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Multidisciplinary Team Approach Usage in Healthcare Annotated Bibliography

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Updated: Feb 27th, 2022


Hospital-acquired pressure ulcers constitute a grave public health problem, diminishing patients’ quality of life, and damaging the country’s economy. The negative consequences of hospital-acquired pressure ulcers are mostly avoidable, but the problem is seemingly not given sufficient attention in medical research. The bibliography intends to locate sources that provide the required theoretical foundation for the proposed research – a multidisciplinary team approach in the prevention and reduction of hospital-acquired pressure ulcers. The gathered sources address a range of topics, coinciding with the subject matter of the proposed research. Among the topics are prevention and reduction strategies, interventions, and the effects of multidisciplinarity.

Annotated Bibliography

Samuriwo R. Pressure ulcer prevention: The role of the multidisciplinary team. British Journal of Nursing. 2012;21: 4-13.

Samuriwo is a clinical academic and researcher at Cardiff University with a background in critical care, which makes the text scientifically trustworthy. Samuriwo’s article explores nurses’ attitudes to pressure ulcer prevention and the role of other health professionals in resolving the problem. It is intended for researchers, educators, and medical professionals who deal with or are interested in the health issue. The text synthesizes and analyses nurses’ understanding of the function that dieticians, tissue viability specialists, physiotherapists, pharmacists, and community nurses fulfill in pressure ulcer prevention. The nurses participating in the research reported high levels of collaboration with dieticians and physiotherapists. Pharmacists and community nurses were also likely to cooperate and became a crucial source of advice. On the other hand, the nurses received little support and guidance from doctors and tissue viability specialists. Additionally, findings suggest that the nurses undervalued the significance of prevention, contradicting other studies’ results. The text concludes by expressing the need for nurses to be more proactive and collaborative. Nevertheless, only 16 nurses participated, signifying that the research results cannot be generalized.

Although a higher number could change the findings, Samuriwo still prompts the proposed research’s hypothesis: multidisciplinarity is needed to deliver better care and prevent hospital‑acquired pressure ulcers. The researcher also states the main functions of each medical professional, which could be useful for constructing the proposed research. Samuriwo emphasizes that collaboration between health care professionals and the multidisciplinary approach result in improved skin integrity and decrease the pressure ulcer incidence. Such factors as correct nutrition, repositioning, provision of guidance, and patient education, are dependent on different medical workers but are essential in pressure ulcer prevention. The assumption aligns with the results of other studies reviewed in the bibliography, for instance, of Miller et al. Moreover, the findings imply what medical workers should be more involved in pressure ulcer prevention.

Gupta P, Shiju S, Chacko G, Thomas M, Abas A, Savarimuthu I et al. A quality improvement programme to reduce hospital-acquired pressure injuries. BMJ Open Quality. 2020;9(3): 1-9.

The researchers are experts in the fields of wound care, pharmacy, quality and patient care, and nursing working at Hamad Medical Corporation. These backgrounds give sufficient basis to consider the article authoritative. The study appears to be designed chiefly for medical professionals and researchers specializing in pressure injuries. Gupta et al. outline the results of a program consisting of evidence-based practices to reduce hospital-acquired pressure injuries in Heart Hospital in Doha, Qatar. Patients in intensive care units were most likely to acquire pressure ulcers and became the target group. The program was effectuated by a multidisciplinary team and risk assessment team. The interdisciplinary team included wound care nurses, respiratory therapists, dietitians, physiotherapists, consultants, and physicians. The evidence-based practices, among others, included: SSKIN bundle care, using heel protectors in addition to air mattresses, barrier creams, turning clocks, incidence calendars, and endotracheal tube tie repositioning. Additionally, nurses participated in educational sessions regarding hospital-acquired pressure ulcer prevention. The researchers report that the incidence and prevalence of hospital-acquired pressure ulcers substantially dropped due to the interventions. Thus, the incidence decreased from 6.1/1000 to 1.1/1000, and prevalence showed a 73.4% decline.

The article contains vital statistical and clinical information for the proposed research. Gupta et al. clearly outline the composition of the multidisciplinary team, each member’s role, and what interventions were used to achieve the improvement. Unlike other texts in the bibliography, this source shows the importance of respiratory therapists to decrease the incidence and prevalence of hospital-acquired pressure ulcers, distinctly in intensive care units. Hence, the inclusion of a respiratory therapist in a multidisciplinary team could be considered in the proposed research. The researchers indicate that endotracheal tube ties contribute to the incidence of pressure injuries, and their regular repositioning is one of the text’s key details. Overall, the highly effective interventions that Gupta et al. employed demonstrate the need for a multidisciplinary approach and evidence‑based intervention to address the health issue.

Kawther A, Waffaa E, Fatma A S, Hoda A. Applying interdisciplinary team approach for pressure ulcer assessment, prevention, and management. International Journal of Novel Research in Healthcare and Nursing. 2019;5(3): 640-658.

