DNP 820 Identification and Evaluation of Literature for Proposed Intervention – Part II
Literature Evaluation Table – DPI Intervention
PICOT-D Question: For elderly and debilitated patients [P],
will the implementation of a pressure preventive bundle [I],
compared to routine pressure injury care [C],
reduce the incidence of pressure injury [O],
within 60 days? [T].
Table 1: Primary Quantitative Research – Intervention (5 Articles)
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APA Reference (Include the GCU permalink or working link used to access the article.) |
Research Questions/ Hypothesis, and Purpose/Aim of Study | Type of Primary Research Design | Research Methodology Setting/Sample (Type, country, number of participants in study) Methods (instruments used; state if instruments can be used in the DPI project)How was the data collected? | Interpretation of Data (State p-value: acceptable range is p= 0.000 – p= 0.05) | Outcomes/ Key Findings (Succinctly states all study results applicable to the DPI Project.) |
Limitations of Study and Biases | Recommendations for Future Research | Explanation of How the Article Supports Your Proposed Intervention |
| Darvall, J. N., Mesfin, L., & Gorelik, A. (2018). Increasing frequency of critically ill patient turns is associated with a reduction in pressure injuries. Critical Care and Resuscitation, 20(3), 217-222. https://europepmc.org/article/med/30153784. | Hypothesis: A change from 5-hourly turns to 3-hourly turns will significantly reduce pressure injury incidence in critically ill patients. Aim of the study: the study determined the significant difference between 5-hourly turns and 3-hourly turns in reducing the incidence of pressure injuries in critically ill patients. | A pre-post intervention evaluation study | Setting/sample: the study was conducted in an intensive care unit at the Royal Melbourne Hospital, Australia. Participants included patients admitted during pre-intervention period (1094) and the study’s post-intervention period (1165). Methods: patient turns were conducted by the nursing staff and clinical assistants amid other interventions for reducing pressure injury incidences, such as regular skin checks, protective dressings, and risk assessment. Random turn audits and chart reviews were conducted monthly. Similar instruments can be applied to the DPI project. Data collection: pressure injury data were derived from the reporting database. | Pressure injury incidence halved in the post-intervention period (p < 0.001). | The key finding was that a change in turn frequency from 5-hourly turns to 3-hourly turns reduced the pressure injury incidence by 50%. As a result, older adults and critically ill patients can benefit from a similar change in the frequency of turns. | Darvall et al. (2018) did not evaluate the potential detrimental effects of increased turning on patients. As a result, the findings are skewed to the positive impacts. | Researchers recommend a future studies through a prospective, multi-center trial. Future studies should also be randomized to reduce systematic errors. | The single-center study affirmed the positive impacts of repositioning and increasing the frequency of turns to reduce pressure injury incidence. Repositioning is a core component of the DPI project’s care bundle. |
| Pickham, D., Berte, N., Pihulic, M., Valdez, A., Mayer, B., & Desai, M. (2018). Effect of a wearable patient sensor on care delivery for preventing pressure injuries in acutely ill adults: A pragmatic randomized clinical trial (LS-HAPI study). International Journal of Nursing Studies, 80, 12-19. https://doi.org/10.1016/j.ijnurstu.2017.12.012 | Hypothesis: optimizing turning compliance with wearable sensors provides a better protective effect against developing pressure injuries than traditional reminders. Aim of the study: the research assessed the effectiveness of wearable patient sensors in improving total time with turning compliance and pressure injuries prevention in critically ill patients. | Randomized controlled trial. | Setting/sample: the study was conducted on 1564 patients in two ICUs in a large academic medical center in California. Among the 1564, 1312 underwent randomization. Methods: patients in the intervention group (n =659) received optimized turning practices, influenced by real-time data from wearable patient sensors while the control group (n = 653) received turning care guided by traditional turn reminders. The DPI project can use similar instruments to optimize turning during repositioning. Data collection: the wearable patient sensors relayed data to a secure SQL database every ten seconds. Position changes were then calculated to