Problem Statement
Pressure ulcers have been regarded as an indicator for quality of care within the nursing context. Today it is part of the measurable aspects of patient outcomes for hospitalized patients. The adoption of the Affordable Care Act further placed measures that would help minimize the prevalence of pressure ulcers as a hospital acquired illness. This was in the knowledge that the costs of hospital acquired illnesses and pressure ulcers primarily was one of the major reasons towards the escalating costs of care even when the value for those costs could not be established. The ACA called for the increased responsibility of nurses in the management of pressure ulcers and related HAIs and this task was delegated to the care facilities so that they would align their quality and safety policies within this requirement. From a legislative perspective, this was supported by the fact the Medicare declined to provide reimbursement for HAIs with pressure ulcers not being an exception (Padula et al., 2015).
This meant that care facilities had to take full financial responsibility for all incidences of pressure ulcers reported within their respective settings. In this regard, the nurses as the direct care givers were given a larger mandate within the policy frameworks so that they would help minimize the incidences of pressure ulcers and subsequently help contain the costs of care associated with the same. Worldwide, similar measures have been placed to help reduce these incidences but the return on investment has been poor. This situation has been associated with the level of awareness, knowledge as well as the attitudes and perceptions of the nurses in regard to the prevention of pressure ulcers. The study by Dilie & Mengistu (2015) sought to explore the issues that actually caused the continued high prevalence of pressure ulcers in hospitalized patients. In their study, they sought to examine any existing knowledge gap for nurses as well as their attitudes and perceptions and how all these affected the quality of care and subsequently their impact on pressure ulcers as an indicator for quality of life. In this examination, the researchers were aware that in examining the nurses’ knowledge, their attitudes and perceptions, it would be easy to identify the apparent barriers that have ensured that pressure ulcers remains a pertinent problem within the healthcare settings. Pressure ulcers like all other HAIs have a negative impact on the quality of life leading to lengthy hospitalization periods, increased costs of care as well as emotional and psychological negativity of the patient on their recovery and restoration (Padula et al., 2015).
Purpose and Research Questions
However, the major questions that the researchers may have wished to answer would include; Do nurses, in their own assessment consider that they have adequate knowledge in regard to prevention of pressure ulcers? Do nurses have any predefined perceptions when dealing with patients with pressure ulcers? Do nurses hold any attitudes (negative and positive) that actually have an impact on how they handle, manage and prevent pressure ulcers in clinical settings? Is there a correlation between the identified knowledge gaps, attitudes and perceptions and the barriers identified in the prevention of pressure ulcers? The researchers’ choice of self-administrated structured questionnaires ensured that nurses would give the relevant information that would help answer the questions within the objective of the study (O’Brien et al., 2014). The method also ensured that the study participants were not just a convenience sample that would in some way cause a level of bias on the findings. Time issues were also catered for as each participant would independently respond to the questionnaire without the necessity of the physical presence of the researcher (Burns & Grove, 2011).
Literature Review
The researchers did not have a separate section for the literature review. However, the introduction section and the discussion section were based on a detailed analysis of previous research with a major focus on the weaknesses of previous research expounded on the introduction section. This was meant to afford the reader enough justification as to why the study was being conducted. The discussion section on the other hand combines the findings and previous literature review drawing comparisons and contrasts but with a major focus on the similarities which indicated a convenient choice of literature to support the findings (Burns & Grove, 2011). The literature utilized in the discussion and introduction sections included expert reviews, qualitative and quantitative research as well as national and international guidelines in regard to pressure ulcers prevention. The diversity of the choices of literature ensured that the apparent bias that may have been caused by the perceived convenient choice of literature was eliminated or minimized.
The literature of choice was typically between the years 2003 and 2014. The quantitative research articles and the national and international guidelines were specifically within the recent years of between 2008 and 2014 while qualitative research articles and expert reviews had a longer timeline from 2003 to 2014. This diversity and prolonged timeline for choice of literature ensured that the authors had significant historical background on pressure ulcers and the questions that the research is expected to answer which would ultimately translate to logical discussion in relation to the findings (Burns & Grove, 2011). On the other hand, the authors have explored the weaknesses of the study from a general view without necessarily exploring the specific weaknesses of each of the literature utilized in the discussion. The fact that the discussion was based on data derived from bivariate and multivariate logistic regression analysis based on a recognized data analysis software package ensured that the wide range of data provided and the significantly high number of operational variables were all considered appropriately without diminishing the role of any of the variables (Burns & Grove, 2011). It is within these highly diverse findings that there was an apparent need to have a diverse choice of literature from which all the findings could be explored to help the reader relate the practicality with the theoretical data and information.
Conceptual / Theoretical Framework
The study was conducted in Felegehiwot Referral Hospital, Bahir Dar, Ethiopia but the choice of location and the actual objective of researchers had no correlation to the geographical or economical perspectives within Ethiopia. The primary focus was to determine the pressure ulcers occurrence and prevalence in relation to the knowledge of nurses as well as their perceptions and attitudes on the same. There were no technical or extraneous variables that the researchers were seeking to determine beyond the primary objective (Burns & Grove, 2011). The identification of the barriers that have continually limited the effective prevention and management of pressure ulcers was a tangible goal and the researchers have backed up their goal by including a set of recommendations to manage the identified barriers in the post-discussion section of the paper.
These recommendations have entirely focuses on the need to afford nurses increased access to knowledge sources with an insistence on evidence-based practice and research-based practice as the key goals that care facilities should consider in prevention of pressure ulcers. Despite this being a qualitative study, the researchers did not indicate or utilize any conceptual or theoretical framework to support the findings. This however, does not affect the descriptive nature of the research since the authors align to the objectives of the study even in the development of arguments and the formulation of recommendations (Burns & Grove, 2011).
Conclusion
The research study by Dilie & Mengistu (2015) has significantly achieved the objectives for which it was meant. While lacking the separate subsections that would have been expected of the study such as a separate literature review, background and data analysis, the researchers prefer to integrate some of these sections may be to afford the reader a more abstract correlation of the data acquired from the research and the available evidence from previous literature. However, this is usually a risky situation in that it allows for loopholes in which some information may be left out in a bid to compress all information within a subsection. In this research, such an incident has been avoided since the researchers are guided by a set of objectives which have been utilized systematically to develop arguments (O’Brien et al., 2013). The researchers, in a bid to assure the readers of adherence to the study objectives have set out a section for recommendations where they relate the findings to the available literature evidence and subsequently to the practice environment. In general, the format of the article has not in any why significantly affected the content and the results of this study can be applied in evidence-based practice since they indicate consistency, reliability and validity.
Reference
Burns, N., & Grove, S. (2011). Understanding Nursing Research (5th ed.). Elsevier. ISBN-13: 9781437707502
Dilie, A., & Mengistu, D. (2015). Assessment of Nurses’ Knowledge, Attitude, and Perceived Barriers to Expressed Pressure Ulcer Prevention Practice in Addis Ababa Government Hospitals, Addis Ababa, Ethiopia, 2015. Advances in Nursing, 2015.
O’Brien, B. C., Harris, I. B., Beckman, T. J., Reed, D. A., & Cook, D. A. (2014). Standards for reporting qualitative research: a synthesis of recommendations. Academic Medicine, 89(9), 1245-1251.
Padula, W. V., Makic, M. B. F., Mishra, M. K., Campbell, J. D., Nair, K. V., Wald, H. L., & Valuck, R. J. (2015). Comparative effectiveness of quality improvement interventions for pressure ulcer prevention in academic medical centers in the United States. The Joint Commission Journal on Quality and Patient Safety, 41(6), 246-246.