The researchers are academics in medical-surgical nursing and nursing administration, which seems like an adequate basis to state that the article is reliable. A range of medical specialists can benefit from the source, especially those interested in pressure injury prevention and management. This longitudinal study aims to measure interdisciplinarity’s effectiveness in preventing, assessing, and managing the health problem under consideration. The study was conducted over three years at Dar Al Fouad Hospital, Egypt – a hospital specializing in transplantations and heart surgeries. In order to achieve the objective, a prevention and management care plan was created. The program included repositioning, skin assessment, preventive skin care, pressure redistribution devices, and minimization of friction, shear, and moisture. The interventions were implemented by an interdisciplinary team, which was comprised of a dietitian, pharmacist, educator, quality specialist, surgery physician, physiotherapist, and nurses. As the results of the interdisciplinary approach and the interventions, the number of patients who acquired pressure ulcers decreased. The decrease is statistically significant (mean score in 2014 was 1.6, and in 2016 – 0.6).

One of the article’s most crucial contributions to the bibliography is that it indicates the responsibilities of each member of the interdisciplinary team. A similar distribution of duties and roles could be considered for the proposed research since the composition of teams partially aligns. Moreover, it crystallizes progressive interventions of pressure ulcer assessment, prevention and management; the text also includes usable clinical recommendations. For instance, Kawther et al. recommend to assess nurses’ knowledge regarding pressure ulcer management and prevention, similar to what Clarkson et al. propose. Overall, the researchers once more prove the effectiveness of multidisciplinarity for decreasing the prevalence and incidence of pressure ulcers.

Simsic J, Dolan K, Howitz S, Peters S, Gajarski R. Prevention of pressure ulcers in a pediatric cardiac intensive care unit. Pediatric Quality and Safety. 2019;4(3): 162-169.

The researcher’s expertise appears to be considerable – the study was conducted by practitioners in the domain of pediatrics, hospital management, and wound care. The text’s intended audience is researchers, theoreticians, and practitioners in wound care and intensive care. The research’s primary goal was to reduce the incidence of stage II pressure ulcers in a cardiothoracic intensive care unit. For this purpose, a multidisciplinary team was composed, including quality specialists, physicians, various nurse practitioners, and respiratory therapists. The team was in charge of designing and incorporating into clinical practice a standardized surveillance plan for pressure ulcer prevention. Firstly, regular skincare rounds for nurse team members, respiratory therapists, and quality specialists were established. Secondly, a care plan was implemented, including the following procedures: use of barrier cream, regular pulse oximeter probe, two-hourly repositioning, the use of supportive surfaces, heel protectors, the elevation of the headboard, and frequent consultations with a wound ostomy nurse. The study began in 2010 and was finalized seven years later. Its outcomes suggest the importance of the delineated care bundle and multidisciplinarity for earlier identification and reduction of hospital-acquired pressure ulcers related to immobility.

The source’s significance for the bibliography consists of endorsing a multidisciplinary team’s vitality for preventing, managing, and reducing hospital-acquired pressure ulcers. Unlike other sources, Simsic et al.’s article concentrates on a younger population group, proving the approach’s efficacy among different demographics. The text also supports the effectiveness of several interventions. Consequently, several studies in the bibliography show that barrier cream, supportive surfaces, and heel protectors could be instrumental in prevention programs. The elements also constitute a part of the program described in the article by Gupta et al. Generally, the text provides a scheme for preventing and reducing pressure ulcers.

Mallah Z, Nassar N, Kurdahi Badr L. The effectiveness of a pressure ulcer intervention program on the prevalence of hospital-acquired pressure ulcers: Controlled before and after study. Applied Nursing Research. 2015;28(2): 106-113.

The study investigates the efficiency of a multidisciplinary intervention program in reducing acquired in a hospital setting pressure ulcers and determining which elements were the most influential. The article seems to be destined for nursing directors, wound care specialists, as well as hospital administrators, and managers. Its authors are nursing theorists working for higher medical educational institutions in the United States and Lebanon, which renders the article sufficiently reliable. The researchers used data collected before and after the multidisciplinary intervention program to evaluate the health outcomes of 468 patients. As a result, the prevalence of hospital-acquired pressure ulcers was reduced from 6.63% to 2.47%, signaling the approach’s effectiveness. The program included: establishing a care bundle, enhanced administrative support, and increased documentation. The researchers state that Braden scores for predicting pressure ulcer risks and skincare management (including McKesson Hydrocolloid Dressing applied over bony surfaces) proved to be the two most significant factors in reducing the prevalence of pressure ulcers among admitted patients.

The study has several advantages that make it instrumental in the proposed research. Firstly, unlike some other sources in the bibliography, it has a large sample size, allowing generalizations. Secondly, the researchers clearly state what parts of the intervention program were the most effective (skin care and the use of Braden scale). In the third place, the article provides an elaborate description of these interventions. In this way, the study can serve as a point of departure for developing a multidisciplinary approach to prevent and decrease the prevalence of pressure ulcers. For example, extensive incorporation of the Braden scale and skincare management are cost-effective interventions essential for avoiding hospital-acquired pressure ulcers. The article also shows what interventions are potentially less effective. The less effective measures include repositioning, which was found not to be a predictor in developing a pressure ulcer.

Miller M, Emeny R, Freed G. Reduction of hospital-acquired pressure injuries using a multidisciplinary team approach: A descriptive study. Wounds. 2019;31(4): 108–113.

