Reduction of Pressure Ulcers in Critically Ill Patients

Implementation of the Program

The implementation phase covers the process that will be involved in performing the evidence-based program to promote reduction of pressure ulcers. The research design adopted in the study will be included in the project’s implementation phase. Other parts that will be considered include the setting of the study, sampling strategy, data collection, and analysis methods. In essence, the timeline for the study is critical and will be incorporated.

Research Design

The study will adopt a qualitative approach to establish the nurses’ knowledge on the risk factors for pressure ulcers and the available measures to prevent the problem. It will also include a quantitative section used in collecting the data on the rate of pressure ulcers at the setting. Collection of the data will be critical in performing a comparison between the rates before and after implementation to establish the effectiveness of the program. The mixed research design is significant, as it will provide detailed analysis of the case. The qualitative study narratives will indicate the nurses’ level of understanding and the gaps in knowledge that should be addressed in future training programs. The quantitative data will indicate the number of cases before and after the program to determine whether there will be a decrease or an increase. The two phases of data collection will indicate the trend in terms of prevention of pressure ulcers following implementation of evidence-based training program.

Setting

Past studies have indicated that most pressure ulcer cases occur in intensive care settings where the patients lie in the same position for a long time based on their inability to move (Aydin et al., 2015). Thus, it would be critical for the study to be carried out in an intensive care setting. The hospital within which the study will be carried is a mid-level hospital in the US with three kinds of ICUs, including the surgical ICU, where there are 10 beds, medical ICU, where there are 11 beds, and anesthesiology ICU with 9 beds. The nurses taking care of the patients within the ICUs will be involved in the study. However, only the full-time nurses will participate in the training program and the interviews.

Sampling Strategy

The study will not use any sampling strategy, as all the nurses providing care to the patients during the study period will be involved. Currently, 14 nurses are involved in providing care, on a regular basis, to the patients within the three ICU settings. However, all the nurses will not necessarily be involved in the study because there are considerations that must be made. It is necessary that the nurses involved in the study provide care regularly to the patients during the entire study period. Any nurse who will be on leave any of the days during the one-month period will not be included in the program. As such, it is anticipated that at least 10 nurses will be available the entire time and take part in the study. The nurses will be involved in the interviews and the training program implementing the preventive measures of pressure ulcers.

Data Collection Procedure

Data will be collected primarily using an interview schedule to provide the awareness of the nurses on the issue of pressure ulcers and the knowledge gap that should be addressed. The interview schedule will cover the four research questions identified earlier, which should be answered by the end of the study. It will cover three areas, including the risk factors for pressure ulcers, the symptoms of pressure ulcers, and prevention measures for pressure ulcers. The second part of the study will be a quasi-experimental study involving implementing a training program for the nurses on the measures used to prevent pressure ulcers. Indeed, the monthly training program will be implemented involving the nurses taking care of the patients within the setting. The nurses will receive training on the use of different evidence-based strategies, including the use of pressure-redistributing devices, post-operative management of patients, repositioning, and nutritional support (Chou et al., 2013). Data will be collected before the implementation of the training program and one month after the implementation of the initiative to establish the potential for effectiveness.

Ethical Issues

Given the fact that the study will be carried out in a hospital setting and will involve human subjects, some ethical considerations must be made. One of the things that will be considered is ensuring that the nurses involved in the study sign an informed consent before proceeding with the study. The participants will also take part in the study willingly and voluntarily. They will also be free to leave the program at any point in the course of the study. The patients will not be directly engaged in the study, while the implementation of the program will not in any way threaten their safety. Their conditions will also remain the same, as it will not be manipulated in any way. Therefore, patients will not be required to sign an informed consent. In fact, provided that the program will be implemented within a hospital setting, ethical approval will be obtained from the ethical board of the hospital board before any data is collected.

Data Analysis

Critical data will be collected using the two research approaches. The data will be analyzed to provide findings that will inform practice and future research on prevention of pressure ulcers. The findings will inform the effectiveness of the training program on preventive measures in reducing the cases of pressure ulcers in intensive care settings (Marsden et al., 2015). The data that will be analyzed using the quantitative measures is what will be collected on the rates of pressure ulcers in the three ICUs before and after the program is implemented. The preliminary data that will be used will be set at a 8.08% rate of pressure ulcer. For the reason of achieving a decrease in pressure ulcer with statistical significance in 80% power, it will be assumed that there will be a reduction in the rate of acquisition of pressure ulcer of at least 30% from the month before the program is implemented to the end of the first month of the evidence-based training.

For the purpose of assessing the changes over time in the rate of acquisition of the pressure ulcers, Poisson regression will be used. The overall rate of bedtime for the patients will be unlisted to calculate the total number of patients developing pressure ulcers. The researcher will use adjusted incidence rate ratios to report the findings together with a confidence interval of 95%. The data will be analyzed using SAS, version 9.2 (SAS Institute, USA) (Yap et al., 2013). For the analysis of the responses obtained using the interview schedules, discourse analysis will be used, which will indicate the changes within the settings following implementing the evidence-based training program for the nurses. It will also indicate the knowledge attainment and gaps that will be filled in future studies.

Project Timeline with Milestones

From the framing of the study, it is evident that more than one month will be necessary to implement the program. The program will take place for two months, where during the first month, preparation and the initial part of the study will be carried out where interviews will be conducted. The training program will be implemented during the second part of the first month. The last part of the second month will involve final collection and analysis of the collected data and writing of the report detailing the findings.

 March-April 2016

Summary

The section provides important information on the implementation of the program aimed at reducing the rate of pressure ulcers within intensive care settings. The study’s design, the sampling strategy used, the data collection, and analysis procedures used in the program are indicated and discussed in the implementation phase.

References

Aydin, C., Donaldson, N., Stotts, N. A., Fridman, M., & Brown, D. S. (2015). Modeling Hospital-Acquired Pressure Ulcer Prevalence on Medical-Surgical Units: Nurse Workload, Expertise, and Clinical Processes of Care. Health Services Research, 50(2), 351-373

Chou, R., Dana, T., Bougatsos, C., Blazina, I., Starmer, A. J., Reitel, K., & Buckley, D. I. (2013). Pressure ulcer risk assessment and prevention: a systematic comparative effectiveness review. Annals of Internal Medicine, 159(1), 28-38.

Marsden, G., Jones, K., Neilson, J., Avital, L., Collier, M., & Stansby, G. (2015). A cost-effectiveness analysis of two different repositioning strategies for the prevention of pressure ulcers. Journal Of Advanced Nursing, 71(12), 2879-2885.

Yap, T. L., Kennerly, S. M., Simmons, M. R., Buncher, C. R., Miller, E., Kim, J., & Yap, W. Y. (2013). Multidimensional Team-Based Intervention Using Musical Cues to Reduce Odds of Facility-Acquired Pressure Ulcers in Long-Term Care: A Paired Randomized Intervention Study. Journal Of The American Geriatrics Society, 61(9), 1552-1559

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