1- Critique different types of evidence ( the area I’ve chosen is pressure ulcer in ICU)
2- Analyse what constitutes Best Evidence for practice in the UK
3- Critically reflect on the BENEFITS and LIMITATIONS of evidence based practice (EBP) within nursing practice. Using Randomised Controlled Trial (RCT)
Student will critique a qualitative and quantitative research paper and explore how research and EBP apply to nursing practice.
Harvard Reference, CINAHL, NICE,

Introduction

Pressure ulcers are among the most underrated issues of medical science within the patient who is ill critically. Despite various advancements within medical technology as well as the usage of the formalized program of prevention which is based on the guidelines of clinical practice, PU prevalence during hospitalization continues mainly to increase dramatically. Pressure ulcers are counted as the third most costly disorder in order to treat after cardiovascular and cancer disease (Al-Dorzi, 2019). An ill patient is critically at higher risk of PU as compared to the patient within the area of general care. Patients within several ICUs are often ventilated and sedated that interferes with the ability and mobility to care. Movement is considered a natural reaction to pressure and it is often lost during periods of critical illness. The ill patient may be critically impacted further by the poor perfusion of tissue related to hemodynamic instability, poor status of nutrition, skin maceration because of moisture, and conditions like renal impairment, vascular failure, or anemia or shock. An important evidence amount has now accumulated indicating that prevention of PU is a necessary element of patient care. The overall write-up is regarding evidence-based practice in the prevention of pressure ulcers within ICU. The write-up contains a short introduction. Then it discusses various types of evidence-based practice. The write-up analyses what constitutes best evidence practice within the UK. The benefits as well a limitation of evidence-based practice have also been evaluated using RCT. Lastly, the overall essay has been concluded briefly.

Main Body

A pressure ulcer is a crucial health issue around the world. In accordance with the national Pressure Counselling Panel, it has been defined as a localized wound on skin or the underlying tissue on bone spur as an outcome of shear or pressure. The warning sign of the disease is a swelling, unusual change in texture or color of skin, and pus-like tender area and draining. It is considered as a condition that lowers life quality, cost of care, and increases the period to stay in hospital(AYDIN SAYILAN, 2019). The prognosis of pressure ulcers with complications and infection has led to a mortality increase. Nowadays, management of knowledge, altering preferences of health care of society, and the policies of cost-effective care have made evidence-based practices mandatory. The overall role of initiatives that are evidence-based is much essential in the prevention of the disease. The skincare, risk assessment, position changing, nutrition, and education are there within the content of the important practices, all of these applications that comprise the basis of nursing care.

Evidence-based risk assessment

An effective and reliable first step within the planning of prevention of pressure ulcers is to utilize the scales of risk identification in order to determine pressure ulcer risk for individuals(Brún, 2020). The risk factor may include injuries in the spinal cord, immobility, lacks the sensory perception, poor hydration and nutrition, neurological disorder, and medical conditions that impact the flow of blood like vascular disease and diabetes. The most generally used scales can be Norton sale of risk assessment, Braden scale of risk assessment, Waterlow scale of risk assessment, Bates-Jansen Tool for Wound assessment, Suriadiand Sanada scale of risk assessment for pressure ulcer and Buch Pediatric tool for risk assessment for pressure ulcer. Using the tools for risk assessment within daily care of medical by the nurses is much essential to be able in order to make objective evaluations. The tools for assessing the risk must be used often in order to offer effective care to nursing within pressure ulcer prevention. Specifically, the selection of valid tools for the assessment of risk which is proper for the patient population is much essential. Regarding skin care, the first thing that is to do while encountering a pressure ulcer is to evaluate the wound. It is much important that skin is dry and clean(Cooper, 2019). The sites of a body which are moistened by the fluids of body and sweat and the body sites that have wrinkles must be washed using a mild soap. Topical care of the wound must be given. Topical care will help the wound to be moist. Pressure ulcer helps to lower the life quality of individual which could cause fast mortality within some of the patients and a significant cost for the organizations of healthcare. Hence, the management and prevention of pressure ulcers are much essential.

