Pressure Injuries for Critical Care Patients

Pressure injuries are of major concern in healthcare facilities. In fact, the occurrence of skin breakdown and pressure injuries is an evaluation and assessment measure for healthcare institutions, with the advance of pressure injuries getting recognition as a patient safety issue since they can fuel illness and death. Hence, the prevention of pressure injuries is a problem for caretakers and the whole healthcare at large. The epidemiology of pressure injuries changes with medical settings and is a supposedly preventable ailment (The Joint Commission, 2016) which means that different healthcare institutions are affected differently by this issue. Also, critical care patients have increased chances of acquiring pressure injuries because of the intensive usage of devices, hemodynamic uncertainty, and vasoactive medications (The Joint Commission, 2016). As such, healthcare facilities need to develop ways to reduce pressure injuries in critically ill patients. 

Quantitative Research 

Quantitative research is that which focuses on numerical or quantified data. In this type of research, objective theories are tested by assessing the relations and disparities among variables (Creswell et al., 2018). Quantitative researchers endeavor to assess associations and variances among variables (Green et al., 2014). The hypotheses to be tested have to be drawn from a theory. Therefore, a researcher must have a working theory that they want to assess by collecting data that will either prove or disapprove suggested facts. Researchers engaging in this type of inquiry devise assumptions about assessing theories deductively, creating safeguards against bias, organizing for alternate or counterfactual justifications, and generalizing and duplicating the findings (Creswell et al., 2018). The variables are likely to be measured using instruments so that numerical data analysis gets done using statistical approaches. Data collection is done using probability samples, interviews, questionnaires, surveys, observations, and document reviews. 

The research into the prevention of pressure injuries will involve the collection of various kinds of data. Since there is no way of doing field research, the research will mainly feature an analysis of previous studies. The studies involved will be a meta-analysis or systematic review and a single study related to the research topic. An analysis of these selected studies’ findings will help obtain conclusions about pressure injuries and their characteristics about critical care patients in healthcare institutions. Data to be collected includes demographic data; and the occurrence, rate, and phase of pressure injuries. Demographic data is used to describe patients involved in the study. 

Article Discussion 

Purpose of Research 

The general goal of this research is to identify ways through which health care facilities can prevent pressure injuries for critical care patients. The two studies selected provide information that meets this objective. The research by Cruz (2020) aims to assess the outcome of pressure injury preventive bundle implementation in lessening the prevalence of pressure injuries in grown-up critical care patients. On the other hand, Tayyib et al.’s (2016) research aims to integrate the most acceptable proof about solitary approaches’ efficiency to lessen the frequency of hospital-acquired pressure injuries’ advance in ICU patients. Critical care patients’ pressure injuries are part of these hospital-acquired pressure injuries. This makes both studies suitable for this research as they all present ways through which pressure injuries can be prevented. 

Research Design and Methodology 

This research employs the quantitative research design and, as such, uses numerical data. The two studies referenced also employ the use of quantitative research design. The research by Cruz (2020) collects data using a form with two sections. The first section dealt with patients’ descriptive data, while the second section functioned as a compliance checklist. The checklist required personnel conformity to the recording of particular measures twice daily (Cruz, 2020). On the other hand, the research by Tayyib et al. (2016) involves secondary data analysis of relevant studies. The selected studies also provide numerical data that matches the requirements of quantitative research. It enables Tayyibe et al. to deliver arguments and conclusions drawn from quantitative data provided. 

