Alternating Pressure Mattresses Effectiveness in Preventing Pressure Ulcers as Compared to the Regular Mattresses - Research Proposal Example

Alternating pressure mattresses effectiveness in preventing pressure ulcers as compared to the regular mattresses By Your Name Unit/Subject Name and Code Instructor’s Name Institution’s Name Abstract The study will evaluate air mattresses effectiveness in preventing pressure sore as compared to the regular mattresses. Pressure ulcer is a serious health problem in the health care system. The pressure ulcer is known to prolong the suffering of patients and also increase the treatment cost. Governments and insurance companies spend much money on the hospitalization of such patients who were diagnosed with pressure ulcers as primary and secondary cases, excluding the maternal and neonatal conditions (McGowan et al. 2000). Most pressure ulcers are preventable by the use of proper and recommended methods. With the use of the said devices, the quality of hospital services and patient safety is improved, therefore, maintaining a low incidence and prevalence of pressure ulcer that will alternatively lead to both reduced patient suffering from a wound and also reduced expenditure. The main purpose of the study is to it to carry out the literature on the alternating pressure air mattresses (APAMs) as an effective preventive measure for ulcers patients (Hansen 2006). The scope and research questions First question: What is the effectiveness of alternating pressure air mattresses in preventing pressure ulcers as compared to the regular mattresses? Second question: what other pressure relieving devices that are mainly used in caring for ulcers patients? Third question: What are the common sites that pressure ulcers attach most? Question four: Can the pressure relieving devices and methods be combined? Question five: what is the comparison between the use of alternating pressure mattress and other pressure relieving devices? Methods of research The research will be conducted by the application of electronic search through searching of electronic database, proQest, pub med, other hand search using the Google scholar, and other online sources will be utilized in the study. Recommended search criteria and strategies for inclusion will be applied using pressure ulcer and prevention of pressure ulcer and relieving of pressure or use of mattress to relieve pressure or redistribution of pressure using mattress (Tweed 2006). Introduction According to medical records kept by the World health organization (WHO), pressure ulceration affects millions of people worldwide. The occurrence of the said conditions is mainly due to both extrinsic and intrinsic of patient’s pressure which is also referred to as decubitus ulcer. The fundamental cause of pressure ulcer in many people has been established as the prolonged pressure from the body weight on the localised bony prominence, nutrients supply to tissue and blood vessels (Polit 2012). The human body can tolerate pressure if skin is intact if there are no any interventions to get rid of the extinct hazard factor. The tissue could result in skin breakdown or deep tissue injury. Pressure ulcer is mostly found in sacrum, heels, ischium and bilateral trochanter areas. Pressure ulcer if often potentially preventable there are a sort of risk factors of developing ulcers that include sensory perception, nutrition status, medical condition and mobility (Cullum 2003). Pressure ulcer is assessed using common tools such as the Braden scale, Norton scores and water low score that indicate pressure. Promptly risk assessment and intervention can be used to minimise the incidence of stress ulceration in a patient, the health costs and pain suffered by patients can be minimized and therefore improve the quality of life of the patient (Cullum et al. 2001). Connectively, the central principle of pressure of prevention and reduction is to remove any existing exert pressure, or either avoid any prolong pressure to certain tissue. In the modern world, we are leaving in; there are many pressure relieving devices that are easily available in the market for health care providers (Polit 2012). Medical practitioners use these devices with the aim of preventing pressure ulcer in daily care, such as foam mattress, alternative pressure air mattress, overlay, cushion and low air loss bed. Nevertheless, due to the advancement of technology, these devices become expensive day by day (Polit 2012). The utilization of this equipment to prevent and reduce pressure ulcer in the threat group is significant in the daily health care. Additionally, the incidence of pressure ulcer in a health setup is also considered as a patient safety issue and an indicator to quality of service to the hospital. Connectively, the utilization of this equipment to prevent pressure ulcer in the risk group is also a significant in the daily health care (Defloo 2000). APAMs have not been studied intensively, however, Pubmed 2004 search; 19 studies were identified where eight randomised controlled trials were applicable to the subject of this study. According to the test five reported no statistical difference in the effectiveness of APAMs and other various constant low-pressure devices. After the test, it was found out that the relative benefits of alternating pressure