Pressure ulcers are one of the most pervasive disorder among hospitalized patients who are rendered wholly or partly immobile by their condition. Pressure ulcers are also often associated with disability and age: 70% of all cases occur in patients over the age of 70 (Khor et al., 2014). Statistics on the prevalence of the disorder vary from country to country: for instance, Khor et al. report that in the US, European, and Canadian hospitals, between 5.8 and 26% of patients suffer from pressure ulcers. Teaching hospitals in China showed a very low prevalence of 1.8% whereas, in Singapore and Japan, the share of elderly patients with PU amounted to 18.1% and 9.6% respectively. As they develop, pressure ulcers result in increased morbidity and are detrimental to a person’s quality of life. Aside from painful sensations, an elderly person is also confronted with the adverse psychological effects of having PU. Khor et al. (2014) also revealed that PU were some of the determinants of mortality in elderly patients. Can studying affected individuals help to develop a preventive framework for elderly patients?
In a descriptive quantitative study, de Brito Vieira et al. (2014) interviewed 215 elderly patients at one of the Brazilian hospitals and analyzed their medical history to identify risk factors for pressure ulcers. As it turned out, almost half of the patients (47%) were at risk of developing PU. The majority of the participants (42.3%) were admitted to the orthopedic unit. De Brito Vieira et al. (2014) argue that aging, in general, takes a toll on a person’s tissues: it reduces skin capillaries and blood supply. Together with collagen rigidity and reduction of adipose tissue in the limbs, these age-related conditions make an individual’s skin more vulnerable to injuries. Apart from that, patients at the orthopedic unit also had decreased turgor, which made them susceptible to pressure ulcers (de Brito Vieira et al., 2014). Hypertension was found to be the second risk factor (de Brito Vieira et al., 2014). Lastly, the third significant factor is the use of analgesics, antihypertensives, and anticoagulants which usually trigger a severe reaction in the human body (de Brito Vieira et al., 2014).
Reliability is defined as the degree to which an assessment tool is consistent with a study’s objectives and can produce stable results (Grove, Gray, & Burns, 2015). In critiquing the article by de Brito Vieira et al. (2014), they used a variety of measurement tools to cover all possible characteristics of patients at risk of developing pressure ulcers. It is stated that the researchers conducted a series of semi-structured interviews to gather personal information that might not have been obtained otherwise (de Brito Vieira et al., 2014). For instance, face-to-face conversations allowed them to gather data on marital status, education, income, and smoking and drinking habits. Physical examination helped reveal such characteristics as decreased turgor (elasticity) while medical history shed light on concurrent conditions such as diabetes and high blood pressure.
According to Grove et al. (2015), the validity of a study is how much the chosen design fits the broader goals set by its authors. The study is characterized by sufficient content validity since the quantitative method is the most appropriate for defining the prevalence of different characteristics in patients at risk or suffering from PU. As for face validity, the authors admit that the study would benefit from medical data analysis over a more extended period. Construct validity is also decent since de Brito Vieira et al. studied vulnerable and affected patients.
Looking at the study by de Brito Vieira et al. (2014), it is possible to point out both its strengths and weaknesses. A distinct virtue is the use of mixed methods of gathering information. The authors did not rely solely on patients’ accounts of their diseases, especially given that the questionnaire showed a low to moderate literacy rate (de Brito Vieira et al., 2014). In addition to interviews, they analyzed hard data such as physical examination results and medical history. De Brito Vieira et al. (2014) succeeded in defining a variety of factors some of which are inevitable due to old age, and some are manageable such as high blood pressure. One of the weaknesses of their study is convenience sampling: the authors contacted only one hospital, which might decrease the inference of the study’s findings. Further, some of the factors identified by de Brito Vieira et al. (2014) might not be actual causes of PU since correlation does not always mean causality.
National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance (2014) emphasize the importance of studying risk factors and conducting a risk assessment. In their handbook Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline, the experts of the respective institutions mention the following predisposing factors: old age, spinal-cord injuries, fractured hips, acute illness, and diabetes. It is recommended that nurses follow through with a risk assessment as soon as possible and repeat as often as the condition of a patient might require. National Pressure Ulcer Advisory Panel et al. (2014) argue that it is essential that health workers make a full skin assessment part of every risk assessment. Every assessment needs to be documented to help to make a prevention or treatment plan.
Despite an ample body of literature on pressure ulcers, a structured assessment plan is still lacking. In their consensus study, Coleman et al. (2014) attempted at clarifying steps and sequencing at evaluating risk factors in elderly patients. The authors claim that in clinical practice, there is certain confusion around the terms PU risk and PU presence, and many health workers use them interchangeably (Coleman et al., 2014). This misconception prevents them from making early interventions, and they have to move on to treating the patient. Coleman et al. (2014) agreed on the following assessment items: immobility, skin status and moisture, nutrition, diabetes, and sensory perception. They also concluded that there was a need for a two-stage assessment: preliminary and full.
In summation, is it possible to identify risk factors by studying elderly patients in clinical settings and develop a preventive plan? The study by de Brito Vieira et al. (2014) showed that a mixed approach to an issue as complex as pressure ulcers could help to receive reliable results. A combination of using patients’ personal accounts of their lives, physical examination, and medical history can reveal both internal and external predisposing factors. Some of them overlap with those outlined in the Prevention and Treatment of Pressure Ulcers handbook. Both National Pressure Ulcer Advisory Panel et al. (2014) and Coleman et al. (2014) agree that health care needs a structured approach toward risk evaluation and that prevention should take priority over treatment.
References
Coleman, S., Nelson, E. A., Keen, J., Wilson, L., McGinnis, E., Dealey, C.,… & Schols, J. M. (2014). Developing a pressure ulcer risk factor minimum data set and risk assessment framework. Journal of Advanced Nursing, 70(10), 2339-2352.
de Brito Vieira, C. P., Sá, M.S., de Araújo Madeira, M. Z., Luz, M. H. B. A. (2014). Characterization and risk factors for pressure ulcers in the hospitalized elderly. Revista da Rede de Enfermagem do Nordeste, 15(4), 650-658.
Grove, S.K., Gray, J.R., & Burns, N. (2015). Understanding nursing research: Building an evidence-based practice (6th ed.). St. Louis, MO: Elsevier Saunders.
Khor, H. M., Tan, J., Saedon, N. I., Kamaruzzaman, S. B., Chin, A. V., Poi, P. J., & Tan, M. P. (2014). Determinants of mortality among older adults with pressure ulcers. Archives of gerontology and geriatrics, 59(3), 536-541.
National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, & Pan Pacific Pressure Injury Alliance. (2014). Prevention and treatment of pressure ulcers: Clinical practice guideline. Web.