Assessing the Adequacy of Pressure Ulcer Prevention in Hospitals - Essay Example

Quantitative Critique Quantitative Critique The study has provided a clear and well-defined problem ment, whereby, the purposeof the study is to obtain insight into the adequacy of interventions used to prevent pressure ulcers in Belgian hospitals. There lacks a clear definition of the variables under this study, as the study does not clearly define which aspects of the study are to be started with (independent variable), and which are to be generated in the course of the study (dependent variables), as result of the ones already determined by the study before its onset. The study implies some empirical testability, as the researchers have not yet hypothesized the likely outcome or the expectation of the study. A statement made in the introduction of the study reinforces this, by clearly stating that there lacks large-scale data in this field, which are based on patient observations in hospitals (Vanderwee, Defloor, Beeckman et al, 2011). Therefore, the study seeks to venture into an area that has not been widely studied before. The population to be considered under the study is not well defined under the problem statement, in that the study seeks to cover patients suffering from pressure ulcers in Belgian hospital, thus lacking clarity in defining the actual population that will be put under consideration. The problem area tackled by the study is relevant to nursing, in that it seeks to measure the adequacy of the interventions applied to prevent pressure ulcers. In obtaining such insights, the study will generate the areas of weaknesses, which nursing, as a profession should address, to enhance pressure ulcers prevention. The study lacks adequate literature review. In fact, the study does not have the literature review section. This however, can be attributed to the fact that the study seeks to venture into an area that has not been widely studied, thus lacking adequate literature, which is relevant for this study. Nevertheless, there is ample literature that tackles the areas of pressure ulcers as a disease and the factors causing this condition. Owing to the fact that, under introduction, the study highlights the effects of pressure ulcers to the society such as mortality, hospitalization, and health care expenditure, and considering that, the necessary prevention measures such as the reduction of pressure on the patient tissues are addressed on the introduction, then, the study ought to have undertaken a broad literature review. Thus, there lacks a literature review of the dependent and independent variables, though there are some data based literature in the introduction of the study, stating that pressure ulcers prevalence in hospitals have been reported at a range of 7% to 26 % in hospitals (Vanderwee, Defloor, Beeckman et al, 2011). Under the study, the conceptual and the operational definitions are lacking, while there is an absence of a synthesis summary for literature review and no clear clarifications on the gap and inconsistencies of the study. Due to a lack of a comprehensive literature in the study, there lacks a formidable background, against which the research is undertaken, limiting the desired broad understanding of the area of study. Additionally, due to the absence of a comprehensive literature review, then, the study lacks any theoretical framework, on which it can be base its methodology, procedure, and findings. However, considering that the study is undertaken on an area that has not been widely studied before, limiting the access to large-scale data for use under this study, then, a suitable basis for establishing a theoretical framework is non-existent. Nevertheless, since the study involves assessing the interventions applied in Belgian hospitals to prevent pressure ulcers, conceptual framework becomes the basis of this study. Considering that, there lacks a clear definition of conceptual terms applied under the study, then, there is an absence of consistency between theoretical framework and conceptual definitions. The undertaking of the study is not based on any theory. This is detrimental to the area of study being undertaken, in that the likelihood of the study evaluating and analyzing the suitability of such a theory to determine its validity, through undertaking further theoretical tests and evaluation is lacking. This way, the likelihood of this study developing new knowledge and either supporting or criticize the already existing theories is limited. Since the study does not apply any nursing theory, the findings, conclusion, and recommendations of the study are limited, as they cannot be based on any existing theory. Additionally, there is no evaluation of the already existing theories of nursing, which is an aspect that would have served to create more knowledge and understanding of the problem area tackled by the study. Hypothesis is yet another element of viable research that is missing under this study. The study does not provide any defined research hypothesis. However, considering that this is a highly empirical study, venturing into an area that has not been widely studied (Vanderwee, Defloor, Beeckman et al, 2011), then there is not already established hypothesis, which the study seeks to test. The study majorly focuses on creating insight into the interventions used in preventing pressure ulcers, thus seeking to develop new understanding, at the expense of proving or refuting already predetermined claims. Another element missing out under the study is the research