Unbalanced and inadequate nutrition is considered a key risk factor for the establishment of pressure ulcers and the healing of wounds because of the negative impact on collagen synthesis and the immune system(Guest, Fuller, Vowden and Vowden, 2018). Tests in the laboratory like pre-albumin, retinol, serum albumin, transferrin, and another measurement of anthropometric like weight, body mass, and height can be used only within the determination of prognosis, but they are not able to identify the nutritional status of individual fully. Although the impact of the optimum intake of nutrients is not specifically known within the promotion of the healing of the wound, vitamins C, A, and E and zinc, the positive impact of energy as well as the amino like glutamine and arginine has been emphasized. Hydration also plays an important role in repairing and preserving the integrity of the skin. The changing of position must be adjusted relying on regions of the body where the ulcer has been developed. The position of the patient must be done in such a way so that it can prevent contact of ulcer area to the bed surface. Training of the professionals of health care is an important part of pressure ulcers. The main aim is to lower the overall frequency of the disease by altering the pattern of behavior. It has been emphasized that offering training in various formats like education that are based on education and didactic within the environment of classroom mainly increases the level of knowledge of the professionals on preventing pressure ulcers.

Best evidence-based practice in the UK

The management of wounds is a vital concern in the UK. A debate has happened regarding establishing a strategy in order to enhance the standard of care of wounds within NHS. PU is considered a disease that comes under major wound categories. All of the healthcare systems have identified the significance of preventing PU(Ozyurek and Yavuz, 2019). Many pressure ulcers are avoidable and the prevention is within domain 5 of the Department of Health’s NHS outcome framework. Successful prevention of PU will require a holistic assessment of the patient, individual profile of risk, and skin status. The management must encompass carer and patient education, repositioning, suitable use of pressure, skincare relieving the devices that have been combined wherever necessary with some nutritional support, and use of proper products for the wound care. Ideally, all of the information that is of good quality about care and health interventions will reflect most of the updated scientific evidence properly. While dealing with the effectiveness of the treatment and systematic review of RCT offers the most reliable evidence source. There are various advantages of using RCT as an evidence source such as reducing bias and balance, acknowledging the uncertainty, using consistent language, it is an explicit process for obtaining evidence and impartiality. Often there are contradictions while collecting evidence(Tsaras et al., 2016). The evidence source of care and health interventions within which the errors or bias are not much commons is known as a systematic review.

Advantages and disadvantages of EPB (Evidence-Based Practice) applying RCT

Evidence-oriented practice in healthcare provides various kinds of advantages to nurses and patients. The healthcare professionals dealing with pressure ulcer patients in ICUs are required to keep practices relevant and current thereby increasing the confidence of nurses as well as acquiring decision-making skills effectively (Sheridan and Julian, 2016). This would contribute to their medical profession. Nurses would use this type of practice by applying principles for making vital decisions with regards to patient care. Integration of nurses with suitable evidence-based practices provides a patient-centered and holistic approach for them to undertake vital operations. They are the three vital elements with regards to evidence-oriented practice. This comprises applying suitable external evidence, drawing on clinical expertise individually as well as taking into consideration the expectations and values of patients. To treat and cure patients experiencing pressure ulcers, it would be the prime role and responsibility of nurses to enhance patient outcomes by delivering them superior care, maximizing the time of providers as well as minimizing costs and adding the latest contributions to the nursing science (Mayoclinic, 2022). Consistent care would be provided to pressure ulcer clients by nurses when they prioritize patients’ necessities. Evidence-oriented practice helps and supports the whole medical team for enhancing patient outcomes by measuring every patient’s experiences and preferences. Improved decisions of patient care would play a vital role in saving time for nurses. Nurses would have the responsibility to enhance practices of infection control by well-knowing the fact that practicing handwashing and wearing personal protective equipment are vital sources to do infection control successfully.

