Assignment Research Review Part 2 Instructions

Assignment Research Review Part 2 Instructions

Assignment Research Review Part 2 Instructions

This is the second portion of your Research Review with a continued focus on your chosen PICO(T).  In this assignment you will be providing detailed findings from all your research review articles and the literature review tables.

This section includes combining and synthesizing the evidence from the literature review to answer your research question, make practice recommendations and describe  the overall of strength/consistency of the findings to support( or not) the intervention.  This portion will examine the levels of evidence and statistical data and its relevance in greater detail.

Included in this portion of the paper will be a discussion that ties together Assignment Part 1 and 2 and gives them meaning.

This would include a detailed discussion regarding major findings, limitation of the reviewed literature, conclusions drawn from the findings and implications for nursing practice. Assignment Research Review Part 2 Instructions

An important discussion in the implications for nursing section is if there is enough data to support and intervention or if there is a need for further research. This section of the paper will include recommendations and application  for nursing practice as well a discussion of  methods to make the intervention inclusive, equitable , and accessible for populations

This is a “building assignment” as this section and Part 1 will be combined to complete the Final Assignment ***You do not have to worry about self-plagiarism when continue on to assignment 2 and so on. You will have a minimum of seven articles or more for the final Research Review

ORDER   A PLAGIARISM-FREE PAPER   NOW

Assignment Part 2 – 75 points possible. This draft should demonstrate appropriate formatting and addresses all rubric criteria.    See Assignment Part 2 Rubric

 Instructions: Follow APA 7^th ed. Format and follow Part 2 Rubric (refer to example paper Assignment Part 2)

1. Use APA 7^th ed. Manual or recommend APA template sites listed in content section to set up paper and. (Chapter 2, APA manual 7^th ed.)
2. Write in 12 font Times New Roman
3. DO NOT write in first person.
4. Write in paragraph format
5. Include your title page from Assignment I with corrections made
6. Follow APA format for headings. Use headings from the rubric (see APA 7^th ed. Section 2.7)
7. 8. Findings: Include detailed findings for new literature and previous literature (literature review tables in this section as well referring to the literature review tables labeled as an Appendix (APA 7^th Chapter 7 see example table 7.1) Include any other data in this section from your research that strengthens your PICO. It is important to refer to the level of evidence for each article you discuss, include the type of research or study, number of participants in the study N=___, the purpose of the research, and any relevant statistical data, CI, p value.  List any type of research tools or methods  and their reliability rating:  example QOL Quality of Life screening, Depression screening, Pain Scale, etc.  * you should review and utilize the Statistical Reference Cheat Sheet found in the course.
8. Limit direct quotes to less than 10% of your paper. Paraphrase with in text citations in APA format. ***
9. Reference page should be a completed section with all data from research minimum 7 articles on a separate page following APA 7^th ed format, Chapter 9-10.
10. Review Turn it in report and correct any paraphrasing issues report should be <20% matching. 

Impact of Delayed Cord Clamping on Incidence of Newborn Jaundice 

Abstract

The purpose of this research review was to understand the impact of delayed cord clamping on the incidence of newborn jaundice and if there seemed to be a correlation or causation. The research review specifically looked at incidences of jaundice within the first week. Discussion was focused on causes of newborn jaundice and the benefits and disadvantages of delayed cord clamping. Eight studies were reviewed for this paper. Evidence suggested that delaying clamping of the umbilical cord was helpful in promoting increased iron and blood volume and did not appear to increase the occurrence of jaundice with a need for treatment in the newborn. Data supported the routine use of delayed cord clamping. Assignment Research Review Part 2 Instructions

Keywords: jaundice, delayed cord clamping, hyperbilirubinemia

Findings

A qualitative study by Faucher et al. (2016) involved a pre-test and post-test to increase knowledge related to the benefits of delayed cord clamping and increase usage of delayed cord clamping among a group of midwives in India. This study found that providing a simulation and lecture increased the knowledge and practice of delayed cord clamping. There were 31 participants in this study and the mean pre-test score was 3.5/7 while the immediate post-test score was 5.5/7 which shows a significant increase. This specific population in India experiences a high level of anemia, and delayed cord clamping has been shown to increase hemoglobin, hematocrit and serum ferritin levels in the newborn which improves the iron status (Faucher et al., 2016). This was a qualitative study and is low on the Melnyk and Fineout-Overholt (2019) strength-of-evidence pyramid. It is also weaker evidence due to the delayed cord clamping policy being developed and not tested, which provides a lower level of reliability. Refer to Appendix A for more information about this study.

A systematic review and meta-analysis by Fogarty et al. (2018) reviewed eighteen randomized controlled trials from different databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Chinese articles to determine the effects of delayed cord clamping versus early cord clamping on preterm infant morbidity and mortality. As a meta-analysis of randomized controlled trials, this is strong evidence and falls at the top of the Melnyk and Fineout-Overholt strength-of-evidence pyramid (2019). The results of these reviews were analyzed with Review Manager and had a 95% confidence interval for continuous and dichotomous variables. 2834 infants were included in this review, and it was found that delayed cord clamping did reduce the incidence of hospital mortality (Risk ratio 0.68, 95% confidence interval) and morbidity. This supports the PICOT and use of delayed cord clamping.

