NRS 493 Topic 4 Literature Evaluation Table GCU

NRS 493 topic 4 literature evaluation table GCU

Literature Evaluation Table 

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Hospital acquired pressure injuries (ulcers) are a critical patient safety concern in healthcare because of their adverse effects. The Centers for Disease Control and Prevention (CDC) asserts that over 2.5 million patients experience hospital acquired injuries (HAPIs) with close to 60,000 dying each year due to complications related to the problem (Cox et al., 2022). As such, nurses and other healthcare providers must develop care bundle approach to address the problem and ensure that patients in critical care settings have reduce chances of developing HAPIs (The Joint Commission, 2022). The purpose of this paper is to evaluate existing literature on the topic and determine how the evidence supports the capstone project.  

Criteria Article 1 Article 2 Article 3 Article 4 
Author, Journal (Peer-Reviewed), and   Permalink or Working Link to Access Article    Grešš Halász, B., Bérešová, A., Tkáčová, Ľ., Magurová, D., & Lizáková, International journal of environmental research and public health, 18(4), 1705.    Amirah, M., Rasheed, A., Parameaswari, P., Awajeh, A., Issa, M., & Abdallah, M. Journal of Intensive and Critical Care, 5(2), 9. DOI: 10.21767/2471-8505.100128 Qaddumi, J. A., & Almahmoud, O. The Open Public Health Journal, 12(1). Pittman, J., Beeson, T., Dillon, J., Yang, Z., & Cuddigan, J. American journal of critical care, 28(5), 338-350.
Article Title and Year Published   Nurses’ Knowledge and Attitudes towards Prevention of Pressure Ulcers (2021)Pressure Injury Prevalence and Risk Factors among Adult Critically Ill Patients at a Large Intensive Care Unit  (2019) Pressure Ulcers Prevalence and Potential Risk Factors Among Intensive Care Unit Patients in Governmental Hospitals in Palestine: A Cross-sectional Study (2019) Hospital-Acquired Pressure Injuries in Critical and Progressive Care: Avoidable Versus Unavoidable (2019)
Research Questions (Qualitative)/Hypothesis (Quantitative)    The study’s hypothesis is that nursing knowledge on pressure injuries can improve their attitude and handling of patients with the problem.1.What is the prevalence of PI among critically ill patients in ICU (excluding stage one)? 2.Where are the majority PIs located? 3.What is the most frequent PI stage in patients admitted to ICU? 4.Is there any association between the development of a PI and other variables?The possible research questions for the study would be; a). What is the prevalence of pressure injuries among patients in intensive care units and; 2). What are the risk factors for these injuries?  The possible research questions for the study include a). What is the proportion of HAPI patients with unavoidable injuries in critical and progressive care units? b) what are the risk factors of patients in these units that distinguish them from unavoidable HAPIs?  
Purposes/Aim of Study The study aimed at determining knowledge and attitudes among nurses  The purpose of the study was to know the prevalence of pressure ulcers, locations, and stages in the intensive care unit and the related factors  The study aimed at determining the prevalence rate and possible risk factors of pressure ulcers (Pus) in intensive care unit patients in government hospitals in Palestine.  The study’s purposes included determining the proportion of HAPIs among patients in critical and progressive care units that cannot be avoided and identifying the risk factors of patients in these units to differentiate avoidable from unavoidable HAPIs.  
Design (Type of Quantitative, or Type of Qualitative) Quantitative exploratory cross-sectional design  Quantitative study using cross-sectional design Quantitative: cross-sectional and descriptive analytical study  Quantitative; descriptive, retrospective, comparative design  
Setting/Sample   Selected (six) hospitals in Slovakia 460 randomly selected nurses with only 225 participating in the study King Saud Medical City with 116 ICU patients.  Intensive care units of four different hospitals 115 participants with analysis focusing on 109 participants.  Six acute care hospitals within a large academic health care system in Midwestern U.S.   
Methods: Intervention/Instruments   Pressure Ulcer Knowledge Assessment Tool (PUKAT) and Attitudes towards Pressure Ulcers Prevention (APuP) tool The intervention entailed using risk assessment tools like Braden scale, positioning after every two hours, alternating air mattresses and barrier cream.  European Pressure Ulcer Advisory panel (EPUAP) guidelines containing Braden Scale.  Demographic information, Braden scores, clinical risk factors, and preventive interventions The also use Pressure Ulcer Prevention Inventory in categorizing HAPIs as avoidable and unavoidable.   
Analysis   The researchers used SPSS 20 to analyze collected data from the study. They also performed a correlation test to determine the relationship among the different variables  The authors used SPSS 21.0 to analyze the variables and present them as frequencies with percentages.  The article analyzed collected data using SPSS 18.0. It also integrated descriptive analysis, mean, median, standard deviation among other tools. It employed Chi-Square test to present relationship  between risk factors and development of pressure injuries  The authors used descriptive statistics to analyze the variables. They used standard deviation (SD) and Student t test. The authors also used logistic regression analyses to describe factors associated with unavoidable HAPIs.
Key Findings   The key findings included positive relationship between nurse knowledge and attitudes to management of pressure ulcers while insufficient knowledge led to ineffective interventions to reduce the injuries.  The prevalence of pressure injuries was about 35.7% with sacrum as the most frequent location of pressure injuries. Most of the PIs were in stage two. The researchers also found a strong correlation between PIs and patients age, body mass index, and length of stay in the hospital.  The prevalence of PIs was about 33% while those beyond stage one had about 7% rates. The researchers assert that the most common stage for the development of PIs is stage one. The number of days in the facility, moisture, and friction were the leading risk factors for PIs.  About 41% of HAPIs are unavoidable and patients’ condition also affecting the prevalence of these injuries. Patients with bowel movement had increased odds of not avoiding PIs. Again, the odds of unavoidable PIs increased with the length of patient stay in the facility.  
Recommendations   The study recommends increasing the general education, continuing education and improving nursing practice to address the issues of pressure injuries.  The authors recommend frequent measuring of the prevalence of pressure injuries among critically ill patients at all stages of critical care.  The authors recommend enhancing staff knowledge concerning PIs and preventive measures to reduce prevalence.  The study recommends the need to have effective interventions since unavoidable HAPIs occur and when preventive approaches are not implemented, they lead to avoidable HAPIs.  