Data Collection 

A crucial part of quantitative research is data collection, as it is how quantitative data is obtained. The research theory under examination defines data collection. As such, a researcher collects data that can describe the variables and therefore allow him to define relations and differences among the variables to prove or disapprove hypotheses of a particular theory. According to Cruz (2020), descriptive data is incorporated to offer valuable contextual evidence when deducing outcomes. Her research uses a form with two parts to collect data. The first part’s data is descriptive of a patient and includes admission date, age, sex, BMI, diagnosis, length of stay in the intensive care unit, Braden risks scores, the prevalence of pressure injuries, and the phases and position of the pressure injuries. The second part, which serves as a compliance checklist, specifies various conditions to which staff must comply. First is staff conformity on the recording of Braden counts twice a day. Next is conformity with rotating the patients in two hours intervals. Also included is acquiring a nutritional check. Staff should also comply with twice daily documentation applying protective bandages to the sacral area, bilateral heels, and body sections that use medicinal apparatuses. They should comply with twice daily recording in utilizing air mattresses on ordinary mattresses. Lastly, they should comply with employee schooling on implementing the bundle. Cruz (2020) argues that a compliance checklist is vital in appraising, scrutinizing, and delivering ongoing positive feedback to the ICU personnel. 

Cruz’s research is set in a tertiary hospital with 36 ICU beds. The hospital has a unit of various personnel dedicated to the intensive care unit. The nurse-to-patient ratio varies over time, is dependent on patient acuteness, and is restricted to a maximum of one nurse to three critical care patients. The research features a sample of 30 patients. Cruz selected grown-up critical care patients aged 18 years and above. These patients had to have a Braden score of 16 or less and no pressure injuries upon admittance to the intensive care unit in April and May 2020. A patient was monitored as long as they were still in ICU, and monitoring only stopped when the patient got relocated to a unit or facility, gets discharged, passes away, or stays in ICU for more than a month. They were monitored for the first 30 days without implementing the bundle, therefore, providing a control group. Then, the bundle was implemented, and then the patients monitored for another 30 days, thereby providing the intervention group. 

On the other hand, Tayyib et al. (2016) collected secondary data by reviewing relevant studies. The selected studies were based on particular quantitative measures that included hospital-acquired pressure ulcer incidence and prevalence, pressure injury severity, time to the occurrence of an injury, and the number of pressure injuries per patient. Therefore, selected studies had quantitative data that was aligned to research on preventing pressure injuries. The document sample used in the review was twenty-five documents which were selected from an initial 675 documents. The selected documents had different types of experiments, but all provided relevant data about critical care patients’ pressure injuries. 

Concepts of Validity and Reliability 

Cruz and Tayyib et al. provide valuable information about preventing pressure injuries for critically care patients. The research by Cruz (2020) involved implementing a Pressure Injury Preventive Bundle. Six specific interventions were applied to generate the anticipated results (Cruz, 2020). It began with using the Braden scale, followed by rotating the participants every two hours and then getting a dietary check. These first three steps would be followed by applying protective bandages to the sacral area, bilateral heels, and body sections that use medicinal apparatuses; using air vented mattresses on ordinary mattresses; and lastly, schooling the medical personnel. Comparisons were made after two months between patients who received the intervention versus those who received standard pressure injury prevention. 

Tayibb et al.’s review, on the other hand, was about the analysis of existing studies on critical patients’ pressure injury prevention. Emerging therapies for hospital-acquired pressure injuries such as polarized light and dressings were explored. The review followed four steps in identifying relevant documents: identification, screening, eligibility, inclusion. Documents with supposedly relevant info were identified: 675 documents. Two independent reviewers then assessed these documents for methodological validity before inclusion in the review. 

Results and Clinical Implications 

There were different results drawn from each study. The research by Cruz (2020) on implementing a pressure injury preventive bundle showed reduced pressure injuries in grown-up critical care patients. Staff compliance was high as records show over ninety percent compliance with 5 out of the six bundle components. The outcomes reinforced other published works. Turning patients every two hours had the least compliance at around seventy percent because it requires physical manpower, which was not effectively sustained by the unit’s personnel recruitment. The research by Tayyib et al. (2016) identified studies that supported most of the intervention proposed in Cruz’s pressure injuries prevention bundle. The interventions identified were efficiency of risk evaluation, better patient nutrition, repositioning and early mobilization, and educational strategies. The review’s climax, however, is the efficiency of utilizing silicone foam bandage to prevent sacral hospital-acquired pressure ulcers in ICU settings. These two studies then point out that implementing a preventive intervention will most likely help reduce pressure injuries. 

