Pressure ulcers are found on bony prominences and are due to continuous pressure supporting the body.   Bed-bound patients are at a greater risk due to immobility or impaired neurological status; these conditions prevent patients in making minor shifts in body movement. increasing the risk of skin breakdown.  Pressure ulcers can develop in less than 12 hours (Rich et al. 2011a).  Proper interventions are necessary for preventing complications and infections caused by pressure ulcers.  Health care facilities are currently repositioning and using redistributed pressure support surfaces (RPSS) to decrease the risk of skin breakdown.  The purpose of this review is to analyze secondary and primary studies on the comparative intervention of redistributed pressure support surface and frequent positioning in treating or preventing pressure ulcers.  The literature review PICO question is “Does the use of redistributed pressure support surface versus frequent repositioning reduce the risk of pressure ulcers in bed-bound patients?”

Literature of Review

Ten articles were selected for literature of review on pressure ulcers and support surfaces.  The articles were narrowed down to five. The articles selected focused on repositioning and pressure redistributing support surfaces.  Five articles were removed because of no relevance to the topic, and outdated information.

Frequent Repositioning

The article by Rich et al. (2011a), was an observation study on elderly patients with hip fractures.  The study found patients’ that had a higher score on the Braden scale were at a greater risk of developing pressure ulcers despite frequent positioning.  Patients’ with a lower score on the Braden scale who received frequent reposition had a lesser chance of getting pressure ulcers.   The second article by Bergstrom et al. (2013), was a randomized clinical study on patients with a diagnosis of cardiovascular and dementia.  The results found patients’ whose nutrition was inadequate, displayed incontinence, and had higher muscle wasting were a higher risk for pressure ulcers, and that frequent repositioning was not vital.  Both studies showed that frequent repositioning was not signifi       cant in preventing pressure ulcers in patients’ with systemic issues, poor mental status and decrease in musculoskeletal functioning.     Although both studies showed frequent positioning to be ineffective in a large number of patients, they also showed that it was beneficial to some, and that manual repositioning should still be utilized.

Redistributed Pressure Support Surface

A study was done on postoperative surgical patients, and found patients’ to be at risk fordeveloping pressure ulcers due to prolonged surgeries (Huang et al. 2013).  An article by Huang et al. (2013), findings showed pressure redistributed surfaces were effective in reducing pressure ulcers in postoperative patients, and lacked supportive significant evidence.  Pressure reducing mattresses should be used cautiously in inter operative and postoperative patients’.  The Pressure ulcer risk assessment tool is used in determining patients’ risk level in developing pressure ulcers.  The risk assessment tool provides interventions to prevent skin breakdown.  According to Chou et al. (2013), the Braden, Norton and Waterloo scales were all ineffective in determining high risk patients.  Despite the ineffectiveness of the risk assessment tools, results showed high tech support surface to be effective in preventing pressure ulcers.   Findings in the study were consistent with other systemic reviews.  The last review by Manzano et al. (2013), findings showed that stage II and higher pressure ulcers were significantly reduced with an alternating pressure air mattress.  Although all the reviews showed pressure redistributed support surfaces to be as effective in preventing or treating pressure ulcers, more research is needed.
Inconsistencies and Contradictions

The article by Mazano et al. (2013), showed inconsistencies regarding alternating pre sure air mattress and alternating pressure air overlay.  The article previously stated that alternating pressure air mattresses were more efficient in preventing pressures ulcer.  Later the article stated that both alternating pressure air mattresses and overlays are provide the same benefit.  The article persuades the reader into considering the overlay due to cost effectiveness.

Conclusion

The literature review analyzed five articles that studied multiple patient populations, and settings pertaining to redistributed support surfaces and frequent positioning.   Based on the findings, two of the articles statically showed that frequent positioning had no positive effect on preventing pressure ulcers (citation).  The last three reviews showed some positive effects that pressure redistributed support surfaces had on high risk patients (citation).  Some of the studies in the review incorporated frequent positioning with pressure redistributed support surfaces.  The results showed either a decrease in pressure ulcers size or a prevention in skin breakdown.  The combination of interventions left researcher unable to determine which intervention produced the positive outcome, but was able to confirm that the combination was beneficial to higher risk patients.  The studies also showed that interventions have to be specific to the patient and that more research is needed in statically determining an effective intervention.

 

 

 

 

References

Bergstrom, N., Horn, S. D., Rapp, M., Stern, A., Barrett, R., & Watkiss, M. (2013). Tur ing for ulcer reduction: A multisite randomized clinical trial in nursing homes. Journal of the American Geriatrics Society, 61(10), 1705-1713. doi:10.1111/jgs.12440.  Retrieved from the Walden library databases.

Chou, R., Dana, T., Bougatsos, C., Blazina, I., Starmer, A., Reitel, K., & Buckley, D. (2013). Pressure ulcer risk assessment and prevention: A systematic comparative effectiveness review. Annals of Internal Medicine, 159(1), 28-38. doi:10.7326/0003-4819-159-1- 201307020-00006. Retrieved from the Walden library databases.   

