Pressure Ulcer Issue In Evidence-Based Medicine Sample Assignment

Problem or Issue

Pressure ulcers (PUs), especially hospital-acquired ones, are an important issue associated with the clinical management of patients. A PU can be defined as a “localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure alone or in combination with shear” (Qaseem, Mir, Starkey, & Denberg, 2015, p. 359). According to different estimates, the prevalence of the issue differs for various settings from 0.4% to 38% (Qaseem et al., 2015, p. 359).

Hospital-acquired PUs are viewed as an essential quality indicator because they represent a preventable issue with significant negative consequences (Padula et al., 2015). Indeed, PUs result in increased morbidity and mortality (Qaseem et al., 2015). The treatment of PUs, especially severe ones, is also associated with expenses (Demarré et al., 2015; Qaseem et al., 2015). As a result, the prevention and effective management of PUs are a significant healthcare concern.

Patient Cohort

PUs appear in various groups of patients, but given the specifics of the described issue, the patients with hospital-acquired PUs are of interest to the present paper. Due to the heterogeneity of this group, various subgroups of the cohort run different risks of acquiring PUs. PUs are caused by friction and shear force, which are often experienced because of the contact with bedding (Park, Lee, & Kwon, 2015). Consequently, patients with reduced mobility are at risk of developing PUs (Anderson et al., 2015).

Moreover, aging processes affect the skin, making older patients more prone to PUs (Park et al., 2015). Other risk factors can include moisture, insufficient nutrition, and hemodynamic instability; the latter is associated with various illnesses, for instance, heart conditions (Anderson et al., 2015; Qaseem et al., 2015; Tayyib, Coyer, & Lewis, 2015). All the mentioned factors can become confounding variables that should be considered in a study of PUs with the chosen population.

Potential Solution

An appropriate approach to resolving the issue is comprehensive interventions or so-called pressure ulcer care bundles. The term refers to the complex interventions which incorporate multiple components that are evidenced to be able to address the problem of PUs and that result in positive outcomes for patients (Tayyib et al., 2015). The bundles can include training, tools, and guidelines meant for risk assessment, patient monitoring, skincare, the use of support surfaces, nutrition, repositioning, and other activities that are shown to reduce PU incidence, prevalence, and severity (Anderson et al., 2015; Tayyib et al., 2015).

Bundles may also incorporate instructions for patients; for example, the INTACT program encourages patients to participate in PU prevention efforts (Roberts et al., 2016). The choice of a specific bundle should be guided by the needs of any particular unit; the present paper has found little evidence concerning the comparative effectiveness of different bundles.

PU care bundles have been receiving notable coverage in recent literature that focuses on varied settings and patients. For instance, Tayyib et al. (2015) launched a randomized controlled trial that showed the positive outcomes of a bundle developed specifically for critically ill patients. The findings demonstrated improvements related to PU incidence, prevalence, and severity. On the other hand, universal bundles also exist; Anderson et al. (2015) studied one of them with the help of a quasi-experimental design and proved that it significantly decreases PU incidence. Loudet et al. (2015) presented the results of a quasi-experimental study which found a significant reduction in PU incidence as a result of the adoption of a multifaceted intervention.

Also, the INTACT program, which is a care bundle with a focus on the activities of both nurses and patients, was studied by Chaboyer et al. (2016) in a randomized trial. The findings incorporated some evidence that could prove the effectiveness of the intervention, especially with respect to PU incidence. All the mentioned studies appear to have sound designs and relatively large samples (the smallest of them had more than 120 patients), which implies that high-quality evidence on the topic suggests that care bundles are effective. However, the studies of the comparative effectiveness of bundles are difficult to find.

For instance, a quasi-experiment by Padula et al. (2015) compared the PU-related quality improvement interventions that were employed in 53 hospitals, but the authors focused on individual activities. Therefore, the results of the study can be used to develop a bundle, but in general, more research devoted to the comparative effectiveness of this type of PU intervention is required.

Potential Clinical Outcome

The main clinical outcome of the proposed intervention is the improvement of the PU-related performance of a studied hospital. Said performance consists of the incidence and prevalence of hospital-acquired PUs and their severity. Some evidence indicates that different PU care bundles can reduce the incidence and prevalence of PUs in varied settings and with diverse patient groups (Chaboyer et al., 2016; Mallah, Nassar, & Kurdahi Badr, 2015; Tayyib et al., 2015).