Evidence 

The quality of evidence was measure using the Johns Hopkins Nursing Evidence-Based Practice tool. The single study by Cruz (2020) is quantitative as it involves the collection of numerical data about critical care patients. It is classified as a randomized control trial because the research involved manipulating an independent variable, a control group, and random assignment of study participants to the intervention and control groups. During the first month, the researcher did not employ the intervention to use the patients as a control group. He then applied the intervention during the second month to obtain the intervention group. The selection of participants for the test was restricted to adult critical care patients hence a random set of age distribution among participants. Its evidence level is high as it meets most of the guidelines stipulated by the tool. The review by Tayib et al. (2016) also met most of the guidelines set about reviews. The review was considered qualitative as it covered qualitative studies in its sample collection. It is a systematic review since it does not generate any new statistics. 

Applicability to Practice and Future Research 

The pressure injury prevention bundle can be applied in various hospitals since there is proof that it works. Cruz’s (2020) research set out to assess the outcome of pressure injury preventive bundle implementation in lessening the prevalence of pressure injuries in grown-up critical care patients. Tayyib et al. (2016) set out to integrate the most acceptable proof about solitary approaches’ efficiency to lessen the frequency of hospital-acquired pressure injuries’ advance in ICUs. Tayyib et al. According to Cruz, the project results verified that applying a pressure injury preventive bundle lessened the frequency and acuteness of pressure injuries in grown-up patients implying improved pressure-injury results. Coyer et al. (2015) employed the same theory as Cruz. However, they tested a bundle protocol called Inspire. The collective prevalence of pressure injuries in the intervention group was considerably lessened than the control group’s collective prevalence. Reduced pressure injuries can bring about patients’ safety, the effectiveness of care, and medical treatments’ efficiency such that patients do not acquire other illnesses while receiving treatment for others. 

Conclusion 

Pressure injuries are a significant issue in healthcare facilities hence the need for prevention. The general purpose of this research is to identify ways through which health care facilities can prevent pressure injuries for critical care patients. Two studies were employed, one being a review of other studies and the other being a single study. The quality of these studies was measured using the Johns Hopkins Nursing Evidence-Based Practice tools. Results show that there are reduced pressure injuries when healthcare facilities apply interventions to prevent pressure injuries. The research of pressure injury prevention interventions can be applied in hospitals to enhance patient safety, care effectiveness, and treatment efficiency. 

References 

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.  https://doi.org/10.4037/ajcc2015930 

Creswell, J. W., & Creswell, J. D. (2018). Research Design: Qualitative, Quantitative, and Mixed Methods Approaches (5th ed.). SAGE Publications, Inc . 

Cruz, C. (2020). Reducing the incidence of pressure injuries in adult ICU patients at McAllen Medical Center with the implementation of a pressure injury preventive bundle: A quality improvement project.  SOAR@USA: Scholarship and Open Access Repository , 1-71.  https://doi.org/10.46409/sr.obvt6457 

Green, S. B., & Salkind, N. J. (2014). Using SPSS for Windows and Macintosh: Analyzing and understanding data (7th ed.). Upper Saddle River, NJ: Pearson . 

Tayyib, N., & Coyer, F. (2016). Effectiveness of pressure ulcer prevention strategies for adult patients in intensive care units: A systematic review.  Worldviews on Evidence-Based Nursing ,  13 (6), 432-444.  https://doi.org/10.1111/wvn.12177 

The Joint Commission. (2016). Preventing pressure injuries. Quick Safety , (25). https://www.jointcommission.org/-/media/tjc/documents/quick-safety-issue-25-july-2016-final3-w-addendumrev2.pdf