mattresses and constant low-pressure devices are unclear. Objectives of the study The paper aims to review the latest articles and research papers of pressure relieving devices that are used in medical institutions and hospitals and also related to the risk group to develop pressure ulcers. The study will also compare the effectiveness alternating pressure air mattresses vs. the overlays to prevent pressure ulcers. The pressure relieving devices where in this case is the air pressure mattresses that are used by patient when sitting and sleeping or lying in bed. The paper will also evaluate the efficiency of current pressure relieving devices and the best practice of pressure relieving mattresses in the use of risk group patient in heath care setting (Keogh 2001). Data source Electronic databases that will be used are the Pubmed and proQuest were used to search literature, Embase, Medline, Ekg and google scholar and other online resources were also used as an a supplement information resources (Cullum et al. 2001). Inclusion criteria The study applied the inclusion criteria for selecting the published paper are; Articles and journals published in English language, the publications are from year 2000 to 2012. The age of the study population is the universal majority age from 18 years from both nursing homes and hospitals. Subgroups were defined with age, sex, race, socioeconomic status and ethnicity (Cullum 2003). Pressure ulcers are most common among the elderly persons or people with spinal cord injuries or other conditions that restrict mobility like chronic diseases. The results of the study are measured using the newly developed pressure relieving alternating pressure air mattress and its positioning technique (Cullum et al. 2001). Exclusion criteria All articles published before 2000 were all excluded from the study since the study will only use the most recent information. Connectively, all articles without full-text were also excluded from the study (Cullum 2003). Outcome measurement According to the NPUAP pressure ulcer stages, the pressure ulcer is categorised into six stages That includes stage 1: the person seems to have a non-lanchable erythema. In stage 2: the patient has a superficial skin loss as an abrasion; this may also be informed of a blister. In stage 3: there is a full thickness skin loss involving subcutaneous tissue also referred to as the fascia. In stage 4: there is a full thickness skin loss with extensive destruction that involves tendon, muscle, bone and joint capsule. Connectively, NPUAP considers the next stage as un-stageable as the patient appears to have a completely obscured by a slough and eschar in the wound bed. Lastly, in the last stage the patient has a suspected deep tissue injury that has a purple or maroon localised are with discoloured intact skin, alternatively the patient may also have a blood- filled blister (Tweed 2006). Quality of assessment The selected previous studies on air pressure mattresses were evaluated to determine their quality, and their validity trial results. The assessment investigated what the results were and also whether their results would be of any help locally. By use of the critical appraisal skills programme (CASP) the study will investigate and evaluate those included papers used in the study. The CASP checklist examined the following criteria. The articles were investigated whether they address the focus issue apparently that is identified on the topic, whether an efficient population recruitment process was carried out with proper intervention that has an acceptable way that is either experiment group or control group. A well-defined outcome measurement that ensures a state conduct effect precisely minimize the bias and any confounding accounted for as it would give a more adequate study on the effects or air pressure mattress (Hansen 2006). Moreover, the CASP also examined the significant confidence size interval and the p-value in additional of the odd ratio and relative risk lastly the study also determine whether the results are applicable to the local population. Selection of articles and studies A total of 250 articles were searched through electronic database listed above by using the keywords for searching the appropriate articles for inclusion. 21 articles were additional identified through other listed online sources making them a total of 271 sources. From the total 271 records, 200 were excluded from the studies making them 71 full-text articles that were published from 2000 to 2014. From the 71 articles selected 30 articles removed for the literature review, 15 articles had incomplete data, 5 were not on trial and /or were conference paper while and lastly16 had incomplete data. Finally, a total of 19 articles from online source were used for review (McGowan et al. 2000). Since there have been few studies on air pressure mattresses as pressure relieving device with association in pressure ulcers conducted a total of nineteen qualitative studies were selected and reviewed for final results (Hansen 2006). Effectiveness of air pressure mattresses Various diverse studies were conducted in different departments such as acute medical, orthopaedic, rehabilitation, intensive care unit, surgical units, and nursing home. Observation studies can be considered to be retrospective in establishing the