NURS-6052N EVIDENCE-BASED PROJECT, PART 3: Critical Appraisal of Research

(I, II, or III)

The level of evidence for this article is a Level II (Randomized Controlled Trial)

(The John Hopkins Hospital, n.d.).

Level of Evidence: Level I (Systematic Review)

(The John Hopkins Hospital, n.d.).

Level of Evidence: Level I (Systematic Review and Meta-Analysis)

(The John Hopkins Hospital, n.d.).

Level of Evidence: Level I (Systematic Review and Meta-Analysis)

(The John Hopkins Hospital, n.d.).

Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**

The theoretical basis of the study is that Aloe Vera gel may be effective in preventing the development of pressure ulcers due to its therapeutic properties, such as its ability to reduce inflammation, reduce pain, and improve wound healing. It is thought that the gel may help to maintain a normal temperature in the skin, thus reducing the risk of skin breakdown.

The theoretical basis for this study is rooted in the concept of evidence-based practice (EBP). EBP is an approach to clinical decision-making that involves the integration of best available evidence, clinical expertise, and the patient’s values and preferences. The goal of this study was to systematically review the literature to identify the most effective nursing interventions to prevent pressure injuries among critically ill patients. The study used an evidence-based approach to identify the most effective interventions and to assess the quality of the evidence supporting the interventions.

The theoretical basis for the study is that pressure injury is a common and preventable adverse event that occurs in healthcare settings, and cardiac patients admitted to intensive care are particularly at risk for developing pressure injuries.

The basis of this research is grounded in the concept of evidence-based practice, which is an approach to healthcare that considers the most up-to-date evidence, the expertise of healthcare professionals, and the values and preferences of the patient.

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

Randomized, triple-blind clinical trial carried out on 80 participants who were purposefully selected from an orthopedic ward in Arak town in 2016. The participants were randomly grouped into two groups, intervention, and control, with the sampling method of choice being the blocking method. For the intervention and control groups, ordinary care aimed at preventing bed sores was being performed by the nurse practitioners. Pure Aloe Vera gel was administered twice a day on top of the routine measures on the intervention group. The specific hours when these were applied were hours 9 and 21. For the control group, placebo application, gel of water and starch, were administered. Evaluations were done on days 3, 7 and 10 to determine any presence of pressure ulcers.

This study was a systematic review of literature that was guided by the PRISMA and SWIM. The inclusion criteria for the studies were research relating to nursing interventions for pressure injury prevention among critically ill patients. The exclusion criteria for the studies were reviews and studies not related to nursing interventions for pressure injury prevention among critically ill patients.

This study is a systematic review and meta-analysis of incidence and prevalence. The authors performed a comprehensive search of the relevant literature from 2009 to 2018 and identified 15 studies that met the inclusion criteria.

This research was a thorough review and synthesis of randomized controlled trials, conducted to assess the effectiveness of interventions in stopping pressure injuries in adults admitted to acute care facilities. It included 2000 records which were searched in the databases CINAHL, MEDLINE, Scopus, Web of Science, and Embase. The inclusion criteria included randomized controlled trials that looked at the effectiveness of pressure injury preventative interventions on pressure injury incidence in adults admitted to acute care settings. Exclusions were trials focused on pressure injury treatment or specialty areas, and non-English reports. The screening, extraction, and risk-of-bias assessment were done independently by two reviewers with a third as an arbitrator. Meta-analyses were conducted when study interventions were similar.

The number and characteristics of

patients, attrition rate, etc.

80 purposefully selected patients with the mean age being 42.34 ± 12.19 years. The attrition rate reported was 3.75 percent.

The sample of this study was comprised of 14 studies examining nursing interventions for pressure injury prevention among critically ill patients. The studies included in the sample were randomized controlled trials, quasi-experimental, case series and cross-sectional studies. The sample was limited to studies published in English and conducted in the last 10 years.

The number of patients varied across the 15 studies included in this systematic review and meta-analysis. The overall sample size was 6371. The attrition rate was 6.7% (1 study did not meet the systematic review criteria).

Number of Patients: 45 studies included in the systematic review

Attrition Rate: Not reported in the article.

List and define dependent and independent variables

Dependent Variable: The occurrence of pressure ulcers

Independent Variable: The application of Aloe Vera gel

Dependent Variable: Pressure Injury Prevention – This is the outcome variable that is being examined by the study and is affected by the independent variable.

Independent Variable: Nursing Interventions – This is the variable that is manipulated by the researcher to evaluate the effect on the dependent variable.

Dependent Variable: Pressure injury (incidence and prevalence)

Independent Variable: Adult cardiac patients admitted to intensive care

Dependent Variable: Pressure Injury Incidence

Definition: The number of pressure injuries experienced by individuals in the study.

Independent Variable: Intervention type

Definition: The type of intervention used to prevent pressure injuries, such as continence management, heel protection devices, medication, nutrition, positioning, prophylactic dressings, support surfaces, topical preparations, or bundled interventions.

Identify primary statistics used to answer clinical questions (You need to list the actual tests done).

The study used descriptive statistics. Other tests include Chi-square tests, F-tests and ANOVA.

The primary statistic used to answer the clinical question is the incidence of pressure ulcers (P=0.047).

The authors did not use primary statistics in this article

14 studies from different sources. Sample size of patients was 6371.

45 studies selected from 2000 records.

The statistics used are risk ratio, p-value (p), and I-squared (I2).

Qualitative findings

(You need to enter the actual numbers determined by the statistical tests or qualitative data).

