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1Wung Buh A, et al. BMJ Open 2021;11:e043042.

doi:10.1136/bmjopen-2020-043042
Open access
Effects of implementing Pressure Ulcer
Prevention Practice Guidelines (PUPPG)
in the prevention of pressure ulcers
among hospitalised elderly patients: a
systematic review protocol
Amos Wung Buh,1 Hassan Mahmoud,2 Wenjun Chen ,3,4
Matthew D F McInnes,2,5,6 Dean A Fergusson 6
To cite: Wung Buh A,
Mahmoud H, Chen W, et al.
Effects of implementing
Pressure Ulcer Prevention
Practice Guidelines (PUPPG)
in the prevention of pressure
ulcers among hospitalised
elderly patients: a systematic
review protocol. BMJ Open
2021;11:e043042. doi:10.1136/
bmjopen-2020-043042
► Prepublication history and
additional material for this paper
is available online. To view these
files, please visit the journal
online (http:// dx. doi. org/ 10.
1136/ bmjopen- 2020- 043042).
AWB and HM contributed
equally.
AWB and HM are joint first

authors.
Received 23 November 2020
Revised 08 February 2021
Accepted 17 February 2021
For numbered affiliations see
end of article.
Correspondence to
Wenjun Chen;
[email protected] uottawa. ca
Protocol
© Author(s) (or their
employer(s)) 2021. Re- use
permitted under CC BY- NC. No
commercial re- use. See rights
and permissions. Published by
BMJ.
ABSTRACT
Introduction Pressure ulcers are serious and potentially
life- threatening problems across all age groups and across
all medical specialties and care settings. The hospitalised
elderly population is the most common group to develop
pressure ulcers. This study aims to systematically review
studies implementing pressure ulcer prevention strategies
recommended in the Pressure Ulcer Prevention Practice
Guidelines for the prevention of pressure ulcers among
hospitalised elderly patients globally.
Methods and analysis A systematic review of all studies
that have assessed the use of pressure ulcer prevention
strategies in hospital settings among hospitalised elderly
patients shall be conducted. A comprehensive search of

all published articles in Medline Ovid, Cumulative Index
to Nursing and Allied Health Literature, PubMed, Embase,
Cochrane library, Scopus and Web of Science will be done
using terms such as pressure ulcers, prevention strategies,
elderly patients and hospital. Studies will be screened
for eligibility through title, abstract and full text by two
independent reviewers. Study quality and risk of bias will
be assessed using the Joanna Briggs Institute for Meta-
Analysis of Statistics Assessment and Review Instrument.
If sufficient data are available, a meta- analysis will be
conducted to synthesise the effect size reported as OR
with 95% CIs using both fixed and random effect models.
I2 statistics and visual inspection of the forest plots will
be used to assess heterogeneity and identify the potential
sources of heterogeneity. Publication bias will be assessed
by visual inspections of funnel plots and Egger’s test.
Ethics and dissemination No formal ethical approval or
consent is required as no primary data will be collected.
We aim to publish the research findings in a peer- reviewed
scientific journal to promote knowledge transfer, as well
as in conferences, seminars, congresses or symposia in a
traditional manner.
PROSPERO registration number CRD42019129088.
BACKGROUND
Pressure ulcers (PU) also known as pressure
injuries are areas of localised damage to the
skin and/or underlying structures due to
pressure and/or friction and shear.1 They
are serious and potentially life- threatening
problems across all age groups from the very
young to the very old and across all medical
specialties and care settings.2 It has been
documented that hospital admissions due to
PU are 75% higher than admissions for any

other medical conditions and that, the conse-
quences of PU development in hospitalised
patients are particularly serious.2 Patients
with hospital admission PU are three times
more likely to be discharged to long- term
care facilities and mortality of these patients is
twice that of patients without hospital admis-
sion PU.3 The cost of treatment of PU is 2.5
times than its prevention, and PU increases
the length of stay in the hospital from 4 to
Strengths and limitations of this study
► This is a systematic review and meta- analysis of
randomised controlled trials.
► This review will be the first to synthesise the ev-
idence regarding the effectiveness of guidelines
used in pressure ulcer prevention for elderly pa-
tients in hospitals and offer the highest level of
evidence for informed decisions on use of Pressure
Ulcer Prevention Practice Guidelines (PUPPG) in
prevention pressure ulcers in the elderly patients in
hospital.
► There may be heterogeneity of interventions used on
eligible studies and incomplete information reported
about the interventions in the literature which could
limit our ability to statistically compare the effective-
ness of interventions.
► The main limitation of this review might be scarcity
of randomised controlled trials on the use of PUPPG
for preventing pressure ulcers in elderly patients,
publication bias and methodological quality of grey
literature that shall be found.

