Determining Enthalpy Of Combustion Of A High-Energy Candy Free Essay


Calorimetry makes it possible to determine the enthalpies of combustion for substances whose heat of formation cannot be found directly. The purpose of this experiment was to determine the enthalpy of combustion of Mickey Mouse Clubhouse in kilojoules using a bomb calorimeter. Benzoic acid was used as the calorimetric standard to determine the instrument’s heat capacity, which was found to be 8.89 KJ/K. This value was used to compute the heat of combustion of the candy that was found to be -16.18 KJ. The experimental and manufacturer’s enthalpies of the candy were compared statistically. No significant differences were seen between the two values at a 95% confidence interval. It was concluded that bomb calorimetry was an accurate and efficient method of determining the enthalpy of combustion of a high-energy candy.


Physical chemists are interested in determining the chemical energy contained in various chemical substances. One way of determining the chemical energy of a substance is using the heat of formation, which may be defined as the sum of heat that is taken in or liberated when a substance is formed from its constituent elements at standard volume and pressure.1 These heats may be negative or positive depending on the internal energy of the substance with respect to its constituent elements. At constant pressure, the heat obtained through this procedure is referred to as enthalpy (ΔH) of the reaction. At constant volume, the heat of formation per mole of a compound formed, which can be found from alterations in temperature, is the energy of the reaction and is denoted by ΔU. Equation 1 can be used to compute ΔU as follows.

ΔU = Cv ΔT[1]

In equation 1, Cv is the heat capacity of the substance, whereas ΔT is the temperature difference obtained by subtracting Tinitial from Tfinal.

However, this experimental approach may not be feasible for all chemical compounds because some compounds are not formed directly from their chemical constituents. Nonetheless, alternative experimental approaches can be used to calculate the heat of formation. These procedures are based on heats of combustion and Hess’ law of constant heat summation, which states that the entire enthalpy change for a reaction is equal to the sum of the enthalpies of the individual steps notwithstanding the number of steps in the reaction.2

Calorimetry is an experimental procedure that quantifies the amount of heat absorbed or liberated during chemical reactions.3 A calorimeter is a piece of special equipment that is used for this function. A bomb calorimeter operates at a constant volume, which implies that the heat obtained using this instrument is equivalent to the internal heat of a substance. The purpose of this experiment was to use calorimetry to determine the calories of a high-sugar candy using enthalpy of combustion.


Two experimental runs were made using 1.0 g portions of benzoic acid to determine the heat capacity of the calorimeter system. In this case, the benzoic acid was referred to as the calorimetric standard. Thereafter, the calorimeter was prepared by flushing with oxygen to remove residual nitrogen. Experimental runs were conducted for 10 to 20 minutes with data collection being done at 30-second intervals before ignition and 5 to 10-second intervals following ignition. Changes in combustion temperatures were determined by finding the difference between pre-ignition temperature and post-ignition temperature.

The actual change in temperature due to combustion was determined by plotting temperature versus time and extrapolating to remove temperature changes due to stirring and environmental loss. The heat capacity of the calorimeter system, C(C), was found by determining the temperature rise (T2 – T1) obtained from the combustion of the known masses of benzoic acid and iron wire. The energy change for the combustion of candy is determined from the rise in temperature (T2 – T1) and the average value of C(C), determine from the two trials with benzoic acid.


Two experimental runs were performed for each experiment. Figures 1, 3, and 4 illustrate sample plots obtained from the combustion reaction of benzoic acid, the first order best line of fit for the flat portion before ignition and after ignition. Other data sets that were collected data included the temperature changes for the combustion experiments for benzoic acid and the candy, which were 3.15oK ± 0.01 (Appendix 1) and 1.831oK ± 0.01 (Appendix 3), respectively as indicated in Table 1. The heat capacity of the calorimeter was then calculated using the known combustion energies of benzoic acid and wire as indicated in Table 2 and was found to be 8.89 KJ/K (Appendix 3). The temperatures recorded in Table 1 were used to calculate the heat of combustion of Mickey Mouse Clubhouse in kilojoules (Appendix 4), which was found to be -16.18 KJ as shown in Table 3. Statistical comparison was done between experimental and manufacturer enthalpies (kcal) of Mickey Mouse Clubhouse Candy at a 95% confidence interval (Appendix 5). Specific parameters that were computed included mean (3.87), standard deviation (0.113), absolute error between experimental and manufacturer (0.13), and % error (3.25). All these values are summarized in Table 4.

