PICOT question for current research: In hospital patients (P), how effective is continuous bedside pressure mapping (I) compared to repositioning every two hours (C), in reducing the incidence of hospital-acquired pressure injuries (O) within one year of implementation (T)?
Background
The background on the issue requires summarizing both qualitative and quantitative studies as related to the identified PICOT question within the evidence-based practice setting. The main problem that the studies aimed to address is the development of pressure-related injuries among patients during their stays at hospitals. The identified problem is significant to nursing practice because pressure-related injuries create additional complications and morbidities when caring for patients in a hospital setting (Jaul et al., 2018). The pressure on the skin and soft tissue are formed when the pressure exceeds a certain threshold. Therefore, the study’s purpose was to find interventions that could help reduce the occurrence of pressure injuries while also facilitating the effective and time-efficient work of nurses within a healthcare setting. Specifically, the effects of the system of pressure mapping for related injuries’ prevention were explored in the studies. While the objective of the qualitative research was describing the perceptions of the staff as to the impact of the system, the quantitative study had the objective to evaluate the influence of the system’s integration on the rates of pressure ulcers within a hospital care context.
Support of the Nurse Practice Issue
The support of the nurse practice issue would be acquired from two qualitative studies and two quantitative studies. All four articles to be included in the exploration are concerned with studying the effects of implementing an information-shared tool, such as pressure mapping or an information technology solution intended to help nurses and patients understand the distribution of pressure throughout the body during prolonged stays in hospital beds. The qualitative study by Gunningberg, Bååth, and Sving (2018) will be used to help answer the PICOT question identified above by providing evidence on how the nursing staff approaches the method of pressure mapping as a preventative pressure injury tool. The study identified several important categories allowing nurses to categorize their attitudes to the mapping tool. The first category was necessary to determine whether nurses need more information, training, or coaching over a long time period for using the pressure mapping tool effectively. The second category was intended to show the usefulness of the pressure mapping method in injury prevention among high-risk patients. Hultin et al. (2019) mentioned that individuals who were at a higher having of developing pressure ulcers were usually older, have dry skin, impaired mobility, altered mental status, and a high body mass index. A critical category identified in the research was the increased understanding and recognition of patients’ vulnerable pressure points to take action in their own care. Additional categories included a new way of thinking and working in a hospital setting as well as the future possibilities related to the implementation of the pressure mapping system.
The quantitative study by Gunningberg et al. (2017) will help to answer the question by showing evidence from an intervention that incorporated the tool into the practice of nurses. The intervention implied the use of continuous bedside pressure mapping displays with real-color imagery that showed nurses how the pressure is distributed throughout the body of the patient. Gunningberg and Carli (2016) implemented a descriptive, comparative design to identify the responses of staff toward the integration of a real-time feedback interface system for optimizing the repositioning of patients. Such an approach provided immediate feedback to nurses by giving information on the pressure points, thus helping facilitate preventive measures related to repositioning and modification.
Method of Study
The method of study in the qualitative research studying the attitudes of nurses toward the implementation of the pressure mapping system for reducing the occurrence of pressure injuries at hospitals implied a descriptive design using qualitative focus group interviews. The study analyzing the use of a communication and information technology tool also used the descriptive method. Descriptive research implies an accurate and systematic description of the population or phenomenon. By using focus group interviews, the researchers collected information as applied to the use of the preventive tool to avoid pressure-related injuries. The scholars’ aim was to describe the experiences of nurses when using the pressure mapping tool, thus adding to the available evidence contributing to the understanding of how new communication technologies facilitate the prevention of pressure injuries among hospital patients. Therefore, the intervention implemented in the qualitative study aligns with the program to be carried out in the current research aimed at answering the PICOT question.
The quantitative study used the pragmatic randomized controlled trial (RCT) methodology. The method employs the usual clinical practice, which is critical to inform the decision-making of patients, clinicians, and policymakers in real-world settings. The pragmatic methodology is especially relevant within the intentions and objectives of the study as it aims to check the effectiveness of an intervention on lowering the prevalence of pressure ulcers and their incidence within a hospital context.
Results of Study
In their study, Gunningberg et al. (2018) found that the system of pressure mapping was essential for increasing the effectiveness of preventative measures aimed at pressure-associated injuries. Besides, considering that the research involved real nurses operating in a hospital setting, it was eye-opening to the participants themselves, who stated that they would work on carrying on the use of the tool in their everyday practice. The staff has shown to appreciate real-time feedback regarding pressure points on patients’ bodies, which, in turn, alerted them regarding the repositioning of patients. The shared agenda between nurse managers allowed for the smooth interchange of information within a healthcare setting, support, and the spreading of innovation. Hultin et al. (2019) found the communication and IT system to be useful for attaining quick feedback as to the management of pressure-associated injuries and performing repositioning if necessary. Thus, a continuous information system for pressure identification could be used as an indicator ntended for increasing the competence of staff, the patients’ involvement in their personal care, as well as the raising awareness of the negative implications of extended hospital stays.