efficiency of current pressure relieving measures and devices. By the application of six randomized clinical trials for comparing the effectiveness of alternating pressure mattresses. Connectively trials with re-positioning and other types of mattresses were also conducted using viscoelastic foam and pressure overlay to compare their effect on ulcer patient with the alternating pressure mattresses (Maltby 2007). Alternating pressure mattresses The use of alternating pressure mattresses, Nixon et al. (2006) and Russell et al. (2003) have carried out studies on a different mattress, overlay they concluded that there is no significant disparity between two groups. Demarre et al. (2012) also concluded that the two multi-stage inflation and deflation of the air cells that are compared with the alternating low-pressure air mattresses were not in the lower grade two pressure ulcer incidences. The frequency rate of pressure in multi-stage air mattress and low air pressure mattress were found to be 5.7% and 5. 8% correspondingly (p=0.97)20 (Matthews 2010). Additionally Theaker et al. (2005), conducted research to evaluate alternating pressure mattress and overlay where both show no significant difference among those products. Through their studies, though substantial evidence was not presented in lower incidence rate of pressure ulcers in the mattress as compared to alternating pressure overlay. The study showed that alternating pressure mattress was more efficient due to the delay ulceration. The alternating mattresses offer more comfort to patients, therefore, is recommended for use in hospitals. Typical pressure ulcer sites Pressure ulcer healing rates mainly depend on, clinical interventions, co morbidities and ulcer severity that considerably. According to the National Pressure Ulcer Advisory Panel (NPUAP) staging system is most commonly used, common site where pressure ulcers are found is the wound environments and healing wound areas, for example, the spinal cord injury, vascular disease and diabetes (Eccles 2001). Intervention In the study, patients were lying on an alternating pressure overlay with no turning protocol and repositioning were not used since the principle of an APAM is to rotate the pressure points on the patient. The theoretical repositioning is not necessary for the control group; a more standardised prevention protocol was used. Patients were lying on a visco-elastic polythyl-ene-erethane foam mattress. The sitting protocol was also standardised and identical in both study groups, when patients were seated in a chair an air cushion was used for all patients. They were also asked to stand up for a period of two hours alone or when assisted to stand. Based on 12 % frequency of pressure ulcers in hospitals a sample size was calculated where a difference of 7% was found between the two groups (Clark et al. 2002). Data collection After the pressure ulcers were assessed on a daily basis by a ward nurse, daily inspection of the skin by a researcher were left to be an unnecessary burden for patients. A random sample of patients was seen at unanticipated moments by both the beneficiary and the data nurse. The data was to be used in the generation of results (Clay 2008). Discussion Pressure relieving alternating air mattresses is effective to most risk groups and the combination with different kinds of pressure; the mattress can be used to optimise the effect of prevention of pressure ulcers and reduce health works workload. A combination of pressure devices was found to promote the effectiveness of pressure reliving and reducing the manpower needed to care for ulcer patients. Randomized controlled studies that were not blind randomized controlled through sort them did the blinded analysis. Within the study the examined efficiency of different kinds of pressure relieving mattresses in which are to encourage the pressure relieving measures to the bony prominence area (Clark et al. 2002). Considering the sacral pressure ulcers it was observed that interactions effect between the prevention protocols in the risk assessment method was a possible hypothesis for the slight tendency of pressure ulcers on an APAM in the pressure on the sacrum that cannot be completely relieved by an APAM. According to the study, it is evident that constant low pressure is more damaging for body tissues than alternating pressure. It was also found out that if there were a constant low-pressure repositioning on an APAM is required. Connectively shearing forces increase the risk for developing pressure ulcers. Alternatively, during the study there were significant less heel pressure ulcers in the APAM group with a mark of 14.7% than in control group that had 45.7%. The control group is dependable with other studies reporting anatomical locations (Brienza et al. 2001). Importance in use of pressure relieving devices The use of traditional pressure relieving measures as used in health care setting for prevention for prevention of pressure ulcer management widely, nevertheless the cost associated with modern relieving devices is high while. The pressure relieving devices decreases the workload to nurse at the same time to maintain the standard for pressure relieving device. Therefore, the effectiveness of pressure relieving equipment would be a concern in health care setting. The alternating pressure