Evidence-Based Research on Pressure Ulcers

Evidence-Based Project Implementation Issues: Pressure Ulcers

Evidence-based research as opposed to evidence-based practice is defined as "research [that] is generating new knowledge about a phenomenon or validating existing knowledge…Although evidence-based practice may have opinion -- expert opinion, but opinion still -- woven in, research is built in such a way to avoid bias" ("Evidence-based practice and avoiding confusion," 2014). Experiments must have controlled variables to ensure that extraneous data does not influence the result. In the case of my DNP project, the use of two-hour turning and positioning to decrease pressure ulcers in elderly bed-bound patients in nursing homes, one clear issue is the extent to which the patient's poor health could influence outcomes. Nursing home patients can have a variety of issues which could impact the results and both experimental and control groups must be carefully balanced. "More than 100 risk factors of pressure ulcers have been identified in the literature. Some physiological (intrinsic) and nonphysiological (extrinsic) risk factors that may place adults at risk for pressure ulcer development include diabetes mellitus, peripheral vascular disease, cerebral vascular accident, sepsis, and hypotension" (Lyder & Ayello 2008).

This ideally requires a large sample size to limit the influence of extraneous variables. Obtaining the permission of multiple nursing homes to implement the experiment could pose a logistical hurdle, however. Socially, there may be resistance to allowing patients to be the subjects of research both by staff and also by the patient's family. Some push-back may ensue if patients are in the control group and there is the perception that they are being denied positive treatment.

Staff may also be resistant to changes in their routines. Organizational barriers include an unwillingness of staff to adhere to proper protocols, particularly when they cannot be observed at all times. The construction of my research study requires compliant staff given the two-hour turning process. It would be physically impossible to supervise all staff members, particularly at multiple facilities. One of the reasons that longer turning durations tend to be more common is that they are easier for the staff. Staff might be persuaded to change after-the-fact but to undertake more work for a speculative study might be a 'hard sell.' Also, patient's families might be worried about their loved ones participating in any trial, no matter how potentially positive the result might be. Simply because something is widely regarded policy or is classified as common sense does not mean it is necessarily a 'best practice.' "National healthcare policies are often moulded by a range of non-evidence-based factors including historical, cultural, and ideological influences. Moreover, when national guidelines or healthcare policies encourage clinicians to perform procedures that are not evidence based, the unnecessary work acts as a barrier to the implementation of other well founded knowledge" (Haynes & Haines 1998). When healthcare policy currently validates a less onerous schedule, participation may be challenging to solicit.

There are always ethical questions about participation in research if the patients cannot consent to the treatment. In this instance, as the patients are residents of nursing homes, this could be a serious issue since many might suffer from dementia or Alzheimer's disease. "Increasingly, the patient's preferences, values, and rights are entering into the process of deciding on appropriate management… although there is some evidence that exploring patients' experiences of illness may lead to improvements in their outcomes, more research is needed into how to improve communication between clinicians and patients if we are to enhance progress in achieving evidence-based health care" (Haynes & Haines 1998). Conversely, despite these ethical considerations there may be a lack of interest and funding to help what is often a silent and marginalized group in our society, namely the residents of nursing homes. Patients cannot always act as advocates for themselves and even family members may not be thoroughly involved in or interested in the care of their loved ones.