Feeding Tubes and the Prevention or Healing of Pressure Ulcers - Case Study Example

Critical Appraisal of Quantitative Published Research Papers Name Institution Course Instructor Date Critical Appraisal of Quantitative Published Research Papers Introduction According to Dr. John Gilbert, Barbara Mary Piro died on 23 October 2008 not only for being very elderly (91years), but for being immobile which led to thrombosis that caused her death. It is also clear from the coronial inquest of the death of Barbara that the immobility state which led to thrombosis was caused by the ankle and bed pressure sores (pressure ulcers). In recent times, the pressure ulcers have emerged as the major cause of death among the elderly people who are mostly bedridden or immobile (Kalava, Cha & Takahashi, 2011, p. 213). The ulcers result from the breakdown of the skin on the area that is under pressure such as the bony parts. In addition to pressure, other factors that contribute to the formation of pressure ulcers include friction, moisture, traction and malnutrition. It is important to note that as people age, the skin also ages with time. Apart from the age, other factors such as exposure to sunlight, hydration and dehydration, and nutrition determine the rate at which the skin ages. They all contribute to the thinning of the dermis tissue of the skin characterized with increased rate of cell turnover (Teno, et al., 2012, p. 698). Practically, the expectation from the above stated facts is that people’s skins deteriorate with age and disability. In this regard, the skin does not only become fragile, but also it takes time to heal when it is wounded or injured. The treatment of pressure ulcers has become more difficult compared to prevention. It is not due to the high cost of treatment, but it is because there is no particular medication that is designed to treat pressure ulcers. The existing medical treatment involves draining of the ulcers, decreasing pressure on the ulcers, cleaning and dressing the ulcerous wounds, administering antibiotics to prevent opportunistic infections, conducting surgery for larger ulcers and finally providing suitable nutrition. A lot of research has been done on the treatment of the pressure ulcers, but no particular concrete medical solution has been found due to the diversity of the ulcers. The only effective way to deal with pressure ulcers it is to prevent their formation in the first place. Prevention involves repositioning of immobile individual at an interval of 1-2 hours (Kalava, Cha & Takahashi, 2011, p. 213). Also, many scientific models label malnutrition as the main factor that contributes to the development of pressure ulcers. There is a lot of scientifically proven evidence that nutrition plays an important part in the well-being of the body and the skin. Also, consumption of adequate balanced diet has been proven as a prevention of many diseases and infection. However, there is no scientific data to show if balanced and adequate diet can prevent the development of pressure ulcers in the elderly (Teno, et al., 2012, p. 700). There is need to conduct a quantitative research to prove the proposed theories on nutrition and pressure sores in adults. Moreover, the findings of the research will be important in designing a preventative approach of balanced nutrition to prevent the rising cases of pressure ulcers in the elderly. Research question The qualitative information on the possibility of preventing development of pressure ulcers in the elderly is based on theoretical concepts. Therefore, there is need to conduct a quantitative research not only to fill the gap on importance of nutrition to the elderly, but also to aid in developing a designated approach that will ensure adequate and effective administration of nutritional needs to the immobile elderly individuals as a way of preventing the initial development of pressure ulcers. In this regard, the quantitative research question will be does nutrition help to prevent pressure ulcers in the elderly people? Critical appraisal of literature It is important to address the background quantitative research on the research question to provide a deeper understanding of the area of research, help to focus on the research question, assist in formulation of objectives and hypothesis and aid in the design of the appropriate research methodology. Therefore, the critical appraisal of literature linked to the study question is important to identify the relevancy of each literature review on the research process. In this regard, this section concentrates on critical evaluation of literature that befits the study. The first study deals with the management of pressure ulcers. As an emerging risk factor among the elderly, the study’s objective is to establish if the current treatment of pressure ulcers is effective compared to standard care (placebo care) (Pham, et al., 2011, p. 467). The study employs a close analytical outcome of the elderly patients who use medications and those who rely on placebo. The study employs a contextual review of the existing literature on treatment of pressure ulcers to provide qualitative information that defines the study’s quantitative analytical methodology (Pham, et al., 2011, p. 467). The methodology relies on the case study approach and comparison tables to determine the collected outcomes. The results reveal that both treatment and standard care provide minimal remedy to the patients with pressure ulcers. The research is important to the research question because it shows the necessity of exploring preventative actions such as nutrition. Therefore, the second possible action calls for the study of preventative measures. In this particular study, the authors’ objective is to establish an appropriate method of preventing pressure ulcers (White-Chu, et al., 2011, p. 242). The study relies on the descriptive analysis and comparison of quantitative secondary information. It retrieves the data from online scientific libraries such as MEDLINE and NCBI. This shows that the study targets to find any previous studies on prevention of pressure ulcers and establish the appropriate possible method of prevention. In the results, the study reveals that the mattress quality plays an important part in the development of pressure ulcers. It recommends the use of a high quality mattress for bed-ridden patients rather than using the standard hospital mattress (White-Chu, et al., 2011, p. 242). However, the study does not indicate the appropriate size of mattress that prevents development of ulcers. The study gives the research a directive recommendation to explore better prevention methods. The third study concentrates on the Decubitus ulcers (Anders, et al., 2010, p. 317). It is the commonest type of the Pressure ulcer, therefore, the study’s objective is to contextualize on its pathophysiological characteristics to find possible methods of preventing the proliferation of the ulcers in elderly individuals. It is an appropriate research in the medical field because it provides the missing information on the formation and occurrence of pressure ulcers. The descriptive methodology in this context includes collection of data on the symptoms, diagnosis, prevention and treatment of Decubitus ulcers (Anders, et al., 2010, p. 317). The results reveal that the pain and soreness accompanies the ulcer. In all patients the study identifies the ulcer with soreness and redness. The study recommends preventative actions such as nutrition as an alternative to the impossibility in treatment of the ulcer (Anders, et al., 2010, p. 317). The study gives the research provides the information of researching on nutrition as the sole inhibitor of pressure ulcers. In the fourth quantitative study of using preventive devices of pressure ulcers among the elderly in early days of hospitalization, the quantitative research question is relevant because the findings of the study equips the medical practitioners with the knowledge of on how to use the devices to reduce the susceptibility to pressure ulcers among the elderly (Rich, et al., 2009, p. 95). The study employs cross-sectional quantitative case study to collect and record data on patients that use preventative devices and those that do not do the same in the early stages of hospitalization. However, contrary to what the expectation, the results of the study reveal that the elderly patients develop the pressure ulcers even if the medical practitioners administer preventative devices. The study fails to fulfill its main objective of proposing the use of preventative devices as an alternative preventative method of pressure ulcers (Rich, et al., 2009, p. 95). However, the study is relevant to the research question because it provides background information on pressure ulcers. Since the preventative devices fails to meet their prospected significance, Kottner & Balzer (2010, p. 103) in the fifth quantitative study assess the effectiveness of ulcer risk assessment scales in measuring the susceptibility of a patient to pressure ulcers. The objective of the study is to establish the relevancy of the scales in the medical field. The semi-experimental approach of the study is in line with its objective, whereby, the authors evaluate the scales on three points of view which include measurements of scales, clinical evaluation and practical application. The results of the study portray the irrelevancy of the scales. However, the study fails to meet the accuracy standards of a scientific paper (Kottner & Balzer, 2010, p. 103). In this regard, the study achieves its objective, but it portrays a certain degree of biasness. The study is relevant to the research question because it provides information on how to avoid biasness in the methodology of the research. The disapproval of scales prompts a sixth study that proposes the use of pressure redistribution approach on the surface area of support for immobile elderly patients. The objective of Rich, et al. (2011, p. 1052) is to establish if there is a relationship between pressure redistribution surface area support (PRSS) and development of pressure ulcers. The methodological design of the study conducts an empirical correlational analysis of the data collected on patients after 21 days of admission; the study focuses mainly on the relationship of PRSS and pressure ulcers. In the process, it fails to address the necessity of the research in the medical field. However, in the results, Rich, et al. (2011, p. 1056) show a slight connection between PRSS and pressure ulcers. In this regard, PRSS proves relevant to immobile patients before they develop pressure ulcers. It is a significant milestone in establishing preventative approaches of pressure ulcers. The study aids the research question on how to focus on the objectives. The slight connection between PRSS and pressure ulcers prompts the authors in the seventh study to conduct a further analysis of the same, but this time they base their study on a prolonged administration of PRSS on patients with pressure ulcers (Baumgarten, et al., 2009, p. 101). Baumgarten, et al.’s (2009, p. 101) objective in this context is to establish if PRSS is advantageous or disadvantageous to the elderly patients with fractured hips. In the process they adhere strictly to prevention guidelines. The methodology reflects the one the sixth study uses, however, this particular study prolongs the time of assessment. The results of the study reveal that prolonged and carefully administration of PRSS in patients with pressure ulcers improves their state of health (Baumgarten, et al., 2009, p. 101). However, the approach requires intensive research to ensure it is risk free. The study contextualizes on the relationship between PRSS and pressure ulcers which makes it significant in the research because it provides the appropriate methodological design. With the increasing complexity in the prevention of the pressure sores, the eighth study explores the influence of myelomeningocele (MMC) in the prevention of pressure sores (Nthumba & Bird, 2010, p. 128). The main objective of the study is to establish the influence of other health disorders in the management of pressure ulcers. It employs a questionnaire (survey) methodology in the collection of data and comparison tables in the analysis process. The study achieves its objective because it reveals that patients with certain disorders such