Looking at the effects of jaundice from a genetic and psychologic viewpoint, Horinouchi et al. (2021) utilized a genetic analysis to examine the relationship between neonatal jaundice and Autism Spectrum Disorder (ASD). There has been some research pointing to an association of ASD with neonatal jaundice due to the damage high levels of bilirubin can have on the brain when crossing the blood-brain barrier. This study included 79 children with ASD who were clinically assessed and evaluated with the Children Autism Rating Scale (CARS) or Parent-interview ASD Rating Scale-Text Revision (PARS-TR). Their medical histories, including previous history of phototherapy for jaundice, were taken from medical records. A sample of their dried umbilical cord was taken for the study and the Fisher’s exact test, Spearman’s rank correlation coefficient, Mann-Whitney U test and Kruskal-Wallis test were used in this study. The UGT1A1*6 gene was examined, and it was shown that there was no significant difference (OR = 1.34, p = 0.26) in the subjects and control population, as well as the UGT1A1*28 gene (OR = 0.80, p = 0.54). These results indicate that neonatal jaundice is not associated with ASD (Horinouchi et al., 2021). This is a nonexperimental study and falls towards the bottom of the strength-of-evidence pyramid as it is not as strong as if it were experimental (Melnyk & Fineout-Overholt, 2019).

A synthesis of findings from computerized databases by Qian et al. (2019) reviewed the harms and benefits of delayed cord clamping. This review included 19 studies related to delayed cord clamping and jaundice and revealed conflicting results indicating a need for more research. In some studies, there was no significant difference in hyperbilirubinemia in infants who experienced delayed cord clamping between 50-60 seconds and those who experienced early cord clamping. Delayed cord clamping did not affect bilirubin levels at 24 hours or incidence of clinical jaundice (Qian et al., 2019). In other studies, however, the serum bilirubin was higher after six hours in term newborns who experienced delayed cord clamping, and some Japanese newborns required increased rates of phototherapy (Qian et al., 2019). These inconsistent results point to a need for greater research before coming to a conclusion. This was a nonexperimental study and is therefore weaker evidence on the Melnyk and Fineout-Overholt (2019) strength-of-evidence rating pyramid. Assignment Research Review Part 2 Instructions

A meta-analysis of randomized controlled trials performed by Rabe et al. (2019) sought to assess the effects of early versus delayed cord clamping using 48 studies with 5721 infants and their mothers. The results of this meta-analysis included a difference of 234 recorded outcomes of hyperbilirubinemia in the group with delayed cord clamping versus 261 total in those with early cord clamping. There is no significant difference in outcomes of hyperbilirubinemia in those with delayed cord clamping versus early cord clamping, while delayed cord clamping is beneficial in preventing deaths in premature infants (Rabe et al., 2019). The GRADE approach was used for this study and a risk ratio of 95% confidence interval is presented for dichotomous data. This is an experimental study and is a high level of evidence at the top of the Melnyk and Fineout-Overholt strength-of-evidence pyramid (2019). See Appendix A for more information on this study.

A randomized clinical trial performed by Rana et al. (2020) included 540 participants and split the newborns into two groups to determine any difference in outcomes between those who received delayed cord clamping versus those who did not. Out of those in the early cord clamping group, 85/261 newborns were classified as intermediate and high-risk for jaundice compared with 92/263 newborns in the delayed cord clamping group. 22/261 of the newborns in the early group compared with 25/263 of the newborns in the delayed group were subsequently high risk for hyperbilirubinemia (Rana et al., 2020). These results reveal no increase in risk of hyperbilirubinemia in newborns with delayed cord clamping. For this trial the chi-square test, t test and MANOVA were all used. This is an experimental research study and is a high level of evidence on the Melnyk and Fineout-Overholt strength-of-evidence pyramid (2019). Refer to Appendix A for further information on this trial.

A retrospective cohort study was performed by Shinohara and Kataoka (2021) to determine risk factors of hyperbilirubinemia. Data was collected from a birth center practicing delayed cord clamping including 1211 patient charts. An independent t-test was performed as well as odds ratios and 95% confidential intervals. The results revealed that 4.7% of neonates were diagnosed with hyperbilirubinemia while 1.8% needed phototherapy. Six variables were identified as risk factors for hyperbilirubinemia and relate to the metabolism of bilirubin. For this study, the numbers of infants who did develop hyperbilirubinemia was not greater than previous studies and supports the conclusion that delayed cord clamping is not a risk factor for hyperbilirubinemia (Shinohara & Kataoka, 2021). This is a nonexperimental study and is a lower level of evidence on the strength-of-evidence pyramid (Melnyk & Fineout-Overholt, 2019).

A randomized controlled trial by Yunis et al. (2021) studied the effect that delayed cord clamping had on preterm infants. Infants were grouped into delayed cord clamping plus placental insufficiency (n = 30), immediate cord clamping plus placental insufficiency (n = 30), and delayed cord clamping with a normal placenta (n = 30). The Mann-Whitney U test, Chi-square test or Fisher exact test were used as appropriate. Infants in the delayed cord clamping with placental insufficiency were found to have considerably higher levels of hemoglobin directly after birth as well as at their two-month follow-up compared to the immediate cord clamped group. Peak serum bilirubin was higher in the delayed cord clamping group with placental insufficiency than in either the immediate cord clamping group or the delayed cord clamping with normal placenta. The need for phototherapy, however, was not significant and none of the infants in the study required exchange transfusion. In term infants, delayed cord clamping was associated with increased bilirubin levels as well as a diagnosis of jaundice but without the need for phototherapy (Yunis et al., 2021). This is an experimental research study and is a high level of evidence, falling at the top of Melnyk and Fineout-Overholt’s strength-of-evidence pyramid (2019). This study supports the PICOT as it reveals that despite increased bilirubin, delayed cord clamping did not increase a need for phototherapy and the levels of jaundice were managed without treatment.

