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Problem and Purpose
In the environment of an ICU, patients are especially vulnerable to the effects of external factors, which means that intricate interventions are required to address typical concerns. Pressure ulcers (PU) are some of the most common occurrences in the ICU setting due to the factors that contribute to the lack of motion in vulnerable audiences. Specifically, in the ICU setting, patients are typically either sedated or immobilized to provide ventilation or any other services for sustaining their health (Gill, 2015). In order to create an effective prevention and management strategy for handling the problem of PUs in the ICU context, one should incorporate the approach involving the active movement of patients with the application of silicone foam dressing, at the same time introducing new and more detailed instructions to nurses regarding the process of meeting patient-specific needs.
Variables
In the course of the study, several key variables will be analyzed. Independent variables will include the variety of approaches used to prevent and address the development of pressure ulcers in patients. For instance, moving patients, reducing the pressure between the patient and the mattress, and other approaches will become the independent variables of the analysis. In its turn, the actual change in patients’ well-being will be the dependent variable of the study.
Definitions
Before commencing the research, one will have to define the key concept analyzed in the study. Specifically, the phenomenon of PUs will require clarifications. Boyko, Longaker, and Yang (2018) define PU as the injuries that a patient’s skin sustains when exposed to a prolonged impact of a particular tissue, such as hospital bed sheets. Although providing a rather basic understanding of the subject matter, the specified definition allows embracing the gravity of the problem. Thus, the definition implies that the variables such as the length of stay and the use of movement approaches, as well as other interventions preventing ulcers, define a patient’s well-being.
Research Questions
In the course of the study, the existing approaches toward managing PUs in the ICU setting will be compared and contrasted with locating the one that has the most beneficial effects on patients. The specified objective is critical to addressing the possible aggravation of patients’ conditions in the ICU environment (Tayyib & Coyer, 2016). Therefore, the research question can be worded in the following way: “What are the current approaches toward the management and prevention of PUs in the ICU setting, and which one leads to the best outcomes?”
Theoretical Framework
Description
Given the fact that the study is aimed at reviewing the existing approaches toward managing PUs in ICU patients and selecting the optimum ones, a theory for managing chronic wounds in the ICU context will have to be reviewed to choose an appropriate one. Particularly, the middle-range theory designed by García‐Fernández, Agreda, Verdú, and Pancorbo‐Hidalgo (2014) will have to be considered as the platform for implementing a positive change in the specified environment.
Concepts
The theory designed by García‐Fernández et al. (2014) comprises several crucial concepts aimed at improving patient outcomes. These include a patient-centered approach and the idea of analyzing all available coadjuvant factors (Tayyib & Coyer, 2016). The latter, in turn, can be defined as the aspects of the external environment that may either improve a patient’s condition or aggravate it (García‐Fernández et al., 2014). The specified notions are critical for understanding the theory proposed by the authors.
Rationale
The application of a middle-range theoretical framework to the specified concern may seem like a rather narrow way of handling the issue, yet it also offers a patient-centered approach that caters to the needs of a particular demographic (García‐Fernández et al., 2014). Therefore, the tool designed by García‐Fernández et al. (2014) should be seen as the platform for improving the existing situation concerning the rapid progression of PUs development in the ICU context.
Review of the Literature
For a nurse, it is critical to address the needs of patients that cannot communicate their needs immediately, which the ICU setting implies. However, because of the specifics of the environment, communication with patients may be hampered by an array of factors, such as the instance in which they are sedated (Tayyib, Coyer, & Lewis, 2016). Therefore, the specified demographic is exposed to the risk of developing PUs in the ICU environment. At present, several strategies aimed at handling the described concern have been utilized. Moving patients regularly is one of the approaches that are used most commonly (Qaseem, Humphrey, Forciea, Starkey, & Denberg, 2015; Tayyib et al., 2016).
The use of the technique involving repositioning serves as the key tool in preventing ulcers, whereas their treatment traditionally includes reducing the pressure on the wounded area and using medications aimed at stifling the pain from PUs, as well as antibiotics to prevent the development of inflammations and nosocomial infections (Bly, Schallom, Sona, & Klinkenberg, 2016). The observed strategies, however, are not sufficient since they do not allow preventing the phenomenon completely. Therefore, a complex approach toward managing PUs is required.
In addition, a nurse has to be aware of the typology of PUs to design an appropriate intervention. As a rule, four stages of PUs development are identified. Stage I represents a nonblanchable erythema with the patient’s skin being relatively unharmed, whereas Stage 2 implies the development of a blister and the following thickening of a patient’s skin (Boyko et al., 2018). At stage 3, a patient’s fat is exposed, whereas Stage 4 is characterized by exposed tissue such as muscles and bones (Boyko et al., 2018). By determining the stage correctly, a nurse can adjust the existing treatment technique to spur a patient’s recovery.