determine the degree of position change. | The primary finding relevant to the DPI project was that the intervention group had fewer pressure injuries than the control group (p =0.031) | The study demonstrates that optimizing turning compliance can reduce the incidence of pressure injuries in critically ill patients. | Pickham et al. (2018) highlighted that the study was not immune to the threats of internal validity due to presence of confounding variables. Selection bias was also noticed since the researchers randomized clusters instead of individuals. | A similar study in the future that randomizes individuals instead of clusters is crucial. | The study demonstrates the link between optimizing patient turns and reducing pressure injuries. The DPI project seeks to use interventions that optimize turns to reduce pressure ulcers among the elderly and debilitated patients. |
| Hahnel, E., El Genedy, M., Tomova‐Simitchieva, T., Hauß, A., Stroux, A., Lechner, A., … & Kottner, J. (2020). The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high‐risk intensive care unit patients: A randomized controlled parallel‐group trial. British Journal of Dermatology, 183(2), 256-264. https://doi.org/10.1111/bjd.18621 | Hypothesis: appropriately dressing pressure ulcer predilection areas will significantly reduce the incidence of pressure ulcers in patients in ICUs. Aim of the study: to determine whether applying preventive dressings on pressure ulcer predilection areas, besides standard prevention, reduces the incidence of pressure ulcers in patients in ICUs. | A randomized, controlled | Setting/sample: the study was conducted on 475 patients in a tertiary care hospital in Berlin, Germany. Methods: besides standard prevention, patients in the intervention group (n = 212) had preventive dressings applied to the sacrum and heels. The dressings were renewed every 3 days and the susceptible area checked. A similar approach can be used in the DPI project, but the frequency will be different. Data collection: Hahnel et al. (2020) measured the risk for pressure ulcers using the hospital standard and the Braden scale. A 1-h skin inspection and pressure injury classification instruction was also used. | The cumulative pressure ulcer incidence was lower in the intervention group (2.8%) than in the control group (10.5%) (p =0.001). | The results affirm that preventive dressings, besides standard prevention, effectively reduce pressure ulcers on predilection (sacrum and heels) areas. | The study was associated with performance and detection bias since the participants were not blinded to the study procedures and randomized allocation. A selection bias was also reported. | Future studies where participants are blinded will reduce the reported bias. | The study found preventive dressings effective in reducing the incidence of pressure injuries. Preventive dressing is among the DPI project preventive bundle’s components. |
| Yap, T. L., Horn, S. D., Sharkey, P. D., Zheng, T., Bergstrom, N., Colon-Emeric, C., … & Kennerly, S. M. (2021). Effect of varying repositioning frequency on prevention of pressure injuries in nursing home residents: TEAM‐UP cluster‐randomized clinical trial results. Research Square, 1-21. https://doi.org/10.21203/rs.3.rs-717425/v1 | Hypothesis: the effectiveness of repositioning significantly varies with the intervals. Aim of the study: the research evaluated the clinical effectiveness of different repositioning intervals (2, 3, and 4-hours) in adult nursing home residents. | A pragmatic cluster randomized controlled trial. | Setting/sample: the study was conducted in 9 nursing homes from a large proprietary system in 34 states in the U.S. 992 residents from the 9 centers participated in the study. Methods: The study had three arms with each containing three nursing homes. Each arm was assigned one repositioning interval (2-hour, 3-hour, or 4-hour) as standard care during the 4-week study period. A wireless patient monitoring system notified the nursing staff about the patients’ repositioning need by displaying it. The DPI project will not apply similar instruments due to cost implications. Data collection: Yap et al. (2021) tracked events using the patient monitoring system. Data were further recorded via the nursing homes’ electronic health records and risk management system for pre-post analysis. | The primary finding was that pressure injury incidence during the intervention was 0.0% and 5.24% in Baseline (p =0.001). The other finding was that repositioning compliance was better in 4-hour repositioning (95%) than 3-hour repositioning (90%) and 2-hour repositioning (85%). | The study confirmed the effectiveness of repositioning in reducing the incidence of pressure injuries in health care facilities. | Cluster trials in settings without extensive preliminary analyses have a large degree of uncertainty. Selection bias: Yap et al. (2021) excluded nursing homes with severe pressure injury risk. | Yap et al. (2021) recommended additional research to identify specific race and risk differences factors influencing outcomes in pressure injury incidence. | The study explored the effectiveness of repositioning intervals, an essential component of the DPI project’s preventive bundle. |