as MMC and Arnold Chiari malformation contribute to formation of ulcers (Nthumba & Bird, 2010, p. 128). They also complicate the process of treatment. However, it recommends for early treatment of the ulcers which is impossible basing on the evidence in the critical appraisal. The study aids the research in identifying other disorders to consider in the methodology to prevent biasness and inaccuracy of the methodology. The diversity of finding factors that influence the prevention of pressure ulcers in the elderly stills forms the objective of the ninth study which explores the effect of feeding tubes on prevention or healing of the pressure ulcers (Teno, et al., 2012, p. 698). The study employs a quantitative meta-analysis approach to establish the relationship between feeding tubes and pressure ulcers. The researches conduct the study in a systematic manner to avoid biasness. In the results, the study reveals that the feeding tubes do not influence the prevention or the treatment of the pressure ulcers. Although the study identifies a factor that the research question does not need to consider in the methodology, it fails to state other unnecessary factors. That calls for the final study in the literature review which explores the importance of vitamin D on patients with pressure ulcers. The main objective of the study is to identify if the deficiency of Vitamin D contributes to the development of pressure ulcers in the elderly (Kalava, Cha & Takahashi, 2011, p. 213). The methodology of the study employs an experimental approach to observe and collect data on patients who access adequate vitamin D and those who do not over a period of six months. Vitamin D is important in the development of the skin this gives the study a mandate to explore it as an independed factor that prevents the development of pressure ulcers. The results reveal that patients who consume enough amounts of vitamin D did not develop pressure ulcers rapidly in comparison with those who did not (Kalava, Cha & Takahashi, 2011, p. 213). This study provides evidence that nutrition prevents development of ulcers. Therefore, it provides the research with directions and appropriate methodology to explore the ulcer-preventative actions of balanced diet nutrition. Conclusion The critical appraisal explores the background of the pressure ulcers. In the process, it is possible to identify Decubitus as the common type of the pressure ulcers that affects the immobile elderly individuals. As a result, it is easier to understand the causative elements of the pressure ulcers and the possible ways of treating the ulcers. However, the literature reveals that there is no concrete medication to prevent or rather treat pressure ulcers. This leads to creation of a research gap to find an alternative way of dealing with pressure ulcers. On this aspect, the literature reveals that the only way to deal with pressure ulcers is to prevent their development in the first place. Although various preventative methodologies are explored in the literature articles, the only method that shows significant results is the administration of balanced diet nutrition to immobile patients. Therefore, the objective of the research will be to establish the relationship between a balanced diet nutrition and development of pressure ulcers in elderly patients. The research will employ the case study and experimental research designs. However, the appropriate design that will answer the research question and the objective of the study will be the experimental design. It is because; the experimental design will provide the methodology required to assess the outcome of providing appropriate nutrition to the elderly. The experimental design will avail supporting literature, procedure, apparatus, safety measures, analytical tools and computational devices for the effective and accurate conduction of the research. In simple words, the whole process itself is experimental intended to test if nutrition is the best approach of preventing or treating the pressure ulcers in the elderly, especially those who cannot move. References Anders, J, Heinemann, A, Leffmann, C, Leutenegger, M, Pröfener, F & von Renteln-Kruse, W 2010, ‘Decubitus ulcers: pathophysiology and primary prevention,’ Deutsches Ärzteblatt International, vol. 107, no. 21, p. 371. Baumgarten, M, Margolis, D, Orwig, D, Hawkes, W, Rich, S, Langenberg, P & Magaziner, J 2009, ‘Use of pressure-redistributing support surfaces among elderly hip fracture patients across the continuum of care: adherence to pressure ulcer prevention guidelines,’ The Gerontologist, p. 101. Kalava, UR, Cha, SS & Takahashi, PY 2011, ‘Association between vitamin D and pressure ulcers in older ambulatory adults: results of a matched case–control study,’ Clinical interventions in aging, vol. 6, p. 213. Kottner, J & Balzer, K 2010, ‘Do pressure ulcer risk assessment scales improve clinical practice?’ Journal of multidisciplinary healthcare, vol. 3, p. 103. Nthumba, P & Bird, G 2010, ‘Marjolin's ulcer in a spina bifida patient. A case report,’ East and Central African Journal of Surgery, vol. 15, no. 2, pp. 127-129. Pham, B, Teague, L, Mahoney, J, Goodman, L, Paulden, M, Poss, J & Krahn, M 2011,’Early prevention of pressure ulcers among elderly patients admitted through emergency departments: a cost-effectiveness analysis,’ Annals of emergency medicine, vol. 58, no. 5, pp. 468-478. Rich, SE, Shardell, M, Hawkes, WG, Margolis, DJ, Amr, S, Miller, R & Baumgarten, M 2011, ‘Pressure‐Redistributing Support Surface Use and Pressure Ulcer Incidence in Elderly Hip Fracture Patients,’ Journal of the American Geriatrics Society, vol. 59, no. 6, pp. 1052-1059. Rich, SE, Shardell, M, Margolis, D & Baumgarten, M 2009, ‘Pressure ulcer preventive device use among elderly patients early in the hospital stay,’ Nursing research, vol. 58, no. 2, p. 95. Teno, JM, Gozalo, P, Mitchell, SL, Kuo, S, Fulton, AT & Mor, V 2012, ‘Feeding tubes and the prevention or healing of pressure ulcers,’ Archives of internal medicine, vol. 172, no. 9, pp. 697-701. White-Chu, EF, Flock, P, Struck, B & Aronson, L 2011, ‘Pressure ulcers in long-term care,’ Clinics in geriatric medicine, vol. 27, no. 2, pp. 241-258. Read More