The results of this study showed that the incidence of pressure ulcers was statistically significantly different between the two groups (P = 0.047). The intervention group, which used Aloe Vera gel, had a lower incidence of pressure ulcers than the control group, which used a placebo gel.

The results of the review indicated that all the included studies reported a decline in pressure injuries following the interventions

The cumulative incidence of pressure injury in adult cardiac patients admitted to intensive care was found to be between 9.8% and 25.6%, while the incidence of all-stage pressure injury was between 8.3% and 28.3%. The prevalence of pressure injury, excluding Stage 1, was 8.8%. Significant heterogeneity was observed between the studies.

The results of the meta-analyses found that only one type of intervention was effective, with Australian medical sheepskin surfaces being more effective than other standard care surfaces (risk ratio 0.42, p = 0.006, I2 = 36%). Support surfaces (active versus other comparison surfaces and reactive versus other comparison surfaces) and heel protection devices compared to standard care were also found to be effective.

General findings and recommendations of the research

Aloe Vera gel can prevent the occurrence of pressure ulcers in patients at risk. Applying of Aloe Vera gel towards the prevention of pressure ulcers in patients at risk of pressure ulcer development is recommended.

Nurses are well-qualified to practically lead in pressure injury (PI) prevention in critical care units. Four effective interventions for PI prevention were identified and these include: PI prevention bundles, repositioning and the use of surface support, prevention of medical device-related pressure injuries, and access to expertise.

This research suggests that pressure injury is as likely to occur in adult cardiac patients in intensive care as it is in general intensive care patients, though it may be more common in those who have had cardiac surgery. The authors recommend that further studies be conducted using consistent methods of data collection and analysis.

The results indicate that only one type of intervention (Australian medical sheepskin surfaces) was found to effectively reduce the incidence of pressure injuries. Also, the meta-analyses for support surfaces and heel protection devices both showed a significant effect in comparison to standard care. However, all trials were at unclear or high risk-of-bias and there were several limitations in terms of heterogeneity across trials and trial outcomes.

It is recommended that larger, better-quality trials should be conducted to establish the effectiveness of pressure injury preventative interventions within acute hospital settings. Furthermore, attention should be paid to true intention-to-treat analysis, and acute and intensive care settings should be reported separately.

Describe the general worth of this research to practice.

What are the strengths and limitations of study?

What are the risks associated with implementation of the suggested practices or processes detailed in the research?

What is the feasibility of use in your practice?

This study provides evidence that Aloe Vera gel can be used to prevent the occurrence of pressure ulcers in patients at risk, however the sample size was small and further research with larger samples is needed to confirm the results. Potential risks associated with implementation of this practice include skin irritation, allergic reactions, and infection. The feasibility of use in practice depends on the availability of Aloe Vera gel and the individual patient’s needs.

The research offered valuable insight into the effective nursing interventions to prevent PI in critical care patients, with strengths of the study being that the systematic review of relevant studies and the identification of four broad categories of interventions. The key imitations include the overall strength of the evidence being rated from moderate to very low. Risks associated with the implementation of the suggested practices or processes include the potential for pressure injuries to occur if interventions are not implemented correctly. The feasibility of use in practice is dependent on the availability of resources and staff.

The research provides quality evidence for the incidence and prevalence of pressure injuries. The strength of this research is its systematic review and meta-analysis approach and has a large sample size. The limitation is that the data was collected and reported in various ways. The risks associated with implementation of the suggested practices or processes detailed in the research include potential harm to the patient due to inadequate data collection. The feasibility of use in practice depends on the availability of resources.

This research provides evidence for the effectiveness of pressure injury preventative interventions in adults admitted to acute hospital settings. Systematic review and meta-analysis of randomized controlled trials, as well as a thorough risk-of-bias assessment were conducted. The included studies were at unclear or high risk-of-bias, and there was heterogeneity across trials and trial outcomes. The risks of implementing the suggested interventions include potential for ineffective interventions due to lack of high-level evidence. Feasibility of use in practice depends on resources and practitioners’ willingness to implement the interventions.

Key findings

Aloe Vera gel can help prevent pressure ulcers in patients

Categories of pressure injury interventions were identified in the systematic review

This systematic review and meta-analysis suggest that the rate of pressure injuries in cardiac intensive care patients is roughly the same as other intensive care patients but may be higher among cardiac surgery patients.

The key finding of the research is that only one intervention (Australian medical sheepskin surfaces) was supported by intention-to-treat meta-analysis.

Outcomes

The application of Aloe Vera gel for at pressure ulcers patients is highly recommended.

Pressure injuries were reduced following the interventions.

Pressure injury in cardiac intensive care units and those in general intensive care was very similar

That only one intervention was supported by intention-to-treat meta-analysis.

This research study offers important highlights on the management of pressure ulcers in patients.

Nurses should have a plan that includes the use of evidence-based care to prevent pressure injuries.

This finding is important as it highlights the need for further research into the incidence of pressure injury in cardiac intensive care patients to better understand and address this issue.

The results of the review showed that only one intervention (Australian medical sheepskin surfaces) was supported by intention-to-treat meta-analysis, while the meta-analyses for support surfaces and heel protection devices versus standard care both showed a significant effect.

The trials included in the review were mostly at unclear or high risk-of-bias, and there were several limitations regarding heterogeneity across trials and trial outcomes. The authors concluded that further large-scale, high-quality trials testing pressure injury preventative interventions are needed to establish effectiveness within acute hospital settings. Attention should be paid to true intention-to-treat analysis, and acute and intensive care settings should be reported separately.