The statement is true for hospital-acquired PUs (Anderson et al., 2015; Padula et al., 2015). Also, bundles promote PU healing, which, among other things, is associated with fewer cases of severe PUs (Loudet et al., 2015; Tayyib et al., 2015). The measurement of the chosen parameters depends on the means of detecting and assessing the severity of PUs, and PU categories are typically used to this end. They include the first, second, third, and fourth categories, which indicate increasing severity, and the unstageable category, in which slough or eschar prevent accurate assessment (Tayyib et al., 2015).

The rest of the components require the recording and processing of relevant data. PU incidence can be measured by determining the number of new cases for a given period of time (for instance, monthly incidence), and prevalence would be best presented by demonstrating the percentage of patients experiencing the issue (Stanhope & Lancaster, 2015). This way, the PU-related performance of a hospital can be measured.

References List

Anderson, M., Finch Guthrie, P., Kraft, W., Reicks, P., Skay, C., & Beal, A. (2015). Universal pressure ulcer prevention bundle with WOC nurse support. Journal of Wound, Ostomy and Continence Nursing, 42(3), 217-225. Web.

Chaboyer, W., Bucknall, T., Webster, J., McInnes, E., Gillespie, B. M., Banks, M.,… Cullum, N. (2016).The effect of a patient centred care bundle intervention on pressure ulcer incidence (INTACT): A cluster randomised trial. International Journal of Nursing Studies, 64, 63-71. Web.

Demarré, L., Van Lancker, A., Van Hecke, A., Verhaeghe, S., Grypdonck, M., Lemey, J.,… Beeckman, D. (2015) The cost of prevention and treatment of pressure ulcers: A systematic review. International Journal of Nursing Studies, 52(11), 1754-1774. Web.

Loudet, C. I., Marchena, M. C., Maradeo, R., Fernández, S., Romero, V., Valenzuela, G.,… Reina, R. (2015). Impact of a multifaceted intervention on the incidence of pressure ulcers in a medical−surgical ICU. A before-after study. Intensive Care Medicine Experimental, 3(Suppl 1), A926. Web.

Mallah, Z., Nassar, N., & Kurdahi Badr, L. (2015). The effectiveness of a pressure ulcer intervention program on the prevalence of hospital acquired pressure ulcers: Controlled before and after study. Applied Nursing Research, 28(2), 106-113. Web.

Padula, W., Makic, M., Mishra, M., Campbell, J., Nair, K., Wald, H., & Valuck, R. (2015). Comparative effectiveness of quality improvement interventions for pressure ulcer prevention in academic medical centers in the United States. The Joint Commission Journal on Quality and Patient Safety, 41(6), 246-AP5. Web.

Park, S., Lee, Y., & Kwon, Y. (2015). Predictive validity of pressure ulcer risk assessment tools for elderly. Western Journal of Nursing Research, 38(4), 459-483. Web.

Qaseem, A., Mir, T., Starkey, M., & Denberg, T. (2015). Risk assessment and prevention of pressure ulcers: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 162(5), 359- 369. Web.

Roberts, S., McInnes, E., Wallis, M., Bucknall, T., Banks, M., & Chaboyer, W. (2016). Nurses’ perceptions of a pressure ulcer prevention care bundle: A qualitative descriptive study. BMC Nursing, 15(1). Web.

Stanhope, M., & Lancaster, J. (2015). Public health nursing. New York, NY: Elsevier.

Tayyib, N., Coyer, F., & Lewis, P. (2015). A two-arm cluster randomized control trial to determine the effectiveness of a pressure ulcer prevention bundle for critically ill patients. Journal of Nursing Scholarship, 47(3), 237-247. Web.

Integral Nursing And Pain Management Practice


The article by Tracy and DiNapoli (2012) explores the fundamentals of Dossey’s (2008) theory that implies the integral approach to health care services provided related to pain management. The authors of the article emphasize the role of holism and healing as the two key components of the mentioned theory. They provide the background of the situation and point out the lack of sufficient knowledge in practitioners, administrative support, and task-centered care.