A potential limitation is found to be mechanistic reasoning as well as clinical judgments’ relegation with over-dependence based on the responsibility of systematic reviews and clinical trials. Systematic reviews and clinical trials can be found limited because of the unrepresentativeness of various trial patients on the basis of comorbidities, therapy and age (Roever, 2015). This can also happen when over-dependence is done on statistics as compared to its clinical importance. It can produce misleading outcomes because of reporting bias, gradual prognosis, alterations in disorder mortality and unsuitable small trials’ pooling. In addition to this, adverse impacts are also imposed on nursing practice like bias in relation to measuring risks easily during the time of relegating fewer tangible values like dignity and experience of patients along with knowledge generation. Commissioned research’s bias shall minimize topics’ independence chosen for distorting or studying the base of evidence (Nurseslabs, 2022). Besides this, a detailed emphasis is needed on devices and drugs that have left huge health aspects in evidence vacuums. Original science and comparative research’s conflation, as well as comparative research, investigate known things along with also identifying what things are unknown. Evidence shortages are a potential limitation to many health care providers within ICU settings so they need to have their common sense. Apart from this, the actual time length as well as finding difficulties requires potential evidence. It would also be required by nursing practitioners to produce the latest skills in appraising and seeking evidence. Hence, it takes potential effort and time to practice practically within the health care setting. If these skills are lacking among nurses then it might result in confirmation bias. This would be considered specific evidence for supporting their personal judgment and experience.

Exploring EBP and research with application to clinical practice

Randomized Controlled Trials take an essential part in healthcare to offer evidence-oriented medicine. Safe clinical decisions can be made to care for clients as well as collaborate clinical judgment by using scientific research methods. Evidence are mainly required in EBM to provide medicines to pressure ulcer patients. Based on this approach, suitable evidence would be delivered by RCTs by performing observational studies. The main motive of an RCT is to use all its elements efficiently. The framework applies its control element for imparting validity with regard to the experiment done (Ahuja, 2019). This kind of control is considered a suitable means to make sure that a single factor can be tested within a particular period of time. In addition, there would not be several variables present in the emerging areas of the healthcare department. It can contain the power in reflecting a bias containing a certain type of sorts and actual outcomes. In addition, a placebo comparison can be put forward by providing an allowance to RCTs for blinding intervention providers, various trial stakeholders like statisticians and participants. Apart from this, there are certain RCTs that do not obtain any power for employing control teams that can also be found like a trial of comparative effectiveness. Therefore, it can be understood that placebo comparison has not accompanied necessary randomization. It would primarily rely on the condition of the patient for evaluating the fact that RCT has the power or not for providing overall effectiveness or net efficacy (Cebma, 2022). The RCT also takes the initiative for eliminating various kinds of biased sources from the care and treatment procedure. It would even make sure that no incorrect conclusions are made from the undertaken experiment. Based on the adverse condition of the client, it would be found out RCT can play an important role in introducing potential therapy and originally creating potential differences for the patients experiencing the adverse disorder. Besides all these, it carries out the experiment by utilizing patients’ control group where the latest therapy is not received and placebo is highly taken into consideration. This would further set the basis carrying the objective to showcase that the latest therapy would not be received by patients and it would perform in a better manner as compared to the control team. It would be evident by the clinical care team that the RCT would perform well while randomizing groups of clients (Hariton and Locascio, 2018). RCTs are found to be double-blind in nature acquiring the belief that anything would not be known by patients which team they are in. The researcher would also not be able to find out which kind of latest therapy is being received by the patient. This is due to the fact that bias would not be removed by RCTs and it would provide a basic evidence standard. Health care professionals need to know that RCTs can provide the expectation and hope for helping and assisting them in making informed and effective decisions.