questions. Although the study problem is clearly defined, the research questions that would be applied to elicit answers to the study problem are not stated, making it difficult to understand the specific areas that the study would address. In the absence of clearly stated research questions, then, the area and scope of the study is not well defined. This way, though the study tackles the interventions for preventing pressure ulcers, it is not clear from the study, which other areas it may seek to address, in a bid to create more understanding and thus effectively and comprehensively answer the research question. The absence of research questions also serves to eliminate the chances of establishing the relationship between the study and the literature. There is no prediction of the likely outcome, which would have been established by the presence of research questions. The study applied quantitative research method, where descriptive research design was used. This research design involved the description of the elements of study, as they are, where the interventions that are used to prevent pressure ulcers are described just as they are applied in different hospitals. The study involved the collection of data from various hospitals, which was then organized, analyzed and interpreted just the way it was collected, to help create an insight regarding the interventions applied. The design offers appropriate control for threats to internal study, in that it involves the observation of subjects of study under their natural settings, where the researchers observed the various interventions applied by hospitals in Belgium to prevent pressure ulcers. The suitability of this research design is in the fact that, the elements of study are not interfered with, thus allowing an opportunity to obtain the actual picture of the situation. The design is however not suitable for such a study that is being undertaken on area, where no broad study had been undertaken previously (Vanderwee, Defloor, Beeckman et al, 2011). This is because, since the design is highly dependent on observation, then it is not repeatable, an aspect that is necessary for such a study, which is being undertaken in a new problem area. However, it is an appropriate design for preceding quantitative research, which can later be undertaken in this area, including a comprehensive literature review and basing it on a theoretical framework. Therefore, the application of this research design points to the need for a subsequent research. A probability sampling method was applied in this study. Stratified sampling technique, which is a probability sampling technique, was applied, where a sample of hospitals was obtained, by selecting the other hospitals among a population of all hospitals, leaving out the psychiatric hospitals (Vanderwee, Defloor, Beeckman et al, 2011). This was followed by selecting another stratum of wards for consideration in the study, where the wards with maternity, pediatric and psychiatry patients were left out. From this stage, among a population of all patients present in the wards, a stratum comprising of individuals aged 18 years and above was selected, leaving out all the patients below this age. The individuals who fall under these categories were considered as the sample amenable for investigation under the study. The sample that was selected for investigation consisted of 143 hospitals, out of which, only 84 of them agreed to participate in the study, which equals 68% of the entire hospital population. Among the hospitals, 1005 wards, out of a potential 2043 participated in the investigations. The bias introduced in this study is the age bias, where all the patients who were under the age of 18 years were left out of the sample population investigated. Therefore, the sample selected was not representative of the actual face of the Belgian patients’ population. The 19,968 individuals in Belgian hospitals, who were over 18 years, formed the sample. The sample considered under this study is sufficient, since all the hospitals and wards were included in the sample, with just a few exceptions. However, selecting such a sample population to investigate points to the lack of accuracy in the findings of the study, as the population involved could have been too big. The rights of the individuals were protected under the study, since the consent of all the patients was sought, before they were engaged in investigation. The consideration to only investigate patients who were 18 years and above is yet another major step towards protecting the rights of the subjects under study, since all the subjects were in the legal age of consenting. Additionally, the eligibility and delimitation criterion of the population and samples is clearly defined, allowing an understanding of the whole sample selection process. The data collection instruments that were applied under the study are clearly defined, which range from risk assessment, to data collection and observation instruments. The study applied five data collection instruments, which consisted of the general data instrument, which collected the general information such as the type of hospital and the wards from which the patients were to be investigated. The second instrument that was applied under the study was the patient data instrument, which collected the information regarding the gender and the age of the patients (Vanderwee, Defloor, Beeckman et al, 2011). The other instrument applied was the Braden scale, which assessed the Pressure ulcer risk of each of the patients. The final instrument