| Santamaria, N., Gerdtz, M., Kapp, S., Wilson, L., & Gefen, A. (2018). A randomised controlled trial of the clinical effectiveness of multi-layer silicone foam dressings for the prevention of pressure injuries in high-risk aged care residents: The Border III Trial. International Wound Journal, 15(3), 482–490. https://doi.org/10.1111/iwj.12891 | Hypothesis: Multi-layer silicone dressing offers better protection against pressure injuries than standard care based on international guidelines among residents in aged care facilities. . Aim of the study: it assessed the clinical effectiveness of multi-layer silicone foam dressings in reducing pressure injury development in high-risk residential aged care patients. | A randomized controlled trial | Setting/sample: the study was conducted in 40 residential aged care facilities in Australia. A total of 288 aged care residents were enrolled in the study. Methods: residents randomized to the intervention group (n =138) had dressings applied on areas susceptible to pressure injuries such as sacrum and heels besides receiving standard pressure injury prevention care. Residents in the control group (n =150) only received the standard pressure injury care as recommended by international guidelines. Researchers used clinical records for data collection and analysis, and a similar approach can be used in the DPI project. Data collection: data were collected daily for the intervention and control groups. Records relevant to pressure injury development included skin assessment on the susceptible areas such as sacrum and heels, patients’ mobility status, continence status, and injury risk score. | Pressure injuries’ incidence was higher in the control group than in the intervention group (p = 0.004) | Appropriate dressing can reduce the risk of developing pressure ulcers in aged care adults. The use of silicone sacrum and heel dressing offers a better protective benefit to high-risk patients such as the elderly than standard care. | Santamaria et al. (2018) did not blind both the subjects and the assessor to the presence or absence of the intervention. The study also included individuals with impaired cognitive function and may have introduced a potentially unknown bias to the study. | Further research is recommended to ascertain whether aging-related tissue changes are the cause of a higher incidence of sacral pressure injuries in aged care residents compared to acute patients. | Skin care through appropriate dressing is a core component of pressure ulcers preventive bundle. The article confirms its effectiveness by demonstrating a significant difference between the intervention and control groups. |
Table 2: Additional Primary and Secondary Quantitative Research (10 Articles)
APA Reference (Include the GCU permalink or working link used to access the article.) |
Research Questions/ Hypothesis, and Purpose/Aim of Study | Type of Primary or Secondary Research Design | Research Methodology Setting/Sample (Type, country, number of participants in study) Methods (instruments used; state if instruments can be used in the DPI project)How was the data collected? | Interpretation of Data (State p-value: acceptable range is p= 0.000 – p= 0.05) | Outcomes/ Key Findings (Succinctly states all study results applicable to the DPI Project.) |
Limitations of Study and Biases | Recommendations for Future Research | Explanation of How the Article Supports Your Proposed DPI Project |