Discussion

These studies indicate that delayed cord clamping is not associated with an increased incidence of jaundice requiring phototherapy. In studies where there was a higher incidence of jaundice in newborn with delayed cord clamping, it was not significant enough to require phototherapy (Yunis et al., 2021). Delayed cord clamping is beneficial in decreasing mortality and morbidity (Fogarty et al. 2018), preventing death in premature infants (Rabe et al. 2019), and increasing hemoglobin and blood levels in the newborn (Faucher et al. 2016). While delayed cord clamping has been proven beneficial, more research is needed to determine the best timing. Despite many studies, it is still unclear just how long is the optimal amount of time to delay the clamping of the umbilical cord. Some limitations of these reviewed studies include the specificity of the populations included, small sample sizes, and the retrospective nature of some of the studies. Despite these limitations, the information gathered from this research encourages a change in how nursing care handles deliveries and the timing of cord clamping. Assignment Research Review Part 2 Instructions

Recommendations for Nursing Practice

The research supports a change in how nursing practice has cared for clamping and cutting the umbilical cord. Research indicates that delaying the clamping of the umbilical cord provides enough benefits and is safe enough to implement as a routine response in the delivery process. More research related to exactly how long to delay cord clamping is needed; however, there is enough research that has shown that it is beneficial to delay clamping of the umbilical cord for at least 30 seconds. Further research involving larger sample sizes and increased populations would be useful to determine timing.

When looking to make a practice change, Melnyk and Fineout-Overholt (2019) describe the important of including stakeholders. Some of the stakeholders involved in this change include nurses involved in the care of the pregnant or laboring women, physicians and midwives involved in the care, unlicensed personnel, and management. Another important part of looking at evidence-based research is deciding how to disseminate the evidence. Melnyk and Fineout-Overholt (2019) include many different examples and descriptions of ways to begin this process. For this research question and purpose, practice change is specific to the labor and delivery unit and should begin at the unit level. There are several ways to begin to implement this change at the unit level including roundtable presentations, poster presentations, and evidence-based clinical rounds (Melnyk & Fineout-Overholt, 2019). All three of these methods involve a more casual approach that would be plausible to implement on a day-to-day basis while still providing information and evidence to all parties involved to begin this change.

Conclusion

This research project sought to determine whether delayed cord clamping is safe and should be implemented in all labor and delivery units, or if it is a cause of jaundice resulting in further damage and should be avoided. Evidence from many levels of Melnyk and Fineout-Overholt’s (2019) strength-of-evidence rating pyramid was reviewed and included in this project. The review of this evidence suggests that delayed cord clamping is beneficial and safe. Delayed cord clamping has not been shown to increase jaundice with a need for phototherapy. The next step on the JHNEBP model (Melnyk & Fineout-Overholt, 2019) is to implement a practice change of delayed cord clamping across labor and delivery units. Further research utilizing larger sample sizes and more diverse populations would be useful in determining the best timing related to how long to delay the clamping of the umbilical cord.

References

Faucher, M. A., Riley, C., Prater, L., & Reddy, M. P. (2016). Midwives in India: a delayed cord

clamping intervention using simulation. International Nursing Review, 63(3), 437-444. https://doi-org.ezproxy.mnsu.edu/10.1111/inr.12264

Fogarty, M., Osborn, D. A., Askie, L., Seidler, A. L., Hunter, K., Lui, K., Simes, J., & Tarnow-

Mordi, W. (2018). Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. American Journal of Obstetrics & Gynecology, 218(1), 1-18. https://doi-org.ezproxy.mnsu.edu/10.1016/j.ajog.2017.10.231

Horinouchi, T., Maeyama, K., Nagai, M., Mizobuchi, M., Takagi, Y., Okada, Y., Kato, T.,

Nishimura, M., Kawasaki, Y., Yoshioka, M., Takada, S., Matsumoto, H., Nakamachi, Y., Saegusa, J., Fukushima, S., Fujioka, K., Tomioka, K.,Nagase, H., Nozu, K., Iijima, K., … Nishimura, N. (2021). Genetic Analysis of UGT1A1 Polymorphisms Using Preserved Dried Umbilical Cord for Assessing the Potential of Neonatal Jaundice as a Risk Factor for Autism Spectrum Disorder in Children. Journal of autism and developmental disorders, 10.1007/s10803-021-04941-w. Advance online publication. https://doi-org.ezproxy.mnsu.edu/10.1007/s10803-021-04941-w

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing &

healthcare: A guide to best practice (4th ed). Wolters Kluwer.