Huang, H., Chen, H., & Xu, X. (2013). Pressure-redistribution surfaces for prevention of surgery-related pressure ulcers: A meta-analysis. Ostomy Wound Management, 59(4), 36- 48. Retrieved from http://www.faces-prevention-surgery-related-pressure-ulcers-meta-analysis

Manzano, F., Pérez, A., Colmenero, M., Aguilar, M., Sánchez-Cantalejo, E., Reche, A., Fernández-Mondejar, E. (2013). Comparison of alternating pressure mattresses and overlays for prevention of pressure ulcers in ventilated intensive care patients: A quasi- experimental       study. Journal of Advanced Nursing, 69(9), 2099-2106. doi:10.1111/jan.12077

Rich, S. E., Margolis, D., Shardell, M., Hawkes, W. G., Miller, R. R., Amr, S., & Baumgarten, M. (2011a). Frequent manual             repositioning and incidence of pressure ulcers among bed- bound elderly hip fracture patients. Wound Repair & Regeneration, 19(1), 10-18. doi:10.1111/j.1524-475X.2010.00644.x. Retrieved from the Walden library databases.

 

 

Literature Review Summary Table

NURS 6052

 

Citation
Type of Study

 

Design Type

 

Framework/Theory

Setting
Key Concepts/Variables
Findings
Hierarchy of Evidence Level

Rich, S. E., Margolis, D., Shardell, M., Hawkes, W. G., Miller, R. R., Amr, S., & Baumgarten, M. (2011a)
Type of Study:

Quantitative

 

Design Type:

Observational

 

Framework/Theory:

Acute Care hospital
Concepts: NA

 

 

Independent Variable:

Frequent positioning and pressure redistributed support surface

 

Dependent Variable:

Bed-bound elderly hip fracture patients,

 

 

Controlled Variable: NA

Patients’ that had a higher score on the Braden scale were at a greater risk of developing pressure ulcers despite frequent positioning.

Patients’ with a lower score had a lesser chance of getting pressure ulcers.

The results found frequent repositioning was just as beneficial to patient who were a lower risk.

Limitation:

The results are inconclusive due to documentation discrepancies and a focused patient population

Unfiltered

Bergstrom, N., Horn, S. D., Rapp, M., Stern, A., Barrett, R., & Watkiss, M. (2013)
Type of Study:

Quantitative

 

 

Design Type:

randomized, clinical trial with blinding

 

 

 

Framework/Theory:

Nursing Home
Concepts:

 

 

Independent Variable:

Repositioning schedule (2, 3, or 4 hour) and high density foam mattress

 

 

 

Dependent Variable:

Moderate to high risk patients’ with a diagnosis of cardiovascular and dementia.

 

Controlled Variable:

Free from pressure ulcer

Results showed patients’ whose nutrition was inadequate, displayed incontinence,  and had higher muscle wasting were a higher risk for pressure ulcers, and that frequent repositioning was not vital.

Results showed that use of high density mattress is effective in preventing or reducing pressure ulcers and that repositioning every 2-3 hours is not needed.

Unfiltered

 

Name

 

 

 

Citation
Study

Design Type

Framework/Theory

Setting
Key Concepts/Variables
Findings
Hierarchy  of Evidence Level

Chou, R., Dana, T., Bougatsos, C., Blazina, I., Starmer, A., Reitel, K., & Buckley, D. (2013)
Type of Study:

Quantitative

 

Design Type:

Randomized trials and observational studies

 

Framework/Theory:

Acute care hospitals, long-term care facilities, rehabilitation facilities, operative andpostoperative settings, and community settings (home care and wheelchair users in the community)
Concepts:

 

 

Independent Variable:

pressure ulcer risk assessment instruments (Braden, Norton & Warterloo scale) and Nurse clinical judgement

 

Dependent Variable:

Patient population diagnosed with urinary incontinence, diabetes, and peripheral vascular disease

 

Controlled Variable:

The pressure ulcer risk assessment scale is no more effective than nurse’s assessment in reducing pressure ulcers.

High tech support surface (Alternating-pressure (AP) mattresses/overlays, Air-fluidised beds and Low-air-loss beds) are more effective in reducing or prevention pressure ulcers in high risk patients that a hospital mattress.

Findings on the effectiveness of preventive interventions are consistent with other systemic reviews.

Unable to determine if repositioning combined with a PRSS was effective in preventing pressure ulcers.

Systematic       Review

Manzano, F., Pérez, A., Colmenero, M., Aguilar, M., Sánchez-Cantalejo, E., Reche, A., Fernández-Mondejar, E. (2013)
Type of Study:

Qualitative

 

Design Type:

quasi-experimental

 

 

 

Framework/Theory:

Medical-Surgical ICU
Concepts:

 

 

Independent Variable:

Alternative pressure air mattresses and alternating pressure air overlays

 

 

Dependent Variable:

Mechanically ventilated intensive care patients

 

 

Controlled Variable:

 

The main study finding was that the use of an alternating pressure air mattress rather than alternating pressure air form better.