| Fallahi, M., Soroush, A., Sadeghi, N., Mansouri, F., Mobaderi, T., & Mahdavikian, S. (2022). Comparative evaluation of the effect of aloe vera gel, olive oil, and compound aloe vera gel-olive oil on prevention of pressure ulcer: A randomized controlled trial. Advanced Biomedical Research, 11(6). doi: 10.4103/abr.abr_121_21 | Hypothesis: aloe vela gel and olive oil are more effective than standard care in preventing pressure ulcers in intensive care units (ICUs). Aim of the study: to determine the effectiveness of aloe vera gel, olive oil, and their combination in pressure ulcer prevention in ICUs. | A randomized controlled trial. | Setting/sample: the study was conducted in Imam Reza Hospital in Iran. 240 patients in the ICUs participated in the study. Methods: the patients were randomized into four groups: 3 treatment groups (each with 60 patients) and a control group (n = 60). Aloe vera gel, olive oil, or a combination was applied in the treatment groups besides standard care for 30 days. Research instruments included the Braden Scale and National Pressure Ulcer Advisory Panel (NPUAP) scale. Scales can be used in the DPI project. Data collection: NPUAP scale and other tools, including clinical information questionnaire, were used to collect daily data on the occurrence, stage, and the location of pressure ulcers. | There was a statistically significant difference between pressure ulcers in the intervention groups and the control group (p < 0.001). | The primary finding is that skin care through aloe vera and olive oil provides better protection for pressure ulcers than standard care. Skin care should be among the preventive bundle components for pressure ulcer prevention in health care settings. | The study was conducted in the ICU, limiting its generalizability to patients in other care units. | Fallahi et al. (2022) recommended further studies using patients in other care units. | The article supports skin care routine as a component of a pressure prevention bundle since it confirms its effectiveness. The DPI project evaluates of a pressure care bundle with skin care as a core component. |
Parizi, F. K., Sadeghi, T., & Heidari, S. (2022). The effect of rosemary ointment on the pressure ulcer healing in patients admitted to the intensive care unit: A randomized clinical trial. Nursing Practice Today, 9(1), 15-23. doi: 10.18502/npt.v9i1.7321 |
Hypothesis: skin care using rosemary extracts will enhance healing in ICU patients. Aim of the study: evaluating the effects of rosemary extracts on pressure ulcers healing in ICUs. | A randomized clinical trial. | Setting/sample. The study was conducted in 70 patients in ICUs in Iran. Methods: patients were randomized into the intervention and control group and rosemary extract applied once daily on high-risk areas for one week (7 days). The control group received regular care and crucial observations recorded using the Pressure Ulcer Scale for Healing. A customized scale can be used in the DPI project. Data collection: data were collected before the intervention and on the 3rd and 7th day post-intervention using the Pressure Ulcer Scale for Healing. | A comparative analysis of ulcer healing effect revealed a significant difference between the intervention and control group (p = 0.004). | The mean score for pressure ulcers in the patients reduced significantly after proper skin care on high-risk areas during the intervention period. | Rosemary extracts were only used once a week and could have affected the study’s results. Patients without stage 1 ulcers were excluded. | Future research with patients with other types/stages of ulcers is crucial. | The study confirms the effectiveness of skin care in reducing the incidence of pressure ulcers in health care settings. Skin care is among the DPI project’s core components. |
| Zhang, X., Wu, Z., Zhao, B., Zhang, Q., & Li, Z. (2021). Implementing a pressure injury care bundle in Chinese intensive care units. Risk Management and Healthcare Policy, 14, 2435–2442. https://doi.org/10.2147/RMHP.S292579 | Hypothesis: implementing a pressure injury care bundle based on the best evidence will reduce pressure injury incidence in intensive care units significantly. The study assessed the effectiveness of pressure injury care bundle in preventing the development of pressure injuries in intensive care units and to identify how nurses’ compliance rates changed during the implementation process. | A quasi-experimental pre- and post-intervention design. | Setting/sample: the study was conducted in all critical care units in Chinese hospitals from 26 provinces. All adult patients admitted in the ICUs during the study were included. Methods: Zhang et al. (2021) designed a care bundle checklist to analyze implementation and compliance. A checklist can be used in the DPI project. Data collection: the unit staff collected the number and stage of pressure injuries at three time points. A compliance checklist was used to measure the implementation compliance rate at two time points. | Implementing the pressure injury care bundle impacted care positively by reducing pressure injury rates from 13.86% to 10.41% while the nurses’ compliance increased from 55.15% to 60.15% after the care bundle implementation (p =0.00) | A standard care bundle based on the best evidence can reduce the incidence of pressure injuries significantly. The bundle’s key