Moncrieff, G. (2018). Bilirubin in the newborn: Physiology and pathophysiology. British

Journal of Midwifery, 26(6), 362-370. https://doi-org.ezproxy.mnsu.edu/10.12968/bjom.2018.26.6.362

Qian, Y., Ying, X., Wang, P., Lu, Z., & Hua, Y. (2019). Early versus delayed umbilical cord

clamping on maternal and neonatal outcomes. Archives of Gynecology & Obstetrics, 300(3), 531-543. https://doi-org.ezproxy.mnsu.edu/10.1007/s00404-019-05215-8

Rabe, H., Gyte, G. M., Diaz, R. J. L., & Duley, L. (2019). Effect of timing of umbilical

cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database of Systematic Reviews, 9. Assignment Research Review Part 2 Instructions

Rana, N., Ranneberg, L. J., Malqvist, M.,KC, A., & Andersson, O. (2020). Delayed cord

clamping was not associated with an increased risk of hyperbilirubinaemia on the day of birth or jaundice in the first 4 weeks. Acta Paediatrica, 109(1), 71-77. https://doi-org.ezproxy.mnsu.edu/10.1111/apa.14913

Shinohara, E., & Kataoka, Y. (2021). Prevalence and risk factors for hyperbilirubinemia among

newborns from a low‐risk birth setting using delayed cord clamping in Japan. Japan Journal of Nursing Science, 18(1), 1–9. https://doi-org.ezproxy.mnsu.edu/10.1111/jjns.12372

Yunis, M., Nour, I., Gibreel, A., Darwish, M., Sarhan, M., Shouman, B., & Nasef, N. (2021).

Effect of delayed cord clamping on stem cell transfusion and hematological parameters in preterm infants with placental insufficiency: a pilot randomized trial. European Journal of Pediatrics, 180(1), 157-166. https://doi-org.ezproxy.mnsu.edu/10.1007/s00431-020-03730-4

N320 Grading Criteria /Rubric Part 2

Criteria	Possible Points	Points Earned	Comments
Title Page: APA format corrected from Assignment I	1
Abstract: Clear concise summary of the paper, identifies purpose, literature review & findings, 100-250 words, single paragraph, not indented, past tense. Include keywords section	5
Findings:  Combine & synthesize evidence from the literature to answer your research question that will support  a practice recommendation. Describe overall strength/consistency of findings (important statistical data, levels of evidence, evidenced based tools or protocols, etc.) to support (or not support) the intervention. Discuss each article utilized in your paper to support your PICOT.  Include research found on literature review tables and any additional research.  Should have a minimum of 7 articles. Refer reader to the lit review table appendix.	30
Discussion:  ties together the other sections & gives them meaning, includes major findings, limitations of the reviewed studies, conclusions drawn from the findings, implications for nursing practice & recommendations for further research.	10
Recommendations for Nursing Practice:  Based on your findings, what do you recommend for nursing practice? Should you implement a practice change & is further research needed? Describe methods to make inclusive, equitable , and accessible for populations	10
Conclusion:  Reviews major points of the paper and is a logical flow from the body of the paper.	6
References: formatted and cited correctly	8
APA Format (Title page, headers, headings, in-text referencing, reference list, page numbering) free of spelling and grammatical errors	5

Total Points Earned__________(out of 75)

 

Comparison of Silicone Foam Dressings Versus Pressure Reduction Techniques 

Abstract

The purpose of this paper was to determine if silicone foam dressings are more beneficial for preventing pressure injuries than pressure reduction techniques alone. Special focus was placed on patients who have the additional risk factor of incontinence. Discussion was focused on assessment tools and differentiating between incontinence-associated dermatitis and pressure injury. Eleven studies were reviewed for this paper. Evidence suggested that applying silicone foam dressings may be beneficial for preventing pressure injuries in addition to pressure reduction techniques. However, the evidence was not strong related to difficulty creating double blind studies and small sample sizes. More evidence will be needed in the form of randomized controlled studies or piloting programs prior to implementing practice change in a hospital system. Assignment Research Review Part 2 Instructions

Keywords: pressure injury, prevention, incontinence, silicone foam dressing

Findings

In the case study about nurse practices and preventing pressure injuries, Teo et al. found that “timely escalation of care, effective communication, support from the wound nurses, and bridging the knowledge-practice gap” were the most effective mechanisms (2019, p. 153). For more information regarding this case study, see Appendix Table 2. This research aims to help bridge the knowledge-practice gap specifically for the hospitalized patient with IAD and pressure injury. In the cross-case analysis by Ghiasas et al., occupational therapy researchers examined how patient involvement contributes to pressure injury development and healing. They found that of 25 participants, 19 participants who adopted positive lifestyle changes also experienced improvement of pressure injuries (2020). See Appendix Table 4 for more detailed information.

Several studies were found comparing the use of silicone foam dressings with pressure reduction techniques alone. Walker, et al. performed a pilot study regarding the prophylactic use of silicone foam dressings to prevent sacral pressure injuries in a general medical surgical setting. In the study, silicone foam dressings were applied to the sacrum of patients indicated as high risk on the Waterlow Scale, in addition to pressure reduction techniques (Walker, et al. 2015). In the follow-up report, they found that of 67 patients that completed the trial, only one patient within the intervention group developed pressure injury, compared to two in the control group (Walker & Aitken, 2015). This study offered promising results, however greater sample size is needed.