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30 days, decreases quality of life, and increases pain,
morbidity and mortality.4
On international level, hospital- acquired PUs (some-
times called decubitus ulcers) are very common.5
Although many of these cases are preventable, their point
prevalence in Canadian hospitals for example is measured
to be 25.1%.6 Unfortunately, the high rates of such condi-
tion are associated with subsequent high burden on the
healthcare system and the national economy considering
the high cost of their management, and the frequent
occurrence of associated significant morbidity and
mortality.5 According to the Ontario Case Costing Initia-
tive database in 2013 using the European Pressure Ulcer
Advisory Panel (EPUAP) staging system, it was estimated
that the cost of management of stage II ulcer is up to
US$40 000 and can reach more than double this price for
managing a single case of stage IV ulcer.7 A good example
of the burden that PU add to the national economy was
measured in USA; it was estimated that hospital acquired
PUs increase the financial expenses on healthcare systems
between US$6 and US$15 billion annually.8
The National Pressure Ulcer Advisory Panel (NPUAP),
the EPUAP and the Pan Pacific Pressure Injury Alliance
(PPPIA)9 have defined PU as a ‘lesion or a trauma to the
skin and/or underlying tissue usually over a bony promi-
nence and is the result of undiminished pressure, or pres-
sure combination with shear, friction and moisture’. It is
a degenerative progress attributable to biological tissues
(skin and underlying tissues) being exposed to pressure
and shearing forces. The pressure constrains the proper

blood circulation and causes cell death, tissue necrosis
and the development of ulcers.9 While the quality of PU
prevention and treatment has increased considerably
over the past years, PUs remains a global concern because
of its frequency of occurrence and negative consequences
for patients and families as well as for the healthcare
system.10 Incidence of PUs for hospitalised patients
ranges from 9% to 18%, among which the elderly popu-
lation appears to be the most common group to develop
the ulcers.11 At the same time, many elderly patients are
more vulnerable to be ‘stuck’ at a certain stage of PU for
a long period of time and sometimes for the remainder of
their lives.12 This may result in longer length of hospital
stay, heavier burdens for the healthcare system and family
members, worst quality of life for elderly patients, which
may also influence their mental health such as emotional
stability.13 14
NPUAP, EPUAP and PPPIA9 developed the Pressure
Ulcer Prevention Practice Guideline (PUPPG), which
involves a range of evidence- based recommendations for
PUs prevention that could be applied by healthcare profes-
sionals globally. Frequently used PU prevention strategies
recommended in this guideline includes PU risk assess-
ment, regular repositioning, prevention management
plan, appropriate use of support surfaces and protection,
continence management, patient education, skin protec-
tion, nutritional assessment and adequate nutrition.15
It also includes some recommendations specifically for
elderly people—‘protect aged skin from skin injury asso-
ciated with pressure and shear forces’, taking into consid-
eration that an aged person’s skin is vulnerable.15
A number of studies have been conducted on the
implementation of PU prevention strategies among

hospitalised patients. One cluster randomised trial
conducted in Canada revealed that multidisciplinary PU
prevention groups are more cost effective than usual care
and yields no significant improvement in the treatment
of PUs.16 Despite the existence of the guidelines on the
prevention of PU, their effective utilisation in preventing
PUs among hospitalised elderly patients varies in settings
and countries. Also, although a number of studies have
assessed strategies used in preventing PUs, there appears
to be little or no information on systematic reviews that
have assessed the effectiveness of guidelines used in PU
prevention for elderly patients in hospitals. This study,
therefore, aims to systematically review studies imple-
menting PU prevention strategies recommended in the
PUPPG for the prevention of PUs among hospitalised
elderly patients globally.
OBJECTIVE
The objective of this review is to assess the effectiveness
of each of the strategies included in the PUPPG guide-
line in reducing the incidence and prevalence of hospital
acquired PUs in hospitalised elderly patients in compar-
ison to no strategy (usual practice), or other strategies.
The review question is: what is the effectiveness of imple-
menting each of the PU prevention strategies included in
the PUPPG in decreasing the incidence and prevalence
of PUs among hospitalised elderly patients compared
with no strategies (basic usual care) or different preven-
tion strategies?
METHODS
Study design
This will be a systematic review and meta- analysis of
published and unpublished studies that have assessed the
use of PU prevention strategies in hospital settings among
hospitalised elderly patients. The systematic review

protocol has been developed and reported following
the Preferred Reporting Items for Systematic Reviews
and Meta- Analyses (PRISMA) criteria (see online supple-
mental appendix 1).17
Inclusion criteria
Population included
This systematic review will focus on studies that involved
all vitally stable (not admitted in the intensive care unit)
bed ridden hospitalised patients aged 60 or above.
Interventions
All studies that assessed the effect of PU preventive strat-
egies found in the PUPPG, that were implemented on
vitally stable bed ridden hospitalised patients aged 60 and
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above with an aim to decrease the occurrence of PUs, will
be included in this review. Interventions will be limited to
use of risk assessment, skin assessment, skin care, nutri-
tion, position and repositioning, education and training,
and medical devices care.
Comparator
Interventions will be compared with other strategies
to identify the most effective among them and/or will
also be compared with no interventions (regular basic
management).
Outcomes
In this study, the primary outcome will be directly related
to the incidence of the disease among elderly hospitalised
patients (incidence shall be considered as the propor-
tion of hospitalised patients who developed PUs while in
hospital). Included studies must measure study duration
related incidence of the disease and/or its point preva-
lence and /or stage of PU (severity) as a measure of the

