PICO Question Do Highly Staffed Units Reduce Acquired Pressure Ulcers

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PICOQuestion: DoHighly Staffed Units Reduce Acquired Pressure Ulcers

PICOQuestion: DoHighly Staffed Units Reduce Acquired Pressure Ulcers

Pressureulcers are a part of the common hospital-acquiredinfections that cause pain to the patientduring their hospitalization. Despite the increased awareness of thedangers of pressure ulcers, new cases arereportedevery day this brings to question the available measures for theprevention or reduction of patients vulnerable to pressure ulcers.According to the National Institute for Health and Care Excellence(NICE), as at December 2013, the prevalence rate was 4.7% (NationalClinical Guideline Centre, 2014). Additionally, the estimated cost oftreating pressure ulcers each day ranges from $53.62 and $466.38(National Clinical Guideline Centre, 2014). Thisincluded the litigation charges as well as numerous lawsuitsfrom the affected families. While other factors have beenimplicatedin causing pressure ulcers, nurse staffing is one of the contributingfactors. Indeed, the number of nurses attending patients in a pointof care facility informs the quality of care that isprovidedto each of them (National Clinical Guideline Centre, 2014). As such,the PICOT question for this research will address the impact ofhighly staffed units to the reduction of pressure ulcers.Consequently, the results of this study will indicate the need forusing staffing as one of the tools in preventing pressure ulcers inhospitals.

Choiand Staggs (2014)investigated the association between nurse staffing and incidence ofpressure ulcers withthe aim ofunderstanding what the administration could do to prevent thehospital acquired the infection.Using 2397 nursing units in the United States, the quantitativearticle assessed the impact of staffing measures to the number ofreported cases regarding pressure ulcers (Choi&amp Staggs, 2014).The results indicated that registered nurse supposed staffingadequacy had the best indicator of acquiredpressure ulcers. Thisimplies that staffing was asignificantcontributor to the acquiringof pressure sores in that, a highernumber of nurses could mean that patients aregivenadequate care (Choi&amp Staggs, 2014).As such, this could beattributedto the patients per nurse in the facilities. While the length of stayin the hospital,as well as nature of the illness,had been theorized to contribute to the developmentof pressure ulcers, the study showed that staffing adequacy was theunderlying problem. Although the study did not find a strongcorrelation between this attribute and pressure ulcers, among the sixtested administrative measures, staffing adequacy was the highestcontribution.

Reliabilityis an attribute of research quality that shows how a study isconsistent in proving claims. The tools used to test the results ofthe surveyshowed correlations that were consistent,and this is one measure of reliability. Using the three models in thearticle, Model 5, 6, 7, the results obtained for the perceptionof staffing adequacy were similar (Choi&amp Staggs, 2014).Thisshows that the results of the study can be used to make inferencewith precision.

Onthe other hand, validity refers to the effectiveness of an instrumenton performing the expected function. The data wascollectedfrom the NNDQI survey which shows that the reported cases andinformation obtained was accurate (Choi&amp Staggs, 2014).The data on the nurse-reported staffing wasalso matchedto the administrative data as well as ulcer data from the otherquarters. Also, the patients used were also categorized regardingtheir demographic profiles to ensure that their responses given couldbe validated. An exclusion criterion wasalso formulatedsuch that Practice Environment Scale (PES) units with fewerrespondents or less than 50% were not included (Choi&amp Staggs, 2014).Similarly, the unit-acquired pressure ulcers (UAPUs) were alsodefined as a variable while control variables werealso included.However, the method used could not be used to infer causalrelationships requiring a further examination using longitudinaldata.

Thearticle provides an overview of the impact of nurse staffing andpressure ulcers. The study succeeded in showing the associations withUAPU occurrences as units with many workers need to have mechanismsto ensure that all patients aretakeninto consideration (Choi&amp Staggs, 2014).The methods used in collecting data were also accurate giving correctinformation on the administrative contribution of nurses on thedevelopment of pressure ulcers in several institutions. Additionally,the use of six selected staffing measures with a combined model wasan efficient way of representing the information (Choi&amp Staggs, 2014).However, the data collected was from convenient sampling asindividuals were only allowed to participate on a voluntarybasis. As such, this cannot be used to infer the situation to otheracute clinics. Also, the inclusion of unit types in the usedregression models for differences in patient population cannot beused to adjust adequatelyfor risk factors and patient acuity. For this reason, future researchmay beneededunderstand some of the patient outcomes while exploring staffingmeasures.

Aguideline from the U.S Department of Health and Human Services on theintervention and treatment of pressure ulcers describes the need forpreparedness and reforms in administration in the nursing platform.The guideline offers facts on care planning which is a crucial factorin individualizing care to the patients that needenough staffing (NPUA, 2014). Also, repositioning of the patients isalso imperative to the nursing staffing adequacy as it well helpsin the reduction of pressure ulcers. Lastly, the guideline on qualityindicators for the controlling of pressure ulcers incidence in thehealth care institutions can be assessed (NPUA, 2014).

Anotherarticle by Daud-Gallotti et al. (2012) expresses the contribution ofnursing workload as one of the factors in contributing to pressureulcers. The understaffing of nurses, increased patient numbers andworkloads are the leadingcauses of occurrence of hospital-acquiredinfections such as pressure ulcers. Few nurses cannot offerpersonalized care to the critical patients leading to the developmentof pressure ulcers (Daud-Gallotti et al., 2012). The PICO questionshows that highly staffed units could indeed leadto a decrease inthe acquired pressure ulcers.

Theresearch showsthat staffing adequacy is crucial for the reduction of pressureulcers incidence among hospitals and health institutions. There is aneedfor a balance between the number of available nurses and patientsadmitted to the hospitals. As a change in nursing practice,practitioners should beeducatedon the need for understanding pressure ulcers as not only anavoidable condition but also a personal mandate.


Choi,J., &amp Staggs, V. S. (2014). Comparability of nurse staffingmeasures in examining the relationship between RN staffing andunit-acquired pressure ulcers: A unit-level descriptive,correlational study.International Journal of Nursing Studies.http://doi.org/10.1016/j.ijnurstu.2014.02.011

Daud-Gallotti,R. M., Costa, S. F., Guimarães, T., Padilha, K. G., Inoue, E. N.,Vasconcelos, T. N. … &amp Levin, A. S. (2012). Nursing workload asa risk factor for healthcareassociatedinfections in ICU: a prospective study. PloSone,7(12),e52342.

NationalClinical Guideline Centre (2014). Pressure ulcer prevention: theprevention and management of pressure ulcers in primary and secondarycare. NICEclinical guideline 179. London (UK): RoyalCollege of Physicians.

NationalPressureUlcer Advisory Panel (NPUA), European PressureUlcer Advisory Panel, Pan Pacific PressureInjury Alliance. Interventionsfor prevention and treatment of pressureulcers.In: Prevention and treatment of pressureulcers:clinical practice guideline. Washington (DC): NationalPressureUlcer Advisory Panel2014. p. 79-125.