All the participants in the study must be persons with stage III pressure ulcers. At this stage, the patient will have lost tissue thickness and may have exposed subcutaneous tissue. Slough is also present at this phase but it does not block the level of tissue loss. The researcher will assess this stage of the disease through a description of wound characteristics.
Participants need to be adequately nourished. None of them should be malnourished as the study will focus on malnutrition prevention programs not malnutrition treatment programs. Patients in the adequate nutrition program need to be on a balanced diet consisting of all vital vitamins and minerals. Patients undergoing the malnutrition program should be on the appropriate calorie percentage depending on their body mass index.
This research will employ the use of purposive sampling. Individuals will be selected in terms of their relevance to the research objective (Kuzel, 1999). Patients who have pressure ulcers in two large hospitals will be selected. Purposive sampling will be done to determine the most relevant patients for the study. Persons with stage III pressure ulcers will be the target. Furthermore, those that are malnourished with being eliminated to minimize confounding factors from undernourishment.
To increase the likelihood of finding the right subjects, it is essential to select institutions that have a high number of pressure ulcer patients. Therefore, the researcher will examine public medical records on the prevalence of pressure ulcers, and institutions with high numbers will be selected. If access to this information is limited, then the researchers will approach major health facilities in the country and investigate this information independently. Thereafter, it will be essential to work with social networks to get information about institutions more accurately. Attendance of training programs, as well as associations that deal with pressure ulcers, will be quite useful.
Gatekeepers or persons who may inhibit access to the study population will need to be handled. This will involve garnering permission from departmental heads. The researcher will make research proposals containing information about the usefulness of the research in the institution. They will also receive assurances concerning the ability of the research to disrupt the organization and the fear that it will consume a lot of resources and time. Patients’ family members may also inhibit access to the study population. Parents or spouses will receive assurance from the researchers that confidentiality and privacy will be assured. Furthermore, they will be assured about the reduced invasiveness of the process.
Patients’ age will be a crucial demographic variable as it may affect their healing processes or response to nutrition. Body mass index will also be critical as it also affects the nutritional approaches chosen. A patient’s history of the condition (pressure ulcers) will also be reported as this affects how they cope with the condition. Additionally, their race will be noted as the capacity to heal sometimes depends on a patients’ race. Courtney & Ayello (2008) report that members of the black race tend to develop more severe cases of pressure ulcers than Caucasian patients. Smoking history will also be noted as most of these issues should be related to the number. Patients’ gender will also be imperative as it has a bearing on their response to nutritional intervention. Their renal functions will be recorded to ensure their ability to cope with protein introduction in the nutritional programs. Additionally, the terminal nature of patients’ illnesses will be reported as this has a bearing on how well they respond to food.
This research will employ the use of two scaling methods known as the Pressure Sore Status tool (PSST) and PUSH (Pressure Ulcer Score of Healing). They have been selected because research indicates that these are the most effective methods of diagnosing the disease. The main goal will be to determine the progress of pressure ulcers among the participants. Therefore, data will be collected continuously for the period of the research. The two studies will be done concurrently and will employ the two research instruments in the assessment of the status of the pressure ulcer wounds (De Laat et. al., 2005).
PUSH is a scoring technique in which medical practitioners analyze the characteristics of a pressure ulcer. The tool focuses on three major parameters: the type of tissue affected, the size of the wound, and the extent of exudates. Exudates may be classified as heavy, moderate, none, or light. Size is determined in terms of the width and the length of the wounds while tissues types could be epithelial, necrotic, granulation, slough, or closed.
PSST is a wound status analytical tool in which 15 traits are analyzed. Some of them include tunneling, would shape, size, condition of the surrounding skin, exudate quantity, and type, wound depth as well as edges.
Scholars affirm that the concurrent validity of PUSH with PSST scores is strong. P values of less than 0.001 have been reported by individuals utilizing this research instrument. The Pearson’s coefficient for research increases overtime during an intervention thus indicating that its validity is satisfactory. Nonetheless, sensitivity to exudates has minimal effect on PUSH scores. Therefore, the latter instrument is more appropriate for the assessment of ulcer size rather than the other two aspects of pressure ulcer healing. Studies also indicate that the predictive validity of the instrument is high. Users have reported variations in the 30 to 50 percentile regions thus implying that progress reports are sufficient. The reliability of the research instrument also illustrates that researchers can get up to 90% agreement among experts. However, this only holds for the early stages of wound healing. Subsequent phases tend to have diminished reliability (Cauble, 2010).
The content validity of the PSST tool is 0.91 after an analysis of the clinical appropriateness of all the 15 traits under analysis. Concurrent validity yields Pearson coefficients of 0.91 and p values equal to 0.001. Other recent studies have placed the Pearson moment at 0.555 thus proving that it is indeed a valid tool. Intra-rater reliability values range between 0.96 and 0.99 for Pearson’s coefficient values. As a result, this tool is quite appropriate for research purposes. However, additional training is necessary when using this tool since it has a huge effect on outcomes. Staff should be well versed to minimize the amount of time spent on each wound (Pillen et. al., 2009).
The inefficiencies in the PUSH tool that relate to extent of wound healing will be mitigated by PSST. Additionally, the excess amount of time needed to research one tool will be neutralized by the time it takes to conduct it in another setting.
References
Cauble, D. (2010). A critical appraisal of two measures for pressure ulcer assessment. Psychometrics, 10(4), 55-58.
Courtney, H. & Ayello, E. (2008). Patient safety and quality: An evidence-based handbook for nurses. London: McMillan.
De Laat, E., Scholte, P., Reimer, W., & Achterberg T. (2005). Pressure ulcers: Diagnostics and interventions aimed at wound-related complaints: A review of the literature. Journal of Clinical Nursing, 14, 464-472.
Kuzel, A. (1999). Sampling in qualitative inquiry. Thousand Oaks: Sage.
Pillen, H., Miller, M., homas, J., Puckridge, P., Sandison, S. & Spark, J. (2009). Assessment of would healing: validity, reliability and sensitivity of available instruments. Wound Practice Research, 17(4), 208-210.