effectiveness of the preventive strategies.
Types of studies
We will focus only on Quantitative studies—experimental
and quasi- experimental studies. These might include
randomised and non- randomised controlled trials in
addition to comparative and before- and- after studies.
Language
Only studies written in English will be included in this
systematic review.
SEARCH STRATEGY
We will use a three- step strategy to find published and
unpublished studies on PUs and their management. First,
we will conduct an initial search through the Medline
Ovid database using an analysis of text words found in the
title and abstract, and the index terms used to describe
the article. Second, we will use identified keywords and
index terms to search for studies in identified databases.
Finally, we will use the reference list of selected studies
from the first and second searches to look for additional
studies not found in the databases. For this study, we will
consider only studies either published or unpublished in
English.
The databases that shall be searched for this review will
include Medline Ovid, Cumulative Index to Nursing and
Allied Health Literature, PubMed, Embase, Cochrane
library, Scopus and Web of Science. See online supple-
mental appendix 2 for the example searching strategy
and results in Medline (Ovid). All these databases will
provide published studies. To find unpublished studies
on our topic, we will use Google, Grey Literature reports
and the Centers for Disease Control and Prevention.

The keywords we will use for our initial searches in
Medline Ovid will include ‘pressure ulcers’, ‘pressure
sore’, ‘bed sore’, ‘pressure injuries’, ‘prevention strate-
gies’, ‘elderly patients’ and ‘hospital’.
Study screening and selection
The titles, abstracts and full text of studies selected for this
study will be reviewed by two independent researchers to
identify studies that potentially meet the inclusion criteria
outlined above. The Covidence software will be used for
title, abstract and full- text screening. After importing
references and inclusion/exclusion criteria into the Covi-
dence software, two independent reviewers will screen
titles of included studies according to the eligible criteria.
Conflicts between those two reviewers will be resolved
through discussion with a third reviewer. The same proce-
dures shall be used for abstract screening. Following the
abstract screening, full texts of these potentially eligible
studies will be retrieved and independently assessed for
eligibility by two reviewers. Any disagreement between
the two reviewers over the eligibility of a particular study
will also be resolved through discussion with the third
reviewer. The process of study selection will be reported
using the PRISMA flow diagram.17
Assessment of methodological quality
Two independent reviewers will be used to assess the
methodological validity of the quantitative papers that
will be selected for retrieval prior to their inclusion in
the review using standard critical appraisal tools from
the Joanna Briggs Institute for Meta- Analysis of Statistics
Assessment and Review Instrument (see online supple-
mental appendix 3). All disagreement between the two
reviewers shall be settled through discussions.
Data extraction

After screening and selecting studies, key information
from those studies will be extracted into an excel sheet for
further analysis. We shall use a data extraction tool adapted
from the standardised data extraction tool from the Joanna
Briggs Institute Meta- Analysis of Statistics Assessment and
Review Instrument (JBI- MAStARI). Considering the infor-
mation, we will need for the data synthesis of our study, we
shall use the JBI- MAStARI to develop a data extraction tool
specifically for quantitative research data extraction (see
online supplemental appendix 4). The tool will be used to
extract: (1) Study characteristics of reviewed papers, such
as authors, year of publication, journal; (2) Methods of the
study, including study design (randomised control trial
(RCT), quasi- RCT, longitudinal, retrospective), research
purpose and/or questions; (3) participant characteristics,
country where the study took place, setting, population,
sample size, age, sex, ethnicity, socioeconomic status and/
or education level; (4) PU prevention strategies used in
experimental group and control group (if applicable),
(5) outcome measures and results and (6) conclusions of
reviewed papers and any comments from reviewers. Two
reviewers will independently perform data extraction.
Authors of reviewed papers will be contacted in case of
any missing details about their studies.
Data synthesis
A meta‐analysis of outcomes combining various studies
included in the review shall be done. We will assess
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statistical heterogeneity with I2, which will indicate the
percentage of the total variation across studies: 0%–40%
low heterogeneity, 30%–60% moderate heterogeneity,
50%–90% may represent substantial heterogeneity and

75%–100% is considerable heterogeneity. If there is a
substantial amount of heterogeneity (75%), then sources
of heterogeneity will be examined through subgroup
and sensitivity analyses. We will also use χ2 test to test the
heterogeneity and consider p<0.05 as statistically signifi-
cant. A fixed‐effects model will be selected for significant
homogeneous studies; otherwise we will apply a random‐
effects model. All outcomes will be summarised using
ORs and 95% CI. An OR <1 will represent a lower rate of
outcome among the group of patients who were treated
following the guidelines. Publication bias will be assessed
by visual inspections of funnel plots and Egger’s test.
We will also provide a narrative synthesis of the find-
ings from the included studies. The narrative synthesis
shall be structured by describing the studies according to
the type of intervention used. This will include the three
categories of interventions recommend in the PUPPG
guideline9:
1. Prevention of PUs, including risk factors and risk as-
sessment, skin and tissue assessment, preventive skin
care and emerging therapies for prevention of PUs.
2. Interventions for prevention and treatment of PUs,
such as nutrition in PU prevention and treatment, re-
positioning and early mobilisation, repositioning to
prevent and treat PUs, support surface and medical
device- related PUs.
3. Treatment of PUs, for example, assessment of PUs and
monitoring of healing, pain assessment and treatment,
wound care, assessment and treatment of infection
and biofilms, wound dressings for treatment of PUs
and surgery for PUs. Results will be presented in tables,
figures and graphs, followed by discussion.