Combustion experiments for benzoic acid

Combustion Reaction of Benzoic Acid Temperature vs Time Run

The best fit line (first order) for the flat portion of the curve before ignition

Best Fit Line of Combustion Reaction of Benzoic before ignition Temperature vs Time Run

The best fit line (first order) for the flat portion of the curve for the flat portion of the curve after the combustion has occurred.

Best Fit Line of Combustion Reaction of Benzoic Acid after ignition Temperature vs Time Run

Table 1: Temperature Changes due to Combustion Reaction of Benzoic Acid and Mickey Mouse Clubhouse Candy.

Run T1(±0.01) T2(±0.01) ΔT = T2-T1(±0.01)
Benzoic acid 1 22.71 26.07 3.36
2 22.87 25.80 2.93
average 3.15
Mickey Mouse Clubhouse Candy 1 22.982 24.87 1.888
2 24.317 26.091 1.774
average 1.831

Table 2: Calculation of heat capacity of calorimeter using the known combustion energies of benzoic acid and wire.

Run Heat combustion of Benzoic acid (kJ) Heat combustion of wire (kJ) ΔT Ccal =-Formula
1 -28.298 -0.049 3.36 8.44
2 -27.308 -0.038 2.93 9.34
Average 8.89

Table 3: Calculation of heat of combustion of Mickey Mouse Clubhouse in kilojoules.

Runs ΔT (±0.01) ΔUCandy+ wire


Heat combustion of wire used (kJ) Heat combustion of ΔUCandy (kJ)
1 1.89 -15.95 -0.049 -15.90
2 1.77 -16.53 -0.068 -16.46
Average -16.18

Table 4: Statistical comparison between experimental kcal and Manufacturer kcal of Mickey Mouse Clubhouse Candy

Runs ΔU (kJ) ΔU


Mass of candy

used (g)





95 % confidence interval
1 -15.90 3.80 0.9618 3.95
2 -16.46 3.93 1.0365 3.79 60/15 = 4 2.84 – 4.89
Mean 3.87
Standard deviation 0.113
Absolute error between experimental & manufacture 0.13
% Error 3.25

Possible sources of error in the experiment are linked to experimental procedures such as errors during the measurement of water, weighing of benzoic acid and the candy, as well as pressure variations when pressurizing or venting the bomb calorimeter.3 The thermometer readings could also contribute to errors in the overall results. The volume of water was measured using the human eye, which could result in meniscus errors, thus affecting the accuracy of the water volumes. It was also likely that the source of heat in the calorimeter was not the combustion of the solids alone. The stirring effect generated some heat in the calorimeter, which contributed to the overall heat.4 On the other hand, part of the heat could have escaped from the calorimeter by dissipating through the walls.

It was suggested that the same amount of water was used in the calorimeter for each run. Varying the amount of water in the calorimeter introduces variations in the effective volume during the experiment as well as the ensuing pressure.4 Consequently, the reactions will not occur at the same volume and pressure that interfering with the accuracy and precision of the values recorded in different experimental runs.

It is advisable to try and get the same O2(g) pressure in the bomb for each run to minimize variations in the resultant enthalpy. When calculating the enthalpy of a reaction, it is assumed that the combustion is taking place at constant volume and pressure. Therefore, varying the pressures at different experimental runs would lead to varying enthalpies and affect the precision of the experiment.4 Nonetheless, it can be said that the experiment is run under constant volume conditions. The volume of the calorimeter is fixed. Furthermore, any additional changes in the volume within the calorimeter are minimized by using the same volume of water. However, as much as the investigator attempts to obtain constant pressure during the experimental runs, there is a likelihood of slight variations in pressure, which is responsible for the differences in the calculated heats of combustion.