applied under the study was the observation guide, under which the observable prevention interventions that were applied in different hospitals were recorded. The data procedures were applied evenly under all the subjects, ensuring that sufficient information was collected from each of the individuals involved in the study. The data collection instruments applied were suitable for the study undertaken, in that they helped to ensure that sufficient and variety of information was collected, as many data collection instruments were applied, which collected different type of information each. The data collection tools and the methodology applied was developed, examined, and investigated by European Pressure Ulcer Advisory Panel (EPUAP), to ensure that they have a high level of predictive reliability (Vanderwee, Defloor, Beeckman et al, 2011). Supervisor and respondents training was undertaken, in order to ensure the accurate completion of the data collection instruments, thus allowing the information collected from such data instruments to be valid and reliable. Under the data analysis, there was an evaluation of the adequacy of pressure ulcers preventive interventions, based on the data collected. Both the patients under the risk of pressure ulcers development and those with no risks were considered under the analysis, where the type of mattresses, the lying or sitting position and patient repositioning as well as cushion used to sit on by the patients were considered under the data analysis. All this information was recorded through the SPSS software, which was then used to analyze the data and provide results inform of percentages and frequencies (Vanderwee, Defloor, Beeckman et al, 2011). The descriptive statistics reported under the study includes the patient environment and handling, such as the mattresses and cushions. However, there was no inferential data recorded under the study. According to the findings of the study, 62.4% of the individuals investigated were from surgical wards, 60% accounted for individuals who were above the age of 70 years, while 25% of the total population investigated was at a risk of developing pressure ulcers (Vanderwee, Defloor, Beeckman et al, 2011). The study found that in general, 30.4% of all the patients investigated, who were under the risk of developing pressure ulcers received adequate preventive attention, while 73.5 % of all patients received partial intervention measures against the development of pressure ulcer. However, though the findings of the study handled the research problem of the study and attempted to answer it, the study did not have any research hypothesis or research questions, which ought to have been supported by the findings of this study. The research findings are well interpreted within the context of the research question, which sought to find out whether the interventions provided for preventing pressure ulcers are adequate. In line with the research question, the findings responded to the effect that there are 12.1% pressure ulcers in Belgian hospitals (Vanderwee, Defloor, Beeckman et al, 2011). The patients under the intensive care units were the mostly affected and under the risks of developing the pressure ulcers. The study came up with a finding that the interventions applied to prevent patients from developing pressure ulcers are inadequate, with only one out of every 10 patients being well provided with preventive interventions (Vanderwee, Defloor, Beeckman et al, 2011). The study is provided with various tables that contain data that support the findings of the study. The study applied various generalizations, to conclude that there is a limited use of preventive interventions in hospitals in Belgium. These findings are applied to mean that the nursing offered in Belgian hospitals is inadequate and ineffective. The findings of the study have been inferred to represent the nursing status of the hospitals in Belgium, even though some of the hospitals could be offering adequate and effective interventions towards the prevention of pressure ulcers (Vanderwee, Defloor, Beeckman et al, 2011). The results of the study are summarized in a clear and concise manner, indicating that pressure ulcers prevalence in Belgian hospitals is 12.1%, and only 10% of the patients are adequately covered by effective interventions (Vanderwee, Defloor, Beeckman et al, 2011). The study concludes that it is possible to improve the interventions necessary for the prevention of pressure ulcers. The improvements can effectively be achieved through the implementation of preventive guidelines, mostly in patient wards. The implications of nursing practices are given, for example, that the nurses do not follow the preventive guidelines, due to barriers such as attitude, lack of suitable equipments, failure to prioritize patient care or a lack of well-defined nursing responsibilities. The study also states the limitations clearly; indentifying limitations such as a higher number of hospital wards and patient participation in the study, with close to 20,000 patients involved, which reduces accuracy. The findings of the study were based on observation and nurses reports as the major sources of data, which may lack precision and accuracy (Vanderwee, Defloor, Beeckman et al, 2011). Reference Vanderwee, K., Defloor, T., Beeckman D., et al. (2011). Assessing the adequacy of pressure ulcer prevention in hospitals: a nationwide prevalence survey BMJ Quality & Safety, 20(3): 260-267. http://qualitysafety.bmj.com/content/20/3/260.full.pdf#page=1&view=FitH Read More