ORDER   A PLAGIARISM-FREE PAPER   NOW

Two studies were identified utilizing silicone foam dressings in intensive care hospital settings. Santamaria et al., found that of the 440 trauma patients studied, only 5 patients in the intervention group developed pressure injury compared with 20 in the control group (2015). In this study, dressings were applied to sacrum and heels of patients admitted to the ED who transferred to ICU. Dressings were applied prophylactically in addition to pressure reduction techniques. For more information regarding this study see Appendix Table 1. Park specifically studied silicone foam dressings for prevention of pressure injury and incontinence-associated dermatitis (IAD) in intensive care. This study examined 102 patients with Braden scores of 16 or less and utilized the Incontinence Associated Dermatitis and its Severity Instrument (IADS) for evaluation. They found that as the IADS score increased, so did the incidence of pressure injuries. They also found that in the intervention group, both the incidence of pressure injury (6% vs.46%) and IADS were decreased (Park, 2014). This study was limited in that it was not blind, and the sacral dressings were applied for only 9 days. Even so, the results were positive toward using silicone foam dressings for decreasing incidence of both pressure injuries and IAD. See Appendix Table 2.

In the systematic review regarding effectiveness of pressure injury prevention strategies, Tayyib and Coyer found that the three studies included involving silicone foam dressings indicated a statistically significant decrease of pressure injuries in ICU. However, because of small sample sizes, lack of randomization and overall differences in structure of studies, “no conclusions could be reached regarding effectiveness” (Tayyib & Coyer, 2016, p. 442). The Cochrane Systematic Review that was utilized in this paper had similar concerns with data reliability related to quality of evidence and reliability (Moore, et al., n.d.). This review included 18 trials, six of which compared silicone dressings versus pressure reduction techniques. They did find that of the 1247 participants across six studies, 16 participants within the intervention group compared with 65 in the control group, developed pressure injury. With these findings, Moore et al. concluded that “silicone dressings may reduce the incidence of pressure ulcers. However the low level of evidence certainty means that additional research is required to confirm these result.” (n.d., p. 28). See Appendix Table 3 for more information regarding this review.

Discussion

These studies indicate that silicone foam dressings may prevent further skin breakdown in hospitalized patients with stage 1 pressure injury and incontinence. They also may help to decrease incontinence associated dermatitis. However, more and better data is necessary to support this intervention. It is difficult to have a true blind study related to the nature of the question (dressing vs. no dressing). But factors like sample size and standardized evaluation practices, could be improved for future studies. Patient experience case studies would be helpful for determining if patient experience is improved by these interventions. Cost-benefit analysis may also be helpful for hospital systems interested in implementing this intervention. The recommendation at this point as indicated by the JHNEBP model would be to consider a pilot or research study prior to implementing a larger scale change.

Recommendations for Nursing Practice

The research is generally supporting utilizing silicone foam dressings, however the evidence is not very strong. With this population it is very difficult to create double blind scenarios, but thought should be given to make them as blind as possible for credibility. Because of  the lack of strong evidence nursing recommendations would be for  further studies. Additionally, a piloting period would be recommended prior to implementing this intervention in a hospital system. Cost, efficacy, and risk versus benefit should be part of this analysis of the pilot prior to large scale intervention or practice change. Webster & Moore advised that “future trials should be large enough to show meaningful differences; include patient-related outcomes, such as product acceptability, adverse events and quality of life, and economic evaluations to assist healthcare managers to make rational decisions” (p. 29, 2018). Hospital systems may choose to determine specific requirements of when silicone foam dressings should be added to maximize effectiveness and cost vs. benefit. Assignment Research Review Part 2 Instructions

The Agency for Healthcare Research an d Quality (AHRQ) website offers a toolkit and a training program for hospitals. This would be an excellent place to start when implementing this policy change. It offers a plethora of information in addition to resources to roll out a new program (Berlowitz et al., n.d.). In addition, further training on assessing pressure injuries, risk for skin breakdown, and the differences between pressure and dermatitis would be helpful training points.

Conclusion

This research project sought to answer whether a silicone foam dressing was more effective than pressure reduction techniques alone in preventing pressure injury in hospitalized patients with incontinence. Evidence from all steps of the Strength-of-evidence rating pyramid was reviewed (Melnyk & Fineout-Overholt, 2019, p. 116, Figure 4.2). Further research is needed in the form of a piloting period or additional randomized controlled trials. Prior to implementation, the research team should focus on determining the most effective scenarios to utilize silicone foam dressings, cost versus benefit for hospitals, and patient experience related to this intervention.

References

Berlowitz, D., VanDeuzen Lukas, C., Parker, V., Niederhauser, A., Silver, J., Logan, C., Ayello, E., Zulkowski, K. (2014). Preventing Pressure Ulcers in Hospitals. Agency for Healthcare Research and Quality. https://www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/index.html.

Campbell, J., Barakat-Johnson, M., Hogan, M., Maddison, K., McLean, J., Rando, T., Samolyk, M., Sage, S., Weger, K., & Dunk, A. M. (2020). A clinical guide to pelvic skin assessment. Wounds International, 11(1), 30–39.

