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Chapter 3.0. Critical Review of Literature


In order to perform a significant and critical review of the literature, four articles have been selected as mentioned in the preceding section. Before the presentation of discussion and review of the research, a thorough explanation of specific notions of each article has been summarised into tabular form. The critiquing framework used for the purpose is adopted from the works of Holland and Rees (2010). The table is displayed in Appendix 4 of this dissertation.


The research articles included in this review have been perceived to be elaborate and effective enough for the purpose of making an understanding on the topic of pressure ulcers and its preventive strategies in a consistent manner. The knowledge, attitudes and barriers of nurses towards the prevention of pressure ulcers were covered in a highlighting manner which is significant in understanding the treatment and care patterns established across several healthcare developments. As stated earlier, the study has recruited four research studies for this review. Amongst these, two studies have been conducted with a quantitative approach (Beeckman et al., 2011; Strand & Lindgren, 2010), one with the qualitative approach (Samuriwo, 2010), and with the use of mixed method that has included both quantitative and qualitative research nature (Sving et al., 2012). All these studies have been conducted within the region of the United Kingdom, which is relevant to the study setting of the researcher.


3.1. Critical Review of the Recruited Articles


The most recent study conducted by Sving et al., (2012) was mixed method research. The study focused on explaining the practices of registered nurses in regard to the prevention of pressure ulcer within the wards of general hospitals located in Central Sweden. Sving et al (2012) implemented a descriptive approach with the help of multi-method consideration. The participating registered nurses were from three different clinical settings in central Sweden including medical, geriatric and an orthopaedic ward. These wards were selected due to an increased possibility of pressure ulcer development in patients. Data was gathered with the help of observations made in a particular nurse-patient care situation with the ones exposed to pressure ulcers. Following the observations, interviews were made including the records of symptoms and signs of the ailment. The analysis was carried out with the help of SPSS 19.0 for the quantitative information and content analysis for qualitative information. As per the outcomes and observations of the study, it has been realised the mixed method approach was helpful modality in determining the nurses’ approach towards preventive practices. The objective data demonstrated that nurses acknowledged the prevention of pressure ulcers as important for the patients within the care. However, the qualitative assessment presented that nurses have not been attentive to provide preventive care during the observation. It is perceived that observation of the practices has a tendency to deviate regular behaviour (Polit & Beck, 2008). As such, the registered nurses remained uninformed about the main purpose of the observation during the study. The participants were later informed about the study approach in order to maintain ethical considerations. Nonetheless, the participants acknowledged that informed observations do create biasedness as it may influence their casual behaviour in practice. The mixed method nature of the study has been found to be helpful in determining the difference between the knowledge, approach and practices of the registered nurses in active facilities. However, it is also considered that the sample size of the study has not been large enough to generalise the study outcomes with regard to the number of registered nurses in the whole region as only nine participants were taken into the account. Although the research included registered nurses from three different wards of different hospitals, the observation of admission wards is again not enough to derive conclusion for the whole caring facility.



The quantitative research by Beeckman et al., (2011) was conducted in the active hospitals of Belgium. The study explored nurses’ approach in terms of knowledge and approach towards the prevention of pressure ulcers. Beeckman et al (2011) followed the similar objectives with the help of a cross-sectional multi-centre study performed on a random sample of 14 Belgian hospitals, projecting 207 wards. Clinical observations were carried out for the assessment of the effectiveness of pressure ulcer prevalence and pressure ulcer prevention. Analysis of statistics was carried out with the help of logistic regression analysis to assess the association between knowledge, attitudes and the implementation of suitable prevention. The study assessed the factors of knowledge, attitude and practical approach of nurses in regard to the prevention of pressure ulcers amongst the patients. 553 nurses participated in this study and realised that the knowledge regarding the subject of prevention has been limited amongst the group. However, it was also revealed that knowledge did not correlate to the practices of preventing the incidence. It was rather observed that nurses’ attitudes hold the potential of significantly influencing the application of preventive measures in practical situations. It has realised that the clinical observations for the application of prevention and prevalence of pressure ulcers were conducted first. Later, the nurses were randomly selected from the targeted units to evaluate knowledge and attitude. Therefore, it can be considered that the application of prevention has been extracted from the whole unit whereas the knowledge and attitude have been taken from the randomly selected group only. As the study has been conducted with the multicentre approach, it is considered highly important to focus on the factors enhancing the knowledge, attitude and application of preventive measures amongst the nurses as practised within the care facilities of the region….