The article’s authors are professionals in wound care, clinical practice, and plastic surgery at Dartmouth-Hitchcock Medical Center, which corroborates the article’s reliability. The text’s intended audience is chiefly practitioners dealing with different wound conditions and researchers in industry and academia. The paper describes the impact of a multidisciplinary pressure injury prevention team on the incidence and prevalence of full-thickness pressure injuries. The team was lead by a wound care nurse and a plastic surgeon. Other team members were from various areas, such as physical therapy, process improvement, and bedside nursing. Implementing a multidisciplinary team approach proved to be effective as the prevalence of hospital-acquired pressure injuries significantly decreased from 4% to 0.2% over three years. The reduction by 89% is a colossal improvement that has substantial implications for pressure ulcer prevention. Thus, establishing a multidisciplinary team to monitor and identify hospital-acquired pressure injuries is an effective method of mitigating the problem.

One of the article’s downsides is that it does not mention a specific number of patients who underwent treatment by the multidisciplinary team. On the other hand, it is mentioned that the institution where the research was conducted is a 400-bed medical center, and the study’s duration is three years; thus, it appears that a sufficient number of patients were involved. Miller et al. also introduce an interesting concept of “safety champions” that could be useful for the proposed research. They represent a group of nurses who meet regularly for informative sessions and are supposed to spread the information in their units. Furthermore, the study accentuates the significance of comprehensive skin assessment for pressure injury prevention – another element to be considered. Most importantly, the study supports the premise of the proposed research – a multidisciplinary team can be instrumental in the prevention of pressure ulcers.

Cano A, Anglade D, Stamp H, Joaquin F, Lopez J, Lupe L et al. Improving outcomes by implementing a pressure ulcer prevention program (PUPP): Going beyond the Basics. Healthcare. 2015;3(3): 574-585.

The paper’s authors are theorists and academics in nursing, pharmaceutical sciences, and physical therapy at the University of Miami and the University of Nevada. The article seems to be intended for health care providers interested or professionally involved in wound care. It outlines a multidisciplinary ulcer prevention program started at the University of Miami Hospital with the objective to reduce the incidence of hospital-acquired ulcers. The following interventions were implemented based on the previous evaluation: wound, ostomy, and continence nursing staff were contracted; support surfaces replaced inpatient beds; lastly, care delivery protocols, and turning schedules were modified. The interventions lead to a substantial drop in the prevalence of hospital-acquired pressure ulcers from almost 12% to approximately 2%. The prevalence increased by 2% three years later in 2012 but decreased again, potentially due to the new skin product and staff’s reeducation. Since these interventions were implemented, the rate remained consistently low and constituted less than 2% in 2015. Accordingly, the article demonstrates the effectiveness of the multidisciplinary ulcer prevention program.

The outlined in the primary source program provides a valuable insight into the role of multidisciplinarity on pressure ulcer prevention needed for the proposed research. The composition of the interdisciplinary team of the University of Miami Hospital differs from the one that is stated in the research proposal. The article is essential for evaluating the role of each member of the multidisciplinary team and choosing the most efficient and logical composition. Additionally, Cano et al.’s work contains insight into managing the pressure ulcer prevention program, which could help with the research implementation. Nevertheless, the team of the University of Miami Hospital included 14 different specialists – the study’s scope in this and several other aspects is significantly larger than the one of the proposed research.

González-Méndez M, Lima-Serrano M, Martín-Castaño C, Alonso-Araujo I, Lima-Rodríguez J. Incidence and risk factors associated with the development of pressure ulcers in an intensive care unit. Journal of Clinical Nursing. 2017;27(5-6): 1028-1037.

The article’s authors work in theoretical nursing, specifically intensive care medicine at the University of Seville, Spain. Their academic background in the domain renders the study’s results sufficiently trustworthy. The text’s target audience appears to be medical professionals working in intensive care units and researches. The study’s main objective is to identify the risk factors associated with developing pressure ulcers. To attain the goal, 335 patients in intensive care units were monitored for a month utmost. The study did not include patients who already have had pressure ulcers before being admitted. González-Méndez et al. established that the main risk factors linked to developing a pressure ulcer were prognostic scores and care complications in the intensive care unit. Notably, the length of immobilization was not associated with higher chances of developing a pressure ulcer. It also seems essential to mention that the vast majority of patients developed a pressure ulcer during the first two weeks of admission.

The study is considerable for designing a multidisciplinary team approach for the prevention and reduction of hospital-acquired ulcers. The presented in the article analysis facilitates prevention since causative elements linked to the health issue are outlined and can be detected more quickly. Furthermore, more efficient detection of risk factors helps develop a protocol for pressure ulcer reduction and prevention needed for the proposed research. The article provides valuable information regarding the impact of a patient’s severity of illness, length of immobilization, and the complications appearing during inpatient care on the likelihood of developing a pressure ulcer. Nevertheless, some controversial points are raised in the text. Unlike the study performed by Gupta et al., which was already summarized, mattresses were not showed to decrease hospital-acquired pressure ulcer incidence in this study.

Clarkson P, Bader D, Schoonhoven L, Worsley P. A multidisciplinary approach to pressure ulcer prevention: Exploring healthcare professionals’ knowledge and attitudes to pressure ulcer prevention in the community. Physiotherapy. 2016;102: 256-257.