The absolute error between the experimental and literature value for the calories of the candy was 0.13. On the other hand, the percent error was 3.25%. The experimental uncertainties identified in the procedure, for example, the inability to guarantee exact pressures at each run, were responsible for the errors. However, the published value was within the 95% confidence interval. Therefore, it was concluded that the experimental kcal calories were not significantly different from the manufacturer’s value.

Conclusion and Recommendation

Through this experiment, it was possible to determine the enthalpy of combustion of Mickey Mouse Clubhouse Candy sample after the combustion of benzoic acid was done to determine the Ccal value, which was 8.89 KJ/K, and the enthalpy of combustion of the candy was found to be 1.83 ± 0.01. A statistical analysis of the manufacturer and experimental enthalpy of combustion of the candy yielded a mean of 3.87, a standard deviation of 0.113, an absolute error of 0.13, and a % error (3.25) at the 95% confidence interval. These findings showed that there was no significant difference between the experimental and reported enthalpy of combustion for the candy. It was concluded that bomb calorimetry is a reliable technique in the determination of enthalpies of combustion and should be used under experimental conditions in the laboratory.


Temperature Changes due to Combustion Reaction of Benzoic Acid

Temperature Changes due to Combustion Reaction of Benzoic Acid

Calculation of heat capacity of calorimeter using the known combustion energies of benzoic acid and wire

Calculation of heat capacity of calorimeter using the known combustion energies of benzoic acid and wire

Temperature Changes due to Combustion Reaction of Mickey Mouse Clubhouse

Temperature Changes due to Combustion Reaction of Mickey Mouse Clubhouse

Calculation of energy of combustion of Mickey Mouse Clubhouse in kilojoules

Calculation of energy of combustion of Mickey Mouse Clubhouse in kilojoules


Agne, M.T.; Barsoum, M.W. Enthalpy of Formation and Thermodynamic Parameters of the MAX Phase V2AlC. J. Alloy Compd. 2016, 665, 218-224.

Spera, D.Z.; Liebman, J.F. Paradigms and Paradoxes: Hess’ Law and the Thermodynamic Validity of Jolly’s Method for Estimating Bond Dissociation Energies. Struct. Chem. 2018, 29, 1589-1591.

Guo, H.; Lyon, R.E.; Safronava, N. Accuracy of Heat-Release Rate Measured in Microscale Combustion Calorimetry. J. Test. Eval. 2017, 46, 1-9.

Kantonen, S.A.; Henriksen, N.M.; Gilson, M.K. Accounting for Apparent Deviations Between Calorimetric and Van’t Hoff Enthalpies. BBA-Gen. Subjects. 2018, 1862, 692-704.

The Conflict Resolution And Moral Distress In Nursing

It could hardly be doubted that conflicts in the workplace have a considerably negative impact on the overall efficiency of any given organization. This assumption is particularly accurate when applied to clinical environments, in which healthcare workers largely responsible for the health and life of their patients, and yet nurses have to deal with the same variety of modern-day problems that affect their resilience and provoke conflicts (Hart, Brannan, & De Chesnay, 2014). The elimination of conflict situations and their negative impact is one of the most important goals of contemporary nursing leaders and workers. The purpose of this paper is to observe and analyze an experienced workplace conflict in detail in order to identify the best strategies for conflict resolution as well as directions for future practice.

Observation of the Experienced Conflict

First of all, it is essential to give a brief overview of the experienced conflict before dwelling upon more particular details and aspects. It is essential to notice that the described conflict situation comes from personal prelicensure experiences in a hospital setting in Miami. In general, it should be stated that the conflict had a recurring nature because it was based on moral distress and job dissatisfaction, which resulted in nurses’ decreased ability to care for patients as they were preoccupied with their problems. Another aspect of the conflict situation that will be discussed is that I was in the position of an observant since at the time, a volunteered in the hospital and thus was not deeply involved in interpersonal relationships in the workplace.