According to the findings of Gunningberg et al. (2017), there was “no significant difference between the incidence and prevalence of pressure ulcers among intervention and control groups” (p. 53). Therefore, the research did not show whether there is a positive effect of a pressure mapping system on reducing the prevalence of pressure-related injuries. This calls for the need for other studies researching the connections between patient care outcomes and the intervention. On the contrary, the quantitative research by Gunningberg and Carli (2016) was beneficial for raising the awareness of the staff regarding the occurrence of pressure-associated injuries, thus initiating a discussion about the ways of prevention and recurrent monitoring. Therefore, it is essential to investigate the experiences of the multidisciplinary team and their patients as to using the pressure mapping system, including the strengths and limitations of the tool.
Ethical Considerations
When conducting research intended to test the effectiveness of pressure mapping systems on the prevention of pressure-related injuries, it is essential to address some ethical concerns that could have an adverse influence on the outcomes of the study. First, it is important to address the challenges of voluntary research participation and consent. The ethical issue is concerned with the need to ensure that the potential participants in the study voluntarily agree to be involved and relevant data on them could be collected. The considerations of ethicality regarding consent also suggest that any participant would be free to terminate their participation whenever they desire. The information provided on an informed consent form would show that the refusal to participate or the decision to end one’s involvement could not lead to any negative consequences.
Moreover, informed consent and the subsequent voluntary participation of study subjects are based on communicating the importance of their involvement in research. Since current research on the impact of pressure mapping on pressure injury prevention involves real patients undergoing treatment at a healthcare facility, it is imperative to inform them that their stay at the hospital could be recorded when it comes to the monitoring of pressure injuries’ occurrence. While some patients may be against that, it is important to communicate that the findings of the study would be supportive for developing evidence-based practices for future care improvement. In addition, since there are no new medications used, there is no potential harm that may be caused to patients. When it comes to nurses using the pressure mapping tool in their practice, it is imperative to communicate to them that any challenges in the program’s implementation are worthwhile because of the possibility to enhance the quality of care and information exchange in the long-run.
Confidentiality is the second important ethical issue to take into account in the current study. It implies the assurance that the information provided by research subjects and their anonymity would be respected and preserved. The human subjects of the study will be asked to sign a consent agreement, and the collection of personally identifiable data would be protected by tools intended to ensure the secrecy of private information. The measures of anonymity that researchers use include keeping records secure and password-protected, using encryption when transferring information, as well as not including any participant names through using coding.
Outcomes Comparison
The outcomes of the research are mixed, considering the implications of previous studies. On the one hand, all studies have shown to shed light on the possible benefits of a pressure mapping tool for pressure-related injury prevention. Nurses have shown to increase their awareness regarding the need for an effective information sharing system when it comes to the ongoing and effective prevention of pressure injuries. On the other hand, some found no relationship between intervention implementation and the improvement of patient outcomes and care quality. However, the anticipated outcome is finding a positive impact of the system on pressure injury prevention.
References
Gunningberg, L., & Carli, C. (2016). Reduced pressure for fewer pressure ulcers: Can real‐time feedback of interface pressure optimize repositioning in bed? International Wound Journal, 13(5), 774-779.
Gunningberg, L., Bååth, C., & Sving, E. (2018). Staff’s perceptions of a pressure mapping system to prevent pressure injuries in a hospital ward: A qualitative study. Journal of Nursing Management, 26(2), 140-147.
Gunningberg, L., Sedin, I. M., Andersson, S., & Pingel , R. (2017). Pressure mapping to prevent pressure ulcers in a hospital setting: A pragmatic randomized controlled trial. International Journal of Nursing Studies, 72, 53-59.
Hultin, L., Karlsson, A. C., Öhrvall, M., & Gunningberg, L. (2019). Information and communication technology can increase patient participation in pressure injury prevention: A qualitative study in older orthopedic patients. Journal of Wound Ostomy & Continence Nursing, 46(5), 383-389.
Jaul, E., Barron, J., Rosenzweig, J. P., & Menczel, J. (2018). An overview of co-morbidities and the development of pressure ulcers among older adults. BMC Geriatrics, 18(1), 305.