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  • Subject Name : Nursing

Musculoskeletal Disorders in Aged Care Workers

Introduction to Pressure Injury Prevention in Aged Care

Due to this pressure, many complications can arise like hydration problems, moisture problems, impaired mobility, impaired activity, oxygen delivery issues, nutrition issues, and many others (Parry, Chow, & Batchelor et al., 2019). A more intensive care service should be delivered if the patient is aged as it becomes difficult for them to self-manage their issues and handle their body themselves (Lovegrove, Fulbrook & Miles, 2020). The following section will critically discuss the research question – procedure for pressure injury prevention, articles for their methodology, ethics, validity, and data collection, using a literature review critique tool.

Background and Critique of Research

Paper 1

The authors used the behavior change wheel for exploring the interventions and advantages in the prevention of pressure injuries in aged patient care services. The background of the research was informative and discuss the guidelines that should be ensured while providing care series to the patient. The repositioning, risk assessments, skin assessment, and many others are considered as per the national and international guidelines while ensuring prevention of pressure-related injuries in aged patients (Hulko, Mirza & Seeley, 2020).

Paper 2

The authors discussed the sliding sheet for repositioning of the patients in aged care, ensuring that the background was informative. This procedure helps in reducing the pain while patient handling. The background of the research discusses the risk of low back pain due to awkward postures, which might arise if proper repositioning devices are not used. It is found that if the aged patients are not provided with effective repositioning devices or procedures then they might suffer from other complications like stress, back pain, or others (Capponecchia, Coman, & Gopaldasani et al., 2020).

Paper 3

The authors discuss in the background was brief and informative about the after-effects of every 2-hour repositioning of the patents to prevent pressure ulcers in aged patients. Repositioning reduces pressure ulcers as it helps in the distribution of the pressure and related risks (Gillespie, Walker & Latimer et al., 2020).

Methodology and Method

Paper 1

 The participants gave written consent for their participation, and the research was organized into 2 parts with 4 steps to explore the procedure and the interventions required for effective and quality care in preventing the pressure injuries. The use and selection of participants as per the search are important, as this increases the integrity and credibility of the data collection and results of the research (Coman, Caponecchia & McIntosh, 2018). However, the paper did not discuss a specific methodology used for the study.

Paper 2

 A comparative study was performed with the use of questionnaires and statistical analysis for the collected data. A comparative study and questionnaire help in exploring the perception and experiences of the aged participants and the nurses who were involved in delivering care to those participants.

Paper 3

The authors conducted a retrospective cross-sectional analytical study; collected the records of aged patients from the hospitals about their frequency of repositioning practice after every 2 hours, and performed a statistical analysis in it. Statistical analysis helps in drawing a meaningful interpretation of the findings but they do not help in understanding in-depth issues and problems (Parry, Chow & Batchelor et al., 2019). Therefore, this might act as a limitation to this research study procedure to explore more about the research question. The research design always influences the reliability of the result attained (Hercegovac, Kernot & Stanley 2020).

Biases and Validity

In all the 3 papers, not only the aged care participants but the nurses or health professionals who were responsible for delivering care to those patients were also involved to eliminate the chances of biased information and get a wider idea/data for the prevention procedure. All the 3 papers included only those aged patient who needs a pressure prevention procedure for their fast and better recovery. According to Edger (2017), the sample size is large then the chances of biases can be reduced. The paper one did not even discuss the sample size, paper 2 had a large sample size and paper 3 also had a large sample size. However, randomization was performed in all the papers which might help in maintaining the validity. Moreover, none of the three papers discussed the research design used – quantitative study or qualitative study. This further impacts the validity of the papers negatively.

Data Collection and Analysis

A study with a large sample size is considered more reliable as it lacks biases, variability, and standard errors (Hughes & McDonagh, 2016). The data collected through in-depth interviews that ere audio-recorded and performed face-to-face. Such interviews various strengths to the study as it enables – observations of body language, clear and brief responses, in-depth data collection, and many other (Brittain, Ibbett & de Lange, 2020).

Paper 1

There is no clear information provided from where the data is collected and the analysis is performed for various aspects that are considered as strong points for the study. The authors looked for psychological aspects, long-term effects, behavioral outcomes, and interventions. In nursing, it is very important to explore the impact of medical procedures on the behavior and long-term outcomes on the patient (Jackson, Durrant & Bishop et al., 2017). Moreover, it was also found that many participants refused to take part in face-to-face interviews, this acted as a limitation to the study as well. It was found that effective interventions and the use of the behavior change wheel increased the positive outcomes of the patient.

Paper 2

Data collected was performed using questionnaires that explored the experiences and characteristics of the nurses and the care consumers as well. The analysis was performed statistically and various factors were considered for analysis like weight, height, age, sex, fatigue, and body mass index. In nursing, it is important to deliver a patient-centered care service for the administration of the medication or procedure to ensure that the patient is progressing positively (Santamaria, Gerdtz, & Kapp et al., 2018). One of the limitations of his paper was it was conducted in an experimental environment and the nurses, in this case, had never used sliding sheets.

Paper 3

Data was collected from hospitals, and during the analysis, the results were recorded and reviewed. During analysis, the interventions and their frequency were also recorded to get better findings. However, this article used randomization and a cross-sectional approach for effective data collections. Interventions help the patient to feel that their needs are fulfilled, so if the aged patient is assessed timely then proper monitoring and evaluation can be performed (Rayner, Carville & Leslie et al., 2019). This ensures patient safety and quality care as well.

Ethics

Ethics are very important in every research as they restrict the researchers from doing mistakes while collecting their facts, information, knowledge, or truth (Ehni & Wiesing, 2019). According to Connor, Copland & Owen (2018), it is also taken or considered as a right of the participant to have ensured privacy, dignity, confidentiality, anonymous, informed consent, and treated without any harm until the completion of the research study. In all the 3 papers the ethics were maintained, as the laws and guidelines were effectively followed and maintained with effective interventions being delivered to the aged participants. In paper 1 and paper 2, as discussed the participants gave written consent which ensures that there was voluntary participation and no third party was involved during the study like the other residents were not involved. This ensured that the privacy and confidentiality of the patients were maintained. In paper 3, UNSW Australia Human Research Ethics Committee HC, number HC14163 approved the ethical approval of the study.

 

Paper 1- (Lavallée, Gray & Dumville et al., 2019)

Paper 2 – (Omura, Yamagami & Hirota et al., 2019)

Paper 3 – (Sharp, Schulz Moore & McLaws, 2019)

Source

 Peer-reviewed publication

Recent

 Peer-reviewed publication

Recent

 Peer-reviewed publication

Recent

 Research Problem

 Problem identified clearly

Significant

 Problem identified clearly

Significant

 Problem identified clearly

Significant

 Literature Review

High quality

High quality

High quality

 Theoretical Framework

High quality

High quality

High quality

 Hypotheses

The hypothesis was not clearly stated

The hypothesis was not clearly stated

The hypothesis was not clearly stated

Design

Not clearly stated

Not appropriate design

Comparative and experimental

Appropriate design

Retrospective cross-section

Appropriate design

 Sample

Not stated

Large

Large

Conclusion on Pressure Injury Prevention in Aged Care

If the methodology, design, methods, and ethics used by the authors for their study are appropriate then it becomes to ensure that the results of the study are reliable and valid. If the pressure injury prevention procedures are delivered with positive outcomes then they should be used with high effectiveness for the aged patient. Nursing interventions should be timely performed in the case of aged patients after they are provided with a pressure injury prevention procedures to ensure their safety. Moreover, privacy and confidentiality should also be maintained during the study.

References for Pressure Injury Prevention in Aged Care

Brittain, S., Ibbett, H., de Lange, E., Dorward, L., Hoyte, S., Marino, A., & Lewis, J. (2020). Ethical considerations when conservation research involves people. Conservation Biology. DOI: 10.1111/cobi.13464

Capponecchia, C., Coman, R., Gopaldasani, V., Mayland, E. C., & Campbell, L. (2020). Musculoskeletal disorders in aged care workers: A systematic review of contributing factors and interventions. International Journal of Nursing Studies, 103715. DOI:10.1016/j.ijnurstu.2020.103715

Coman, R. L., Caponecchia, C., & McIntosh, A. S. (2018). Manual handling in aged care: Impact of environment-related interventions on mobility. Safety and Health at Work9(4), 372-380. DOI:10.1016/j.shaw.2018.02.003

Connor, J., Copland, S., & Owen, J. (2018). The infantilized researcher and research subject: Ethics, consent and risk. Qualitative Research18(4), 400-415. DOI:10.1177%2F1468794117730686

Edger, M. (2017). Effect of a patient-repositioning device in an intensive care unit on hospital-acquired pressure injury occurences and cost: A before-after study. Journal of Wound Ostomy & Continence Nursing44(3), 236-240. DOI: 10.1097/WON.0000000000000328

Ehni, H. J., &Wiesing, U. (2019). Illegitimate authorship and flawed procedures: Fundamental, formal criticisms of the Declaration of Helsinki. Bioethics33(3), 319-325. DOI:10.1111/bioe.12503

Gillespie, B. M., Walker, R. M., Latimer, S. L., Thalib, L., Whitty, J. A., McInnes, E., & Chaboyer, W. P. (2020). Repositioning for pressure injury prevention in adults. Cochrane Database of Systematic Reviews, (6). DOI:10.1002/14651858.CD009958.pub3

Hercegovac, S., Kernot, J., & Stanley, M. (2020). How qualitative case study methodology informs occupational therapy practice: A scoping review. OTJR: Occupation, Participation and Health40(1), 6-16. DOI:10.1177%2F1539449219850123

Hughes, J., & McDonagh, J. (2017). In defence of the case study methodology for research into strategy practice. Journal of Management36(2), 129-145. DOI: 10.1515/ijm-2017-0013

Hulko, W., Mirza, N., & Seeley, L. (2020). Older Adults’ Views on the Repositioning of Primary and Community Care.  Journal on Aging, 1-13. DOI:10.1017/S0714980819000540

Jackson, D., Durrant, L., Bishop, E., Walthall, H., Betteridge, R., Gardner, S., & Usher, K. (2017). Health service provision and the use of pressure-redistributing devices: Mixed methods study of community dwelling individuals with pressure injuries. Contemporary Nurse53(3), 378-389.DOI: DOI:10.1080/10376178.2017.1364973

Lavallée, J. F., Gray, T. A., Dumville, J. C., & Cullum, N. (2019). Preventing pressure injury in nursing homes: Developing a care bundle using the Behaviour Change Wheel. BMJ Open, 9(6), e026639. DOI:10.1136/bmjopen-2018-026639 

Lovegrove, J., Fulbrook, P., & Miles, S. (2020). International consensus on pressure injury preventative interventions by risk level for critically ill patients: A modified Delphi study. International Wound Journal. DOI:10.1111/iwj.13461

Omura, Y., Yamagami, Y., Hirota, Y., Nakatani, E., Tsujimoto, T., & Inoue, T. (2019). Evaluation of the effectiveness of the sliding sheet in repositioning care in terms of working time and subjective fatigue: A comparative study with an experimental design. International Journal of Nursing Studies, 99, 103389. DOI:10.1016/j.ijnurstu.2019.103389 

Parry, S., Chow, M., Batchelor, F., & Fary, R. E. (2019). Physical activity and sedentary behaviour in a residential aged care facility. Australasian Journal on Ageing38(1), E12-E18. DOI: 10.1111/ajag.12589

Rayner, R., Carville, K., Leslie, G., & Dhaliwal, S. S. (2019). A risk model for the prediction of skin tears in aged care residents: A prospective cohort study. International Wound Journal16(1), 52-63. DOI:10.1111/iwj.12985

Santamaria, N., Gerdtz, M., Kapp, S., Wilson, L., & Gefen, A. (2018). A randomised controlled trial of the clinical effectiveness of multi‐layer silicone foam dressings for the prevention of pressure injuries in high‐risk aged care residents: The border III trial. International Wound Journal15(3), 482-490. DOI:10.1111/iwj.12891

Sharp, C. A., Schulz Moore, J. S., & McLaws, M.-L. (2019). Two-Hourly Repositioning for prevention of pressure ulcers in the elderly: Patient safety or elder abuse? Journal of Bioethical Inquiry. DOI:10.1007/s11673-018-9892-3 

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