Explanation of How the Article Supports EBP/Capstone Project   The article supports the Capstone project as it demonstrates that nurses require sufficient knowledge on hospital acquired pressure injuries to develop effective interventions. The article is essential as it supports the use care bundle that includes nursing education.  The study supports the capstone project as it shows the importance of integrating effective care like measuring pressure injuries at all levels of care provision.  The study supports the capstone project as it illustrates the critical role that knowledge among nurses and other measures play in reducing PIs among patients in critical care area.  The study is critical for the capstone project as it shows that having preventive measures is essential to curbing the prevalence of HAPIs in critical care settings.  
Criteria Article 5 Article 6 Article 7 Article 8 
Author, Journal (Peer-Reviewed), and   Permalink or Working Link to Access Article    Lindhardt, C. L., Beck, S. H., & Ryg, Journal ofNursing open, 7(4), 1020-1025.   DOI: 10.1002/nop2.474   Yilmazer, T., & Tuzer, H. Journal of Wound, Ostomy and Continence Nursing, 49(3), 226-232. DOI: 10.1097/WON.0000000000000875 Edsberg, L. E., Cox, J., Koloms, K., & VanGilder-Freese, C. Journal of Wound, Ostomy, and Continence Nursing, 49(3), 211. DOI: 10.1097/WON.0000000000000878Coyer, F., Cook, J. L., Doubrovsky, A., Campbell, J., Vann, A., McNamara, G., … & Fulbrook, P. Australian Critical Care, 35(2), 143-152.
Article Title and Year Published   Nursing care for older patients with pressure ulcers: A qualitative study (2019) Effectiveness of a Pressure Injury Prevention Care Bundle; Prospective Interventional Study in Intensive Care Units (2022)  Implementation of Pressure Injury Prevention Strategies in Acute Care (2022) Implementation and evaluation of multilayered pressure injury prevention strategies in an Australian intensive care unit setting (2022)
Research Questions (Qualitative)/Hypothesis (Quantitative)   The possible hypothesis for the study was; nurses have different perceptions and experiences concerning pressure ulcers  The possible hypothesis for this study is pressure injury prevention care bundle is effective in reducing the prevalence of pressure ulcers among patients in critical care settings.  The possible research question would be; What is the effectiveness of implementing pressure injury prevention strategies in adult acute care settings?  The possible hypothesis for the study would be; nurse-centered and patient-centered preventive measures are essential in lowering the prevalence of HAPIs in care settings.  
Purposes/Aim of Study The aim of the research was to explore nurses caring for older patients and their perception as well as experience of pressure ulcers  The study aimed at assessing the effectiveness of a pressure injury prevention care bundle  The aim of the study was to assess the implementation of pressure injury (PI) prevention strategies in adult acute care settings within the United States.  The aims of the study included implementation of targeted evidence-based pressure injury prevention strategies and evaluation of their effectiveness using patient pressure injury observations
Design (Type of Quantitative, or Type of Qualitative)   Qualitative study based on interviews Prospective interventional study design  Observational, cohort with cross-sectional data collection and retrospective data analysis.  The researchers used a prospective multi-phased design
Setting/Sample   Geriatric department of university hospital. Sample entailed six nurses   University hospital in Turkey with 13 nurses and 104 patients as participants  Sample comprised 296, 014 patients in over 1801 acute care facilities across the United States  Intensive care unit of tertiary health setting. 
Methods: Intervention/Instruments   Descriptive thematic tool by Braun and Clarke was used  Pre-care and post-care bundle stages. Training program for nurses and provision of care using care bundle International Pressure Ulcer Prevalence (IPUP) survey.  Interventions included staff-centered and patient-centered approaches.  
Analysis   The authors used thematic analysis based on descriptive approach to analyze the outcomes of nurses’ experience and perception.  Statistical analysis using descriptive statistics like Shapiro-Wilk test and normality plots.Descriptive statistics that entailed frequency distributions, mean, and standard deviation were uses to analyze data based on R Version 4.0.2). The authors use X2 test to determine the differences in prevention practices among patients at different stages.The authors analyzed the findings using logic regression They also used the Standards for Quality Improvement Reporting Excellence checklist.  
Key Findings   The authors found that nurses require skills to prevent pressure ulcers. These include nursing resource, basic, nursing skills, bedside teaching, and understanding of pressure ulcers are essential to reduce their prevalence  The findings show that care bundle can reduce the prevalence of HAPIs in critical care units. The implemented intervention reduced pressure injuries, especially in stage 1.The authors found that compliance to pressure injury (PI) prevention approaches differed among patients who were at risk for HAPIs. The researchers also increased compliance to these strategies enhanced positive management and reduction in the rate of HAPIs.  The interventions led to a reduction in pressure injuries among the patient setting targeted. These prevention strategies targeted at nurses and patients lowered the prevalence of pressure injuries in the settings under research.  
Recommendations   The authors recommend more training and equipping nurses with necessary skills to reduce the occurrence of pressure injuries in hospital settings. The authors assert that majority of interviewed nurses agree on the need to integrate interventions aimed at reducing pressure ulcers among patients in all settings.  The researchers recommend the implementation of care bundle to reduce HAPIs in critical care units because of its effectiveness. The implementation in this case demonstrated positive outcomes for patients and satisfaction for the nursing staff.  The researchers recommend that improving the implementation of the suggested interventions could lead to better preventive measures and reduce the overall incidence of pressure injuries. The researchers also recommend the implementation of diverse strategies like heel elevation, nutritional support, repositioning and moisture management as effective ways to reduce HAPIs.  The authors recommend the integration of these interventions to reduce susceptibility to pressure injuries among patients in critical care settings.  The authors are categorical that care bundle comprising different interventions can lower pressure ulcers among patients in critical care settings.
Explanation of How the Article Supports EBP/Capstone   The article supports the capstone project as it illustrates the important role that nurses play, especially when they have sufficient knowledge on pressure injuries.  The article shows that the suggested intervention will lead to better patient outcomes when implemented in critical care settings.  The article is important as it informs the best practice in care bundle that one can implement based on the resources and support from organizational leaders.  The article is critical as it supports the capstone project by illustrating that integration of best practices is critical in reducing the rates of HAPIs among patients, especially those in critical care and progressive care.  The article is effective in demonstrating how patient-centered and nurse-centered preventive strategies can reduce the occurrence of HAPIs. The article supports the capstone project as it demonstrates the efficacy of using interventions focused on both nurses and patients to reduce HAPIs in critical care.  