The text’s authors strive to bridge the gap existing in the knowledge regarding the role of a multidisciplinary team in bedsore treatment and prevention, despite the fact that the approach is considered to be quite useful in this aspect. Although the article appears to be intended for physiotherapy educators and researchers, it is also helpful for wound care specialists. The authors are theoreticians in health sciences at the University of Southampton, United Kingdom. In the study, the Pressure Ulcer Knowledge Assessment Tool and Attitudes to Pressure Ulcer Prevention Instrument were used to test the knowledge and attitude of health care professionals working at Southern Health NHS Foundation Trust. One hundred-sixty healthcare professionals participated in the study: 160 in the attitude survey and 119 in the pressure ulcer prevention knowledge survey. It was established that the knowledge and attitude of the institution’s multidisciplinary team were satisfactory. Nevertheless, it was also discovered that nurses have a less positive attitude to pressure ulcer prevention than healthcare assistants and occupational therapists. Another interesting discovery is that the multidisciplinary team’s knowledge of preventive strategies was the lowest.

Compared to other texts in the bibliography, Clarkson et al.’s work investigates an entirely different aspect of a multidisciplinary team approach in the prevention of hospital-acquired pressure ulcers. The primary source reminds the necessity to test interdisciplinary team members’ attitudes and knowledge before effectuating the proposed research. Clarkson et al. accentuate the need to ensure that a multidisciplinary team’s expertise is adequate, particularly in aspects concerning the health issue’s prevention. The team’s knowledge and attitude are influential factors for reaching the research objectives – decrease hospital-acquired pressure ulcer incidence, improve nursing outcomes, and lower death rate. Similar testing instruments might be applied to the team members at the outset of the proposed research, so that possible lack of knowledge could be addressed timely.

Romanelli M, Clark M, Gefen A, Ciprandi G. Science and practice of pressure ulcer management. 2nd ed. New York: Springer; 2018.

The book is written by professionals in the prevention and treatment of pressure ulcers: its authors are theoreticians and practitioners specializing in wound care, dermatology, and biomedical engineering. The text is intended for nursing staff, wound care specialists, dermatologists, surgeons, and medical professionals in related fields. Science and Practice of Pressure Ulcer Management provide basic and advanced information on the health issue; it is approved by the European Pressure Ulcer Advisory Panel, an authority regarding the health issue. The text covers a variety of problems linked to pressure ulcers ranging from methods of risk assessment to new perspectives on causes and origination of pressure ulcers. It provides indispensable insight into fundamental issues such as the classification of pressure ulcers, steps of pressure ulcer removal, and potential complications. The detailed step-by-step descriptions of procedures commonly included in pressure ulcer management compose a sizeable part of the work. On the other hand, the book also incorporates advanced treatment therapies, prevention methods, and novel interventions such as the SKIN bundle and the use of prophylactic dressings.

The work is a crucial clinical reference text in what concerns pressure ulcer prevention and management, and especially difficult from the clinical perspective medical issue. Science and Practice of Pressure Ulcer Management contains plenty of helpful information for wound care professionals and opportunities to refresh knowledge. In opposition to other works included in the bibliography, this one can serve as a particularly extensive theoretical basis. The chapters “The Potential of Biomarkers in the Early Detection of Pressure Ulcers” and “Risk Assessment in Pressure Ulcers” are abundant with instrumental information regarding pressure ulcer prevention. On the other hand, the information might be somewhat cursory in general, yet the health issue is too nuanced for one work to cover it entirely. The book also indicates that pressure ulcer risk assessment requires multidisciplinarity, as does overall pressure ulcer prevention. Overall, the book is a cornerstone of the bibliography since it provides theoretical support for the approach, interventions, and methods of pressure ulcer prevention and management.

Chamanga E, Ward R. Documentation and record-keeping in pressure ulcer management. Nursing Standard. 2015;29(36): 56-63.

The article outlines the function of record-keeping and documentation in mitigating the public health problem in question, particularly the classification of hospital-acquired pressure ulcers as avoidable and unavoidable. Its authors are practitioners in the sector of hospital management and tissue viability. Similar to other articles in the bibliography, this one is peer-reviewed, and thus the text’s reliability does not seem questionable. The text is intended for administrators, ward managers, and nurse managers. The researchers designed a transfer sticker with the time and location of a pressure injury, date, risk evaluation, and a care plan to alleviate the problem. The sticker is meant to facilitate record-keeping and, by enhancing clarity, decrease the incidence of hospital-acquired pressure ulcers. According to the authors, the strategy has numerous advantages, among which several are especially impactful for the proposed research. Thus, the transfer sticker serves as a basis for more informed clinical decisions, increases staff accountability, secures more effective communication between members of a multidisciplinary team, and quicker detection of complications.

The article undertakes an essential element in pressure ulcer prevention and reduction that other mentioned texts do not. Pressure ulcer prevention and reduction is a challenging and complex issue. To a degree, the challenge stems from record-keeping and documentation. The capacity of proper record-keeping to improve health outcomes sometimes might be overlooked, so it is instrumental in finding an optimal method to collect, store, and transmit patient-related information. The transfer sticker that Chamanga and Ward designed can serve as an alternative to other more traditional record-keeping methods. Nevertheless, the enumerated advantages are not supported by research, the text’s most significant downside. Anecdotal evidence and national guideline recommendations are the principal reasoning behind the claim. Considering more positive sides, a transfer sticker’ example is provided in the article and can be employed as a basis for a different design.

