Introduction to Nursing Research NRS 433
Grand Canyon University
November 23, 2014
Introduction As discussed in their study, Effectiveness of two cushions in the prevention of heel pressure ulcers, (2009), by Heyneman, Vanderwee, Grypdonck, and Defloor, pressure ulcers are a constant concern for nursing professionals. Pressure ulcers are emotionally, physically, and financially expensive. More evidence-based practice research into effective methods of reducing the incidence of pressure ulcers is needed. The authors sought to fill the gap in research on the effectiveness of a wedge-shaped cushion versus a typical pillow for preventing heel pressure ulcers. This paper critically evaluates this study’s ethical guidelines, the variables involved in the research, the methods of data collection and analyses, and the implications of its findings for current nursing practice.
Protection of Human Participants
Benefits and Risks By their participation, the sample population contributed to essential research affecting evidence-based care. In their research, the authors discovered that heel pressure ulcers often occur within the first few days of hospitalization, and early prevention with the use of a wedge-shaped cushion is a more effective intervention than using a standard pillow for heel elevation. A risk the participants incurred, while participating in the study, was that those not receiving the wedge-shaped cushion as a treatment were more likely to develop a heel pressure ulcer, and they were more likely to incur the consequential costs. The article did not list any resources as a means of addressing these costs. However, those that did not receive the wedge-shaped cushion for treatment were administered pillows as an intervention. Per the statistical outcomes listed in the article, a standard pillow was still an effective means of reducing the incidence of heel pressure ulcers (Heyneman et al, 2009).
Ethical Considerations The ethics committee of all participating facilities approved this study. 162 participants either voluntarily signed or, if unable to make their own decisions, a relative of the patient signed a written informed consent before the start of the research. There was no mention in the article regarding recruitment efforts, confidentiality, nor any planning to compensate for financial issues that the participants may incur (Heyneman et al, 2009).
The independent variables of this study were the “wedgeshaped, bedwide, viscoelastic foam cushion and a standard pillow,” (Heyneman et al, 2009, p. 114). The researchers standardized the size, dimensions and raw materials of the pillow and the wedge-shaped cushion for all participants.
The dependent variables included that the patients: were older than 75 years, were in either a nursing home or an acute care hospital, were expected to stay in the facility longer than 3 days, had a grade 1 nonblanchable erythema (NBE) on a heel, were considered “at-risk” for the development of a grade 2 (or more) pressure ulcer, and were turned every 4 hours. All nurses were trained to assess the skin using the European Pressure Ulcer Advisory Panel (EPUAP 1999) classification system (Heyneman et al, 2009).
Collection Techniques In order to minimize extraneous variables, the EPUAP classification system and the Braden Scale were adopted. Using clear definitions, ulcers were staged using a grading system of 1-4. Differentiation in grading was assisted by using a 4 cm x 4 cm transparent pressure disk. Skin integrity was assessed during the morning shift, daily. The authors did not mention the length of time to complete the study (Heyneman et al, 2009).
Data Management and Analysis
There was no mention about the data management other than the tools, interventions and techniques utilized (see above). In order to reduce bias and promote rigor in their analysis, patients were randomly selected based upon