Publication bias will be assessed in all analyses synthe-
sising 10 or more studies to ensure adequate power in
the analysis.18 For investigation of the effect of small
studies and publication bias, data from included stud-
ies will be entered into a funnel plot asymmetry test if
we have at least 10 studies in the meta- analysis. Egger’s
statistical test will be implemented using STATA/SE
V.13 (StataCorp). The quality of supporting evidence
will be assessed by the Grades of Recommendation,
Assessment, Development and Evaluation.19
Patient and public involvement
No patient involved.
Ethics and dissemination
This review will only use published literature and will
not recruit participants. Therefore, no formal ethical
approval or consent is necessary. It is anticipated that
this systematic review will provide a detailed summary
of the evidence of the effectiveness of the PUPPG in
preventing the occurrence of PUs among elderly patients
in hospital. It is also expected that the study will provide
recommendations on the best PU preventive strategies
applicable in healthcare settings. We aim to publish the
research findings in a peer- reviewed scientific journal to
promote knowledge transfer, as well as in various media,
such as: conferences, seminars, congresses or symposia in
a traditional manner.
Author affiliations
1Interdisciplinary School of Health Sciences, University of
Ottawa, Ottawa, Ontario,
Canada
2School of Epidemiology and Public Health, Faculty of
Medicine, University of

Ottawa, Ottawa, Ontario, Canada
3School of Nursing, University of Ottawa, Ottawa, Ontario,
Canada
4Xiangya School of Nursing, Central South University,
Changsha, Hunan, China
5Department of Radiology, University of Ottawa, Ottawa,
Ontario, Canada
6Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Ottawa,
Ontario, Canada
Acknowledgements The authors would like to thank Lindsey
Sikora (librarian) for
counselling in developing the searching strategies.
Contributors AWB, HM and WC contributed to the conception
of the research
question and writing of the protocol. HM, AWB, WC, MDFM
and DAF contributed to
the development of search strategies, eligibility criteria and
methodology for data
synthesis. HM, AWB, WC, MDFM and DAF contributed to
drafting of the protocol and
provided approval for the final version of this protocol. HM,
AWB and WC will work
in duplicate to screen the titles and abstracts of all the materials
obtained using
the search strategy to exclude the articles that do not meet the
eligibility criteria.
HM, AWB and WC will evaluate the potentially eligible studies
with the full text and
further exclude studies with documentation of the reason for
exclusion. All authors
will contribute to the bias assessment strategy and data
extraction criteria. HM,
AWB and WC will independently extract data from the included

studies. HM, AWB
and WC will analyse the data and draft the manuscript. All
authors will read, provide
feedback and approve the final manuscript.
Funding This work was supported by Hunan Provincial Key
Laboratory of
Nursing, grant number (2017TP1004), Hunan Provincial Science
and Technology
Department, China.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer
reviewed.
Supplemental material This content has been supplied by the
author(s). It has
not been vetted by BMJ Publishing Group Limited (BMJ) and
may not have been
peer- reviewed. Any opinions or recommendations discussed are
solely those
of the author(s) and are not endorsed by BMJ. BMJ disclaims all
liability and
responsibility arising from any reliance placed on the content.
Where the content
includes any translated material, BMJ does not warrant the
accuracy and reliability
of the translations (including but not limited to local
regulations, clinical guidelines,
terminology, drug names and drug dosages), and is not
responsible for any error
and/or omissions arising from translation and adaptation or
otherwise.

Open access This is an open access article distributed in
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4.0) license, which
permits others to distribute, remix, adapt, build upon this work
non- commercially,
and license their derivative works on different terms, provided
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properly cited, appropriate credit is given, any changes made
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by- nc/ 4. 0/.
ORCID iDs
Wenjun Chen http:// orcid. org/ 0000- 0001- 5398- 8508
Dean A Fergusson http:// orcid. org/ 0000- 0002- 3389- 2485
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https://www.who.int/news-room/fact-sheets/detail/mental-
health-of-older-adults
http://dx.doi.org/10.1080/10376178.2016.1190657
http://dx.doi.org/10.1186/1472-6963-14-83
http://dx.doi.org/10.1186/1472-6963-14-83
https://www-bmj-
com.proxy.bib.uottawa.ca/content/349/bmj.g7647
https://www-bmj-
com.proxy.bib.uottawa.ca/content/349/bmj.g7647
/handbook/current
http://dx.doi.org/10.1136/bmj.39489.470347.AD
http://bmjopen.bmj.com/Effects of implementing Pressure Ulcer
Prevention Practice Guidelines (PUPPG) in the prevention of
pressure ulcers among hospitalised elderly patients: a
systematic
review protocolAbstractBackgroundObjectiveMethodsStudy
designInclusion criteriaPopulation
includedInterventionsComparatorOutcomesTypes of
studiesLanguageSearch strategyStudy screening and
selectionAssessment of methodological qualityData
extractionData synthesisPatient and public involvementEthics
and disseminationReferences
APPENDIX F
Appraisal Guide
Findings of a Quantitative Study
Citation:

