NURS 412 Research Critique Paper Guidelines Spring 2019 The Research Critique Paper is worth 50 points and is due Monday, April 15th at 800am. The purpose of this assignment is to help you find comple

Pressure Ulcers


Institutional Affiliation:


Research Critique Paper


It is evident that pressure ulcers and its risks are connected to the health and behavior of a

patient. Suggestive evidence also shows that how treatment takes place and care given

afterward can affect the patients’ risk propensity. The research objective aims to get a clear

understanding of the organizational context influences the advancement of a more severe

pressure ulcer. The second objective is in identifying the various ways in which root cause

analysis of the reportedly pressure ulcer could be made better to gain knowledge on them.

This abstract summarizes the background, methods used, the study made, results gotten as

well as the summary in a logical manner.


In the healthcare setting, pressure ulcers have been a major issue, and they are more

prominent in people who have difficulty moving or those who cannot change positions.

Mostly it happens among the elderly, those with a spinal cord injury or those who are being

operated on. They occur due to the prolonged and uneased pressure due to the force. There is

a basis in thinking about a patient’s pressure ulcer. The first is assuming the pressure ulcer is

linked to the patient’s behavior or their health. Medical practitioners are therefore required to

assess and identify those who are at a higher risk, evaluate the degree of the risk and come up

with intervention to reduce or counteract the potential effects. This method of approach

highlights the urgency of taking the assessment. The other way of looking at it assumes the

quality of care and treatment has a part to play in influencing the risks of getting pressure

ulcers. As some environments are riskier than others are, patients who receive inadequate

care and treatment are at more risk of developing pressure ulcers. This can be seen in the

events at the Mid Staffordshire NHS foundation trust, which had more than dozens of

pressure ulcers being reported in a month. This makes the last assumption significant to this


We will look at the second assumption in this study. In official guidelines, that pressure ulcer

of category 2 or above is rated on the NPUAP/EPUAP, on a scale of between 1 to 4. Pressure

ulcer in group 3 and 4 should be reported as severe. In the NHS Safety Thermometer,

pressure ulcers are one of the four indicators when it comes to patient safety. In the CQUIN

(Commissioning for Quality and Innovation) structure, there are incentives made for the

avoidance of pressure ulcers. For nurses and midwives, NHS has a ‘no avoidable pressure

ulcer’ goal thus classifying pressure ulcer prevention as a high-impression action. There are

however little resources linking the care procedures influencing the occurrence of pressure

ulcers and making them sever. This study will act as a guide when it comes to assessing

pressure ulcers as well as ways in which the care process brings about the development of

pressure by backtracking to events that lead to the growth of a pressure ulcer until it becomes

severe (White et al., 1983).

Research problem, purpose and question

The research problem addressed in this paper is the relationship between a patient’s pressure

ulcer and the care they get from nurses and medical practitioners. This is a major issue

especially when a certain number of patients are getting pressure ulcers, which translate to

poor care (Lanig,1989).

The study has three major works to make the work package. They include empirical work to

improve our comprehension and grasp how taking care of patients influences the

development of pressure ulcers in 9 patients. The second is the conduct of the patient

involved in the workshop. Last is the development of a methodology for the root cause

analysis of pressure ulcers. Nurses and those offering patients the care needed should

understand how their actions affect the development of pressure ulcers and why it affects the

severity of these ulcers. Another purpose is to identify how the root causes of pressure ulcers

can be improved to learn from them.

Study Design

Our organized workshop was facilitated as well as developed by the PURPOSE PPI Office, a

field researcher specializing in severe pressure ulcer study and a member of PURSUN UK.

The design of the workshop was along the lines of public enquiry where participants would

get invited to act as a witness in the cases given to them.

Materials of three types were well prepared before the start of the workshop. In the first, the

patient talks on her health problem and the treatment used to create a briefing for a simulated

patient. The member of PURSUN UK, who holds his position as specialist expertise took the

patient’s role in this case. The researcher then interviewed the simulated patient on their

experiences, of which results were presented live at the seminar.

The seminar took place on the 17th May of 2013 in Leeds and had nine members present

from PURSUN UK, six research project team members as well as two NHS PPI managers.

Various make-believe patient models have been in use in the for the past 5 centuries, and

used especially in training in communication skills or health professional assessment

regarding research. The second was a professional’s account of events that were made into a

short video. Seminar facilitators prepared a brief for the actors and were asked to avoid using

quotes or reading from the script, which might have made the patient get identified. Lastly,

using the Prei software, a visual timeline of events was prepared for presentation.

These two arguments influenced this research design – severe pressure ulcers were due to the

organizational structure in the care and treatment given to them by the nurses. However, this

could not be simply assumed as they could get studied empirically. Empirical evidence

though limited has literature, which gives three major explanations in the development of

pressure ulcers following the mistakes from the caregivers’ side, maybe from an unrelated

error, and lastly there are weaknesses within the systemic organizational context of care

delivery in which the development of pressure ulcers can quickly occur.

The other argument is based on the nature of pressure ulcers occurring over a wide range of

events and settings, over a period of days to weeks. Though it is not possible to know who

will develop them or who will not, it is only possible to identify the risks factors and those

who have ever developed a severe pressure ulcer. The reason behind identifying those who

had developed these ulcers was to recreate the scenario. Using a process-tracing method, the

experiences of the nine individuals were captured and used in the reconstruction. Events and

accounts of their experiences were compared so to identify common features as well as



The nine patients recruited were from five NHS trust foundations, England. For four patients,

their accounts occurred mainly in hospitals, another four in their homes and the last one in

both a community hospital and a rehabilitation ward.


The dependent variables in this study were the presence of the pressure ulcer, the stage in

which the pressure ulcer was at and its severity. The independent variables included those as

tissue oxygenation, the patient’s age and the length at which they were in the hospital, the

length of the surgical procedures as well as factors like their blood pressure and smoking.

Literature Review

Pressure ulcers are a major issue in the health facilities, especially when it is due to the

negligence and the poor quality of care the medical practitioner. As for the patient, they are to

be treated and monitored effectively. This is followed by immediate intervention as soon as it

has been identified using various actions to prevent any further severe damage or the

occurrence of another pressure ulcer. Responses include those as making sure that a PURA

(Pressure Ulcer Risk Assessment) has been carried out and completed. Secondly, the Pressure

Ulcer Prevention Care Plan is suitable for the patient’s risk status. What is also critical and

crucial when assessing a pressure ulcer is constant vigilance concerning the skin around the

ulcer and ensuring the wound management and care method in place is relevant for each

stage as well as the skin area. Findings should be documented and actions taken as an

ongoing process of pressure ulcer management as per the service care record. Let the patient,

as well as the family members, know the damages made from pressure ulcers as well as the

next step to be taken. This is not just important in letting them know what it is or what is

involved as it contributes to confidence as well as trust between the patient, medical

practitioner as well as the family members. Effective equipment use, nutritional interventions

as well as consistent management should be continued with as well as evaluating the

effectiveness of the strategies used to manage the pressure ulcers.

Two medical experts involved in the empirical study of severe ulcer study conducted the

research work. One member played two roles having experienced severe pressure ulcers and

as a senior researcher in the NHS organization. The project’s scope was established as

devising an investigative process suitable for use in the NHS to drive care setting in the

community. Another reason is to establish the value of the patient’s voice and the difference

in traditional root cause analysis process as well as the significance of the findings for better

planning and management change. The used methodology encouraged open contributions to

understand better and learn what improvements are required as well as what practice is the

best. Feedback is also important in the management and prevention of pressure ulcers.

As per the findings of the study, the team viewed the methodology includes a narrative of the

events leading to the development of the pressure ulcer as per the conversations with the

patients and family or staff with the knowledge of relevant incidents. There should also be a

timeline outlining the relevant events based on the information in the patient’s records,

identification of the best practice that maybe the patients might have expected.

It was found that seven of the nine participants had complex needs in terms of care and

treatment. As with the interviewed nurses, they blamed the patients for not having complied

with the advice in managing the risk. The patients in the same account blamed it on not being

regularly being turned especially at night, not being provided with a specialized mattress or

the nurses not paying attention to comments about the risks involved.

Those who participated in the interview had different opinions. Some patients and nurses

knew what was or had gone wrong while others did not criticize any event during their care.

Some accounts saw the patients moving from ward to ward (Bredesen et. al, 2016).

Implications for Future Nursing and Research

Findings of the reviews were those based on decisions and events identified in the root cause

analysis. The patients and the caregivers did not recognize the actions and the decision to be

taken, themselves. Instead, investigators did so using the descriptions the patients gave. This

enabled the patients to provide their side of the story regarding the manifestation of the

pressure ulcers.

The study proved to be worthwhile with the integration of the best research evidence and

clinical practices as well as patient needs and values in delivering high-quality health care.

Also, there is a need for information and guideline synthesis to direct better nursing practices

and interventions.

Strengths and Limitations of the Study

The strengths in the study include the study being the first in evaluating the patient’s

pathways and the link to resource use, outcomes as well as costs in managing the pressure

ulcers over close to 12 months. Second, the study used evidence from anonymous records and

those in the real world. The estimates made were gotten from a systemic analysis of a

patient’s health, characteristics as well as the care used in the management of the pressure

ulcers. These care resources used were contained in electronic sources, therefore, their safety

and importance when it came to information retrieval.

Some limitations included the electronic information collected by the general practitioner, as

well as other terminology has not been made valid in the clinical practice. Also, the analysis

doesn’t put into consideration those with wounds that were still unhealed long after the study

period was due or even the potential effect on managing patients with pressure ulcers and

those being cared for in homes both residential and nursing.


It was found out that pressure ulcers were more likely to develop when the medical

practitioners refused or failed to respond to a patient developing pressure ulcer or already had

one, as well as poorly conducted services. As with the findings, there is a need to steer away

from identifying the root cause analysis and shift towards a more comprehensive explanation

of events to determine the best fit in patient safety and management literature.

In conclusion, the pressure ulcer study package included three pieces of works including the

study of the nine patients who have ever had severe pressure ulcers. The second work

involved the participation of patients in the workshop and seminars, and lastly, the study shed

light on the development of the methodology used in the root cause analysis. The study

reinforces the paying attention to details, promoting learning instead of blaming others and

the importance of collecting the right information as well as logically presenting it.

Works Cited

Bredesen, Norman, M., Bjoro, Kaland, H., Gunningberg, Lewis, D., & Hofoss,Lopez, D.

2016. Effect of e-learning Program on Risk Assessment and Pressure Ulcer Classification: A

randomized study. 4


Edition. p. 191-197.

Seekins, Tanker G., White, Greg, M., Ravesloot, Clement C., Lopez, John. C., Norris, Khole,

B., Golden, King, H., & Darrow, Aaron. A. 1993. Qualitative assessment of health practice

and outcomes of adults with physical disabilities. 3rd Edition. p. 441

White, Greg, W., Mathews, Ramon, M., & Fawcett, Smith, B. 1989. Reducing Risk of

Pressure Sores: Effects of watch prompts and alarm avoidance on wheelchair push-ups.

Journal of Applied Behavior Analysis. 3


Edition. p. 287-295.

Whiteneck, Graham, G., Charlifue, Shawn, W., Gerhart, . A., Lammertse, Deon, P., Manley,

Sohn, L., Menter, Ruiz, R., & Seedroff, Keller, R. 1993. Aging with spinal cord injury. 2nf

Edition. p. 78

Elliott, Trevor, R., Witty, Titus, E., Herrick, Stephen, N., & Hoffman, John, T. 1991.

Negotiating reality after physical loss: Hope, depression, and disability. Journal of

Personality and Social Psychology. 4thEdition. p. 608-13.

Lanig, Issa, S., Chase, Tim, M., Butt, Lohan, M., Hulse, Kling, L., & Johnson, Luther, K.

1996. A practical guide to health promotion after spinal cord injury. 5th Edition. p. 332

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