Effectiveness Of Pressure Ulcer Prevention Essay

Discuss About The Effectiveness Of Pressure Ulcer Prevention Strategies For Adult.



The paper aims to provide a critical appraisal of the chosen health related systematic literature review that discusses about the effectiveness of the Pressure Ulcer (PU) prevention strategies for adult patients. To control the building of Hospital-Acquired Pressure Ulcers (HAPUs), the healthcare industry is emphasizing on scientific and innovative strategies for the advancement of the medical inventions. The reduction of the occurrences of HAPUs is prioritized due to the frequent occurrence and high risk factor associated with it among adult patients (McInnes et al., 2015). This article systematically and analytically judges the effectiveness of the prescribed clinical research paper to evaluate whether the requirements and proposed deliverables are met or not at the end of the research (LoBiondo-Wood et al., 2013). Usually, the prevention of PU is easier by adopting multiple prevention strategies. Thus, the purpose of the literature study is to research and analyse whether a single prevention strategy is impactful for preventing PU or not.

Systematic review or meta-analysis

A systematic review can be described as a variation of literature review where the purpose is to address the identification, analytical evaluation, and accumulation of the discoveries from the result. The author utilises systematic methodologies for systematic review. On the other hand, the meta-analysis can be defined as the statistical processes that use statistical tools for drawing conclusion on the collected data (Athappan et al., 2013). It uses specific quantitative measures, like evaluating effect size, for identifying association among variables. The result of the research study calculates the effect size as result (Wacker et al., 2013). The chosen report is therefore a representative of both systematic review and meta-analysis.

Clearly focused question

If a study addresses a specified topic and maps to identify solution for that particular topic only, then it can be said that the study labels a clearly focused question. The chosen research literature attempts to find out single strategy to reduce the problem of PU and ends up finding a full proof solution of PU. Thus, the study addresses a clearly focused question.

Population studied

The research study has considered the population of intensive care severely ill patients for the study and the conclusion has been drawn based on the heterogeneity of the population.

Intervention given

The intervention in this research study is to prevent the development of PU and to devise treatment process.

Outcome considered

All the primary outcomes have been considered along with statistical results.

Comprehensive literature search

The literature research has considered all the electronic databases from 2000 to 2015. Besides, the data from s4everal health care agencies have been used. Thus, the study has used comprehensive literature search.

Study design and its appropriateness

There are three types of research design which are

  1. Descriptive or analytical design
  2. Explanatory design and
  3. Exploratory design.

Out of all these research designs, the analytical research design uses all the available information to analyse the data and make critical evaluation from the available data to draw conclusions (Nassaji, 2015). The analytical design provides a deep-rooted analysis too. Therefore, the given study has used analytical research design. This research design is appropriate as the research study aims to provide a deep analysis of the single strategy for the treatment of PU.

Usage of appropriate database and outside resources

The information from database and other resources have been used and have been utilized for further calculations to obtain the systematic review. The data from CINAHL, NICE, and other significant medical institutions have been collected for the purpose of this study. In addition to this, how the outside resources have been manipulated, has been represented through a flow-diagram. Therefore, the study has utilized all the databases and resources properly.

Methods of assessing risk of bias

The risk of bias in any systematic review can be explained as a systematic deviation from the originality of the statement at the time of inference. The systematic review of any medical literature frequently gets affected by the risk of bias for several reasons. The risks of bias are primarily of two types – High risk of bias and Low risk of bias. Assessing the risk of bias indicates the assessment of the strength of the evidence that has been evaluated (Sterne et al., 2016). The selected systematic review has been assessed by the standardized tool JBI-MAStARI for identifying any sort of risk of bias in study selection (Feng et al., 2013). It is a critical appraisal tool that stands for Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (Tarandeep et al., 2018). It works by extracting the data using an extraction tool and it is reviewed then to check any bias and significant error. If the risk of bias is found then the bias is minimized by the reviewer. The criteria for allowing the data in the systematic review is to meeting 50% criteria of JBI-MAStARI checklist tool.

Characteristics of the included & excluded criteria

The included criteria can be defined as the factor that a study must have to be mentioned in the systematic review. On the other hand, the exclusion criteria is the factor that must not be included the review of the study. There is a protocol in every systematic review that handles the inclusion and exclusion criteria for t6hje assessment of the research study. The characteristics of the criterion are-

  1. The studies which are published other than English languages are excluded from the study.
  2. The previous studies published from the year 2000 to 2015 are included for the research.
  • The studies that have satisfied the criterion of the methodological validity by two independent reviewers, are included in the study.

There are two reviewers for reviewing the methodological validity of the secondary data resources that is the previous research studies.

Appraisal checklist

An appraisal checklist is a list of that checks a list criterion for assessing the authenticity of the city. Appraisal checklist of the given systematic review consists of e JBI-MAStARI tool that will check presence of bias, review the collected studies, and assess the inclusion and exclusion criterion.

Data synthesized

A dataset is said to be synthesized if any statistical approach is used for evaluating the results from the data (Biswas et al., 2015).

