Literature Evaluation Table

Sample Answer

Proposed PICOT-D Question

Among the elderly and debilitated patients in a Long-Term-Care Facility [P], does a preventive pressure bundle [I], compared to routine pressure injury care [C], reduce the incidence of pressure injury [O] within 60 days? [T].

Table 1 Primary Quantitative Research – Supports Element of PICOT-D Question
APA Reference

(Include the GCU permalink or working link used to access the article.) Research Questions/ Hypothesis and Purpose/Aim of Study Type of Primary

Research Design Research Methodology

• Setting/Sample (type, country, number of participants in study)
  
• Methods (instruments used; state if instruments can be used in the DPI Project)
  
• How were the data collected? Interpretation of Data
  (State p-value acceptable range is p= 0.000 – p= 0.05) Outcomes/
  

Key Findings

(Succinctly states all study results applicable to the DPI Project.) Limitations of Study and Biases Recommendations for Future Research
Explanation of How the Article Supports Your Proposed PICOT-D Question (P.C.O.T or D)

Barakat‐Johnson, M., Lai, M., Gefen, A., & Coyer, F. (2019). Evaluation of a fluidized positioner to reduce occipital pressure injuries in intensive care patients a pilot study. International Wound Journal, 16(2), 424-432. https //doi.org/10.1111/iwj.13051 The aim of this study was to examine the clinical impact and use of a preventive care bundle consisting of patient skin assessment and a fluidized positioning device in reducing pressure ulcers. A pilot post-test design.

The study was carried out in a fifty-four-bed adult ICU in Australia. While a total of sixty-four patients were recruited in the intervention group, sixty-three were recruited in the control group; data was collected using data collection tools created by the lead author and validated by senior nurse researchers. One of the instruments used was a survey with a five-point Linkert Scale.

A p-value of <0.001was obtained. One of the study results that support the DPI project is that, upon the analysis of the results, it was found that the patients in the control group were more likely to develop pressure injuries in comparison to those in the intervention group. This indicates the efficacy of the intervention.

Among the limitations is that data was collected at different time periods for the two groups; hence the seasonal difference could have affected the results hence introducing bias. One of the recommendations is that a similar study should be performed that include a wide range of participants, as the current one considered only patients admitted to the ICU.

This article supports the proposed PICOT question in that it shows the efficacy of a preventive care bundle consisting of skin assessment and a fluidized positioning device in preventing pressure injuries.

Darvall, J. N., Mesfin, L., & Gorelik, A. (2018). Increasing frequency of critically ill patient turns is associated with a reduction in pressure injuries. Critical Care and Resuscitation, 20(3), 217-222. https //europepmc.org/article/med/30153784 This study aimed at determining the impact of the three-hourly and five hourly turns on the incidences of pressure injuries among critically ill individuals. pre-post intervention evaluation study.

This study was carried out in an intensive care unit in a metropolitan tertiary hospital in Australia. A total o 1094 patients were admitted during the pre-intervention period, while a further 1165 were admitted during the post-intervention period. Data was collected through the use of records. A significant p value= of 0.028 was recorded in the difference between the development of pressure ulcers in the post and pre-intervention durations.

There was also a substantial decrease in decubitus injuries in the post-intervention period (p-value of <0.001) Among the key findings is that the change to turning patients every three hours led to a drop in pressure injury development cases as well as the incidence of decubitus injuries. The major limitation is a potential lack of generalizability It is recommended that the study be performed as a multicenter to improve generalizability.

This study also supports the PICOT question as it shows the efficacy of using patient repositioning, which is among the interventions in the proposed bundle.

Tayyib, N., Asiri, M. Y., Danic, S., Sahi, S. L., Lasafin, J., Generale, L. F., … & Reyes, M. (2021). The Effectiveness of the SKINCARE Bundle in Preventing Medical-Device Related Pressure Injuries in Critical Care Units A Clinical Trial. Advances in Skin & Wound Care, 34(2), 75-80. Doi 10.1097/01.ASW.0000725184.13678.80 The main aim of this study was to explore the effect of a pressure injury prevention bundle on the development of pressure ulcers.

The design used in this study was a prospective, single-arm, open-label clinical design. The study was done a two adult CCUs and a pediatric unit in a tertiary hospital in Saudi Arabia. A total of two hundred and twenty-three patients were recruited to take part in the study, with 60% being male. Various instruments were used in the study, including a skin assessment tool; the Braden Scale score was also used in predicting pressure injury risks.

A p-value of 0.001 was observed upon comparing the total number of pressure ulcers that developed before and after the intervention. The key finding is that when the preventive bundle was implemented, the researchers observed a significant drop in the cases of pressures ulcer development indicating the efficacy of the applied skincare preventive bundle. The study was carried out in a single population (which is CCU patients), limiting the results’ generalizability.

There is also a limitation of potentially incomplete data due to collecting the data retrospectively from the nursing documents. The recommendation is that further research should be built on proven prevention strategies. In addition, for better outcomes, increased staff awareness regarding the problem should be undertaken, and more regular measurements of pressure ulcer development should be undertaken. This research supports the PICOT question as it shows that the application of the bundle led to improve outcomes as it reduced the incidence of pressure injury development.