elements relevant to the DPI project were pressure-reducing device, patient repositioning, skin care, ad risk identification. | The before and after study design was susceptible to time changes. Besides, researchers did not collect all participants’ demographic characteristics; thus, they could not analyze how different demographic characteristics impacted the interventions on patients. | Future research should explore how pressure injury prevention interventions affect patients with different characteristics such as age, gender, and disease severity. | The article confirms the effectiveness of preventive care bundle in reducing the incidence of pressure injuries. The DPI project compares the effectiveness of a preventive bundle with routine pressure injury care. |
| Oe, M., Sasaki, S., Shimura, T., Takaki, Y., & Sanada, H. (2020). Effects of multilayer silicone foam dressings for the prevention of pressure ulcers in high-risk patients: A randomized clinical trial. Advances in Wound Care, 9(12), 649–656. https://doi.org/10.1089/wound.2019.1002 | Hypothesis: silicone foam dressing can significantly control the development of pressure ulcers among high-risk patients. Objective of the study: evaluating whether silicone foam dressings can prevent pressure ulcers in high-risk patients. | A randomized clinical trial | Setting/sample: the study was conducted in three institutions in Tokyo, Japan. 600 patients participated in the study. Method: patients were randomized into the intervention (n =300) and control group (n =300). Patients in the intervention group received the dressing treatment (multilayer silicone foam dressings on pressure areas [coccyx and sacrum]) besides standard care. A similar approach can be applied in the DPI project. Data collection: Baseline data and data during the intervention were collected and pressure ulcers confirmed by nurses. The incidence and severity were recorded and staged using the Braden scale and Pan Pacific Pressure Injury Alliance (PPPIA) guidelines. | Pressure ulcers were higher in the control group than the intervention group (p = 0.001) | Proper (multilayer silicone foam) dressings can help to prevent pressure ulcers development in critical care settings. | The main cause of pressure ulcers was unclear, affecting generalizability. Data collectors were not blinded for the treatment. | A future study where the causes of stage II pressure ulcers are clear is crucial. | The study underscores the role of protective dressings in reducing the incidence of pressure injuries in critical care settings. |
| Forni, C., Gazineo, D., Allegrini, E., Bolgeo, T., Brugnolli, A., Canzan, F., … & Zanelli, S. (2022). Effectiveness of a multi-layer silicone-adhesive polyurethane foam dressing as prevention for sacral pressure ulcers in at-risk in-patients: Randomized controlled trial. International Journal of Nursing Studies, 127, 104172. https://doi.org/10.1016/j.ijnurstu.2022.104172 | Hypothesis: adding foam dressing to standard pressure ulcer care provides better protection against pressure ulcers than basic care. Objective of the study: to evaluate whether polyurethane foam dressing for sacrum prevents pressure ulcers development in at-risk patients. | A multi-center randomized controlled trial. | Setting/sample: the study was conducted in medical, surgical units, and ICUs in 12 hospitals in Italy. 709 patients participated. Methods: besides standard preventive care, patients in the intervention group received multi-layer polyurethane dressing on the sacrum. Eligibility for inclusion was determined using the Braden scale. A similar scale can be used in the DPI project. Data collection: registered nurses experienced in pressure ulcers care and in clinical research collected data and evaluated participants for pressure ulcers development at baseline and at seven days. | 15 patients in the control group and 4 patients in the intervention group developed pressure ulcers (p = 0.010). | In addition to standard care, silicone foam dressing is an effective protection for pressure ulcers development in at-risk patients. | The length of follow-up (7 days) was short and affected the results. | Future studies with a longer follow-up period are vital. | The study affirms the critical role of preventive dressing as a component of a preventive bundle in reducing the incidence of pressure ulcers in health care facilities. |