Conclusion

For the treatment of pressure ulcers, nurses as well as other healthcare professionals would require the support of evidence-based practices. This would ease the treatment process in nursing care units such as maintaining good nutrition, controlling pain as well as preventing infection. The treatment team would comprise members like care physicians, dieticians, social workers, neurosurgeons and physical therapists to reduce the pressure of the patient as well as dress and clean wounds. Repositioning needs to be carried out effectively and it would be based upon the condition of the client as well as the surface quality. The treatment group must work in collaboration for providing sufficient support to pressure ulcer patients dealing with depression, social isolation, pain and discomfort. Proper education also needs to be delivered carrying terminal illness or long-term caregiving. There are certain limitations in using RCTs while considering the fact that it is an essential medical research element. Potential questions can be raised in healthcare units for applying RCTs practically. These experiments are very much expensive for conducting medical experiments. By the application of these experiments, a better opportunity can be gained by healthcare organizations from obtaining huge amounts of profits. The follow-up procedure is also difficult.

References

Ahuja, A., 2019. Should RCT’s be used as the gold standard for evidence based medicine?. Integrative Medicine Research, 8(1), pp.31-32.

Al-Dorzi, H., 2019. Prevention of pressure injury in the intensive care unit. Saudi Critical Care Journal, 3(1), p.24.

AYDIN SAYILAN, A., 2019. Evidence-Based Practices for the Prevention of Pressure Ulcers. Journal of Health Services and Education, 3(1), pp.7-10.

Brún, C., 2020. Finding the Evidence A key step in the information production process. [online] England.nhs.uk. Available at: <https://www.england.nhs.uk/wp-content/uploads/2017/02/tis-guide-finding-the-evidence-07nov.pdf> [Accessed 15 March 2022].

Cebma, 2022. Limitations of Evidence-Based Practice – Center for Evidence Based Management. [online] Cebma.org. Available at: <https://cebma.org/faq/limitations-evidence-based-practice/> [Accessed 15 March 2022].

Cooper, K., 2019. Evidence-Based Prevention of Pressure Ulcers in the Intensive Care Unit. Critical Care Nurse, 33(6), pp.57-66.

Guest, J., Fuller, G., Vowden, P. and Vowden, K., 2018. Cohort study evaluating pressure ulcer management in clinical practice in the UK following initial presentation in the community: costs and outcomes. BMJ Open, 8(7), p.e021769.

Hariton, E. and Locascio, J., 2018. Randomised controlled trials – the gold standard for effectiveness research. BJOG: An International Journal of Obstetrics & Gynaecology, 125(13), pp.1716-1716.

Mayoclinic, 2022. Bedsores (pressure ulcers) – Diagnosis and treatment – Mayo Clinic. [online] Mayoclinic.org. Available at: <https://www.mayoclinic.org/diseases-conditions/bed-sores/diagnosis-treatment/drc-20355899> [Accessed 15 March 2022].

Nurseslabs, 2022. 3 Pressure Ulcer (Bedsores) Nursing Care Plans. [online] Nurseslabs. Available at: <https://nurseslabs.com/pressure-ulcer-nursing-care-plans/> [Accessed 15 March 2022].

Ozyurek, P. and Yavuz, M., 2019. Prevention of Pressure Ulcers in the Intensive Care Unit. Clinical Nurse Specialist, 29(4), pp.210-217.

Roever, L., 2015. Endpoints in Clinical Trials: Advantages and Limitations. Evidence based Medicine and Practice, 1(s1), pp.20-23.

Sheridan, D. and Julian, D., 2016. Achievements and Limitations of Evidence-Based Medicine. Journal of the American College of Cardiology, 68(2), pp.204-213.

Tsaras, K., Chatzi, M., Kleisiaris, C., Fradelos, E., Kourkouta, L. and Papathanasiou, I., 2016. Pressure Ulcers: Developing Clinical Indicators in Evidence-based Practice. A Prospective Study. Medical Archives, 70(5), p.379.

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