NUR 0067
Literature Search and Review
Name: Angelina House

You are a nurse on a medical unit and part of your unit’s quality improvement committee. The clinical problem that you committee is starting to work on is an unacceptably high rate of pressure ulcers. Your group wants to develop a prevention program for high risk patients and members of the committee have been assigned to look for evidence on various preventive measures. You agreed to look for evidence about the potential benefit of positioning (turning and bed position) in preventing pressure ulcers.

1. Write this clinical problem as a PICO question

What type of question is this?
Prevention
P patients at high risk for pressure ulcers
I
turning and positioning patients
C
not turning and positioning patients
O
Patients who were turned repositioned in bed had less ulcers than those who did not go through this internvention.
Clinical question in PICO format
For patients at high risk of getting pressure ulcers does the use of positioning methods reduce the future risk of getting pressure ulcers compared to not using positioning methods?

2. Below are abstracts from a number of studies that were retrieved when you did a literature search using the key word “pressure ulcer”. Below each indicate whether or not you would retrieve the article to use in answering your PICO questions along with the reason(s) you would or would not retrieve it. Indicate the level of evidence.

Abstract 1:
St-Arnaud D. Paquin MJ. Safe positioning for neurosurgical patients. AORN Journal. 87(6):1156-68; quiz 1169-72, 2008.

Abstract:
Positioning the patient for surgery is an important part of perioperative nursing care that should not be underemphasized. The combined factors of time, mechanical pressure, and immobility increase the risk of tissue damage. The objectives of perioperative positioning activities are to balance optimal surgical exposure with the prevention of any injury related to position and to maintain normal body alignment without excess flexion, extension, or rotation. General principles of positioning and specific considerations with surgical rationale are presented in this article for each of the commonly used neurosurgical positions (eg, supine, knee-chest, prone, lateral, park-bench, sitting).

Would you retrieve this article?
No
Why or why not? I would not choose it because the article does not specifically relate to pressure ulcers, but is concentrated on optimal surgical exposure and preventing injury in patients. Also, it is an informational article that does not conduct an experiment. Level VII evidence is not very strong.

Level of Evidence?
Level VII: opinion of authorities and/or reports of expert committees

Abstract 2:
Peterson M. Schwab W. McCutcheon K. van Oostrom JH. Gravenstein N. Caruso L. Effects of elevating the head of bed on interface pressure in volunteers. Critical Care Medicine. 36(11):3038-42, 2008

OBJECTIVE: Intensive care unit patients are at particular risk for pressure ulcers and ventilator-associated pneumonia. Current guidelines recommend that mechanically ventilated patients be kept in a semirecumbent position with the head of bed elevated 30 degrees -45 degrees to prevent aspiration and ventilator-associated pneumonia. We tested the effects of elevating the head of bed on the interface pressure between the skin of the sacral area and the bed with healthy volunteers. INTERVENTIONS: Interface pressure profiles of the sacral area were obtained for the 0 degrees , 10 degrees , 20 degrees , 30 degrees , 45 degrees , 60 degrees , and 75 degrees head of bed elevated positions from 15 subjects (14 men, one woman). MEASUREMENTS AND MAIN RESULTS: Peak sacral interface pressures increased with large increases in head of bed elevation. The 30 degrees , 45 degrees , 60 degrees , and 75 degrees head of bed positions all had peak interface pressures that were significantly (p < 0.02) greater than the supine measurement and also were