The research made by Tracy and DiNapoli (2012) shows that the four quadrants are important to take into account while maintaining pain management, including individual interior and exterior and collective interior and exterior. Considering that more and more patients tend to rely on information found on the Internet, a nurse should be able to search and synthesize the evidence for the relevant care. In other words, the authors conclude that the integral theory presents a rather advantageous model of care based on patient-centeredness, involvement, and appropriate relationships.


The purpose of the given article is clearly defined by the authors, who note the need for the creation of adequate pain management theoretical provisions. This need is also supported by Barr et al. (2013), who note that the current clinical practice guidelines on pain management fail to ensure patients with adequate health care. Tracy and DiNapoli (2012) apply for a literature review as a methodology and overview of many recent credible scholarly sources.

They select Dossey’s theory of integral nursing as a theoretical framework to develop theoretical guidelines for nurses, thus enhancing the effectiveness of their work to meet patients’ needs. The mentioned theory seems to be a reliable and useful one as it integrates the most significant points of the nursing care setting. The key findings are presented in the table format and supported in the written form that promotes visibility of the article and helps readers to understand the authors’ ideas and implications.

Speaking of the implications, one may note that relationship-centered communication is a key goal nurse should pursue to involve in their practice. As noted by the authors of the article, nowadays, patients prefer to be considered as individuals. In this regard, it is of great importance to value their individual needs, expectations, and other peculiarities. By introducing the integral theory of nursing in the clinical setting, nurses will promote an open atmosphere by facilitating conversations between patients, nurses, and physicians.

As a result, patients would feel more comfortable communicating with care deliverers about their pain, thus helping the latter identify the corresponding treatment options and preventing potential complications in the future. Among the Essentials of Master’s Education in Nursing (MSN) that Advanced Practice Nurse (APN) may apply in practice, there are Informatics and Healthcare Technologies and Quality Improvement and Safety.

The strong points of the article are the well-designed organization, theoretical nature, proper citation, use of credible sources, and adequate presentation that facilitates reading. Also, the problem discussed in the article corresponds to the current needs of nursing. The decision suggested by the authors seems to be important as the evidence-based on the previous research supports it. The lack of quantitative data may be considered as a weakness of the article since it could provide more information on the current statistics in the field of pain management, making the article more informative.


Barr, J., Fraser, G. L., Puntillo, K., Ely, E. W., Gélinas, C., Dasta, J. F.,… Coursin, D. B. (2013). Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Critical Care Medicine, 41(1), 263-306.

Tracy, S. M., & DiNapoli, P. P. (2012). Exploring the theory of integral nursing with implications for pain management practice. International Journal for Human Caring, 16(1), 26-33.

Obesity Among The Adult Population: Research Planning

The investigation of the problem implies a specific setting. Considering the hypothesis which states that the improvement of the healthcare will contribute to the better outcomes related to obesity rates, the most common approaches used in the given sphere could be considered the main aspects of the investigation. These become a crucial element that should be included in the investigation because of the character of the research question and the obvious necessity to determine the character and impact of the approaches that are explored in the healthcare today (Fallah-Fini, Rahmandad, Huang, Burens, & Glass, 2014).

About 10 medical care units across the state are chosen in terms of random sampling. Considering the aim of the research, it is necessary to trace the correlation between the level of the suggested services, workers competence and obesity rates. For this reason, such variables as practices that help to treat obesity and the obesity rate in the USA are chosen These are dependent and independent variables correspondingly.

In other words, a set of methods that are today used in the healthcare sector along with the specific equipment becomes crucial for the research (Dietz et al., 2015). The chosen medical care units are located in different regions and are characterized by different environment. The additional training to improve the care delivery and admit its impact on population is common to all units.

As for the type of the research, it could be considered quantitative study that is focused on the investigation of a causal impact of an intervention on a target population. In the suggested study, alteration of the quality of care preconditions quantitative changes in obesity rates. For this reason, it is crucial to apply this study design to calculate basic alterations.


Dietz, W. H., Baur, L. A., Hall, K., Puhl, R. M., Taveras, E. M., Uauy, R., & Kopelman, P. (2015). Management of obesity: Improvement of health-care training and systems for prevention and care. The Lancet, 385(9986), 2521–2533.

Fallah-Fini, S., Rahmandad, H., Huang, T. T. K., Burens, R. M., & Glass, T. A. (2014). Modeling US adult obesity trends: A system dynamics model for estimating energy imbalance gap. American Journal of Public Health, 104(7), 1230-1239.

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