Literature Analysis

Table of Contents







The literature review aims to identify and evaluate the effectiveness of hospital mattresses against the standard mattresses. Whether or not the alternative mattresses are useful in preventing the potential risks of pressure ulcers has been explored in this assignment, using various research papers and studies. This study is intended to identify factors and causes of pressure ulcers, risks related to them, prevalence among adult patients, and how the alternative mattresses can help in eliminating these. According to researchers, the possibility of pressure ulcers depends on the severity of patient clinical status and age. It is a preventable syndrome which occurs mostly due to prolonged hospital stay among adult patients.


Pressure ulcers are common among adults who get hospitalized because of a prolonged stay. The prevalence is generally more in aged patients. Several risk factors are associated with pressure ulcers both physiological and non- physiological. Some of these are diabetes, peripheral vascular disease, cerebral vascular disease, sepsis, and hypotension. The physiological factors place the patients at greater risk because it impairs microcirculation systems. All this results in impairment of neural and endothelial control of blood flow. Hence the patient becomes more susceptible to organ damage (Smith, 2014).

We will also discuss why prolonged hospital stay can place an adult patient at greater risk of pressure ulcers. Some of the causes are low BMI, urinary and fecal incontinence, dressings, malnutrition, and so on. Pressure ulcers are more common in white race patients. However, pressure ulcers occurring in black patients could be more severe.

Pressure ulcers are induced by the friction of skin and unrelieved pressure. It is more likely to occur in people with poor skin conditions and reduced mobility. Air fluidized surfaces, alternative foam mattresses, low-pressure supports, and other electronic-associated beds are better to reduce the potential risk related to the development of PU.


Here, in the paper, titled “Comparing alternative pressure mattresses and high-specification foam mattresses to prevent pressure ulcers in high-risk patients: the PRESSURE 2 RCT” has been discussed. It is written by the author Jane Nixon has tried to shed light on the time it takes for a PU to develop in patients via alternating pressure mattresses (Nixon et al., 2019).

Main findings: In severely ill patients those who are bedridden/chair fast and have a PU of category 1 and localized skin discomfort, APMs have given a benefit that is lessened after some time. In the case of APM patients, very low PU occurrence frequency was observed but the result was not so different in case of using APM and HPFM. So while making conclusions other direct and indirect contributing factors need to be considered.

The research design of this study involves adults in hospitals in critical ailments who was an elevated chance of getting a pressure ulcer. Sufferers were randomly administered APM or HSFM and data on the patient's skin and changes were collected. It was found that 132 patients developed at least one new PU. Of these, 53 patients were assigned to the APM and 79 to the HSFM, a gap of 2.6% was found in which a minute but the notable difference is present. Again, after 30 days, patients were checked for who had stopped using a trial mattress (Nixon et al., 2019). The research was designed involving more than one medical or research institution, stage III, enclose, expected, a dual group having the form of a triangle type sequent, comparable team, (Randomized Control Trial - RCT) along with dual procedure interval assays in case of the contingency of untimely suppressing likewise uselessness or trumpery.

As this study was done only on patients with high PU risk and a limited no. of patients got the PU, it recommends that elimination of PU can be done by using the two mattresses. These findings indicate some precise patients’ groups may receive higher comfort by the APMs like those patients have skin reddening.

The paper also has some drawbacks in presenting its points like prevention of PUs doesn’t only depend on choosing mattresses, but also on other factors like moisture, age, nutrition, acute illness, perfusion, skin status, mobility. However, the study does not discuss the effectiveness of such factors as backed by any strong evidence. As there is still limited data available on these other factors so further research is required to conclude more clearly on planning prevention of PUs (Nixon et al., 2019).

It excludes outlook in the mission of treatment, particularly discretion tendency and frustration. By researching the article we also have found some disadvantages that are- the quality or state of being valid is provided involving more than one spot, that would be complicated to handle. The bottom of something considered as its support, the prescribed guide for conduct or action of GCP (Good Clinical Practice), this article has suggested several as well as few weaknesses. Very strict body of methods given permits to keep away from bent which is connected to discomfit ingredients, discretion bend, and explanation bent. In whatever manner, patients fill up the number of new members in a clinical examination and pursue experimental sequences that are different from how something is placed concerning their real-life surroundings.

In another paper, titled “Preventing pressure ulcers in adults: An Integrative Review”, the author Abram Bassinger, has tried to ascertain whether alternative mattress or standard mattress decreases the possibility of PUs more efficaciously or not (Bassinger, Kistler & Soule, 2016).

The main findings of the paper are elucidated by the seven articles reviewed in this paper, 5 have noteworthy substantiation supporting the usage of alt. mattresses, and 1 article concurred but data was not sufficient. The outcome shows that PU can be better prevented using the alternative mattress as compared to the standard (Serraes et al., 2018).

This research design is based on an interview conducted with a nursing staff manager in the burn center and enterostomal care unit on 12 October 2015. Nurses were recommended to follow the Therapeutic Surface medical Guidelines to ascertain the utilization of alternative mattresses based upon a stable or unstable spine, Braden Scale for predicting pressure ulcer risk and current skin condition. Conventional application is explored as per the Nurse Society recommendations mentioned in the paper. 313 articles were assessed here all over, 18 were chosen with 8 repetitions for a total of 10 articles (Bassinger, Kistler & Soule, 2016).

The paper has some advantages as the Lowa model basic substructure for this above discussed integrative review gives a clear illustration of the problem. The research outcome recommends that present-day implementation is advancing the use of foam mattresses over the standard ones as appearing evidence that the hospital-foam ones are more effective at helping PUs (Mirwanti, Nuraeni & Prawesti, 2019).

However, the pressure diffusion on differing alternative mattresses could not be understood from this study, so further research is needed to determine this. Another point is that standard mattresses are not elucidated here with clarity.

Now, combining the two articles it was found that APMs are more efficient in eliminating the risk of developing PUs than ordinary ones, and HSFMs are furthermore effective than APMs in averting the prevalence of PUs in high-risk patients. During choosing mattresses, other factors like comfort, existing PUs, and the patient's ability to care for themselves should be considered (Bassinger, Kistler & Soule, 2016).

The next paper is “Prevention of pressure ulcers in the acute care setting: innovations and technologies" by Tran, Jaquelynn P.BS. Pressure ulcer has a prevalent, universal matter and supported upper layers are used in a wide amount to prevent ulcer related cancer. Moreover, the condition of having or being composed of differing elements available for supporting hospital surfaces. are widely used to pressure ulcer prevention. The expansion of support upper layer availability has connected lacking by comparing with RCTs is a rather critical decision (Tran, 2016).

The system of channels resembling a network for determining the rate or amount of pressure ulcer occurrence to be made up an outward sign of small or very small certainty causes most systematic contrasts. Observing reasonable limits along with shreds of evidence, which powered producing or involving action or movement heterogeneous in origin or composition upper boundary of air probably cause to converge pressure ulcer occurrence by comparing with a conspicuous hospital exterior to certitude intervals.

To fix conclusively, expanding channels in quantitative statistical analysis, the effects of having a relation of separate advocate surfaces have been explored in the paper (Elsabrout, Orbacz, McMahon & Apold, 2018).

The main findings of this research paper include several innovations and technologies that have been developed to prevent the risk of pressure ulcers. It is important to take care of the patient's dressings and special attention should be made on using the right type of chemicals and moisture while doing prophylactic dressings (Berlowitz, Berman & Cochran, 2018). Another important is factor is the nutrition care of the patient, as the risk of PU can be increased due to malnutrition. Some associated elements with this are diabetes mellitus, infection, or SCI, which is the Spinal Cord Injury. If wound healing serum of under 2.0gm/dl is used, there is a higher chance of getting pressure ulcers (Shahwan, 2015). Implementation of support mattresses and proper care of patient's dressing and nutrition can go a long way in preventing PU risks in hospitals.

The article also discusses the usage of various risk assessment methods like the Braden scale, for evaluating the patient's spine and soft-tissue pressure area (Smet, Graaf, Bernaerts, Casaer & Beeckman, 2019). The idea is based on the inverse relationship between pressure and ulcers. This paper discusses the associated risk factors of pressure ulcers in detail and helps the hospital management as well as the nursing care team with various relevant information. Another advantage of this paper is that it is backed my numerous articles and studies for coming to some conclusion.