Bergstrom N [Internet]. . Mdcalc. 2018. Web.

The webpage contains an online Braden scale and is created by Dr. Nancy Bergstrom. Dr. Bergstrom is a retired associate dean of research at Cizik School of Nursing at UTHealth, whose primary research interest is pressure ulcer prevention and reduction. Additionally, Dr. Bergstrom became a part of the Nursing Research Hall of Fame. In this way, the reliability of the webpage is not questionable. The webpage contains an interactive Braden scale and calculates the likelihood of developing a pressure sore automatically. The site also provides a formula with variables and points, facts and figures, and interpretation of the results. The evaluation is based on the standard criteria included in the Braden scale: nutrition, mobility, friction and shear, moisture, and sensory perception. The webpage also gives an opportunity to copy the results. Moreover, based on the results, in the future, it will be able to provide medical advice. The webpage might be of interest for wound care specialists, researchers in the domain, and patients.

Braden scale is an instrumental part of the proposed research, as the eligibility of patients at risk of developing a pressure injury will be based on it. The automatic format of an online Braden scale can potentially alleviate some problems related to record-keeping and documentation, an essential part of hospital-acquired pressure ulcer management. Since the webpage allows for copying results, the digitalization of patient-related records becomes more convenient. Additionally, using this format of the Braden scale renders the risk assessment results more easily accessible for other members of a multidisciplinary team. The format also minimizes the chances of a human error in calculations and record-keeping, inconveniences linked to paper format, and is environmentally friendly. Overall, utilizing Dr. Bergstrom’s webpage could accelerate information transmission and make it more efficient and straightforward.

Murphy L, Browne M, Branagan O, Doyle I, Hogan C, Fitzsimons J. Final report Pressure Ulcers To Zero collaborative. Phase 3. 2018. Web.

The report provides a detailed description of the Pressure Ulcers to Zero collaborative, the main objective of which is to reduce the prevalence of the health issue by 50%. Its main goal is to state the outcomes, recommendations, and procedures of the collaborative. The report is written by the administrators and leaders of the Pressure Ulcers to Zero, practitioners in pressure ulcer management. Hence, the text’s authority is not questionable, and it can be considered a reliable source. The text’s intended audience seems to be nursing and a hospital’s administrative staff. The initiative described in the text occurred within the Irish health care system, and 22 multidisciplinary teams participated in it. The initiative’s results are encouraging – at least a 55% reduction in the prevalence of hospital-acquired pressure ulcers was achieved by all the teams in six months. The teams employed SSKIN intervention, consisting of six elements: early inspection, selecting correct support surface, nutrition and hydration, movement, and preventing moisture.

The report contains extensive information regarding various aspects of the Pressure Ulcers to Zero collaborative. Similar to several other sources, it corroborates an essential idea for the proposed research – a multidisciplinary approach is effective in pressure ulcer management. On the other hand, compared to other sources, this one centers more on the managerial side of the health issue. One of the key lessons retained from the report is the positive influence of focal leadership. Another important lesson is that the report emphasizes challenges in documentation, such as incorrect data entry, thus stressing the need for improved record-keeping. Furthermore, the text presents several recommendations and strengths that could be taken into consideration in the proposed research. Challenges and weaknesses are also provided and represent a significant learning opportunity. Overall, the report is abundant with useful statistical data, practical recommendations, and mistakes to be avoided.

European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIA: 2019.

The international guideline on prevention and treatment of pressure ulcers is designed by the European Pressure Ulcer Advisory Panel, the National Pressure Injury Advisory Panel, and the Pan Pacific Pressure Injury Alliance. The organizations are widely-recognized authorities, and the document seems clinically reliable. The guideline’s targeted audience is international healthcare professionals in the field of pressure injuries treatment and prevention. The text contains an extensive review and evaluation of the most commonly implemented practices regarding prevention, treatment, risk assessment, and diagnosis of pressure ulcers. The included interventions and good practice statements are evaluated based on the strength of the evidence supporting them, specifically evidence quantity, levels, and consistency. Consequently, through a voting process involving academic and clinical professionals in the wound care field, each procedure was assigned a strength of recommendation and graded. The recommendations’ strength signals their capacity to enhance patient outcomes and serves as an indicator of their clinical trustworthiness.

The texts’ recommendations can serve as a generalized guide to adequate clinical practice. Similar to Science and Practice of Pressure Ulcer Management, the guideline is a key clinical reference text in the bibliography. The text serves as a reservoir containing the best evidence-based practices to be used in the proposed research. In this regard, the first part of the guideline is of particular interest, as it contains chapters on prevention and interventions for pressure ulcers. The source also accentuates the role of dietitians and physiotherapists. Consequently, nutrition screening and anodal and cathodal electrical stimulation performed by corresponding specialists are described as positive recommendations. Moreover, the document can resolve uncertainties and contradictions that emerge from conflicting statements found in the reviewed texts, for instance, concerning the efficacy of repositioning. The guideline acknowledges the uncertainty surrounding the intervention’s effectiveness reflected in previously reviewed articles (for example, Gunningberg et al.’s work) and describes it as a positive recommendation, not discouraging nurses from doing it. Primarily, the guideline is a fundamental reference text, justifying selected prevention methods and resolving uncertainties about their efficiency.