Detailed Description of the Experienced Conflict

Since the conflict had a recurring nature, it is possible to exemplify various instances of it. However, the most typical situation was the following. Primarily it involved nurses and nursing coordinators, and conflict situations happened in the hospital during nurses’ shifts, especially at night. Usually, a nurse refused to complete particular tasks on his or her shift, arguing with the nursing coordinator that he or she does not feel that their job is worth doing it and that they are too stressed out to perform all of their tasks properly. It is obvious that such situations had a negative impact on nursing and patient outcomes in the clinical environment. Also, I consider this conflict unresolved because the management of the hospital did not employ any concise intervention or policy to resolve the conflict.

The Four Stages of Conflict

Outline of the Four Stages of Conflict

Four stages of conflict represent a theoretical framework for analyzing the process of conflict development. The first stage is Latent, in which future participants of the conflict are not aware of the existence of the potentially controversial situation. The second Perceived stage refers largely to the conflict itself: the participants are fully aware of it, and the confrontation occurs. The third Felt stage represents the feelings of stress, anxiety, dissatisfaction, and resentment, which are provoked by the participation in the conflict situation. Finally, the Manifest stage refers to a phase in which the conflict could be observed by its participants in order to retrieve meaningful conclusions and develop an intervention or solution for the conflict.

The Relation between the Conflict Stages and the Example

As the four stages of conflict are outlined, it is essential to investigate the relation between them and the particular experienced situation provided in the previous sections. It could be suggested that I did not have a chance to observe the Latent stage since the process of nurse burnout and cumulation of moral distress had happened before my volunteering experience (Allen & Butler, 2016). However, the Perceived stage was presented evidently since there were numerous occasions in which nurses in the hospital expressed their dissatisfaction with the amount of work and their self-worth as healthcare workers. The Felt stage was also observed due to the apparent manifestations of negative feelings associated with the conflict situation. Nevertheless, the Manifest stage was not reached as there was no particular decision on how to resolve the conflict.

Delegation as a Conflict Issue

The role of delegation as a driving factor of conflict situations could not be overlooked. It is possible to suggest that in the particular situation, which is described in this paper, the delegation could be considered the part of the issue. Since many nurses felt that they do not receive enough credit for their work or that the amount of work is too big or difficult for them, they neglected some of their responsibilities. Later, when they were asked by managers about the reasons why some tasks were incomplete, they delegated these responsibilities to other nurses. Additionally, I also experienced delegation as several times; some nurses asked me to perform activities for which they were initially responsible.

Strategies for Conflict Resolution

Further, it is essential to discuss strategies for efficient conflict resolution. It is possible to state that the academic literature on the topic is vastly concerned with the topic of conflict resolution, and thus it is possible to retrieve various approaches proposed by scholars. For example, the article by Twigg and McCullough (2014) provides distinct guidelines for the creation and enhancement of positive practice environments in clinical settings. The author mentions the following strategies: nurse participation in hospital affairs, developing nursing foundations for quality care as well as nurse manager ability, leadership and support of nurses, staffing and resource adequacy, and collaborative nurse-physician relationships (Twigg & McCullough, 2014).

Additionally, the article by Brown et al. (2015) promotes the establishment and maintenance of efficient teamwork among nurses. The authors argue that it is one of the most effective approaches to preventing and resolving conflicts in the workplace. It is also possible to mention the research by Hart et al. (2014), in which the authors argue that resilience is one of the most important factors for the improvement of clinical environments’ working climate.

Also, it is appropriate to mention that collaboration between healthcare workers and nursing leaders is considered by the vast majority of authors as a highly significant aspect of conflict prevention and resolution. The positive impact that could be potentially brought by an efficient nursing leader is positively valued by Twigg and McCullough (2014). The authors argue that the implementation of evidence-based interventions supported by the employment of theoretical frameworks has a vast potential for the improvement of current hospital settings’ conditions.

Summary of the Experienced Conflict and Future Directions

In conclusion, it should be stated that the conflict that was described in this paper is a highly important experience for me as a healthcare professional. The importance of working toward mutual goals and resolving conflict situations in a timely manner is of high importance in any clinical environment. For future directions, I consider using my experience and support from academic literature on the topic in order to resolve emerging conflicts in the workplace.


Allen, R., & Butler, E. (2016). Addressing moral distress in critical care nurses: A pilot study. Int J Crit Care Emerg Med, 2(2), 1-6.