_____________________________________________________
______________________
_____________________________________________________
______________________
_____________________________________________________
______________________
Synopsis
What was the purpose of the study (research questions,
purposes, and hypotheses)?
How was the sample obtained?
What inclusion or exclusion criteria were used?
Who from the sample actually participated or contributed data
(demographic or clinical profile and dropout rate)?
What methods were used to collect data (e.g., sequence, timing,
types of data, and measures)?
Was an intervention tested?
1. How was the sample size determined?
2. Were patients randomly assigned to treatment groups?
What are the main findings?
Credibility
Is the study published in a source
that required peer review?
*Did the data obtained and the
analysis conducted answer the
research question?
Were the measuring instruments
reliable and valid?
*Were important extraneous
variables and bias controlled?
*If an intervention was tested,
answer the following five questions:
clear
1. Were participants randomly
assigned to groups and were
the two groups similar at the
start (before the intervention)?

2. Were the interventions well
defined and consistently
delivered?
3. Were the groups treated
equally other than the
difference in interventions?
4. If no difference was found, was
the sample size large enough
to detect a difference if one existed?
clear
5. If a difference was found, are
you confident it was due to the
intervention?
Are the findings consistent with
findings from other studies?
clear
Are the findings credible?
Clinical Significance
Note any difference in means, r2s, or measures of clinical
effects (ABI, NNT, RR, OR)
*Is the target population clearly
described?
*Is the frequency, association, or
treatment effect impressive enough
for you to be confident that the finding
would make a clinical difference if used
as the basis for care?
Are the findings
clinically significant?
* = Important criteria
Comments
_____________________________________________________
______________________
_____________________________________________________

______________________
_____________________________________________________
______________________
APP F-2 Brown
Brown APP F-1
2
Role Reversals: Understanding Our Gendered Selves
Section 1
1. Summary of Proposed Act
Typically, most men tend to shy away from unnecessary
interactions and communications as they prefer to enjoy their
space. The perception has been across most communities over
the years as individuals feel that too many interactions is linked
to feminism. With such bias perceptions, I decide to challenge
myself in the “playing-with-gender act”. I was motivated to
increase my engagement level throughout my gender reversal,

notably at work by initiating talks. Therefore, my action was
specifically predicated on altering the way I normally interact
and direct talks. I initiated this modification upon my morning
arrival to the office. I welcomed all my coworkers. The morning
also included a staff meeting during which I delivered my
performance. I tried something new by serving as the meeting's
facilitator for my first time since joining the firm. I was
responsible for ensuring that all participants had the opportunity
to voice their thoughts about debate. I also expressed my
opinion on the matter at the conclusion of the meeting.
2 & 3: Description of the Search
While looking for quality reviewed articles for my task, I
considered the most applicable catchphrases that drove me to
get to the most pertinent articles to the subject I am handling
for this task. The key terms I considered incorporate interaction
and gender during the examination. Inside 0.13 seconds, I got
44,578 outcomes. Getting such countless outcomes had two
ramifications for me. From one perspective, I was relieved on
the grounds that I realized I would not battle to track down
some good articles for finishing my task. Then again, I realized
I had a big task, to sifter through the numerous articles, to
choose the most significant articles to use for my task. Thus, I
needed to limit my examination by adjusting the timeline from
2011-2022 and several keywords as well then the outcomes
decreased to 10789. It was simple for me to choose two
applicable articles on the grounds that the site organized them
properly.
.4: Full References of Selected Articles
1. Sherrod, D. (2018). The bonds of men: Problems and
possibilities in close male
relationships. In The making of masculinities.
2. Williams, S. A., & O’Donnell, N. (2016). Becoming a person
of dialogue. Journal for Perspectives of Economic Political and
Social Integration, 22(1-2), 275–289.
https://doi.org/10.1515/pepsi-2016-0014
Section 2

Williams, S. A., & O’Donnell, N. (2016). Becoming a person of
dialogue. Journal for Perspectives of Economic Political and
The analysis above affirms that there has been a gradual change
in the way men are approaching social life at work. More and
more men are starting to see the importance of networking and
building relationships with colleagues. However, many men still
feel hesitant to engage in social activities because they fear
coming across as weak or too feminine. These feelings are
slowly disappearing as more companies incorporate social
activities into their corporate policies and encourage employees
to spend more time with each other outside of the office
(Williams & O’Donnell, 2016). Men who embrace this type of
environment tend to perform better at work because they are
constantly learning new things and meeting new and interesting
people. There are many benefits to building a strong network of
colleagues and friends at work. One of the main benefits is that
it can help increase job satisfaction and make the workplace
more enjoyable. It can also make the job more interesting and
help break the monotony of everyday work. Social activities can
also help improve communication and interpersonal skills. It is
a great way to foster stronger relationships with colleagues and
make more meaningful connections. Companies that integrate
social activities into their corporate policies have many
benefits. First, it helps promote a healthier work environment
and encourages employees to build more personal relationships
with their co-workers. Second, it promotes team spirit and gives
employees the opportunity to interact with one another in a
more relaxed environment. Besides, men ought to be active in
networking as it promotes better communication between
employees and helps them work together more effectively.
Finally, it allows managers to get to know their employees on a
personal and professional level and makes the company feel
more like family and less like a business. Despite its many
benefits, there are still a few drawbacks to integrating social

