Nursing Interventions for Geriatric Patients at Risk for Pressure Ulcers

Synthesize Research to Formulate a Recommendation

1. Identify how many articles you have at each level for the hierarchy of evidence. Note that levels 1 and 5 are intentionally missing because they do not include primary research.

• Level 2

Four articles (Elli et al., 2022; Haavisto et al., 2022; Yun & Park, 2020; Arisandi et al., 2020)

• Level 3

Two articles (Neziraj et al., 2021; Abusalem et al., 2021)

• Level 4 - Evidence from well-designed case-control or cohort studies

Two articles (Doroszkiewicz & Halina; Sierakowska, 2021; Kilpatrick et al., 2020)

2. Evaluate how the volume of articles in an evidence level impacts the strength (or weakness) of the literature review, including the articles’ distribution across levels, identifying the level having the most volume and the difference in the strength of evidence based on whether the majority of the articles have a higher or lower evidence level.

The majority of articles (4 out of 8) are at Level II, which provides a strong foundation for the literature review. Having half of the articles at this higher level of evidence strengthens the overall review. The distribution across Levels II, III, and IV offers a balanced perspective, incorporating both higher-quality evidence and more descriptive studies. The concentration of articles in Level II, followed by an equal distribution in Levels III and IV, suggests a robust evidence base with a good mix of study designs.

3. Discuss the similarities across all the studies with respect to settings, interventions, populations, or findings.

Settings: The majority of the cited studies focus on long-term care facilities, nursing homes, or geriatric care settings.

Populations: The majority also target elderly patients or residents in care facilities.

Interventions: Many studies involve risk assessments, preventive measures, or quality improvement strategies.

Findings: Several studies emphasize the importance of identifying risk factors, implementing preventive interventions, and improving care quality to manage pressure ulcers or overall health risks in elderly populations.

4. Identify the differences between all the studies with respect to settings, interventions, populations, or findings.

Specific interventions vary, ranging from risk assessment tools to implementation of nurse practitioner roles. Likewise, sample sizes differ significantly, ranging from 20 patients to over 12,000. Some studies focus on healthcare professionals, while others concentrate on patients.

Methodologies include cross-sectional studies, cohort studies, and mixed-methods approaches.

The specific outcomes measured vary, including pressure ulcer risk, care dependency, and overall safety culture.

5. Assess how the evidence can be applied to the population in the PICO question.

The evidence appears highly applicable to the PICO population of elderly individuals in long-term care settings at risk for pressure ulcers. The studies cover various aspects of prevention, risk assessment, and management strategies that could inform interventions for this population.

6. Evaluate the strength of the evidence, considering the evidence level and article quality.

The evidence can be considered moderately strong to strong. Half of the articles are at Level II, indicating high-quality evidence. The article quality ratings vary from medium to high, with several high-quality studies. The inclusion of different study designs and levels of evidence also provide a comprehensive view of the topic.

7. Determine the evidence-based recommendation.

Based on the studies, a multi-faceted approach to pressure ulcer prevention and management in long-term care settings is recommended, including 1) regular risk assessments using validated tools (e.g., Norton scale); 2) implementation of evidence-based preventive measures (e.g., repositioning, specialized mattresses); and 3) staff training and education to ensure consistent application of preventive practices.

Communicate and Disseminate the Recommendation

Following the identification of an evidence-based recommendation, consider the following:

8. Examine the potential stakeholders for the evidence-based recommendation.

The potential stakeholders for these evidence-based recommendations span a wide range of individuals and groups within the healthcare ecosystem. Key stakeholders include long-term care facility administrators and management, who would be responsible for implementing and overseeing the recommended practices. Nursing staff and direct care providers are crucial stakeholders, as they would be directly involved in carrying out the preventive measures and assessments. Patients and their families are also important stakeholders, as they are the direct beneficiaries of improved care practices. In addition, nursing leaders and other healthcare policymakers and regulators would be interested in these recommendations to inform guidelines and standards of care.

9. Evaluate the dissemination differences between stakeholders and external audiences.

The dissemination of evidence-based recommendations differs significantly between stakeholders and external audiences due to their varying levels of expertise, involvement, and information needs. For example, stakeholders such as healthcare professionals, administrators, and policymakers, dissemination would involve detailed, technical information including specific implementation strategies, comprehensive data analyses, and in-depth explanations of methodologies. Conversely, dissemination to external audiences such as the general public or media would focus on more accessible, high-level information. This could include simplified summaries of key findings, emphasizing the broader impacts on patient care and health outcomes.

References

Abusalem, S., Polivka, B., Coty, M. B., Crawford, T. N., Furman, C. D., & Alaradi, M. (2021). The relationship between culture of safety and rate of adverse events in long-term care facilities. Journal of Patient Safety, 17(4), 299-304.

Arisandi, D., Ogai, K., Urai, T., Aoki, M., Minematsu, T., Okamoto, S., ... & Sugama, J. (2020). Development of recurrent pressure ulcers risk factors in older patients: A prospective observational study. Journal of Wound Care, 29(Sup4), S14-S24.