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Pressure Ulcers Methodology and Limitations Research Paper

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Updated: May 11th, 2022

Introduction

The purpose of the research is to determine the most effective program for managing pressure ulcers between adequate nutrition programs and malnutrition primary prevention. Scholars are still not certain about the most effective method for the treatment of pressure ulcers. This will be an experimental study in which Stage III pressure ulcer patients will participate in the study. One group will belong to an adequate nutrition program while the other will participate in a malnutrition primary prevention program. The researcher will compare their pressure ulcer status at the beginning of the study to their status eight weeks after the intervention. The intervention that causes the greatest reduction in pressure sores will be the most effective program.

Procedure

The first process in the experiment is an assessment of the medical history of the patient. This will include age, gender, smoking status, renal function, race, pressure ulcer history, and nature of the ailment. Thereafter a physical examination of the patient must occur by looking at aspects that could alter healing like systematic infection or perfusion of the patient. Laboratory tests will be necessary as well as vascular assessment of the ulcers that are in the extremities. An analysis of patients will occur to establish whether they have an increased risk of developing new pressure ulcers (De Laat et. al., 2005). It will be imperative to focus on those individuals who have minimal chances of a recurrence of other pressure ulcers. Pressure-relieving methods, as well as pain-relieving methodologies, need to be recorded too. Even the condition of bed surfaces will be noted. Care will be taken to ensure that similar conditions exist for the research subjects to minimize confounding factors.

The patients’ ulcers will also be assessed after recording all the relevant, historical, physical, and care-related characteristics. As mentioned earlier, two methods will be used; one is the PUSH instrument and the other is PSST. This two-pronged approach was necessary to mitigate the risks inherent in relying on one instrument. The PSST will make up for the lack of precision in the PUSH tool (Pillen et. al., 2009). During measurement, all patients must be placed in a consistent and neutral position where visibility of the wound is uncompromised. In the PUSH tool, the researcher will assess the following: wound size, exudates characteristics, and tissue type. The researcher will also record all the sub-scores and note the total scores. PSST will also be used to assess 15 characteristics like size and tissue characteristics. All parameters except the shape and location of the wound will be crucial to the study, so the observer will also record them (Cauble, 2010).

After the wound characteristics assessment, the nutritional status will follow. The researcher will assess the adequacy of their entire nutritional intake as well as their weight and history of weight. Percentage weight decreases and uptake of nutrition will allow the caregiver to determine the patients’ dietary needs. All malnourished subjects will not participate in the analysis since they could confound results. Thereafter, the researcher will place patients into two groups. One will be the adequate nutritional group in which members will eat a balanced protein diet with minerals and vitamins. The second group will be the malnutrition prevention group, where patients will eat calorie percentages based on their body mass indices. After 8 weeks, the observer will assess patients for the progress of pressure ulcer healing using the above procedure. A comparison of results before and after the nutritional intervention will occur.

Research design

The first aspect of the research design is a definition of the problem statement, which is “research is unclear on which nutritional intervention program is effective between adequate nutrition and malnutrition prevention’’. The next component is the definition of research variables. The dependent variable is pressure ulcer healing while the independent variables include malnutrition prevention programs and adequate nutrition programs. The research hypothesis is “Adequate nutrition programs are more effective in managing pressure ulcers than malnutrition prevention programs.” The research paradigm is positivist because the investigator will make assumptions and confirm them from the analysis. Finally, data collection will occur through a cross-sectional experiment in which the researcher will compare wound status before and after nutritional intervention (Adèr et. al., 2008).

Methodological limitations

The experimental research design is disadvantageous because a limit exists on the number of subjects that can be enrolled for the analysis. Since only stage all patients could participate in the study, then a small sample size is likely to arise from the analysis. The small sample size will likely undermine the application of the findings from this research. About the above limitation is the fact that purposive sampling will be crucial to the analysis. This will create an inherent basis in the study because subjects cannot be randomly selected (Kuzel, 1999). A range of other variables such as consent and acceptance by hospital administrators will restrict the ability of the researcher to randomly select subjects.

The research is also cross-sectional, which means that the examiner will assess the condition of the pressure ulcers before and after a certain time duration. Other variables may also come into play during the eight weeks that could affect outcomes. Although caregivers will receive instruction on how to offer the same quality of care to all the subjects, it is difficult to control all the factors of pressure-ulcer development. For instance, how one nurse handles wound dressing may be substantially different from another nurse’s approach, yet shift rotations are inevitable in healthcare settings. Additionally, one caregiver may pay more attention to a patient’s positioning than another so this could also affect outcomes. Risk factors in the patients could also change outcomes as it is not possible to control all the factors that affect a patient’s healing process (Courtney & Ayello, 2008).

Some challenges will also arise owing to the nature of the research instruments. The PUSH tool does not fully describe wound characteristics. It does not allow one to know the nature of exudates in the patient’s ulcer. Additionally, PUSH is not sensitive to a decrease in the length of wounds. This means that patients with large wounds may not be adequately assessed on the nature of wound size. Additionally, the PSST instrument is not faultless either. The tool requires a lot of practice and exposure for effective recording of patient characteristics. Unless thorough training takes place among all the concerned practitioners, rating scores could be substantially different for the same patients in the same amount of time. Harmonization of the use of the instrument among all practitioners may not be entirely possible so certain discrepancies may arise.

Research design diagram
Research design diagram

References

Adèr, H. J., Mellenbergh, G. J., & Hand, D. J. (2008). Advising on research methods: a consultant’s companion. Huizen: Johannes van Kessel Publishing.

Cauble, D. (2010). A critical appraisal of two measures for pressure ulcer assessment. Psychometrics, 10(4), 55–58.

Courtney, H. & Ayello, E. (2008). Patient safety and quality: An evidence-based handbook for nurses. London: McMillan.

De Laat, E., Scholte, P., Reimer, W., & Achterberg, T. (2005). Pressure ulcers, Diagnostics, and interventions aimed at wound-related complaints: A review of the literature. Journal of Clinical Nursing, 14, 464–472.

Kuzel, A. (1999). Sampling in qualitative inquiry. Thousand Oaks: Sage.

Pillen, H., Miller, M., Thomas, J., Puckridge, P., Sandison, S., & Spark, J. (2009). Assessment of wound healing: Validity, reliability, and sensitivity of available instruments. Wound Practice Research, 17(4), 208–210.

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