activities into the workplace.
One of the biggest concerns is that most male employees may
feel uncomfortable participating in these activities and feel as
though they are being pressured to build relationships. This can
make them feel anxious and uncomfortable and as a result,
discourage them from forming genuine relationships. Another
concern is the fact that some people just do not like to socialize
and would rather spend all of their time working alone instead.
As a result, they may feel reluctant to take part in company
events and extracurricular activities even though they are
offered for free. Ultimately, it is important to have a good
balance between work and play to promote productivity and
maintain a healthy work-life balance. Working long hours
without a break can be detrimental to both your physical and
mental health. As a result, it is important to set limits on how
long you should work each day and take the time to relax and
unwind in the evening by spending time with friends and
family. In addition, it is important to take a break from your
busy schedule every now and then to enjoy life outside of work
and have fun. By incorporating more social activities into your
workday, you will be able to strike a healthy balance between
your work and personal life and maintain a high level of
productivity without having to put in countless hours of
overtime every day.
Section 3
Sherrod, D. (2018). The bonds of men: Problems and
possibilities in close male relationships. In The making of
masculinities.
Sherrod’s editorial affirms that there is a prevailing idea that
men are more inclined to act boldly and take risks than women.
This is partly true, but it doesn't explain why men often shy
away from unnecessary interactions and communications. There
are a number of reasons for this behavior, some of which can
largely be attributed to biology and others that can be explained

by cultural conditioning. Biologically, men tend to be more
attuned to potential danger and risk than women, partly due to
the testosterone that their bodies produce. This means that when
interacting with new people or situations, men are more likely
to rely on their gut instincts than on logic and reason, which can
make them less likely to engage in social interactions that are
unnecessary or a waste of time. This can result in men having
fewer close friends than women and generally interacting less
with others. Men also tend to have a stronger drive for
independence than women and are therefore less likely to seek
social support from others. These factors all play a role in
creating a world in which men tend to be reserved and less
likely to seek out contact with others than they might otherwise
like to be.
A combination of biology and culture also plays a role in
shaping the way that men interact with one another. The male
social hierarchy in our society tends to reinforce the idea that
men should be tough and independent, and that women should
take care of their needs by taking care of their families. As a
result of this societal pressure, men are socialized to be less
concerned with the needs of others than they are with their own.
Such feelings make it difficult for them to understand or
empathize with other people's experiences or feelings, which in
turn leads to a lack of sensitivity and a reluctance to offer
emotional support to others when they need it most (Sherrod,
2018). As a result, many men are reluctant to reach out to other
men for support, which can sometimes lead them to feel isolated
and vulnerable when they are dealing with difficult emotional
issues. While our culture has come a long way in recognizing
the value of helping and supporting one another, there is still a
lot of work to be done in order to break down the barriers that
prevent men from reaching out for emotional support when they
need it most.
From the article, it’s pretty evident that biological
predisposition to be sensitive to potential threats and take risks
when necessary serves them well in many circumstances.

However, it can lead to unnecessary conflict and isolation if it
becomes the driving force behind all of their decisions and
actions. Many men struggle to balance their natural tendency
towards independence and decisiveness with the need to listen
to their feelings and communicate with others in a positive
manner. Therapy can help teach them how to be compassionate
towards themselves and prioritize their own needs while still
maintaining their sense of strength and independence.
References
masculinities.
dialogue. Journal for Perspectives of Economic Political and
2

Role Reversals: Understanding My Playing-with-Gender Act
Section 1: Performed Act
Having realized that most men shy away from unnecessary
interactions and communications, I designed an act contrary to
this in the office. Upon arrival at the office in the morning, I
sought to increase my interaction with others. My act was that I
reversed how I interacted with other people and moved away
from my normal know self to a more plastic construed self. I
started by initiating modifications in the office to prepare for
performing the act. In the staff meeting, I was the facilitator,
and I did ensure that I welcomed all the members who were in
for the meeting. I presented my part throughout the discussion,
ensuring that all those who were in for the meeting made their
submissions in the meeting.
As concerns the preparation for this act, I had made some
practice actions before I came for this activity. I equipped
myself with skills in communication techniques, listening, and
being open-minded. I also gained ideas on the skills needed of a

