Introduction
Every other day, new study get published in different prominent journals which highlight the importance of the study, the changes, costing, etc. Critical appraisal of a paper has the ability to adversely affect the quality, output, cost of care, especially when the proposed changes are not relevant to the study’s data. It also helps in pointing out the issues that need considerations and which are essential for making a decision. Based on the critics one can recommend or to not recommend an intervention. The purpose of Research critique is to discover whether the methods and results of the study have the potential to create successful information. The main objective is not to assess the authors but to point out the unforeseen difficulties of the study as they influence the results of the study. A critical appraisal is concerned with assessing the hard facts of the research.
In many cases published articles do not discuss the weakness of the research and readers have to spend a considerable amount of time to identify them. It creates a problem for the physicians who have a busy schedule to evaluate study’s findings. In this article, the authors have selected simple guidelines for appraising medical research on patients with pressure ulcer. Pressure ulcers are caused when an area of skin is placed under pressure. Thus, it becomes important to identify the risk factors that are associated with the development of the condition in the patients who are already receiving standardized preventive care. In this article, I will be discussing the categories of Protection of Participants, Data Management, Data Collection and Analysis and Findings / Interpretation of Findings, Future Research and Implications for Practice.
Protection of Human Participants
In this study, the author points out both the benefits and the risk factors of developing pressure ulcer in patients who are already receiving standardized preventive care. One of the benefits of using this method is that the health care professionals can improve the resources that are frequently needed and can reduce the expenditure while maintaining or improving the quality of care at the same time. The disadvantage of the method used is that even if adequate prevention is provided, continuous caring and observation to these patients is necessary.
Data Collection
All data were collected through the ward nurses of the hospitals, who were trained to treat patients with pressure ulcer and patients who are at risk of developing pressure ulcer prior to this study. The authors also explained the nurses about the study aims, protocol and the use of the data collection instrument. Data were obtained in the period of 26 months (December 2007–January 2010). The authors defined the rationales to each of the nurses. They defined pressure ulcers based on the NPUAP/ EPUAP classification system. There were 4 categories: Category I was Non-blanchable erythema while Category II was partial thickness skin loss, Category III was full thickness skin loss and Category IV was full thickness tissue loss . The transparent plastic disc method was used to differentiate between blanchable erythema and non-blanchable erythema . The reactive response of the skin to chronic exposure to urine and fecal material was defined as IAD. The wound-related characteristics and patient-related characteristics were evaluated to differentiate pressure ulcers from IAD .
Data Management and Analysis
The data management and analysis methods were: 1) Categorical variables were shown in percentages by chi-square and Fisher’s exact tests 2) Continuous variables were described as medians (IQR) 3) Continuous data were presented using Mann–Whitney U-tests 4) In multiple binary logistic regression methods, the purposeful data were selected 5) Univariate binary logistic regression analyses were performed on all potentially predictive factors 6) The retained variables were simultaneously entered into the multivariate binary logistic regression 7) The odds ratios and 95% confidence intervals were calculated 8) There was no multi- co-linearity in the multivariate model.
Findings / Interpretation of Findings: Implications for Practice and Future Research
The presentation of the findings was logical as once the patient was found at risk for pressure ulcer development, the preventive care as immediately started. Continuous tailoring to the patients’ could be done easily and thus, the findings can be implemented in nursing practice. The findings have indicated the risk factors which can be used in nursing practice to prevent pressure ulcers in patients. The findings suggested future research is needed to examine the effectiveness of stepped care prevention.
Conclusion
The study revealed that hospitalized patients who had urogenital disorder, non- blanchable erythema, and higher body temperature had a higher risk of developing pressure ulcers despite the preventive measures. However, the authors did not discuss what should be done if the measures failed. In that case it satisfied the thesis statement which did not discuss the weakness of the research.
The researchers found that the pressure ulcer can be prevented if proper prevention measurement has been taken at the time of treatment. In that context, some points had been aroused that can help today’s nursing practice. The healthcare professionals need to be more attentive in case of patient categorization and provide proper care. The findings point out the importance of regular skin observation and timely detection of non-blanchable erythema regularly. The finding can be applicable in nursing practice by implementing daily skin observation and identifying IAD as a predictive factor for superficial sacral pressure ulcers, the healthcare professionals can assess the risk of pressure ulcer. By critical analyzing the study, the knowledge which has been gathered is that it is a continuous process of caring which has to be implemented in general nursing practice.
References
Bursac, Z. G. (2008). Purposeful selection of variables in logistic regression. Source Code for Biology and Medicine .
Defloor, T. S. (2005). Statement of the European Pressure Ulcer Advisory Panel Pressure classification. Journal of Wound Ostomy and Continence Nursing , 302-306.
Halfens R.J., B. G. (2001). Relevance of the diagnosis ‘stage 1 pressure ulcer’: an empirical study of the clinical course of stage 1 ulcers in acute care and long-term care hospital populations. Journal of Clinical Nursing , 748- 757.
NPUAP & EPUAP. (2009). Prevention and Treatment of Pressure Ulcers: Clinical Practice Guidelines. Washington DC: National Pressure Ulcer Advisory Panel.
Schoonhoven, L. H. (2002). Prospective cohort study of routine use of risk assessment scales for prediction of pressure ulcers. British Medical Journal , 325.