Brown, J. B., Ryan, B. L., Thorpe, C., Markle, E. K., Hutchison, B., & Glazier, R. H. (2015). Measuring teamwork in primary care: Triangulation of qualitative and quantitative data. Families, Systems, & Health, 33(3), 193-202.

Hart, P. L., Brannan, J. D., & De Chesnay, M. (2014). Resilience in nurses: An integrative review. Journal of Nursing Management, 22(6), 720-734.

Twigg, D., & McCullough, K. (2014). Nurse retention: a review of strategies to create and enhance positive practice environments in clinical settings. International Journal of Nursing Studies, 51(1), 85-92.

Improving Outcomes By Implementing A Pressure Ulcer Prevention Program


The prevalence of pressure ulcers in immobile patients still presents an important issue in the field of health care. The given study uses a mixed methods design to contribute to the field and conclude on the effectiveness of improved PU prevention protocols. According to the research results, the use of an improved PU prevention strategy in immobile patients helps reduce the prevalence of PUs threefold if compared to the traditional care strategy. The potential barriers to PU prevention in hospital settings were analyzed with the help of face-to-face interviews. The results indicate that, despite the benefits of PU prevention, nurses are concerned about increasing workload and the need to improve risk-assessment skills. In addition, patients’ unwillingness to collaborate and follow self-care recommendations is another theme related to PU prevention barriers. These results can provide the basis for recommendations helping to improve currently used strategies.


Pressure ulcers (PUs) are a significant burden to healthcare as they are associated with high morbidity expenditures. According to Cano et al. (2015), “the cost of care for one PU is between $500 and $70,000, depending on the stage” (p. 574). At the same time, PUs are considered to be a preventable health problem. Therefore, by changing the procedures of patient risk assessment and undertaking measures to mitigate those risks promptly, hospitals can minimize unnecessary costs associated with the occurrence of PU and improve patient safety indices.


The given topic is interesting because the development of PUs in hospitalized patients can be mainly regarded as a nurse-sensitive outcome. It means that a nurse should have the knowledge and the skills needed to recognize at-risk individuals and commence timely interventions in order to improve patient results. It is possible to say that, by impacting the area of nursing directly, the exploration of the effects of PU prevention protocols in emergency departments can help practitioners in acquiring these necessary competencies. Additionally and more specifically, the proposed research project will aim to explore the links between patient outcomes and nurse behaviors, as well as to inform the design of new potential solutions to the PU problem. These goals are measurable and realistic, yet their accomplishment will largely depend on the quality of research design in general.

The topic is relevant today because the prevalence and incidence of PU remain high although their rates may significantly vary across different types of settings. Additionally, Truong, Grigson, Patel, and Liu (2016) note that hospitals may implement different standards of PU prevention and treatment. It means that the efficacy of patient care may vary depending on the undertaken measures, as well as setting contexts. Thus, in-depth research of new care algorithms and materials may substantially benefit both patients and hospitals by providing opportunities for practice improvement.

Target Audience

Considering that the research project is meant to modify nurses’ behaviors, it will primarily target the given group of healthcare practitioners. Firstly, it will aim to provide the educational tool for all nurses regardless of their cultural, social, and demographic backgrounds in a specific, selected setting. However, it is expected that the findings will benefit every nursing practitioner and hospital working with at-risk individuals.

Research Questions

  • Does the implementation of the prevention protocol reduce the incidence of PU in hospitalized patients?
  • What are the patient and the hospital costs of utilizing the new protocol compared to usual care procedures?
  • How effective is the new protocol in treating PUs registered on patient admission in terms of wound recovery?
  • What are the major difficulties and barriers to the implementation of the PU prevention protocol in the hospital environment?

Problem Statement

Considering that emergency departments are associated with a high risk of PU development in hospitalized patients, the lack of standard and effective preventive care protocols may compromise patient safety and lead to excess treatment costs.