Pressure injuries, especially HAPIs), are a patient safety concern and requires evidence-based practice (EBP) interventions to reduce and prevent their occurrence. Patients in critical and progressive care are at increased susceptibility to getting HAPIs because of their delicate nature and medications that they use. As such, having sufficient evidence about the use of care bundle to reduce HAPIs is essential as illustrated in this paper. Through the evidence, nurses and other stakeholders in healthcare facilities, particularly in critical care units, can implement care bundle to reduce the prevalence of these adverse patient events.


Cox, J., Edsberg, L. E., Koloms, K., & VanGilder, C. A. (2022). Pressure injuries in critical care

patients in US hospitals: results of the International Pressure Ulcer Prevalence Survey. Journal of Wound, Ostomy, and Continence Nursing, 49(1), 21. DOI: 10.1097/WON.0000000000000834

The Joint Commission (2022). Quick Safety 25: Preventing pressure injuries (Updated March


NRS 493 topic 4 literature evaluation table GCU

In nursing practice, accurate identification and application of research is essential to achieving successful outcomes. The ability to articulate research data and summarize relevant content supports the student’s ability to further develop and synthesize the assignments that constitute the components of the capstone project.

The assignment will be used to develop a written implementation plan.

For this NRS 493 Topic 4 Literature Evaluation Table Assignment, provide a synopsis of the review of the research literature. Using the “Literature Evaluation Table,” determine the level and strength of the evidence for each of the eight research articles you have selected. The articles should be current (within the last 5 years) and closely relate to the PICOT question developed earlier in this course. The articles may include quantitative research, descriptive analyses, longitudinal studies, or meta-analysis articles. A systematic review may be used to provide background information for the purpose or problem identified in the proposed capstone project.

While APA style is not required for the body of this NRS 493 Topic 4 Literature Evaluation Table Assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This NRS 493 Topic 4 Literature Evaluation Table Assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

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