person when leading dialogues since it was majorly what was to
happen during the meeting that I was to lead in the office.
Through random searches on speech presentations in google, I
was able to gain the most relevant techniques that I would
employ for the act performance. Further, ideas on attention-
grabbing and fascinating modalities of speech presentation have
also been helpful to me in the presentation of the said speech to
the audience.
In the performance of my speech, I noticed that members paid
much attention to the way I talked and were able to maintain
eye contact with me, having realized the new version of me that
had come before them. Mack et al. (2005) argues that observing
and participating are integral to understanding the breadth and
complexities of the human experience. This was the case with
my session in that we learned from each other through the two
modalities. I also observed that as I presented my speech, many
of the members nodded appropriately, showing that they agreed
with what I was presenting to them. They were able to ask
questions about the speech and the contribution I had made
during the speech. Many of them smiled at me, meaning that
they had likened to what I presented, after which they gave a
clap on my speech. However, there was also a challenge in
writing data in that all of those that were near me noticed that I
was moving at a faster pace and were unable to catch up with
everything I said throughout the session (Mack et al. 2005, pg
14)
However, I could have done more better by doing what I was
putting on less official clothing to increase interactivity. Mack
et al. (2005, pg. 19) argues that focusing on physical attributes
and their appearance is very important in the interaction. I
would also have employed my body language and gestures to
make the session livelier and signaling. I think I would also be
able to institute more rules for the meeting such that there
would be no moving in or out across the room in the course
meeting to increase concentration.
Section 2: Impact of the Act

The session when carrying out this activity was very interactive
as seen with other members present in the interaction. One of
the responses that were key in the intersection at this
presentation was that members nodded, and others could ask
questions which I clarified at the end of the presentation.
Williams & O’Donnell (2016) argues that more and more men
can see the importance of networking and creating networks and
interaction. This is just as seen in the discussion in the said
forum. Unlike previously, I interacted with men who could
share more on issues surrounding the topic in question. In
addition to this, and as per the arguments of the authors, the
discussions were more enjoyable and interesting as the
discussion went on. This was a form of social activity that the
authors argue that companies can start for their members to
interact with each other and promote teamwork. In addition,
some of the male members still felt that it was uncommon for
men to prepare the ground for which to meet, a situation
traditionally reserved for the female gender and which these
colleagues thought that it should have been taken up by a
woman.
In addition, aspects such as biology and sexuality were
determinant factors in this said interaction with this act. Some
of the members were reluctant to speak, and others still
maintained a low profile throughout the meeting. Men are
attuned to their biology and the production of testosterone,
which may turn many of their interactive chaotic, a reason why
they tend to carry their own with few friends. This played out
during the interaction since many of them failed to reach out for
the interaction and participated by using shorter duration and
being more focused on getting done with their contribution to
getting seated. Silver et al. (2019) show that feminist
identification of men focuses on men who identify or those
whose goals align with feminine ideals. This was, however, not
a feminist act since it was a simulation to understand how
others take the issues of men taking on roles that are not
traditionally reserved for them. However, others may take a

position that it was a feministic approach to the same and hence
may be for the ideas that this was an act of feminism. It can be
seen that, to some extent, those supporting men's involvement in
feminist approaches engage in feminist activism. This act could
not be classified as such since it was an observational study
actually the role of gender roles in society and how they have
shaped how men take on certain issues, especially with being
outgoing, caring, and making new connections.
However, the act was, apart from simulation, an act that could
be seen as activism. This is because it sought to challenge the
existing norms on how men take certain behaviors. It quashes
the existing belief that men cannot form networks and bring
them as capable of taking on activities similar to those of
females. These ideas are like those proposed by (Williams et al,
2016). The creation of these networks is key to improving how
people, especially men interact in the workplace. The fact that
most of the participants did participate in the discussion, asked
a question, and appreciated the new approach, which I took
through the discussion, is a fact that this act was one that
created a social change. It was a short one to create the
awakening that men could still do some acts that have long been
associated with or assigned to the female gender. The act was a
way of making known to the participants that sometimes, some
existing norms about the disconnect between men and female
are just some fixated actions or situations that can be easily
challenged by making changes in how we act. It is not the role
of the female gender to take some given roles, but any role
worth sharing can be carried along by any individual
irrespective of gender. It challenges the objectivation and the
misrepresentations over time that come with different genders
and allows members to have their eyes opened to the real issues
with gender than the construed ones.

References
Mack et al. (2005). "Module Two: Participant Observation,"
from
Qualitative Research Methods: A Data Collector's Field
Guide, Family Health International. Read Module 2, pages 13-
27. Retrieved from
https://www.fhi360.org/sites/default/files/media/documents/Qua
litative%20Research%20Methods%20-
%20A%20Data%20Collector's%20Field%20Guide.pdf
masculinities.
Silver, E. R., Chadwick, S. B., & van Anders, S. M. (2019).
Feminist identity in men: Masculinity, gender roles, and sexual
approaches in feminist, non-feminist, and unsure men.
Sex Roles: A Journal of Research, 80(5-6), 277–290.
https://doi.org/10.1007/s11199-018-0932-6
dialogue. Journal for
Perspectives of Economic Political and Social Integration, 22(1-
2), 275–289.
1
2