Martin D, Albens, L, Van Haute S, Froese M, Montgomery M, Lam M, et al. Healthy Skin Wins: A glowing pressure ulcer prevention program that can guide evidence-based practice. Worldviews on Evidence-Based Nursing. 2017;14(6): 473–483.

The article’s authors are theoreticians and practitioners in the field, which makes the text sufficiently authoritative. It is intended for medical professionals practicing wound care and other interested individuals. The article describes the efficiency of an evidence-based pressure ulcer prevention program combined with a staff awareness campaign to reduce pressure ulcer prevalence in a community hospital. Additionally, the researchers aimed to measure the staff’s awareness and knowledge of pressure ulcer prevention methods. To establish whether the program was efficient, a mixed-methods study was designed and involved 242 patients admitted to a community hospital with high-pressure ulcer prevalence. The study showed the effectiveness of the evidence-based program and staff awareness campaign – the prevalence of hospital-acquired pressure ulcers reduced from approximately 34% to 7%, a significant improvement. It is indicated that this considerable drop was due to a combination of factors. Yet, the researchers also notice that equipment (low air-loss mattresses, sliders, heel-lift boots, et cetera) and communication processes were principal contributors.

The articles provide additional valuable insight into the significance of equipment and modes of communication to mitigate the health issue under consideration. The role of equipment for pressure ulcer management is seemingly ignored in many other resources but should be acknowledged: possessing the right material resources can tangibly facilitate pressure ulcer prevention. On the other hand, although the study did not concentrate on multidisciplinary, it was facilitated by an interdisciplinary approach since the prevention program was created by a committee comprised of members from different medical knowledge areas. The knowledge areas include wound care, nursing, materials management, and physical therapy. Hence, a multidisciplinary approach enhanced best prevention practices and helped to create a systematic operative referral pathway. One of the article’s downsides is that it does not outline the referral pathway.

Upton D, Upton P. Psychology of wounds and wound care in clinical practice. New York City: Springer; 2015.

The book’s authors are academics in healthcare, working at renowned higher education institutions in the United Kingdom and Australia. Their central research interests are different aspects of wound care and improved life quality of people experiencing the health problem. The work is aimed at various medical professionals, including general practitioners, wound care nurses, tissue viability nurses, as well as educators and researchers in the domain. Psychology of Wounds and Wound Care in Clinical Practice investigates wound care and prevention from a psychological perspective. It addresses the implication of pressure injuries and other wounds on patients’ mental health and the psychological aspect of wound care and prevention. The book’s content is founded on present-day research evidence and clinical guidelines. Additionally, the authors discuss the implications for clinical practice. A separate comprehensive segment is dedicated to the health issue in question. The segment contains useful but relatively basic information on pressure ulcers as well as rare insights into the impact of the injury on a patient’s emotional state. Throughout the text, an accent is placed on the psychological consequences of wound care and treatment.

In comparison to other works in the bibliography, the book covers an untouched but notably relevant for a multidisciplinary approach aspect of the health issue. In a multidisciplinary approach to hospital-acquired pressure ulcer prevention and reduction, psychologists’ role can sometimes be underestimated. Nevertheless, developing a pressure ulcer entails suffering that can have overwhelming repercussions for patients’ well-being and life quality. To design an actually comprehensive multidisciplinary approach, the psychological aspect of pressure ulcers should be considered. Psychology of Wounds and Wound Care in Clinical Practice could help fill this gap in the proposed research.

Tariq G, Hamed J, George B, Cruz S, Jose J. Pressure ulcer prevalence and prevention rates in Abu Dhabi: An update. Journal of Wound Care. 2019;28: 4-11.

Tariq et al. are medical professionals specializing in wound care and who underwent the International Interprofessional Wound Care Course – this background seems sufficient to state that the work is reliable. The text’s intended audience is wound care specialists and fellow researchers. The report presents the outcomes of a new pressure ulcer audit in Abu Dhabi. The audit was conducted at the SKMC hospital to establish whether the interventions introduced almost seven years ago were effective. The report shows that the prevalence of hospital-acquired pressure ulcers somewhat decreased – it was 2% in 2013 and became 1.8% in 2018. Although this change does not appear statistically meaningful, the indicator is lower than the benchmark of the International Pressure Ulcer Prevalence survey, which is 3.1%. The authors conclude that the interventions implemented at the SKMC hospital led to a decrease in prevalence. The text also contains demographic statistical data, indicating the sex and age of the patients who developed a hospital-acquired ulcer the most frequently. According to the authors, women aged 20–29 and 70–79 years old are population groups at higher risk of developing a pressure ulcer; the possible reasons for the phenomenon are not given.

The report is indispensable for the bibliography since it indicates the population groups that should be given increased attention in the prevention and reduction of hospital-acquired pressure ulcers. The text also outlines interventions included in the pressure ulcer prevention strategy. The intervention could be adjusted to the proposed research, although they coincide with practices suggested in other sources. For instance, turning and repositioning are also recommended in the guideline developed by EPUAP, NPIAP, and PPPIA. In this way, the source to an extent complements the suggestions found in other texts, and its foremost contribution to the bibliography is the demographical information.