Table 2 Primary Quantitative Research – Supports Intervention Directly

APA Reference

(Include the GCU permalink or working link used to access the article.) Research Questions/ Hypothesis and Purpose/Aim of Study Type of Primary

Research Design Research Methodology

• Setting/Sample (type, country, number of participants in study)
  
• Methods (instruments used; state if instruments can be used in the DPI Project)
  
• How were the data collected? Interpretation of Data
  (State p-value acceptable range is p= 0.000 – p= 0.05) Outcomes/
  

Key Findings

(Succinctly states all study results applicable to the DPI Project.) Limitations of Study and Biases Recommendations for Future Research
Explanation of How the Article Supports the Intervention for Your Proposed

PICOT-D Question

Bueno de Camargo, W. H., Pereira, R. D. C., Tanita, M. T., Heko, L., Grion, I. C., Festti, J., … & Carvalho Grion, C. M. (2018). The effect of support surfaces on the incidence of pressure injuries in critically ill patients a randomized clinical trial. Critical Care Research and Practice, 2018. https //doi.org/10.1155/2018/3712067 The aim of the study was to determine the impact of the viscoelastic mattress support surface in reducing the incidence of pressure injury development.

The research design used is a randomized controlled trial This study recruited a total of 62 patients recruited into the study with 31 each randomized into the control and intervention groups. The study was carried out among patients admitted to the ICU. One of the instruments used in the research is the Braden scale A p-value of < 0.001 was observed in the difference between the frequency of pressure injury development between the intervention group and the control group.

The key outcome that supports the DPI project is that lower incidences of pressure injury development were observed in the intervention group, which used viscoelastic mattresses. The relatively smaller size of participants who participated in the study could have led to study bias. A similar study should be designed with a bigger sample size.

This article supports the PICOT question as it explores the use of support surfaces in preventing the development of pressure injuries. The study showed that the surfaces are effective. The intervention used is part of the proposed bundle to be used for the project.

Mohamed, S. S., & Ibraheem, R. A. (2019). Effect of Preventive Bundle Care on Nurses’ Knowledge, Compliance and Patients’ Outcome Regarding Pressure Ulcer in the Intensive Care Unit. Evidence-Based Nursing Research, 1(4), 12-12. https //doi.org/10.47104/ebnrojs3.v1i4.86 The aim of this study was to examine the impact of preventive bundle care on patients outcomes and nurses’ compliance and knowledge concerning pressure ulcers in intensive care units.

The design used in the study is the quasi-experimental design. The study recruited a total of eighty-five patients to take part in the study. The research was done at an intensive care unit in a teaching hospital in Egypt. A structured interview questionnaire was used in data collection. P-value of <0.05 was observed for patient outcomes differences in intervention groups and control group.

The key finding is that the use of the bundle led to decreased risks of developing pressure ulcers in the study group as compared to the control group showing the efficacy of the intervention used. Limited generalization as data was collected from a single center. Challenge in data collection as the nurses involved were always busy.

The preventive pressure injury bundle should be revised more often, while nurses need to be provided with continuous education to enhance the chances of effectively using the bundles and the guidelines. This article also supports the PICOT question as it shows that the use of a preventive bundle is effective in preventing pressure injuries.

Table 3 Clinical Practice Guidelines (If applicable to your project/practice)

APA Reference 

Clinical Guideline

(Include the GCU Library permalink or working link used to access the article.)

APA Reference –

Original Research (All)

(Include the GCU Library permalink or working link used to access the article.) Explanation of how clinical practice guidelines will help address your proposed PICOT-D question or intervention.

Place the primary quantitative research used in the clinical practice guidelines in Table 1. This is part of the primary quantitative research used to support your intervention.

References

• Barakat‐Johnson, M., Lai, M., Gefen, A., & Coyer, F. (2019). Evaluation of a fluidized positioner to reduce occipital pressure injuries in intensive care patients a pilot study.
  International Wound Journal, 16(2), 424-432. https //doi.org/10.1111/iwj.13051
  
• Bueno de Camargo, W. H., Pereira, R. D. C., Tanita, M. T., Heko, L., Grion, I. C., Festti, J., … & Carvalho Grion, C. M. (2018). The effect of support surfaces on the incidence
  of pressure injuries in critically ill patients a randomized clinical trial. Critical Care Research and Practice, 2018. https //doi.org/10.1155/2018/3712067
  
• Darvall, J. N., Mesfin, L., & Gorelik, A. (2018). Increasing frequency of critically ill patient turns is associated with a reduction in pressure injuries.
  Critical Care and Resuscitation, 20(3), 217-222. https //europepmc.org/article/med/30153784.
  
• Mohamed, S. S., & Ibraheem, R. A. (2019). Effect of preventive bundle care on nurses’ knowledge, compliance, and patients’ outcome regarding pressure ulcer in the
  intensive care unit. Evidence-Based Nursing Research, 1(4), 12-12. https //doi.org/10.47104/ebnrojs3.v1i4.86
  
• Tayyib, N., Asiri, M. Y., Danic, S., Sahi, S. L., Lasafin, J., Generale, L. F., … & Reyes, M. (2021). The effectiveness of the SKINCARE bundle in
  preventing medical-device related pressure injuries in critical care units a clinical trial. Advances in Skin & Wound Care, 34(2), 75-80. Doi 10.1097/01.ASW.0000725184.13678.80