Now, the above-discussed paper help in forming a better idea about the problem of pressure ulcers especially in adult patients, in the hospital settings, along with an analysis of the effectiveness of hospital mattresses. Pressure ulcers are a cause of a major burden on patients, health workers, and health care professionals. Symptoms of patients who get affected include pain, odor, etc. If pressure ulcers occur in a patient there is a requirement of bed rest and prolonged rehabilitation at times hospitalization. Some measures can be undertaken in healthcare units to reduce risks of pressure ulcers such as repositioning of patients, taking care of skin condition by dressing and exposure to moisture, and use of alternate mattresses.

Alternate mattresses are of various types. Normal ones are padded with gel or foam and there are ones that are electronically operated. An alternate mattress prevents the occurrence of pressure ulcers because it distributes the weight of the patient over a larger surface thus reducing any unnecessary friction. This relieves the patient of pressure beneath. The foam and gel mattresses are low technology whereas electrically powered ones are high technology mattresses. It also becomes very important for health care units to take care of factors, which cause pressure ulcers. Repositioning of patients in case of prolonged stay and routine checkup, dressing, etc. is required. It is a proven fact that pressure-relieving mattresses can reduce risks of pressure ulcers so if the healthcare units use this it will relieve patients and prevent pressure ulcers from occurring.


Pressure ulcers occur in aged adults due to prolonged hospital stays. There are several factors, which are related to the occurrence of pressure ulcers such as immobility, friction, bad skin condition, unrelieved pressure, fecal discontinuity, etc. Hospital mattresses increase risks of pressure ulcers simply because they cause unrelieved pressure and friction with the skin. Alternative mattresses are available these days, which are known to be more efficient in preventing the occurrence of pressure ulcers. Foam mattresses, low-pressure supports, and electric profiling are some of the alternative options. However, the situation depends on the patient's age and his period of stay in the hospital.


Bassinger, A., Kistler, K., & Soule, M. (2016). Preventing Pressure Ulcers in Adults: An Integrative Review.

Berlowitz, D., Berman, R. S., & Cochran, A. (2018). Prevention of pressure-induced skin and soft tissue injury. UpToDate. Waltham (MA): UpToDate.

Elsabrout, K., Orbacz, E., McMahon, L., & Apold, S. (2018). Large‐Scale Hospital Mattress Switch‐Out Leads to Reduction Hospital‐Acquired Pressure Ulcers: Operationalization of a Multidisciplinary Task Force. Worldviews On Evidence-Based Nursing, 15(3), 161-169. doi: 10.1111/wvn.12280

Mirwanti, R., Nuraeni, A., & Prawesti, A. (2019). Perceived Facilitators to Preventing Pressure Ulcer among Intensive Care Unit Nurses. Kne Life Sciences. doi: 10.18502/kls.v4i13.5307

Nixon, J., Brown, S., Smith, I. L., McGinnis, E., Vargas-Palacios, A., Nelson, E. A., ... & Gilberts, R. (2019). Comparing alternating pressure mattresses and high-specification foam mattresses to prevent pressure ulcers in high-risk patients: the PRESSURE 2 RCT.

Serraes, B., Van Leen, M., Schols, J., Van Hecke, A., Verhaeghe, S., & Beeckman, D. (2018). Prevention of pressure ulcers with a static air support surface: A systematic review. International wound journal, 15(3), 333-343.

Shahwan, S. (2015). Management and Prevention of Diabetic Pressure Ulcers with Neuropathy. General Medicine: Open Access, 03(04). doi: 10.4172/2327-5146.1000197

Smet, S., Graaf, A., Bernaerts, K., Casaer, M., & Beeckman, D. (2019). The Belgian pressure ulcer risk assessment project: Is assessing mobility and skin status a more accurate, reliable, and feasible approach to assess pressure ulcer risk in hospitalised patients?. International Wound Journal, 16(6), 1577-1578. doi: 10.1111/iwj.13240

Smith, A. (2014). Pressure ulcer prevention. Nursing Standard, 28(31), 61-61. doi: 10.7748/ns2014.

Tran, J. P., McLaughlin, J. M., Li, R. T., & Phillips, L. G. (2016). Prevention of pressure ulcers in the acute care setting: new innovations and technologies. Plastic and reconstructive surgery, 138(3S), 232S-240S.

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