Egan C [Internet]. Two-hourly repositioning disrupts sleep, doesn’t prevent pressure ulcer. HelloCare. 2019. Web.

The main idea behind the webpage is that the common practice of repositioning every two hours is ineffective and can be viewed as a form of abuse since it disrupts patients’ peace throughout their sleep. The webpage’s target audience is health care providers and patients dealing with the problem. The author is not an expert in wound care and has relatively limited experience in aged care, which may put the argument under strain. Nonetheless, the issue described on the webpage, doubtfulness of the efficacy of every two hours repositioning in pressure ulcer prevention and reduction, is an issue that other researchers whose works are presented in the bibliography also explore. Furthermore, Egan supports her opinion by referring to a scientific, seemingly authoritative study published in 2019, “Two-Hourly Repositioning for Prevention of Pressure Ulcers in the Elderly: Patient Safety or Elder Abuse?”. Overall, it is concluded that the practice does not decrease the chances of developing a pressure ulcer and is a somewhat cruel vestige of the past.

The article is convergent with the reviewed literature as it similarly supports the idea that repositioning is a contradictory preventive intervention. Thus, the study performed by Qaseem et al. showed mixed results that the practice produces in reducing incidence and severity of pressure ulcers. On the other hand, in the guideline created by EPUAP, NPIAP, and PPPIA, repositioning is recommended. At least, the text indicates that two-hourly repositioning should not be practiced in the proposed research, and six-hourly and four-hourly repositioning (for patients at high risk) could be considered instead, as they are somewhat less intrusive and disruptive. Yet, when dealing with critical patients, two-hourly repositioning still might be needed.

Levine M J [Internet]. . Geripal.org. 2017. Web.

Dr. Levine is a specialist in wound care and pressure injuries. He has an active practice in a long-term care facility and wrote multiple works on the subject, some of which were published by the American Geriatrics Society. Hence, the validity and reliability of the author’s claim are undeniable. The text is written for researchers and medical professionals in wound care and related fields. In the text, Levine recognizes that the wide prevalence of pressure ulcers became a burden for public health systems. Although pressure ulcers are frequently linked to inadequate health care provision, the author indicates that it is not necessarily so in every case. In some instances, pressure ulcers emerge even when commonly accepted preventive measures are incorporated. Dr. Levine introduces and defines the notion of “skin failure” that supposedly explains the emergence of hospital-acquired pressure ulcers even when adequate preventive measures are taken.

Incorporating into the work the notion of “skin failure” could help prevent problems in establishing the efficiency of a multidisciplinary team approach in the prevention and reduction of hospital-acquired pressure ulcers. The notion could help render data collection and classification more precise, consequently enhancing the research quality. Furthermore, the notion could account for the cases if the pressure ulcer prevention methods do not yield expected results. Particularly, the notion could be applied when managing hospital-acquired pressure ulcers among senior patients. According to the author, skin failure can explain the pressure injuries that occur closer to the end of life and intensive care settings. The webpage is worth including in the bibliography since it enriches its terminology and understanding of hospital-acquired pressure prevention and reduction by introducing an indispensable notion mostly absent from other sources.

Woodhouse M, Worsley P, Voegeli D, Schoonhoven L, Bader D. How consistent and effective are current repositioning strategies for pressure ulcer prevention?. Applied Nursing Research. 2019;48: 58-62.

The authors’ research is authoritative – Woodhouse et al. are theoreticians in health sciences with extensive experience at the University of Portsmouth, University of Southampton, and Utrecht University. The article is seemingly intended for nurses, nurse managers, and researchers interested in pressure ulcer reduction and prevention. In the article the effectiveness of such pressure ulcer prevention strategy as repositioning is analyzed. Additionally, the researchers aimed to establish inter-practitioner variability of the intervention, and whether written instructions improve practitioners’ repositioning technique. To answer the research question, Woodhouse et al. asked research participants to reposition a volunteer prior to and subsequent to receiving written instruction. The researchers established that the quality of repositioning technique was not consistent among nurses. The use of written guidance helped decrease turn angles, yet other criteria defying repositioning quality remained irregular. Hence, Woodhouse et al. conclude that training with live demonstrations of the correct technique and clear guidance should be provided to increase pressure ulcer prevention effectiveness.

Unlike other articles included in the bibliography, this one concentrates on a single aspect of repositioning for pressure ulcer prevention. The paper complements the sources questioning the efficiency of repositioning, stressing the need for nursing staff to use the correct technique for the prevention intervention to be effective. Even in a multidisciplinary setting, a nurse’s role should not be underestimated, and medical professionals might need to refine their repositioning technique to improve research results. The article introduces a considerable notion for the proposed research – the necessity to ensure that the members of a disciplinary team are sufficiently trained for the research to be able to reflect the effectiveness of multidisciplinarity.

Khanna A, Tiwary S. Ulcers of the Lower Extremity. New York: Springer; 2016.

The book details a number of vital aspects of wound care. It is essential reading for podiatrists, dermatologists, orthopedic surgeons, as well as wound care nurses. The book’s editors, Khanna and Tiwary, are professors in general surgery with considerable expertise, which makes the work sufficiently reliably. The twentieth chapter, “Pressure Ulcers of the Lower Limb,” is of particular interest and relevance since it outlines general information, such as the mechanism of ulcer formation, treatment, surgical management, et cetera. Although, to an extent, the text focuses on treatment, it also contains important information for multidisciplinary pressure ulcer prevention. Ulcers of the Lower Extremity provides a detailed description of factors and causes that prompt the emergence of pressure ulcers. Among them are shear, immobility, friction, loss of sensation, and pressure. These factors and causes need increased attention in pressure ulcer prevention and reduction. Additionally, Khanna and Tiwary included the protect-treat-protect algorithm in the book.

Like several other bibliography sources, the book is a crucial reference text and reference guide. It is abundant with relatively basic but necessary data regarding pressure ulcers. Additionally, Ulcers of the Lower Extremity contains essential theoretical information needed for developing a scientifically sound argument at the core of the proposed research. Information regarding the etiology and pathology of pressure ulcers is necessary for constructing a multidisciplinary prevention program that would have an extensive scientific basis to support it. Without the information, the proposed research would not have a sufficient factual foundation. In this way, the book is an indispensable source of pressure ulcer-related information and facts.

Gunningberg L, Sedin I, Andersson S, Pingel R. Pressure mapping to prevent pressure ulcers in a hospital setting: A pragmatic randomized controlled trial. International Journal of Nursing Studies. 2017;72: 53-59.

Gunningberg et al.’s research focuses on the use of continuous pressure mapping to prevent the development of hospital-acquired pressure ulcers. This longitude study occurred over nine months and involved 190 patients who were supposed to stay in the hospital for more than three days. The study hypothesized that the pressure mapping system could potentially have an impact on the incidence and prevalence of pressure ulcers in a hospital setting. The system shows the hospital’s nursing staff the pressure distribution of patients, which was supposed to help nurses reposition patients functionally. Nevertheless, it has been shown that the system did not perceptibly influence the prevalence and incidence of hospital-acquired pressure ulcers. The use of the system was accompanied by standard pressure ulcer prevention care. The authors’ authority does not seem questionable – they work at the Department of Public Health and Caring Sciences at Uppsala University, Sweden. This study seems to be designed for principally medical professionals specializing in nursing and bedside care.

Although the primary source does not prove the efficiency of pressure mapping, its results to a degree are in line with the results of the previously discussed article. Mallah et al.’s extensive research showed no influence of repositioning on hospital-acquired pressure ulcer prevention, while the continuous pressure mapping system’s principal purpose was to facilitate it. Still, the authors suggest that further investigation on how the multidisciplinary team involved in the study used the system is needed for a definite conclusion. The study is significant for the proposed research since it helps to narrow down the possible interventions. The researchers similarly used a multidisciplinary team approach, yet it apparently did not yield positive results in combination with pressure mapping. On the other hand, the value of repositioning and the use of pressure mapping should be scrutinized further. In this way, the use of pressure mapping is not sufficiently effective for the proposed research.

Qaseem A, Mir T, Starkey M, Denberg T. Risk assessment and prevention of pressure ulcers: A clinical practice guideline from the American college of physicians. Annals of Internal Medicine. 2015;162(5): 359-369.

The article is written by members of the American College of Physicians (ACP) and medical professionals – the authors’ background does not undermine the text’s credibility. The researchers state that the paper’s target audience is clinicians in general and patients at risk of developing pressure ulcers. The researchers critically analyzed recommendations regarding risk assessment and prevention of pressure ulcers. Firstly, it is recommended that clinicians effectuate a risk assessment to detect patients that require special attention. Secondly, static mattresses and static overlays are suggested for such patients. Thirdly, the use of alternating-air mattresses and alternating-air overlays is discouraged. Qaseem et al. view only the second recommendation as reliable. The first and the third recommendations are described as weak and having low-quality evidence in their support. Such conclusions are based on a systematic evidence review and evidence report by the Agency for Healthcare Research.

Qaseem et al. provide a different perspective on some of the widely used hospital-acquired pressure ulcer prevention methods. Their guideline somewhat contradicts the suggestions found in the previously discussed articles. For instance, Mallah et al. encourage using risk assessment methods such as the Braden scale, while Qaseem et al. somewhat dismiss this recommendation. Nonetheless, later the researchers state that there is moderate-quality evidence supporting the use of Braden and some other scales despite their insensitivity and insufficient specificity. It is mentioned that the instrument still can help detect patients at an exceptionally high risk of developing pressure ulcers. The article also establishes the efficacy of advanced static mattresses and overlays, as they decrease the risk of pressure ulcers. On the other hand, the researchers state that there is insufficient evidence to make a conclusion regarding the other two critical elements of pressure prevention – repositioning and skincare. Overall, the article provides an alternative point of view, crucial for a comprehensive literature overview.


The examined articles, primary sources, books, websites, and reports provide theoretical information to corroborate the proposed research’s premise. The sources can be divided into three categories depending on their thesis. Firstly, a number of sources examine the effectiveness of multidisciplinarity in hospital-acquired pressure ulcer prevention and reduction. Secondly, some sources investigate specific interventions that could be used in the research. In the third place, sources analyzing the knowledge and attitude of members of a disciplinary team are also included in the bibliography. Additionally, some texts’ theses are at the intersection of the topics. Thus, the bibliography covers all the needed subjects to conduct comprehensive research.

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