| Tayyib, N., Asiri, M. Y., Danic, S., Sahi, S. L., Lasafin, J., Generale, L. F., … & Reyes, M. (2021). The effectiveness of the SKINCARE bundle in preventing medical-device related pressure injuries in critical care units: A clinical trial. Advances in Skin & Wound Care, 34(2), 75-80. doi: 10.1097/01.ASW.0000725184.13678.80 | Hypothesis: implementing the SKINCARE bundle intervention will significantly reduce the incidence of pressure ulcers in critically ill patients. Objective: to determine the effect of the SKINCARE bundle on the incidence of device-related pressure ulcers in critically ill patients. | A prospective, open-label clinical design. | Setting/sample: the study was conducted in critical care units in a tertiary hospital in Saudi Arabia. 223 patients participated. Method: all patients received the care bundle and the development of device-related pressure injuries assessed and documented. The Braden Scale risk assessment and a skin assessment tool were the main instruments and can be applied in the DPI project. Data collection: data was collected using a patient checklist and assessed using the relevant tools. | Pressure injury incidence significantly reduced after implementing the care bundle (p = 0.001). | A care bundle can effectively reduce the incidence of pressure ulcers in critical care settings. | The study only included CCU patients, affecting its generalizability. | Future studies on other populations are necessary to promote generalizability. | The study confirms the effectiveness of a preventive care bundle in reducing the incidence of pressure ulcers which is the primary focus of the DPI project. |
| Renganathan, B. S., Nagaiyan, S., Preejith, S. P., Gopal, S., Mitra, S., & Sivaprakasam, M. (2019). Effectiveness of a continuous patient position monitoring system in improving hospital turn protocol compliance in an ICU: A multiphase multisite study in India. Journal of the Intensive Care Society, 20(4), 309-315. https://doi.org/10.1177/1751143718804682 | A patient position monitoring system will improve turn protocol compliance in patients at risk of developing pressure ulcers. Objective: the study evaluated the effectiveness of a patient position monitoring system is improving turn compliance. | A prospective, multiphase, multicenter trial. | Setting/sample: the study was conducted in two adult ICUs in Tamil Nadu, India. 47 patients at risk of developing pressure ulcers participated. Method: a monitoring system was used to generate alerts for patients in the intervention group. Such a tool will not be used in the DPI project. Data collection: patient position data (1450h) were collected and compared for turn protocol compliance. | Turn compliance was significantly higher in the intervention group than control group (p < 0.001) | Patient monitoring system can be used to improve turning compliance to prevent pressure ulcer development in at-risk patients. | Patient monitors could fail to sense if they were attached to the skin. | Future studies using more devices to capture the entire body movement is recommended. | The study confirms the connection between patient turns and reducing the incidence of pressure ulcers. It illustrates how turn compliance can be improved using technology. |
| Hassan, N., & Afzal, M., Sehar, S., & Gilani, S. A. (2020). Effects of body repositioning in immobilized patients to prevent pressure ulcer in intensive care units at public hospital, Pakistan. Iris Journal of Nursing & Care- IJNC, 2(4), 2020. http://dx.doi.org/10.33552/IJNC.2020.02.000543 | Hypothesis: body repositioning will reduce pressure ulcer incidences in patients admitted in intensive care units. Aim of the study: assessing the effect of body repositioning in immobilized patients to prevent pressure ulcers. | A quasi-experimental with non-equivalent control group design | Setting/sample: the study was conducted in intensive care units of neurosurgery department at a public hospital in Pakistan. All immobilized patients admitted in the ICU were enrolled in the study. Methods: the research instrument had three essential segments: patients’ socio-demographic data, Braden risk assessment scale, and repositioning (frequency and outcomes) of immobilized patients. Patients susceptible to pressure injuries received 2-hourly repositioning and the schedule attached at the bedside. A risk assessment scale will be used in the DPI project to evaluate the risk of pressure ulcers. Data collection: nurses recorded repositioning turns and pressure injuries and filled the Braden risk assessment form which was kept it in the nursing file. | There was a major difference between the interventional and control group mean of body repositioning. p = 0.000 (less than 0.001) showed a significant difference. | Repositioning (2-hour) patients can reduce the incidence of pressure ulcers among debilitated patients. | The sample proportion was small and from a particular confined group. Thus, the results cannot be comprehensive to the broader population. | Future research on repositioning is needed but should recruit a larger sample from a broader population to ensure that the results are generalizable. | The article confirms the effectiveness of repositioning, which is among the components of the DPI preventive bundle. |