  • The review has considered the results from 25 studies. Therefore the results are combined.
  • Individual study have been displayed in the course of this research as only one study has examined the strategies related to nutrition for the treatment of PU.
  • The similarities among the individual studies have been taken into account and they have been described in this systematic review.
  • The similar results from different studies have been considered.
  • The variations in results are discussed and demonstrated well in the course of the study.

Overall results

The entire result can be summed up into the evaluation of 25 studies and from the meta-analysis, the statistical significance of the performance strategy of a silicone foam with an effect size of 4.62. The evaluation of the effect size suggests that the effect size is large and it suggests that the outcome is quite effective that can be seen with the naked eye. Moreover, the prevention of the building of HAPU is controllable with the implication of the single strategy.

Publication bias

It is a type of bias that occurs during the publication of the research paper. It generates due to influential decision regarding the publication of the paper and it leads the publication of the research paper based on certain criterion like publication of those papers showing more statistically significant results (Biswas et al., 2015). The chosen systematic review includes publication bias, more specifically language bias as it excludes studies published in other languages than English. Also, only the methodological valid studies have been considered. Thus, the publication bias is available.

Precision of the results

The precision of a study can be defined as the imminence of two or more studies. It shows the accuracy of the result evaluated from the study. The result has analysed all the significant outcomes of the individual studies amd all the results have been combined to provide the outcome of the clearly focused research question of the systematic review.

Result analysis

  • The evaluated results can be applied on patient as they single strategy of the application of silicone foam is statistically significant with the confidence interval of 0.05-0.29 at 99.99% level of significance having a large effect size of 4.62 (van Assen, van Aert & Wicherts, 2015).
  • The review has focused on all the vital outcomes as it includes the outcomes on nutrition, skin-care, positioning schedule and HAPU prevention treatment.
  • Advantage- This systematic review discusses the strategy for the prevention of PU based for the well-being of the critically ill adult patients admitted in ICU. Moreover, the study devises a single prevention strategy beside the existing multiple prevention strategy which shows an advancement of the clinical treatment (Pickering & Byrne, 2014).
  • Disadvantage – The presence of publication bias is the main disadvantage of this systematic review. Therefore, in general systematic reviews have issue in providing good results. The chosen systematic review is of no exception (Pickering & Byrne, 2014).
  • The study offers an evidence based rules for the future clinical studies on the treatment and prevention of the PU. The study literature devises an impactful medical strategy for controlling the development of HAPU. Thus, it has bright scope for the future research and study.


From the above discussion of the critical appraisal of the systematic review of the medical literature study, it can be concluded that this paper critically analyses the chosen systematic review and checks all the points that need to be checked in the course of a critical appraisal. This paper has verified the advantages and disadvantages of the study with the examination of the presence of publication bias and the consequences of the risk of bias. In addition to this, this appraisal also addresses the inclusion and exclusion criterion of the review and analyses the significance of the statistical results. The data under study has been synthesized. The critical appraisal is valid and sufficient for the systematic review.


Athappan, G., Patvardhan, E., Tuzcu, E. M., Svensson, L. G., Lemos, P. A., Fraccaro, C., ... & Tamburino, C. (2013). Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: meta-analysis and systematic review of literature. Journal of the American College of Cardiology, 61(15), 1585-1595.

Biswas, A., Oh, P. I., Faulkner, G. E., Bajaj, R. R., Silver, M. A., Mitchell, M. S., & Alter, D. A. (2015). Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysis. Annals of internal medicine, 162(2), 123-132.

Biswas, A., Oh, P. I., Faulkner, G. E., Bajaj, R. R., Silver, M. A., Mitchell, M. S., & Alter, D. A. (2015). Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysis. Annals of internal medicine, 162(2), 123-132.

Feng, J. Y., Chang, Y. T., Chang, H. Y., Erdley, W. S., Lin, C. H., & Chang, Y. J. (2013). Systematic review of effectiveness of situated e?learning on medical and nursing education. Worldviews on Evidence?Based Nursing, 10(3), 174-183.

LoBiondo-Wood, G., Haber, J., Berry, C., & Yost, J. (2013). Study Guide for Nursing Research-E-Book: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences.

McInnes, E., Jammali?Blasi, A., Bell?Syer, S. E., Dumville, J. C., Middleton, V., & Cullum, N. (2015). Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews, (9).

Nassaji, H. (2015). Qualitative and descriptive research: Data type versus data analysis.

Pickering, C., & Byrne, J. (2014). The benefits of publishing systematic quantitative literature reviews for PhD candidates and other early-career researchers. Higher Education Research & Development, 33(3), 534-548.

Sterne, J. A., Hern?n, M. A., Reeves, B. C., Savovi?, J., Berkman, N. D., Viswanathan, M., ... & Carpenter, J. R. (2016). ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. Bmj, 355, i4919.

Tarandeep, O., Laver, K., Crotty, M., & Killington, M. (2018). Effectiveness of multicomponent interventions on incidence of delirium in hospitalized older patients with hip fracture: a systematic review.

van Assen, M. A., van Aert, R., & Wicherts, J. M. (2015). Meta-analysis using effect size distributions of only statistically significant studies. Psychological methods, 20(3), 293.

Wacker, C., Prkno, A., Brunkhorst, F. M., & Schlattmann, P. (2013). Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. The Lancet infectious diseases, 13(5), 426-435.

How to cite this essay: