Pressure Ulcers Literature Review

Introduction: Pressure Ulcers Literature Review

Through the previous papers, we have comprehensively analyzed the pressure ulcers concept in the healthcare industry, which has recently increased significantly due to higher hospital admissions due to covid19 and ventilator care. Our PICOT question was how pressure ulcers could be reduced in healthcare by turning the patient at least once per two hours or using pressure distribution mattresses. Additionally, there was a need to educate the patients on the importance of turning themselves or calling nurses. Pressure ulcers occur when patients remain in the same position for a long time (about 2 hours) and can lead to further complications, increased hospital stay, poor satisfaction and other risks. Buh et al. (2021).

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Research Questions Comparison

In the previous assignment, we selected eight articles directly relating to pressure ulcers and how they can be gradually reduced through mechanical or equipment ways. The research questions were almost similar; however, the wording was different; for example, the first one focused on how clinical practices can prevent pressure ulcers bundle among elderly patients. This approach included educating the patients to turn themselves or nurses being involved. Additionally, the second, fourth, fifth and eighth researches were also related to the first ones sought to understand how pressure ulcers reduction in healthcare can help promote patient’s wellbeing. However, the fourth and sixth research questions sought to understand how medical devices could be used to prevent pressure ulcers. The studies revealed that equipment like pressure distribution mattresses was essential to automatically prevent ulcers, especially those under emergency care where turning patients could introduce other complications. Finally, the seventh research question sought to understand how men and women respond differently and have higher rates to pressure ulcers; it found that men have higher chances of pressure ulcers than women. Gefen et al. (2019).

Sample Populations Comparison

Based on the different studies considered in the literature review, there were varied samples based on the specific target that the researcher sought to achieve. However, the major subjects within the samples include nurses and patients in different healthcare departments. Out of the eight articles, six focus on the population within the healthcare facilities, the example used about 50 healthcare departments within Odense university’s healthcare facility. At the same time, the third study involved 377 nurses and 318 patients within eleven facilities. The fourth study had the highest sample of 2079, while the sixth study had 38 655 patients within nursing homes as their sample. However, the second and eighth studies were different since the second one was a proposal that had not been researched; therefore, literature from the library was reviewed, including cumulative index to nursing, Medline Ovid, etc., while no sample was indicated in the sixth study. Therefore, the sample sizes were used to determine potential methods that could increase sensitization towards pressure ulcers reduction and its importance to the healthcare industry. The samples also mainly focused on the adult populations since they are the core victims of pressure ulcers and are admitted for relatively lengthy periods within healthcare facilities. However, the time taken during different researches also depended on what the authors sought to achieve; therefore, they varied. Horup et al. (2020).

Limitation’s Comparison

For the eight focused research studies, there were common and different limitations that may have affected their overall results. The major limitation observed throughout the studies included finances, especially on the fourth and eighth research that focused on using medical equipment like pressure mattresses and other pressure ulcers prevention devices that are relatively expensive to purchase and maintain. The second limitation was not harming the patients during the research; turning the patient was supposed to be normal and harming the patient would lead to unwanted results and ethics breaches. This specifically affected the fourth and eighth research where mechanical devices were used. Another limitation was that some samples used relatively smaller samples whose results cannot be generalized to the entire population. For example, the first and fifth studies used a sample of below thirty participants, leading to irrelevant results and statistical insignificance. The final limitation was that some research focused on the elderly people within healthcare facilities could have led to potential psychological harm to the patients. Older adults may not fully and willingly engage in research; it may be psychological torture to Saleh et al. (2019).


In conclusion, there are varied arguments that relate to pressure ulcers prevention in healthcare facilities. We specifically wanted to understand whether mechanical devices can properly work like the normal patients turning during the first study. However, I believe that nurse’s knowledge and understanding of potential ways to prevent ulcers is appropriate for full patient recovery. Additionally, patients in critical conditions should be sensitized on the importance of turning regularly and engaging in physical activities like walking and sitting that could potentially reduce ulcers. Therefore, my major recommendation is further research should be conducted to understand how pressure ulcers can be reduced and incorporated into evidence-based practice in healthcare.


Buh, A. W., Mahmoud, H., Chen, W., McInnes, M. D., & Fergusson, D. A. (2021). Effects of Implementing Pressure Ulcer Prevention Practice Guidelines (PUPPG) in preventing pressure ulcers among hospitalized elderly patients: a systematic review protocol. BMJ open11(3), e043042.

Fremmelevholm, A., & Soegaard, K. (2019). Pressure ulcer prevention in hospitals: a successful nurse-led clinical quality improvement intervention. British Journal of Nursing, 28(6), S6-S11.

Gefen, A., Alves, P., Ciprandi, G., Coyer, F., Milne, C. T., Ousey, K., … & Worsley, P. (2020). Device-related pressure ulcers: SECURE prevention. Journal of wound care, 29(Sup2a), S1-S52.

Gefen, A., Cohen, L. P., Amrani, G., Hoffer, O., & Ovadia‐Blechman, Z. (2019). The roles of infrared thermography in pressure ulcer research with focus on skin microclimate induced by medical devices and prophylactic dressings. Wounds Int, 10(1), 8-15.

Horup, M. B., Soegaard, K., Kjølhede, T., Fremmelevholm, A., & Kidholm, K. (2020). Static overlays for pressure ulcer prevention: a hospital-based health technology assessment. British Journal of Nursing, 29(12), S24-S28.

Lichterfeld-Kottner, A., Lahmann, N., & Kottner, J. (2020). Sex-specific differences in prevention and treatment of institutional-acquired pressure ulcers in hospitals and nursing homes. Journal of tissue viability, 29(3), 204-210.

Saleh, M. Y., Papanikolaou, P., Nassar, O. S., Shahin, A., & Anthony, D. (2019). Nurses’ knowledge and practice of pressure ulcer prevention and treatment: An observational study. Journal of tissue viability, 28(4), 210-217.

Seo, Y., & Roh, Y. S. (2020). Effects of pressure ulcer prevention training among nurses in long- term care hospitals. Nurse education today, 84, 104225.

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