Compared to usual care initiated within the emergency department, the implementation of the PU protocol, covering a broad range of nursing behaviors in relation to the identified adverse health condition, can potentially help reduce the occurrence of hospital-acquired PUs during a prolonged hospitalization. The hypothesis suggests that the frequency and correlation of the implementation of preventive care measures (independent variables) are directly related to patient outcomes (dependent variable). The relationship between them will be tested through the comparison of pre- and post-utilization data, whereas the factor of nurse adherence and PU incidence rate will be measured at both stages of research.

Review of Literature

Silicone foam dressing is one of the primary methods of preventing pressure ulcers in patients. However, it is not widely implemented as a standard protocol, which relies primarily on repositioning and use of soft padding under the points of contact. Truong et al. (2016) analyzed the available literature on the effectiveness of silicone foam dressings versus standard protocols. According to their findings, silicone foam shows greater effectiveness in preventing ulcers – it is 42.9% vs. 3.6% for standard protocol (Truong et al., 2016, p. e730). In addition, the average net cost of the intervention was $52.87 dollars, whereas about $107.9 was needed for the implementation of usual care protocols (Truong et al., 2016, p. e730). This source directly answers some of the research questions pertaining to the thesis of this paper. However, its major limitation lies in the duration of the experiment and its small sample size, which makes it difficult to extrapolate the results.

Cano et al. (2015) experimented with changes to the standard protocol and the materials used for preventing the development of pressure ulcers in patients. Namely, all standard supportive surfaces were replaced with Hill-Rom Advanced Microclimate Technology Mattresses. Advanced protocols of supervision and care were strictly followed. As a result, the incidence of PU dropped from 11.7% to 2-4% (Cano et al., 2015, p. 574). This source directly answers the first, second and third research questions, providing data for financial feasibility and the overall effectiveness of the intervention. One of the potential gaps in this research, however, lies in the lack of comparison between newly introduced and standard protocols. It is possible that high results were achieved because of higher percentages of compliance associated with motivation from participation in an experiment.

The article by Worsley, Clarkson, Bader, and Schoonhoven (2016) investigated some of the barriers and facilitators to participation in pressure ulcer prevention. According to their findings, the greatest barriers to practicing PU prevention were limitations in resource (not enough staff/lack of equipment), lack of professional education, and professional boundaries. This source answers the fourth research question by addressing factors directly and indirectly associated with the implementation of PU prevention protocols. One of the greatest limitations of this study is that it does not provide any guidelines for overcoming the problem.

There are various obstacles to the implementation of special protocols reducing the incidence of HAPUs in emergency departments and other types of hospital settings. Discussing the barriers to PU prevention, Balzer and Kottner (2015) focus on the necessity to institutionalize changes, agree on the most effective patient care practices to be used, and successfully incorporate the revised care protocols into practice. Apart from that, many authors highlight the negative impact of challenges related to outcome evaluation. Thus, many researchers agree that the question of determining relevant patient-important outcomes is still open even though there is a range of valid tools helping to study health changes (PU staging procedures, visual assessments, etc.) (Balzer & Kottner, 2015; Padula et al., 2015).

The use of prophylactic dressings helping to reduce pressure on certain parts of the body is widely discussed by modern researchers and is often listed among the most promising components of HAPU prevention strategies. As the authors of certain systematic reviews conclude, special medical dressings (especially multi-layer) have a significant impact on HAPU incidence rates and can reduce chronic wound prevention costs that exceed $15 billion in the United States (Black et al., 2015, p. 484). As for the results of long-term experiments, the implementation of comprehensive HAPU prevention programs including adhesive dressings leads to a 69% reduction in incidence rates in ICUs (Swafford, Culpepper, & Dunn, 2016).

According to the study with the sample size exceeding 400 adult ICU patients, prophylactic wound dressings help reduce the incidence of HAPUs by more than 10% (Black et al., 2015, p. 485). The ability of wound dressings made of different materials to reduce the incidence of HAPUs in high-risk patients is also discussed in the review by Clark et al. (2014). As is clear from their findings, the use of wound dressings in EDs positively impacts patient outcomes, whereas hydrocellular foam dressings cause the 11 times reduction of HAPU incidence rates if compared to gauze dressings (Clark et al., 2014, p. 467).

Apart from the use of special medical equipment and repositioning techniques, current PU prevention strategies can be improved with the help of patient education and the promotion of self-help. In their systematic review, Baron et al. (2016) suppose that behavioral and educational interventions help patients better recognize worrying symptoms. Despite that, the extent to which education on self-help and PU prevention in patients with movement issues impacts the actual incidence rates presents a significant research gap that needs to be addressed in the nearest future.

Other components of effective PU prevention strategies discussed in the reviewed articles include the use of CBPM devices and electric stimulation. In their study, Behrendt, Ghaznavi, Mahan, Craft, and Siddiqui (2014) prove that modern CBPM systems can decrease the incidence of HAPUs by generating pressure images and providing recommendations that allow “off-loading high-pressure areas” (p. 127). Having studied the sample of more than 400 patients, the authors found out that the use of CBPM was associated with a five times decrease in HAPU incidence rates (Behrendt et al., 2014, p. 131). Specific preventive interventions included in HAPU prevention strategies may vary depending on patients’ medical conditions. For instance, electric stimulation is among promising methods to be used in people with spinal injuries despite numerous issues related to the choice of stimulation frequency, currents, and length (Liu, Moody, Traynor, Dyson, & Gall, 2014).

Research Methods Used and Data Collected

Research Design and Search Strategy

Within the frame of the research, a thorough literature review was conducted in order to analyze the hypothesis and make conclusions concerning the effects of special PU prevention protocols on the costs of treatment and health outcomes of high-risk patients. A mixed-methods research design was chosen to conduct the study and take into account both quantitative and qualitative findings reported by the previous researchers in the field. An opportunity to analyze the combination of numerical and categorical data can be listed among the key advantages of literature reviews. Given that it is helpful in identifying trends in various research fields, the use of the specified research design was regarded as the best option.

The following steps were taken to construct and implement a proper search strategy:

  • Choose at least 2 professional medical databases;
  • Determine the right keywords related to the hypothesis;
  • Conduct keyword search;
  • Sort search results to exclude repetitions;
  • Eliminate irrelevant and low-quality articles.

Professional databases utilized for the research included CINAHL and MedLine (accessed via PubMed). Given that the hypothesis referred to the financial and health effects of specialized PU prevention protocols, both topics needed to be reflected in search queries. Therefore, the following keywords were used: barriers to PU prevention, HAPU, PU, pressure ulcer prevention program, hospital-acquired pressure ulcers, standard pressure ulcer protocol, PU prevention costs. During the first stage of data collection, 112 articles from professional nursing and medical journals were retrieved in total (with repetitions excluded). Then, the search results were sorted based on the up-to-dateness (articles no older than five years were preferred) and quality of studies. In reference to the latter, it was determined with special attention to the hierarchy of evidence (systematic reviews and RCTs were included first), researchers’ objectivity (the discussion of study limitations, etc.), and the impact factors of journals. Finally, 11 journal articles relevant to the topic and meeting the requirements above were included in the literature review, and their findings were summarized to answer the research questions. The chosen studies are dated 2014 (3 articles), 2015 (4 articles), and 2016 (4 articles).

Results and Analysis of Research Findings

The Effects of Comprehensive PU Prevention Protocols

The first part of the study presented an experiment, in which nurses were provided with improved PU prevention guidelines. Prior to the intervention, the researchers used the Braden Scale to determine the risks of PU in participants. According to the results, all participants had high or very high risks (the score range from 6 to 12). Given the health characteristics of the population, the highest risks were associated with the mobility subscale (see Appendix).

The intervention and control groups that took part in the experiment were heterogeneous in terms of ethnicity, age, and medical condition. The mean age in the intervention group was 59 years and 5 months. On average, the members of the control group were older (the mean age was 62 years and 3 months). In reference to the racial composition of the groups, the data was the following for the intervention group: White – 45%, Asian – 10%, African American – 25%, Hispanic – 20%. In the control group, the larger part of the participants was White (35%), whereas the percent of people identifying themselves as African Americans, Hispanics, and Asians was 30, 15, and 20 respectively. When it comes to gender composition, women presented 55% of the intervention group and 40% of the control group. The causes of the participants’ immobility were extremely different and included severe arthritis, hip traumas, stroke, fractures, and neurodegenerative disorders.

To measure the effectiveness of the above approach to decreasing the incidence of hospital-acquired pressure sores, a standardized PU classification scale was used. Before and after the intervention, the pressure ulcer status of the participants was measured using the NPUAP guidelines concerning PU classification. The following results were retrieved with the help of the Braden Scale: 70% of participants in the intervention group and 65% in the control group had high risks of PUs, whereas the risks for the remaining participants were very high.

The measurements taken prior to the start of the program indicated that, despite high risks, there were no cases of bed sores in both groups since the patients had been hospitalized recently and received appropriate care from their relatives. Two weeks after the implementation of improved PU prevention guidelines, the presence of stage 1 pressure ulcers was discovered in 10% of the intervention group, whereas the cases of stage 2, 3, 4, and unstageable PUs were absent. The control group received usual care; in particular, there were no strict requirements concerning the frequency of skin assessments and patient repositioning. As it has been mentioned, the risks of PUs were extremely high for 35% of participants receiving usual care. The following data on the PU status of patients from the control group were collected after the experiment: stage 1 PUs developed in 20% of the participants, whereas 10% had stage 2 pressure sores. The analysis of the practical results of the tested intervention indicates that the cases of stage 1 and 2 PUs were three times more often in the group receiving usual care if compared to the intervention group. The results demonstrate that the combination of measures with proven effectiveness positively impacts patient outcomes regarding pressure ulcers, which is consistent with previously reported findings (Behrendt et al., 2014; Baron et al., 2016). However, defining the specific role of each measure included in the protocol may require the use of a larger sample.

Perceived Barriers to PU Prevention

Ten nurses agreed to participate in qualitative interviews and share their opinion on the problems related to the prevention of pressure sores in immobile people. The participants were nursing professionals aged 27-39 with a minimum of 3 years of professional practice. The following questions were included in the interview:

  • Demographic data, professional experience;
  • Do you find the prevention of pressure sores time-consuming and why?
  • What do your colleagues think about standard PU prevention practices, do they find them overrated?
  • Can the majority of bedsores be prevented and why?
  • What aspects of PU prevention should be emphasized in staff education to improve patient outcomes?

A thematic analysis was conducted to analyze the interviews and single out the most common ideas related to factors that make PU prevention strategies less successful. From reliability considerations, all interviews were coded by the two researchers, and three themes were found to be the most frequent in the nurses’ answers. Among them, there were a heavy workload that increases with the implementation of new PU prevention practices (in 60% of the interviews), the need to improve nurses’ risk assessment skills (in 50% of the interviews), and patients’ unwillingness to cooperate (30%). In general, the findings support the opinion that the professional skills of nursing staff and their attitudes toward nurse-patient communication can have an impact on the prevalence of PUs (Balzer & Kottner, 2015). Importantly, there were no interviewees who regarded the currently used PU prevention practices as extremely effective.

Discussion of Hypothesis/Conclusion

The study hypothesizes that the use of improved risk assessment and PU prevention practices positively impacts patient outcomes and reduces the costs of PU treatment. Importantly, the issue impacts both health outcomes of vulnerable patients and the costs of treatment because managing the consequences of hospital-acquired pressure sores involves significant financial expenditures (Swafford et al., 2016). The given research focused on studying the effectiveness of a comprehensive pressure ulcer prevention protocol if compared to standard care that patients at one of the local hospitals received. Another area of focus that has been identified earlier is the range of barriers to pressure ulcer prevention in hospital settings.

The results of the study demonstrate that healthcare managers can positively impact patient outcomes in relation to HAPUs by increasing the frequency of skin assessment and repositioning procedures, using high-quality equipment, and providing necessary patient education. Also, from the qualitative analysis, it is clear that the barriers related to workload, staff education, and patients’ attitude to self-care can pose a threat to the success of PU prevention programs. However, given that sample size directly impacts validity, conducting similar studies with larger samples is recommended.


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Risk for Pressure Ulcers
Risk for Pressure Ulcers (ProHealth Wound Care, n.d.).

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