Pressure ulcers NSG 502: Advanced Nursing Research: Evidence-Based Project Part III

Pressure ulcers NSG 502



Pressure ulcers can cause detrimental health effects on the patient if not prevented or managed properly. These conditions continue to remain a threat to patients despite advances in healthcare. A pressure ulcer is a localized injury of the skin and underlying tissue. They normally occur over bony prominence due to pressure and shear acting together on the bony surface. Pressure ulcers not only increase morbidity but also mortality in elderly and frail patients.

They may cause pain and suffering, and reduced the overall quality of life. The use of alternating-pressure air mattresses is one of the many ways of preventing pressure ulcer incidences. This is the third part of the research study; it will cover research design, sampling, data collection, data management, data analysis, ethical considerations, and possible limitations. 

Research Design

This is a quantitative study using a quasi-experimental design. This study design is preferred considering the nature of this research study proposal. It will entail statistical analysis, hence, quantitative study (Maciejewski, 2020). All patients in the hospital will be recruited into the study, so, there will be no controlled arm. For that reason, there is no need to carry out randomization; it is for this reason that a quasi-experimental design is preferred (Rogers & Revesz, 2019).

This study design is one of the subtypes of non-experiments that tends to mimic true or randomized experiments but does not apply random assignment (Maciejewski, 2020). These participants will not be selected randomly; selection will be based on pre-existing conditions and certain attributes. Using a quasi-experimental design, a purposive sampling method can be utilized to ensure that only patients who are hospitalized and have limited mobility and are at higher risk of developing pressure ulcers (PUs) are selected for the study (Rogers & Revesz, 2019).




This study might take the retrospective approach so that the comparator group is patients who received care before the initiation of the program. Specific measures or outcomes will be evaluated retrospectively to identify any change before and after the intervention implementation. 


The study participants include hospitalized adult patients in a single unit with limited mobility who have a higher risk of developing pressure ulcers. Participants will be recruited based on the inclusion and exclusion criteria (Meaume & Marty, 2018). Inclusion criteria will include patients who have a higher risk of developing pressure ulcers, those with limited mobility, and those who are bed bound and/or chair-bound (Meaume & Marty, 2018).

In addition, patients must be18 years and above, not have pressure ulcers at the baseline visit, and be sitting in a chair during the day for at least four hours, lying between 15–20 hours per day on an alternating pressure air mattress. The Braden score will be used to assess the eligibility of these patients.

The main purpose of the Braden Scale is to help care providers and researchers measure the risk of developing pressure ulcers (Meaume & Marty, 2018). This instrument can help in planning effective interventions to prevent pressure injuries. The exclusion of patients presenting with malnutrition has been selected to meet the requirements of the French authorities for reimbursement by national health insurance. 

Data Collection

Data collection will be conducted using various instruments including questionnaires. Data collection methods include observation and surveys/interviews (Mwita, 2022). A physician will assess the patients at the baseline after which the care team will monitor the patient, including skin condition at least once a day throughout the period (Ahtiala et al., 2018). At the baseline, information will be collected on regarding demographics (age, sex, weight, and height), unit, comorbidities (high blood pressure, diabetes, urinary incontinence); medical condition responsible for the situation involving risk of PU.

 Other data include the duration of sitting time per day and time spent on the alternating pressure air mattresses. Braden scale will be used to assess the risk of pressure ulcers. The Karnofsky score will be used to assess the patient’s ability to move (Sauvage et al., 2017). All patients will be placed on alternating-pressure air mattresses throughout the period. Patient care teams will be instructed on the use of alternating-pressure air mattresses (AP). The healthcare team will practice the PU prevention care plan including the general rules on preventing PUs and specific instructions for each patient.

Data Measurement

The primary measurement is the percentage of patients that will develop pressure ulcers in 6 months. Electronic health records will be an essential instrument to collect information related to prevalence. Electronic health records will indicate whether the PU rates have reduced (Ahtiala et al., 2018). Secondary measurements will include pressure ulcer risk, patient satisfaction, and care team assessment regarding the use of alternating pressure air mattresses. The Braden score is the second tool that will be used to assess the level of risk of pressure ulcers. It consists of six subscales and the total scores range from 6 to 23. 

A lower Braden score indicates higher levels of risk for pressure ulcer development. Jackson/Cubbin’s (mJ/C) risk scale can also be used to assess the risk of pressure ulcers (PU) (Ahtiala et al., 2018). This instrument is a PU risk calculator that consists of 12 categories that are graded from 1 (highest risk) to 4 (lowest risk). The maximum score is 48 and the e lower the score, the higher the risk of pressure ulcers. The PU risk assessment can be done weekly. A satisfaction questionnaire will be essential to assess the perception of patients’ comfort using mattresses (Sauvage et al., 2017). In addition, a questionnaire will be used to assess the healthcare provider’s perspective of the intervention. 

Data Analysis

Various statistical methods of analysis will be used in this study where appropriate. Descriptive statistics will be used in the analysis of the results of this project. Descriptive statistics include numbers, percentages, mean, median, mode, standard deviation (SD), and variance (Ezeamuzie et al., 2019). These statistical methods can be used to analyze variables such as age, gender, new infections, and increase or decrease in incidences before and after the intervention among others.

Descriptive statistics are used to describe the characteristics or features of a dataset. Using distribution, data may be presented as a number list, table, or graphically (Ezeamuzie et al., 2019). The primary interest of the researcher is to analyze the influence alternating pressure air mattresses have on the incidence of pressure ulcers (Ahtiala et al., 2020). Statistical evaluation of the mattress effect will be based on survival analysis and the Cox proportional hazards model, a regression model, which delivers a direct comparison of the efficacy of different support surfaces (Beeckman et al., 2019). The exact 95% CI was calculated for the primary endpoint. 

Ethical Considerations

Research ethics will be practiced appropriately to ensure the successful completion of the study. Participants’ privacy and confidentiality will be ensured (Bah & Sey-Sawo, 2018). All the participants will receive education or a brief explanation of the project. The participants will then be provided with oral and written informed consent to meet the ethical requirements of research studies using human samples (Fleming & Zegwaard, 2018). Before the initiation of the project, the Institutional Review Board (IRB) will first approve it.

Limitations of the Proposed Study

A possible limitation of this study is that it does not use a randomized sampling method. Lack of randomization can be a source of bias. In addition, it is a single-unit study and that might lead to a problem regarding its generalizability. Finally, yet importantly, a financial constraint might be a challenge since the mattresses are expensive to procure. 


This paper is a continuation of a proposal for a project that would assess the effectiveness of alternating pressure air mattresses to prevent pressure ulcer injuries among hospitalized patients. It presents the third part of the study, covering research design, sampling, data collection, data management, data analysis, ethical considerations, and possible limitations. This study uses a quantitative-quasi-experimental design. It will take a retrospective approach to compare the results with those collected at baseline or before the intervention.

Purposive sampling will be relevant for this study. Data collection will be conducted using various instruments. The primary measurement is the percentage of patients that will develop pressure ulcers in 6 months. Credible and reliable methods of statistical analysis will be used. A consent form will be provided before the commencement of the study. 


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