Evidence-based nursing practice relies on evidence from research and refers to clinicians making an effort to integrate research finding into clinical thinking and decision making (JA Fain, 2017, P. 5). Critically appraising studies is necessary before basing your practice on it. Critical appraisal focuses on weighing up evidences, assessment of benefits, strengths and weakness of the research, and assessing research method, process and results.
This writer is interested in studies of how the use of air mattresses on patients with limited mobility helps to prevent pressure ulcers from developing. In this critique, a qualitative study published in 2017 in the British Journal of Nursing is inspected. This article “A 100 patient clinical evaluation of an alternating pressure replacement mattress in a home-based setting” was written by Stephen-Haynes, Jackie, & Callaghan, Rosie.
Pressure ulcers are a concern in the US and internationally due to their significant clinical and financial impact. According to the Agency for Healthcare Quality and Research, 2.5 million patients per year are affected by pressure ulcers in the US and the cost related to pressure ulcers ranges from $ 9.1 to $11.6 billion per year. Patients affected by pressure ulcers suffer from complications such as pain, infection, scarring, prolonged hospital stay, and permanent disability. Each year 60,000 patients die as direct result of a pressure ulcer.
The authors have depicted the significance of the research in an effective manner wherein they have discussed the prevalence of pressure ulcers in European hospitals ranged from 8.3% to 23%, the high cost incurred for treating pressure ulcers in the UK is estimated to range from £43 to £374 daily. Authors discussed on the need of a multidisciplinary approach in prevention and management of pressure ulcers, such as: skin inspection, surface assessment, keeping patient moving, management of incontinence, maintain and monitor nutritional and hydration status, the provision of pressure-redistributing equipment remain paramount.
Purpose of The Study
A health and care National Health Service (NHS) trust was exploring for an alternating pressure air mattress (APAM) because the system it used was being discontinued. The trust was looking for an alternating pressure air mattress that plays a positive role in prevention and management of pressures ulcers, and at the same time a mattress with low maintenance cost that would need servicing once every two years as opposed to once a year. The authors have described the research purpose to evaluate the impact of an alternating air pressure mattresses on people with a high risk of pressure ulceration and those with existing pressure ulcers of up to grade 4. Determine patient and family satisfaction with comfort, gather the views of clinicians who provided care for patients using the APAM in response to clinical outcomes. In addition, the study considered the input on infection prevention and control, servicing, maintenance and electrical engineer.
List of Research Questions
Researchers used closed ended question to conduct the study. However, three patients’ comments were included in the study. To consider the outcome on general skin condition clinicians were asked if the skin remained the same, improved, and deteriorated. To evaluate moving and handling staffed asked if it remained the same, improved, or unchanged. Patient comfort was assessed by asking patients if the APAM was more comfortable, the same, or less comfortable compared to previous foam mattress. To evaluate noise level patients were asked if the pump noise was the same, quieter, or noisier as compared to previous pressure mattress. Set up and instructions were evaluated by asking staff if the mattress was quick to set up or not. To evaluate clarity of instruction manual staff asked if they found the instruction manual clear or unclear. Finally clinicians were asked if they recommend the use of the evaluated APAM with in the trust, 96% said they would recommend.
Method of Study
The study was phenomenological, the data was collected from individuals who lived through those experiences and described their experiences. The study took place for a 12-month period on a hundred patients in their own homes. The authors selected participants who met the following criteria: over 18 years old, lived in their own home, able to consent, were at high risk for pressure ulcers (Waterlow, 2005) or had an existing deep pressure ulcer, and required an alternating pressure mattress using the trust equipment algorism. Giving the criteria they used in the study.
For this research work, the literature review for the study was included in the introductory paragraphs of the article. Authors used eight articles for literature review, all articles are published within five years of the study and included both qualitative and quantitative studies.
Results of Study
After the study, skin condition of the 100 patients who were at high risk for pressure ulcers or had existing pressure ulcers were evaluated by clinicians. The skin remained the same in 50% of the patients, skin condition improved in 39% and deteriorated in 7%, assessment was not complete in 4% of patients. While using APAM 53% of patients had their pressure ulcer improved, 20% remained the same and 5% deteriorated. Comfort level was rated by patients; 43% think the mattress was more comfortable than previous foam mattress, 28% saying it was the same, 5% reported it is being less comfortable. The mattress was accepted by patients and families, and staff members. The alternating pressure mattress replacement system was evaluated as comfortable, less noise, easy to set up and use. No issue with cleaning.
The study was approved by clinical governance department. All patients received comprehensive information about the study. All patients were above 18 years old and capable to consent. Patient privacy were maintained on the published article.