type of setting: inpatient, outpatient, etc.?	The study was conducted within a community setup. It involved community-dwelling patients.	The study was conducted in an inpatient setting in a level three hospital in Beijing, China.	An inpatient setting. The study was conducted across residential aged-care facilities.	The study took place in an inpatient setting, specifically in an ICU.
Sample Number and characteristics of participants	15 community-dwelling patients.	27 nurses took part in the study.	80 patient records.	3300 patients admitted to ICUs across the region.
Methods Interventions/Instruments	A pragmatic qualitative study utilized observation to collect data on the interactions between community-dwelling patients and nurses and interviews.	Qualitative descriptive study utilizing face-to-face semi-structured interviews to collect data.	Cross-sectional survey of 80 randomly selected patient records.	Randomized controlled trials of two parallel groups.
Analysis How were the collected data analyzed?	Observational and interview data was analyzed through ATLAS-ti software.	Deductive and inductive approaches were used to analyze the collected data.	Collected data was exported to a spreadsheet and STAT SE software for statistical analyses.	Collected data was analyzed using an adjusted Chi-square test.
Outcomes/key findings of the study and implications for nursing practice Summary of study results	Patient repositioning is one of the strategies perceived to be effective in preventing pressure injuries.	Nutritional interventions and frequent postural changes, among others, were some of the approaches perceived by nurses to be effective in addressing pressure ulcer injuries.	Two-hour repositioning was effective in reducing pressure ulcer injury.	Enough evidence proves that postural change is efficacious in reducing the incidence of pressure ulcers among patients admitted to the ICU.
Recommendations of the researcher	Educating the patients and their families on the significance of repositioning should be encouraged among those at risk of developing pressure ulcers.	Specific interventions, such as nutritional optimization and patient repositioning, are some of the strategies that could lower the incidence of pressure injuries, among inpatient care.	Two-hour repositioning should be implemented early in all patients at risk of pressure ulcer injuries.	Postural change is one of the strategies that can be used to reduce pressure ulcers among hospitalized patients.
Explain how this article supports your proposed PICO(T) question.	This article addresses the intervention component of the PICOT. It utilizes a qualitative approach to demonstrate that patient repositioning is one of the best practices in preventing pressure injuries.	The article addresses the interventions and outcome components of the PICOT question. It highlights a strategy that nurses could use to prevent pressure ulcers.	The article addresses the interventions and outcome components of the PICO question. It highlights a strategy that nurses could use to prevent pressure ulcers.	The article addresses the interventions and outcome components of the PICO question. It highlights a strategy that nurses could use to prevent pressure ulcers. It also details the outcome of implementing preventive approaches against pressure ulcers.

References

Asiri, S. (2023). Turning and repositioning frequency to prevent hospital-acquired pressure injuries among adult patients: Systematic review. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 60. https://doi.org/10.1177/00469580231215209

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). https://doi.org/10.1186/s12912-021-00616-0

Ledger, L. J., Worsley, P. R., Hope, J., & Schoonhoven, L. (2023). Patient perceptions and understanding of pressure ulcer risk in the community: Empirical research qualitative. Journal of Advanced Nursing, 79(9), 3312–3323. https://doi.org/10.1111/jan.15637

Li, Z., Marshall, A. P., Lin, F., Ding, Y., & Chaboyer, W. (2022). Registered nurses’ approach to Pressure Injury Prevention: A Descriptive Qualitative Study. Journal of Advanced Nursing, 78(8), 2575–2585. https://doi.org/10.1111/jan.15218

Sharp, C. A., Schulz Moore, J. 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://doi.org/10.1007/s11673-018-9892-3

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Question

The purpose of this assignment is to refine the PICOT question you developed in the discussion forum this week and begin evaluating literature that you will use in subsequent weeks to write your research paper.

Pressure Ulcers in Older Adults

Use the “Literature Evaluation Table” to complete this assignment. Prior to starting the “Literature Evaluation Table,” complete the following:

Review the feedback you have received in the discussion forum related to your PICOT question so far. Make any necessary edits to your PICOT question.
Conduct a literature search to locate four research articles focused on your selected nursing practice problem of interest. Note: This literature search should include two quantitative and two qualitative, peer-reviewed, primary research articles to support your nursing practice problem. A mixed methods article can qualify towards meeting a qualitative or quantitative methodology. The two articles identified in Topic 1 DQ 2 can be used should you still find them relevant to your PICOT question.
Articles must be published within the past 5 years, appropriate for the assignment criteria, and relevant to nursing practice.

The PICOT question and four peer-reviewed research articles you chose will be utilized for subsequent assignments.

Note: For best search results, do not include the words qualitative and quantitative in your search terms. Do include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic reviews, literature reviews, and metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles. Therefore, they should not be included in this assignment.

Pressure Ulcers in Older Adults – The Impact of Repositioning and Nutrition