Ghaisas, S., Pyatak, E. A., Blanche, E., Blanchard, J., & Clark, F. (2015). Lifestyle Changes and Pressure Ulcer Prevention in Adults With Spinal Cord Injury in the Pressure Ulcer Prevention Study Lifestyle Intervention. The American Journal of Occupational Therapy, 69(1), 1-10. http://dx.doi.org.ezproxy.mnsu.edu/10.5014/ajot.2015.012021

Gray M, Giuliano KK. (2018). Incontinence-Associated Dermatitis, Characteristics and Relationship to Pressure Injury: A Multisite Epidemiologic Analysis. J Wound Ostomy Continence Nurs, 45(1), 63-67. doi:10.1097/WON.0000000000000390

Melnyk, B. & Fineout-Overholt, E. (2019). Evidence-based Practice in Nursing & Healthcare (4^th ed). Philadelphia: Lippincott, Williams & Wilkins.

Park K. H. (2014). The effect of a silicone border foam dressing for prevention of pressure ulcers and incontinence-associated dermatitis in intensive care unit patients. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society, 41(5), 424–429. https://doi-org.ezproxy.mnsu.edu/10.1097/WON.0000000000000046

Santamaria, N., Gerdtz, M., Sage, S., McCann, J., Freeman, A., Vassiliou, T., De Vincentis, S., Ng, A. W., Manias, E., Liu, W., & Knott, J. (2015). A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: the  border trial. International Wound Journal, 12(3), 302–308. https://doi-org.ezproxy.mnsu.edu/10.1111/iwj.12101 Assignment Research Review Part 2 Instructions

Tayyib, N., & Coyer, F. (2016). Effectiveness of Pressure Ulcer Prevention Strategies for Adult Patients in Intensive Care Units: A Systematic Review. Worldviews on evidence-based nursing, 13(6), 432–444. https://doi-org.ezproxy.mnsu.edu/10.1111/wvn.12177

Teo, C., Claire, C. A., Lopez, V., & Shorey, S. (2019). Pressure injury prevention and management practices among nurses: A realist case study. International wound journal, 16(1), 153–163. https://doi-org.ezproxy.mnsu.edu/10.1111/iwj.13006

Walker, R., Aitken, L.M., Huxley, L. & Juttner, M. (2015) Prophylactic dressing to minimize sacral pressure injuries in high‐risk hospitalized patients: a pilot study. Journal of Advanced Nursing 71( 3), 688– 696. doi: 10.1111/jan.12543

Walker, R., & Aitken, L. (2015). Pressure injury prevention pilot study: a follow-up. Queensland Nurse, 34(3), 33.

Webster, J., & Moore, Z. E. (n.d.). Dressings and topical agents for preventing pressure ulcers. Cochrane Database of Systematic Reviews, 12. Assignment Research Review Part 2 Instructions

Appendix

Literature Review Table 1

Article, Source, year	Gray M, Giuliano KK. (2018). Incontinence-Associated Dermatitis, Characteristics and Relationship to Pressure Injury: A Multisite Epidemiologic Analysis. J Wound Ostomy Continence Nurs, 45(1), 63-67. doi:10.1097/WON.0000000000000390	Santamaria, N., Gerdtz, M., Sage, S., McCann, J., Freeman, A., Vassiliou, T., De Vincentis, S., Ng, A. W., Manias, E., Liu, W., & Knott, J. (2015). A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: the border trial. International Wound Journal, 12(3), 302–308. https://doi-org.ezproxy.mnsu.edu/10.1111/iwj.12101
Purpose	To measure the prevalence of incontinence-associated dermatitis (IAD) among incontinent persons in acute care setting, characteristics of IAD in this group, and associations among IAD, urinary, fecal, and dual incontinence, immobility, and pressure injury in the sacral area.	To investigate the effectiveness of multi-layered soft silicone foam dressings in preventing intensive care unit pressure ulcers when applied in the emergency department.
Sample	N=5342   (n=2492/5342, 46%)  incontinent or urine, stool or both (n=1140/5342, 21.3%)   prevalence of IAD (n=1140/2492, 45.7%)  prevalence of IAD within incontinent population (n=596/1140, 52.3%)  IAD considered mild within incontinent population (n=318/1140, 27.9%)  IAD considered moderate within incontinent population (n=105/1140, 9.2%)  IAD considered severe within incontinent population   (n=169/1140, 14.8%)  patients with IAD who also had a fungal rash (n=427/2492, 17.1%)  prevalence of pressure injury in sacral area among individuals with incontinence (n=95/2492, 3.8%)  prevalence of full-thickness pressure injury among individuals with incontinence	N=440 (n=219) Mepilex Border Sacrum and Mepilex Heel dressings applied in ED and maintained throughout ICU stay. (n=221) Control group receiving usual care.
Design and level of evidence (Melnyk 4.2)	Epidemiologic analysis utilizing multivariate analysis. This type of study seeks to describe the distribution of diseases in the population and analyze the causes of these diseases – analyzing multiple variables at one time.   Categorized as non-experimental study. Variables are not being changed, data is gathered at particular time. In the second level of the Strength-of-evidence rating pyramid seen in Melnyk & Fineout-Overholt (2019, p.116, Figure 4.2).	Randomized controlled trial – this type of study seeks to reduce bias while testing the effectiveness of a certain treatment by having two groups – control group and experimental group.   Categorized as experimental research study, it is an RCT. This is found in the third level of the Strength-of-evidence rating pyramid from Melnyk & Fineout-Overholt (2019, p. 116, Figure 4.2).
Variables, measurement	Clinical variables include incontinence of urine, stool, or both urine and stool, immobility, concurrent fungal infection.	Clinical variables include reason for admission, comorbidity, physiological variables, Australasian Triage scale score, and time commenced on mechanical ventilation.
Results, findings	Prevalence of facility-acquired pressure injury in sacral area among individuals with incontinence was 17.1%.   Patients with IAD were more likely to experience a facility-acquired pressure injury of the sacral area compared to those without IAD (32.3% vs. 1.5%).   Patients who were immobile were almost 3.5 times more likely to develop facility-acquired sacral pressure injury than those who were mobile (12.1% vs. 3.2%).   Prevalence of IAD and facility-aquired pressure injury in the sacral area remained statistically significant even after adjusting for immobility (P<0.0001).	The intervention group had significantly less patients who developed a pressure ulcer in ICU (5 vs. 20, P=0.001).
Implications	Both mobility and incontinence – specifically incontinence associated dermatitis – are significant risk factors for developing sacral pressure injuries in acute care. IAD was found to be an independent risk factor apart from immobility.	A benefit was found for applying mepilex dressings to sacrum and heels of ICU patients, in combination with pressure reduction and skin care. As a result, this hospital has now mandated the use of these dressings for all patients who are high risk for pressure injury.
Limitations of Research	Not all data was filled out on each electronic survey as each field was not mandatory.   Participants did not receive standardized training in assessment of IAD and pressure injury.   Assessments of IAD were not made using a validated instrument.   Interventions and products used for prevention of skin breakdown was not standardized.	Study was conducted at a single site for a limited time.   It was impossible to blind data collectors to the nature of the treatment intervention.     Only studied patients who admitted to ICU from ED, cannot be generalized to other patient populations.   While patients with incontinence were not excluded from the study, there was no comment toward how much of the population was incontinent and if that affected the results in any way.
Comments	The purpose of this study was to establish the link between IAD and pressure injury. Further study is needed to indicate which interventions best prevent pressure injuries specific to the population of patients who are incontinent in acute care.	This is promising evidence for using a particular silicone foam dressing to prevent pressure injury in a specific population. More research would need to be done to determine whether these results can be duplicated in the medical/surgical population, with a greater sample size, and for my research specifically examining the implications of concurrent incontinence.