| Hekmatpou, D., Mehrabi, F., Rahzani, K., & Aminiyan, A. (2018). The effect of Aloe Vera gel on prevention of pressure ulcers in patients hospitalized in the orthopedic wards: A randomized triple-blind clinical trial. BMC Complementary and Alternative Medicine, 18(1), 1-11. https://doi.org/10.1186/s12906-018-2326-2 | Hypothesis: an evidence-based skin care routine can reduce pressure ulcers among orthopedic patients. Aim of the study: to investigate Aloe Vera gel’s effectiveness in preventing pressure ulcers in patients admitted in the orthopedic ward. | A randomized, triple-blind clinical trial. | Setting/sample: the study was conducted on 80 purposefully selected patients in an orthopedic ward in Arak town, Iran. Methods: in the intervention group, nurses rubbed pure Aloe Vera gel on areas at risk of pressure injuries such as hips, sacrum, and heels. The control group’s care was through water gel and starch. A similar skin care routine will be applied in the DPI project but not necessarily with Aloe Vera gel. Data collection: pressure ulcers signs on the susceptible areas (sacral, hips, and heels) were evaluated on days 3, 7, and 10. | Data analysis showed a significant difference in the incidence of pressure ulcers between the groups (p =0.047). Twelve pressure ulcer cases were recorded in the control group while only three were reported in the intervention group. | The statistical difference implied that Aloe Vera gel prevented the occurrence of pressure ulcers in the intervention group. | The sample was limited. | Researchers recommended future studies with more samples. | The study confirmed the effectiveness of skin care, which is among the components of the DPI preventive bundle. |
| Sharp, C. A., Schulz Moore, J. S., & McLaws, M. L. (2019). Two-hourly repositioning for prevention of pressure ulcers in the elderly: Patient safety or elder abuse?. Journal of Bioethical Inquiry, 16(1), 17–34. https://doi.org/10.1007/s11673-018-9892-3 | Hypothesis: repositioning alone will not exclusively prevent aged patients from developing pressure ulcers. Objective: to determine behaviors and factors hampering repositioning outcomes among elderly patients. | A cross-sectional survey. | Setting/sample: the study was conducted in eight residential aged care facilities in Australia. Data from random patients from 65 years and above was used. Method: Sharp et al. (2019) reviewed medical records to determine whether routine repositioning was successful in preventing pressure ulcers. Medical records can be reviewed in the DPI project. Data collection: Sharp et al. (2019) used data from selected medical records. | Repositioning prevented pressure ulcers development in 21% of the patients (p = 0.04). | Repositioning failed to prevent pressure ulcers in more than two-thirds of the study population necessitating other interventions. | The study did not rely on raw data. | Future studies exploring the interventions that should be combined with repositioning to improve outcomes are crucial. | The study confirms the usefulness of repositioning in pressure ulcers prevention and highlights the need for supplementing it with other interventions. As a result, a preventive bundle should have multiple components as suggested in the DPI project. |
Table 3: Theoretical Framework Aligning to DPI Project
| Nursing Theory Selected | APA Reference – Seminal Research References (Include the GCU permalink or working link used to access each article.) | Explanation for the Nursing Theory Guides the Practice Aspect of the DPI Project |
| Imogene King’s goal attainment theory | King, I. M. (1994). Quality of life and goal attainment. Nursing Science Quarterly, 7(1), 29-32. https://doi.org/10.1177/089431849400700110 King, I. M. (1999). A theory of goal attainment: Philosophical and ethical implications. Nursing Science Quarterly, 12(4), 292-296. https://doi.org/10.1177/08943189922107205 | Nursing theories serve as organized and detailed bodies of knowledge that assist nurses in explaining various nursing phenomena. In a broader sense, these theories delineate the essence of nursing practice and the pivotal role nurses play in day-to-day healthcare scenarios. Imogene King’s theory of goal attainment is particularly applicable to the Direct Practice Improvement (DPI) project, and its foundational principles will be utilized to provide guidance throughout the implementation process.