mattresses reduce the incidence of pressure ulcer as compared with standards mattress with cushion (Brienza et al. 2001). Moreover, the application of proper repositioning and turning tome interval to patients who are already used the alternating devices may have better results to prevent pressure ulcers. Contrary to people’s perception that frequent turning can promote the pressure ulcer free, the study revealed that frequent re-positioning lowers the risk of developing ulcers, the proper positioning is 300 tilt (Bale 2007). Implication in health care setting Since pressure is the main cause of ulcer than the nutritional status continence, mobility, and medical conditions all are risk factors to patients. Risk assessment to the patient is a beginning part to evaluate the kind of intervention that are suitable for such a patient, alternating pressure relieving devices should be available to the patients who require them (Bale 2007).Connectively, the right pressure relieving equipment should be used in the right time with the right method (Bader et al. 2005). Limitations Small number of papers Since the study only used, a total of 19 papers it may be biased as this does not represent the whole population under study the limited quantitative studies were narrow to explore the review question were narrow to explore the review questions. The studies were also conducted in European and United States, the design of health care may be different from local systems. On the other hand, the cost of pressure relieving equipment to the patient is also difference in different locations; however, the implications of pressure relieving device application could also act as reference (Bader et al. 2005). Alternatively, the papers were reviewed and searched by one author. This concludes that the appraisal assessment to those who that are included in the studies may cause bias according to subjective assessment. One author can give shallow results as compared to many authors who can provide comprehensive results (Tweed 2006). Conclusion Pressure ulcer is one of the main reasons of patients mobility and mortality; the pressure ulcer prevention is significant to patients and hospitals operation cost some may concern the pressure ulcer prevention that is significant to patients and hospitals operation cost. The utilization of alternating pressure mattresses would be high expensive to some healthy care settings. Nevertheless, the consequence cost of prolong hospitalization and further treatment cost wound management is higher (Tweed 2006). The use and combination of two different pressure relieving devices and methods would far more benefit the patient and the hospital at large. The alternating pressure mattresses are good since they help nurses to prevent ulcers and also reduce the frequency needed in the repositioning of patients (Brienza et al. 2001). References Bader, D., Bouten, C., Oomens, C., & Collin, D 2005, The Aetiopathology of pressure ulcers: A hierarchical approach, In D Bader editor. Pressure ulcer research, Germany, Springer Bale, S., & Dealey, C 2007, The experience of living with a pressure ulcer, European Pressure Ulcer Advisory Panel, vol. 103, (15), p. 42. Brienza, M., Karg, E., Geyer, J., Kelsey, S., Trefler, E 2001, The relationship between pressure ulcer incidence and buttock-seat cushion interface pressure in at-risk elderly wheelchair user,. Archives of Physical Medicine and Rehabilitation, vol. 82 (4), pp.529-533. Clark, M., Benbow, M., Butcher, M., Gebhardt, K., Teasley, G., Zoller, J 2002, Collecting pressure ulcer prevention and management outcomes: 2. British Journal of Nursing, vol. 11, pp. 310-314. Clay, S 2008, Risk Assessment, In KS Clay editor, Evidence-based Pressure Ulcer Prevention, USA, HCPro, Inc.; 2008, pp.45-51 Cullum, N., Deeks, J., Sheldon, T., Song, F., & Fletcher A 2001, Beds, mattresses and cushions for pressure sore prevention and treatment. Cochrane Wounds Group. Cullum, N., Deeks, J., Sheldon, A., Song, F., Fletcher, W 2003. Beds, mattresses and cushions for pressure ulcers prevention and treatment. The Cochrane Library 2003 (2), Oxford: Update Software Ltd. Defloor, T 2000, The effect of position and mattress on interface pressure, Appl Nurs Res 2000, vol. 13, pp.2–11. Eccles, M., & Mason, J 2001, How to develop cost conscious guidelines. Health Technology Assessment, vol. 5 (16), pp. 34-45 Hansen, E 2006, Successful qualitative health research: a practical introduction, Allen & Unwin, Crows Nest Keogh, A., Dealey, C 2001, Profiling beds versus standard hospital beds: effects on pressure ulcer incidence outcomes, Journal of Wound Care, vol. 10(2), pp.15-19. Matthews, B., & Ross, L 2010, Research Methods: A Practical Guide for the Social Sciences, Pearson, New Jersey. Maltby, J., Day, E., and Williams, G 2007, Introduction to Statistics for Nurses, Pearson Education, New Jersey. McGowan, S., Montgomery, K., Jolley, D., Wright, T 2000, The role of sheepskins in preventing pressure ulcers in elderly orthopaedic patients, Primary Intention, pp.127-134. Polit, D., & Beck, T 2012, Nursing Research: Generating and Assessing Evidence for Nursing Practice, 9th edn, Williams & Wilkins, Lippincott Tweed, C., Weatherall, M 2006, Hidden under the covers: Pressure ulcers in primary care, New Zealand Family Physician June, vol. 33(3), pp.192-197. Read More