 

Literature Review Table 2

 

Article, Source, year	Park K. H. (2014). The effect of a silicone border foam dressing for prevention of pressure ulcers and incontinence-associated dermatitis in intensive care unit patients. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society, 41(5), 424–429. https://doi-org.ezproxy.mnsu.edu/10.1097/WON.0000000000000046	Teo, C., Claire, C. A., Lopez, V., & Shorey, S. (2019). Pressure injury prevention and management practices among nurses: A realist case study. International wound journal, 16(1), 153–163. https://doi-org.ezproxy.mnsu.edu/10.1111/iwj.13006
Purpose	To determine if the development of pressure injuries and incontinence-associated dermatitis are lessened when silicone border foam dressings are applied to patients in ICU.	To portray what nurses current pressure injury prevention practices are in a hospital in Singapore.
Sample	N=102 n=52, experimental group n=50, control group	N=24
Design and level of evidence (Melnyk 4.2)	Quasi-Experimental Study. This type of study is a nonrandomized control study, which falls under the category of experimental research studies. This is in the third level of the Strength-of-evidence pyramid in Melnyk & Fineout-Overholt (2019, p. 116, Figure 4.2). Assignment Research Review Part 2 Instructions	Case Study. This type of study uses a small case size and interviews participants to obtain data. It falls on the bottom of the Strength-of-evidence rating pyramid mentioned by Melnyk & Fineout-Overholt (2019, p. 116, Figure 4.2).
Variables, measurement	Clinical variables include gender, age, reason for ICU admission, urinary continence, stool form, BMI and braden score.	Clinical variables include gender, ethnicity, years of nursing experience, and type of nursing employment (those not responsible for pressure injury prevention were excluded).
Results, findings	Patients in experimental group (with silicone foam dressing applied) had lower occurrence of pressure injury than control group (6% vs. 46%, P <0.001)   Patient’s in experimental group (with silicone foam dressing applied) had lower occurrence of incontinence-associated dermatitis than control group (0.54 +/- 0.73 vs 0.98 +/- 1.25, P <0.033).   Correlation between pressure injury and incontinence-associated dermatitis (r = 0.264, P = 0.005).   With every 1-point increase in IADS score, risk of developing pressure injury increased by a ratio of 1.9.	There were 5 conjectured context-mechanism-outcomes (CCMOs) that arose throughout the study: escalation of care, maximizing opportunities for communication, adopting novel forms of communication, support from wound nurses, and bridging theory-practice gaps (Teo et al., 2019).
Implications	In this study they found that the silicone foam dressing did decrease the occurrence of pressure injury development in ICU setting. They found that the dressing improved both the incidence of pressure injuries and incontinence-associated dermatitis. It also found a link between incontinence-associated dermatitis and pressure injuries.	The study found that nurses need hands-on training of information that is directly applicable to their work. Education should be individualized to the nurses role (this study included nursing assistants, nurses, and specialists). Resources should be appropriately allocated to maximize pressure injury prevention.
Limitations of Research	This was not a randomized study. Also it is taking place in one hospital with only 100 patients. Silicone dressings were only applied for 9 days. More research would be needed on a wider scope of patients to determine if this is duplicable.	The hospital that this study took place at is 3 years old, so each nurse had only worked there for maximum of 3 years. Age range of participants was predominantly younger. Participant observation was not completed due to time restraints. May be difficult to generalize data related to case study design.
Comments	Further study is needed to determine if these results can be duplicated outside of this study. Also, further research is needed to explore the link between incontinence-associated dermatitis and pressure injury.	Further study is needed to test the CCMO’s to determine if this study can be generalized to other countries. Some findings may transfer where as others may be found to be cultural or related to the specific structure of healthcare delivery in this country.