King’s theory is grounded in the notion that the care process is transactional, and the nurse’s primary responsibility is to assist patients in maintaining their health (King, 1999). To achieve optimal outcomes, patients should comprehend the care process and actively participate in decision-making, becoming integral partners in implementing the treatment plan. In the context of the DPI project, the application of King’s goal attainment theory involves collaborative identification of the problem by both the nurse and the patient. Subsequently, mutual goals are established, and mechanisms are developed to achieve these goals, aligning with the recommendations of King’s theory (King, 1994). This collaborative approach will be mirrored in the implementation of the DPI project’s preventive bundle within the long-term care facility. In the context of the DPI project, the nurse will work in conjunction with the patient to identify the significance of the preventive bundle for pressure ulcers. Patients will be informed about the targeted outcomes, and their active involvement in every step of the process will be emphasized. This aligns with King’s theory, ensuring that the goals and functions of both the nurse and the patient are harmoniously synchronized (King, 1994). By fostering a shared understanding and active participation, the implementation of the preventive bundle is more likely to be successful, promoting better patient outcomes in the long-term care setting. |
| Change Theory Selected | APA Reference – Seminal Research References (Include the GCU permalink or working link used to access each article.) | Explanation for How the Change Theory Outlines the Strategies for Implementing the Proposed Intervention |
| Kurt Lewin’s change theory | Burnes, B. (2004). Kurt Lewin and the planned approach to change: A re‐appraisal. Journal of Management studies, 41(6), 977-1002. https://doi.org/10.1111/j.1467-6486.2004.00463.x Lorenzi, N. M., & Riley, R. T. (2000). Managing change: An overview. Journal of the American Medical Informatics Association, 7(2), 116-124. https://doi.org/10.1136/jamia.2000.0070116 | Change theories provide a framework for introducing positive transformations in patient care, acknowledging that change is a disruptive process that requires systematic implementation. In the context of the complexity and sensitivity of patient care, nurses are advised to approach change systematically and develop effective strategies to manage potential resistance (Hussain et al., 2018).
Kurt Lewin’s change theory serves as a guiding principle for the systematic implementation of change, aligning well with the proposed Direct Practice Improvement (DPI) intervention. This theory introduces the concept of restraining and driving forces, suggesting that these forces influence individuals and groups to respond to change in different ways. Restraining forces work to maintain the status quo, while driving forces propel change in a direction that instigates its occurrence (Lorenzi & Riley, 2000). Lewin’s three-phase model of change—unfreezing, change, and refreezing—offers a structured approach. The unfreezing phase involves preparing for change, with the change step focusing on implementing the desired alterations (Burnes, 2004). Finally, the refreezing phase aims to solidify the implemented change, making it sustainable over time. The unfreezing phase is particularly pertinent to the DPI project, where readiness for change is crucial among the organization’s management, patients, and all stakeholders. This preparation involves ensuring a comprehensive understanding of the benefits of the proposed preventive bundle and addressing concerns to minimize resistance. The subsequent change phase will encompass the implementation of various components of the preventive pressure bundle, aimed at enhancing patient outcomes by reducing the incidence of pressure ulcers among elderly and debilitated patients in the long-term care facility. The final step, refreezing, will involve several measures to maintain and sustain the implemented change. Continuous evaluation of outcomes, ongoing support from management, and the dissemination of results to enable other nurses to implement the preventive bundle in the future are integral components of this sustaining phase. |
Table 4: Clinical Practice Guidelines (If applicable to your project/practice)
| APA Reference – Clinical Guideline (Include the GCU permalink or working link used to access the article.) |
APA Reference – Original Research (All) (Include the GCU permalink or working link used to access the article.) |
Explanation for How Clinical Practice Guidelines Align to DPI Project |
| N/A | Place the primary quantitative research used in the clinical practice guidelines in Table 1. This is part of the primary quantitative research used to support your intervention. | N/A
|
References
Darvall, J. N., Mesfin, L., & Gorelik, A. (2018). Increasing frequency of critically ill patient turns is associated with a reduction in pressure injuries. Critical Care and Resuscitation, 20(3), 217-222. https://europepmc.org/article/med/30153784.
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