The sources that will be selected for the support of the key argument and the essential evidence will be mostly primary since it is critical to focus on the use of the data that has been tested and verified a posteriori. However, the research may also incorporate certain secondary evidence that will provide insight into the nature of PU management techniques. Thus, a balanced approach toward managing the available information will be undertaken.
Methodology
Study Type, Design, and Rationale
The present research is aimed primarily at analyzing the qualitative aspects of the subject matter. Particularly, the nature of PUs and the tools for their management will be identified. Therefore, the qualitative design should be used. Furthermore, since the essence of the analysis implies exploring the available array of management techniques, as well as the causes of PUs in the ICU setting, and creating a new approach, the grounded theory should be deployed as the study type.
Sample Size, Type, and Sampling Method
Because of the application of the qualitative research design, the sample size of the study is going to be rather small. Particularly, a total of 20 participants will be selected as the study sample to represent the target population. To choose the research subjects, one will need the method of criterion-based sampling. The suggested tool is critical due to the small number of participants and the need to represent the target demographic properly.
Inclusion/Exclusion Criteria, Setting, and Data Collection Method
In order to be deemed as the population that is eligible for participating in the research, the participants are required to have the experience of tending to the needs of ICU patients. Nurses will have to share their experiences of addressing ICU patients’ needs and preventing the development of PUs. Furthermore, the key information that will be used in the research will be obtained with the help of semi-structured interviews. The proposed data collection tool creates the setting for gaining additional information that will inform the choice of the optimum PUs management technique. Thus, an in-depth analysis of the problem will be built.
Method for Protection of Human Subjects
In order to protect the needs of the research subjects, one will have to ensure that each of the participants is provided with an informed consent form to sign. The form will be distributed to the selected individuals via e-mail. In the form, the key information about the research goals, process, and data management will be provided (see Appendix A). Thus, one will be able to avoid misunderstandings leading to the following conflict of interests and threats to participants’ data security.
Data Analysis
The information will be collected with the help of interviews and analyzed by using the inductive approach, in general, and narrative analysis, in particular. The specified tools will allow building upon a larger concept of managing patients’ needs in the ICU context. As a result, an effective framework for preventing the incidences of PUs development in the ICU setting will be designed to promote further improvements in nursing care. The gathered information will be split into categories based on the characteristics that will be ascribed to each management tool. Thus, a comprehensive analysis will be possible.
Applicability to Nursing
It is believed that the suggested technique will lead to a gradual drop in the cases of PUs development in ICU patients. In addition, the specified framework will help address the needs of patients who have already acquired PUs in the ICU environment more carefully. By shaping nurses’ attitudes toward the use of the provided guidelines and introducing an evidence-based approach for improving the clinical practice, one will reduce the instances of PU development and aggravation in ICU patients.
Therefore, the current study will require a profound comparison of the suggested technique and the existing frameworks for preventing and managing the development of PUs in patients. With the focus on the improvement of the present guidelines, one will create the scenario in which nurses will also explore opportunities for rapid professional growth.
Appendix A: Informed Consent Letter
To the prospective research subject: please, consider the information provided below carefully to familiarize yourself with the study and its goals. Please, feel free to ask any questions about the research whenever you need. By signing the consent form, you agree that all data acquired during the study, except the personal one, will be mentioned in the paper.
The goal of the project is to explore the strategies for preventing PUs development in ICU patients. In the course of the study, you will be asked about the nature of your PU-associated problems and the way in which nurses handle your condition. Afterward, the obtained data will be synthesized to be presented in the article.
I (First Name Last Name) understand the conditions of the research and agree to participate in it.
References
Bly, D., Schallom, M., Sona, C., & Klinkenberg, D. (2016). A model of pressure, oxygenation, and perfusion risk factors for pressure ulcers in the intensive care unit. American Journal of Critical Care, 25(2), 156-164. Web.
Boyko, T. V., Longaker, M. T., & Yang, G. P. (2018). Review of the current management of pressure ulcers. Advances in Wound Care, 7(2), 57-67. Web.
García‐Fernández, F. P., Agreda, J. J. S., Verdú, J., & Pancorbo‐Hidalgo, P. L. (2014). A new theoretical model for the development of pressure ulcers and other dependence‐related lesions. Journal of Nursing Scholarship, 46(1), 28-38. Web.
Gill, E. C. (2015). Reducing hospital acquired pressure ulcers in intensive care. BMJ Open Quality, 4(1), 1-5. Web.
Qaseem, A., Humphrey, L. L., Forciea, M. A., Starkey, M., & Denberg, T. D. (2015). Treatment of pressure ulcers: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 162(5), 370-379. Web.
Tayyib, N., & Coyer, F. (2016). Effectiveness of pressure ulcer prevention strategies for adult patients in intensive care units: A systematic review. Worldviews on Evidence‐Based Nursing, 13(6), 432-444. Web.
Tayyib, N., Coyer, F., & Lewis, P. (2016). Saudi Arabian adult intensive care unit pressure ulcer incidence and risk factors: A prospective cohort study. International Wound Journal, 13(5), 912-919. Web.
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