 

 

Literature Review Table 3

 

Article, Source, year	Moore, Z. E., Webster, J., & Moore, Z. E. (n.d.). Dressings and topical agents for preventing pressure ulcers. Cochrane Database of Systematic Reviews, 12.
Purpose	To determine how effective dressings and topical agents are at preventing pressure injuries, in at risk populations in any healthcare setting.
Sample	18 trials, N=3629 6 trials, n=1247 – silicone dressing vs. no dressing 4 trials took place in ICU, 2 in med-surg
Design and level of evidence (Melnyk 4.2)	Systematic review, which is also known as an evidence summary. These types of studies collect and analyze data from multiple studies. This is at the top of the Strength-of-evidence rating pyramid outlined in Melnyk & Fineout-Overholt (2019, p.116, Figure 4.2).
Variables, measurement	Variables within the studies include different interventions: this study looked at topical applications, dressings, and both topical agents and dressings.   Variables in the participants of the studies include: age, country of origin, Braden pressure ulcer scale score, level of acuity of care during study.
Results, findings	Per Moore et al., “Silicone dressings may reduce pressure ulcer incidence at any stage” (n.d. p. 24). Just 3% of patients who had silicone dressings applied developed pressure injuries, and 11% of patients with no dressing developed pressure injuries. However, Moore, et al., caution about the risk of bias in these studies especially as it is impossible to create a true blind study with this intervention.   Pressure Ulcer Incidence: RR 0.25, 95% CI, low-certainty evidence Stage 1 Pressure Ulcer Incidence: RR 0.27, 95% CI, low-certainty evidence Stage 2 Pressure Ulcer Incidence: RR 0.40, 95% CI, low-certainty evidence
Implications	All studies stated that silicone foam dressings prevented pressure injuries better than no dressings, however more evidence is needed because this study found a “low level of evidence certainty” related to bias (Moore, et al., n.d., p. 28). The authors suggested future studies should include large sample sizes, validated tools, and include more patient-related outcomes. They also suggested looking at the cost vs. benefit of these interventions.
Limitations of Research	Only RCT’s were used, and most of the studies had considerable risk of bias. Evidence needed to be downgraded to low or very low quality related to risk of bias and/or imprecision.
Comments	There is positive evidence for utilizing silicone foam dressings to prevent pressure injuries, however, more research is needed and studies should be created to decrease bias in this particular situation. Also more evidence is needed specifically as it relates to incontinence.

 

Literature Review Table 4

 

Article, Source, year	Ghaisas, S., Pyatak, E. A., Blanche, E., Blanchard, J., & Clark, F. (2015). Lifestyle Changes and Pressure Ulcer Prevention in Adults With Spinal Cord Injury in the Pressure Ulcer Prevention Study Lifestyle Intervention. The American Journal of Occupational Therapy, 69(1), 1-10. http://dx.doi.org.ezproxy.mnsu.edu/10.5014/ajot.2015.012021
Purpose	A cross-case analysis of a previous randomized controlled trial of lifestyle interventions for preventing pressure injuries in adults with spinal cord injuries.
Sample	N=47 Total Participants in Pressure Ulcer Prevention Program   n=17 participants did not develop pressure injuries and were excluded n=2 participants had poor adherence to program and were excluded n=25 participants involved in this cross-case analysis
Design and level of evidence (Melnyk 4.2)	This is a secondary cross-case analysis of treatment notes of 47 participants in a previous randomized controlled trial. Analyzed treatment notes from previous study in case-study format. It is considered a non-experimental study which is on the second level of the Strength of evidence rating pyramid found in Melnyk & Fineout-Overholt (2019, p.116, Figure 4.2).
Variables, measurement	Clinical variables include primary language spoken, education, gender, income, residence type, years since spinal cord injury, BMI, comorbidities, paralysis type and spinal cord injury type.
Results, findings	19 of participants made positive lifestyle changes and had improved pressure injuries, 3 made positive lifestyle changes but pressure injuries did not improve, 1 participant made minimal or no changes and pressure injuries improved and 2 participants made minimal or no changes and pressure injuries worsened.
Implications	There is a relationship between lifestyle factors and development of pressure injuries for patients with spinal cord injuries, however, there are many additional outside factors that also affect pressure injury development and healing.
Limitations of Research	This is a small sample size that is in a concentrated geographic area from one clinic in California. More information would be helpful regarding how cultural and socio-economic factors affect patient’s success with interventions. For the purpose of this paper it would be helpful to see a broader group of diagnoses in the sample size, and how these interventions would hold when introduced during inpatient hospital stays.
Comments	This shows promising design for Occupational Therapists to work with their patients with spinal cord injuries toward lifestyle changes to prevent pressure injuries in the community. It would be interesting to see if the interventions discussed would help improve outcomes in the hospitalized population that is being discussed in this research project. Assignment Research Review Part 2 Instructions