Pressure Ulcer Prevention: Evidence-Based Project Issues
This paper examines the key implementation challenges facing a Doctor of Nursing Practice (DNP) evidence-based project designed to reduce pressure ulcers in elderly, bed-bound nursing home patients through two-hour turning and repositioning protocols. The discussion covers methodological concerns such as controlling for the many risk factors associated with pressure ulcer development, logistical barriers to recruiting multiple nursing home facilities, staff resistance to protocol changes, and ethical complexities surrounding research consent for patients with dementia. The paper also addresses the broader problem of inadequate attention and funding for nursing home populations and underscores the growing public health burden of pressure ulcers, arguing that these obstacles must be overcome given the serious clinical and financial consequences of the condition.
- Introduction: Evidence-Based Practice and Pressure Ulcer Research: Defines evidence-based research and frames DNP project
- Methodological and Logistical Challenges: Sample size, recruitment, and control group difficulties
- Organizational and Staff Resistance: Staff compliance barriers and protocol adherence challenges
- Ethical Considerations and Patient Advocacy: Consent issues for cognitively impaired nursing home residents
- The Public Health Burden of Pressure Ulcers: Growing prevalence and underrecognition of pressure ulcers
- Conclusion: The Case for Overcoming Barriers: Argues barriers are surmountable given clinical and financial stakes
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What makes this paper effective
- Grounds the discussion in a concrete clinical intervention — two-hour turning and repositioning — giving abstract methodological concerns a tangible focus throughout.
- Balances multiple types of barriers (methodological, logistical, organizational, ethical, and public health) rather than fixating on a single dimension, demonstrating awareness of real-world implementation complexity.
- Uses cited statistics (e.g., a 63% increase in pressure ulcer hospitalizations from 1993 to 2003) to elevate what could be a purely procedural discussion into a compelling argument for urgent action.
Key academic technique demonstrated
The paper demonstrates problem–response structuring: each barrier is identified and then contextualized with supporting evidence or a proposed rationale for why it can be addressed. This technique, common in applied health sciences writing, moves the paper beyond mere problem-listing toward a practical, solution-oriented argument.
Structure breakdown
The paper opens by distinguishing evidence-based research from evidence-based practice and situating the DNP project within that distinction. It then works through overlapping categories of challenge — sample size and recruitment, staff compliance, ethics and consent, and funding gaps — before closing with a brief but forceful conclusion linking clinical and financial imperatives. The progression is roughly problem-to-consequence-to-call-for-action, which suits the advocacy purpose of a DNP capstone discussion.
Introduction: Evidence-Based Practice and Pressure Ulcer Research
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 this DNP project — examining 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 patients' poor health could influence outcomes. Nursing home patients can have a variety of conditions that may impact results, and both experimental and control groups must be carefully balanced. As Lyder and Ayello (2008) note, "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."
References
Evidence-based practice and avoiding confusion. (2014). Health Leader's Media Council.
Haynes, B., & Haines, A. (1998). Barriers and bridges to evidence-based clinical practice. BMJ, 317(7153), 273–276.
Lyder, C., & Ayello, E. (2008). Chapter 12: Pressure ulcers: A patient safety issue. In Patient safety and quality: An evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality.
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