The alternating pressure air mattress outperformed the alternating pressure air overlay due to increase in cell depth.

Stage II and higher pressure ulcers were significantly reduced.

Unfiltered

Huang, H., Chen, H., & Xu, X. (2013)
Type of Study:

Meta-analyses

 

 

Design Type:

RCTs and quasi-randomized controlled trials

 

 

Framework/Theory:

Concepts:

 

 

Independent Variable:

Pressure reducing mattress (air or fluidized-therapy beds, pressure-redistributing support surfaces, dry viscoelastic polymer, a multicell pulsating dynamic mattress, and thermo-active viscoelastic foam overlays).

Dependent Variable:

high-risk, surgery related-PU patients (high-risk surgeries include cardiac, general, orthopedic, vascular surgery, or surgeries with an expected operative time of more than 3 hours.

Controlled Variable: foam mattresses

Pressure redistribution surfaces are beneficial in postoperative patients in preventing pressure ulcer.

Pressure redistribution surfaces used intra operatively did not have a preventive effect

Matresses did not provide statistically significant prevention

Overall findings were insignificant and warrant precaution when using pressure reducing mattress inter operative and postoperative.

Systematic Review

 

 

 

 

Walden University M.S. in Nursing

Formative Evaluation Criteria for Applications and Formal Papers

 

Categories and Criteria

Points

QUALITY OF WORK SUBMITTED – 35 Possible Points

1. The extent to which work meets the assigned criteria and work reflects graduate level critical and analytic thinking                                                                                                             (0-30 Points)

Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics.
25-30
24

Assignment meets expectations. All topics are addressed with a minimum of 50% containing good breadth and depth about each of the assignment topics.
20-24

Assignment meets most of the expectations. One required topic is either not addressed or inadequately addressed.
16-19

Assignment superficially meets some of the expectations. Two or more required topics are either not addressed or inadequately addressed.
 

0-15

2. Purpose of the paper is clear                                                                                       (0-5 Points)

A clear and comprehensive purpose statement is provided which delineates all required criteria.
5
5

Purpose of the assignment is stated, yet is brief and not descriptive.
4

Purpose of the assignment is vague.
1-3

No purpose statement was provided.
0

ASSIMILATION AND SYNTHESIS OF IDEAS – 50 Possible Points

 The extent to which the work reflects the student’s ability to-

1. Understand and interpret the assignment’s key concepts                                               (0-10 Points)

Demonstrates the ability to critically appraise and intellectually explore key concepts.
9-10
8

Demonstrates a clear understanding of key concepts.
8

Shows some degree of understanding of key concepts.
5-7

Shows a lack of understanding of key concepts, deviates from topics.
0-4

2. Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources                                                                                              (0-20 Points)

Demonstrates and applies exceptional support of major points and integrates 2 or more credible outside sources, in addition to 3-4 course resources to support point of view.
15-20
15

Integrates specific information from 1 credible outside resource and 3 to 4 course resources to support major points and point of view.
10-14

Minimally includes and integrates specific information from 2-3 resources to support major points and point of view.
3-9

Includes and integrates specific information from 0 to 1 resource to support major points and point of view.
0-2

3. Synthesize (combines various components or different ideas into a new whole) material in course resources (i.e. video, required readings, and textbook) by comparing different points of view and highlighting similarities, differences, and connections.                                                                        (0-20 Points)

Synthesizes and justifies (defends, explains, validates, confirms) information gleaned from sources to support major points presented. Applies meaning to the field of advanced nursing practice.
18-20
18

Summarizes information gleaned from sources to support major points, but does not synthesize.
16-17

Identifies but does not interpret or apply concepts, and/or strategies correctly; ideas unclear and/or underdeveloped.
14-15

Rarely or does not interpret, apply, and synthesize concepts, and/or strategies.
0-13

 

 

 

WRITTEN EXPRESSION AND FORMATTING – 15 Possible Points

1. Paragraph and Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused–neither long and rambling nor short and lacking substance.                                  (0-5 Points)

Paragraphs and sentences follow writing standards.
5
5

Paragraphs and sentences follow writing standards 80% of the time.
4

Paragraphs and sentences follow writing standards 70% of the time.
3

Paragraphs and sentences follow writing standards < 70% of the time. 0-2 2. English writing standards: Correct grammar, mechanics, and proper punctuation (0-5 Points) Uses correct grammar, spelling, and punctuation with no errors. 5 3 Contains a few (1-2) grammar, spelling, and punctuation errors. 4 Contains several (3-4) grammar, spelling, and punctuation errors. 3 Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. 0-2 3. The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list                    (0-5 Points) Uses correct APA format with no errors. 5 5 Contains a few (1-2) APA format errors. 4 Contains several (3-4) APA format errors. 3 Contains many (≥ 5) APA format errors. 0-2 Total Points for Assignment: 83

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The post The Use of Redistributed Pressure Support Surface Versus Frequent Repositioning Reduce the Risk of Pressure Ulcers appeared first on Custom Writing Service.