Playing-with-Gender Act Proposal (Part 2 of Applied Final
Project)
Typically, most men tend to shy away from unnecessary
interactions and communications as they prefer to enjoy their
space. The perception has been across most communities over
the years as individuals feel that too much interactions is linked
to feminism. With such bias perceptions, I decide to challenge
myself in the “playing-with-gender act”. I was motivated to
increase my engagement level throughout my gender reversal,
notably at work by initiating talks. Therefore, my action was
specifically predicated on altering the manner in which I
normally interact and direct talks. I initiated this modification
upon my morning arrival to the office. I welcomed all of my
coworkers. The morning also included a staff meeting during
which I delivered my performance. I tried something new by
serving as the meeting's facilitator for my first time since
joining the firm. I was responsible for ensuring that all
participants had the opportunity to voice their thoughts on the
subject of debate. I also expressed my opinion on the matter at
the conclusion of the meeting.
My preparations for this day included working on my

presentation skills, such as quasi communication techniques,
listening, and keeping an open mind. I was ready. In addition, I
had acquired knowledge on the interaction abilities that may be
utilized by an individual when leading dialogues. I was able to
acquire these capabilities by obtaining the material that is
contained on online sites that provide an overview of how
speeches are presented. I also viewed videos that break down
the most effective ways to deliver fascinating and attention-
grabbing presentations to large groups of people.
1
2
My Gendered Story

Gender and Gender Roles
Gender refers to socially constructed traits of men and boys or
women and girls. They include all the roles or behaviors that
are associated with a man or women in the society (Maclaran
and Chatzidakis, 2022). On the other hand, gender roles refer
how the society expects us to live, speak, act or conduct
ourselves based on our sex or gender. Gendered institutions
refer to institutions that fight for gender equality and ensure
that men and women are given equal opportunities. Social
constructions refer to the culture, norms and ideas that people
have learned and hence, incorporated in their daily life.
Societies have different construction and expectations. As Katz
and O'Barr (2019) observe, some societies are striving to
promote gender equality between men and women. Others, some
indigenous communities are still holding upon their primitive
ideas that men are superior to women. This paper will discuss
the concept of gender and activities that define our
responsibilities as either men or women.
The concept of gender and gender roles has played a key
part in shaping my daily routine. I have always seen myself as a
person who is responsible and who should take responsibilities
seriously. In the morning, I have to ensure that my house is neat
and well-organized. When I wake up in the morning, I have to
prepare my bed and clean the house as part of my job
description. As Katz and O'Barr (2019) state, this helps to have
clear peace of mind and focus on other daily goals. Secondly, I
also have to ensure that my family is well-taken care of. During
school days, I have to prepare the children. I ensure that I bathe
them in the morning and also prepare breakfast for them before
they leave for school. Despite these daily tasks, I feel proud of
my gender because it helps me to fit into society. Maclaran and
Chatzidakis (2022) observe that our roles and responsibilities in
society help to define who we are. Therefore, I am most
comfortable with my gender roles.

On the other hand, I always like to use beauty products since
they give a sense of confidence. I always like to enhance my
skin by having nice clothes, shoes, and other fashion trends. As
Maclaran and Chatzidakis (2022) state, the majority of fashion
products also help us to have confidence and also integrate into
modern society. It also helps me to have a sense of confidence
when I am close to my peers. Every time I visit a beauty shop, I
am always keen to identify new design products. I believe that I
belong to this modern society that is constantly changing. My
gender roles and responsibilities have also shaped how I interact
with other members of society. I believe that I am still a youth
and therefore, I try to get along with all the members of society.
Since I was young, my parents have always taught me to have
etiquette, especially with adults. Therefore, I always ensure that
I greet or socialize with other society members. As Katz and
O'Barr (2019) state, this helps to create cohesion and also helps
one to earn the respect of others. Moreover, I have always
valued the concept of gender equity. Hence, I always believe
that men and women are equal. In our school, I am the class
representative and therefore, I represent the interest of both men
and women equally.
In all the institutions that I have worked in, they are gendered
towards equality and fairness. In our school, the roles of men
and women are equal and everyone is given an equal chance to
perform or excel. Women play similar games to men and they
are also graded on an equal platform as men. This is what I
value about gender conformity in our institutions. On the other
hand, I also believe that gender informs the largest and smallest
decisions in my everyday life. First, I always believe that we
are all equal, both men and women. Therefore, when I interact
with the opposite gender, I always treat them as I do people of
my gender. I always try to be respectful and always interact
positively with my friends from all genders. Secondly, the
concept of gender equity also helps me to choose the type of
institution or the people I associate with. I don’t associate with
institutions or people who don’t value the concept of gender

equality. Katz and O'Barr (2019) state that in the modern era,
we need to avoid institutions or people with ‘primitive ideas’
and this includes those who don’t value gender equality.
To conclude, the concept of gender and gender roles has
shaped our lives and also altered our culture. The course
materials have helped me understand my roles and
responsibilities in line with my gender. Moreover, I have
learned to love in harmony with my family members and also
take care of the needs of all people including my family.
However, I also believe that both genders and equal, and if
people understood their roles and their positions in society, we
can transform our societies for the better.
References
Katz, J., & O'Barr, W. M. (2019).
Masculinities and the Media: An Interview with Activist
Jackson Katz. Advertising & Society Quarterly, 20(2).
Maclaran, P., & Chatzidakis, A. (2022).
Introduction: an overview of gendered marketing. Gendered
Marketing, 1-20.

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