Article Analysis
Abstract
Introduction
Methods
First, all patients were admitted to the trial wards and those who met the inclusion criteria were considered. Secondly, the members were recommended by ward staff to the study nurses. Thirdly, the entry criteria included; age of 65 years and above; the pressure ulcer risk of 15 to 20 based on physiologic, demographic, and disease specific features and consent to regular examination of pressure areas. Also, the members were transferred to the trial beds after their consent was sought. In addition, the exclusion criteria were employed such as obesity greater than 155 kilograms, if the patient was in the previous trial participation and those who refuse to consent.
Clinical relevance
The aim of the prevention of pressure ulcers was to determine effectiveness of viscoelastic polymer and standard hospital mattresses. The study nurses monitored the patients and completed data collection records on the weekly basis. Also, they recorded pressure ulcers using a Torrance grade I and II scale respectively. In addition, for consistent assessments the pressure ulcers identified especially by ward staff was checked and graded. Further, the development of non-blanching erythema was identified as the main outcome measure from the study.
Ethical considerations
The consent of the members of the study was sought before they were transferred to the trial beds. Also, the standards committee asked for interim analyses during the test phases. Further, the research team confirmed the research values before proceeding with the trial.
Interventions
During the study, the members were provided with either standard hospital mattresses and equipment or viscoelastic foam mattresses and experimental equipment. Also, standard represented the mattress the hospital could have allocated to a patient.
Study procedures
First, for purposes of consistency and reliability of data collection, the researchers introduced training program. In the training, the definition of non-blanching and blanching erythema was given. During the admission, the participants were subjected to either the standard or experimental equipment group. The patients’ pressure was observed on a daily basis by research nurses. Further, the study nurses monitored the patients and completed data collection records on the weekly basis. Also, they recorded pressure ulcers using a Torrance grade I and II scale respectively. In addition, for consistent assessments the pressure ulcers identified especially by ward staff was checked and graded. Finally, data was transferred from the paper to a database for analysis.
Outcome measures
First, the primary end points included death, discharge with no ulcer, development of non-blanching erythema and transfer to other pressure relieving equipment. Secondly, the secondary end point was signified by the development of blanching erythema. Alternatively, the patient remained on the allocated mattress. Further, the development of blanching erythema was recorded. Thirdly, the patients completed a questionnaire to rate their comfort on the standard scale. Also, power estimation was used to reduce the likelihood of type II errors. The standards committee asked for interim analyses during the test phases. In addition, the research team confirmed the research values before proceeding with the trial. The study nurse conducted randomization of the patients selected to participate the test organization. However, the statistical analyses did not include the patients who passed mid test. During the study, data analysis was blinded only by relating the participant trial number and bed allocated in the database. Moreover, cost effectiveness of the study was conducted and the purchase of both experimental and standard mattresses discounted.
Results
The findings of the study were not clear. First, there was the violation of research protocols. Two of the participants allocated to experimental equipment were incorrectly placed on standard mattresses. Later, the participants were excluded from the trial after two days. The primary intention was not achieved as expected. The study targeted all the selected individuals except the two excluded members. The study had five sixty two members for experimental and 604 were included in the standard equipment group. Regarding the development of erythema, only 110 participants progressed to develop erythema. However, the progression from blanching to non-blanching erythema was not significant. Also, the expected reduction of erythema cases did not achieve the aim of the study. Further, only twelve members on experimental and eighteen from a standard group were transferred to pressure relieving equipment. Regarding the cost effectiveness analysis, the study members on experimental equipment had lower usage of beds, dressing costs and few days on pressure relieving surfaces.
Discussion
However, several limitations during the study were found. First, it was difficult to identify blanching and non-blanching erythema. Secondly, the study nurses reported the barriers when using the Waters low score to assess risks of developing pressure ulcers.
Conclusion
The research found that the pressure ulcers cause patient morbidity and death. However, there was no conclusive evidence of evaluating the performance of pressure relieving equipment for the prevention of pressure ulcers. Therefore, the report found inadequate data to make recommendations for the prevention of pressure ulcers. The authors used different references between articles, books and website.
References
Queen Sophia University College of Nursing, H. M. (2003). Advances in Skin and Wound Care.
