Medeiros LNB de, Silva DR da, Guedes CDFS et al. .docx

Medeiros LNB de, Silva DR da, Guedes CDFS et al.
Prevalence of pressure ulcers in intensive...
English/Portuguese
J Nurs UFPE on line., Recife, 11(7):2697-703, July., 2017 2697
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.10939-
97553-1-RV.1107201707
PREVALENCE OF PRESSURE ULCERS IN INTENSIVE
CARE UNITS
PREVALÊNCIA DE ÚLCERAS POR PRESSÃO EM
UNIDADES DE TERAPIA INTENSIVA
PREVALENCIA DE ÚLCERAS POR PRESIÓN EN UNIDADES
DE TERAPIA INTENSIVA
Luan Nogueira Bezerra de Medeiros1, Deyvisson Ribeiro da
Silva2, Cintia Danielle Faustino da Silva Guedes3,
Thuanne Karla Carvalho de Souza4, Belisana Pinto de Abreu
Araújo Neta5
ABSTRACT
Objective: to detect the prevalence of Pressure Ulcers (PUs) in
patients admitted to Intensive Care Units
(ICUs). Method: cross-sectional, quantitative study, developed
in an emergency and trauma reference

hospital in the State of Rio Grande do Norte located in the
eastern sanitary district of Natal (RN), Brazil.
Results: the prevalence found of PUs was 69% in the four ICUs.
Individually, the Cardiac ICU had an incidence
of 44.4%; the Bernadete ICU, 85.7%; the General ICU, 60%;
and the Emergency ICU, 87.5%. Conclusion: It is
necessary to focus on a strategic planning for prevention and
treatment measures to reduce the PU indexes in
the institution. Descriptors: Nursing; Pressure Ulcer; Intensive
Care Units; Prevalence.
RESUMO
Objetivo: detectar a prevalência de Úlceras por Pressão (UPs)
em pacientes internados em Unidades de
Terapia Intensiva (UTIs). Método: estudo transversal, de
abordagem quantitativa, desenvolvido em um
hospital de referência para o estado do Rio Grande do Norte em
urgência e trauma, situado no distrito
sanitário leste do município de Natal (RN), Brasil. Resultados: a
prevalência encontrada de UPs foi de 69% nas
quatro UTIs. Individualmente, a UTI Cardiológica apresentou
44,4%; UTI Bernadete, 85,7%; UTI Geral, 60%; e
UTI do Pronto-Socorro, 87,5% de prevalência de UPs.
Conclusão: é necessário nortear um planejamento
estratégico para medidas de prevenção e tratamento para
redução dos índices de UPs na instituição.
Descritores: Enfermagem; Úlcera por Pressão; Unidades de
Terapia Intensiva; Prevalência.
RESUMEN
Objetivo: detectar la prevalencia de Úlceras por Presión (UPs)
en pacientes internados en Unidades de
Terapia Intensiva (UTIs). Método: estudio transversal, de
enfoque cuantitativo, desarrollado en un hospital de

referencia para el estado de Rio Grande do Norte en urgencia y
trauma, situado en el distrito sanitario este
del municipio de Natal (RN), Brasil. Resultados: la prevalencia
encontrada de UPs fue de 69% en las cuatro
UTIs. Individualmente, la UTI Cardiológica presentó 44,4%;
UTI Bernadete, 85,7%; UTI General, 60%; y UTI de
Pronto-Socorro, 87,5% de prevalencia de UPs. Conclusión: es
necesario guiar un planeamiento estrategico
para medidas de prevención y tratamiento para reducción de los
índices de UPs en la institución.
Descriptores: Enfermária; Úlcera por Preisón; Unidades de
Cuidados Intensivos; Prevalencia.
1Nurse, Post-graduation in the Multiprofessional Residency
Program in Maternal and Child Nursing, Federal University of
Rio Grande do
Norte/UFRN. Santa Cruz (RN), Brazil. Email: [email protected];
2Nurse, Postgraduate student in Urgency and Emergency,
Estácio Ponta Negra Faculty. Natal (RN), Brazil. Email:
[email protected]; 3Nurse, Post-graduate student in Public
Health,
Estácio Ponta Negra Faculty. Natal (RN), Brazil. Email:
[email protected]; 4Nurse, Post-graduate student in Public
Health, Estácio
Ponta Negra Faculty. Natal (RN), Brazil. Email:
[email protected]; 5Nurse, Professor, Nephrology Specialist,
Estácio Ponta Negra
Faculty, Natal (RN), Brazil. Email: [email protected]

ORIGINAL ARTICLE
mailto:[email protected]
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97553-1-RV.1107201707
Pressure ulcers (PU) are caused by the
pressure exerted on the skin and underlying
tissues of a prominent bone. The National
Pressure Ulcer Advisory Panel (NPUAP)

presented in 2014 a new classification for PUs.
Based on the severity of the PU in the skin,
this can be classified in the following stages:
stage I (intact skin with non-blanchable
erythema); stage II (partial loss of skin
structure or blister); stage III (full loss of skin
structure with visible subcutaneous tissue);
stage IV (full loss of tissue with exposed
muscle and bone structure); unstageable
(total loss of skin structure or tissues of
unknown depth); and suspected deep lesion (a
dark red or purple area located on intact skin
or blister filled with blood)..1
The indexes of Pressure Ulcers (PUs) in
some countries of the world are much lower
than in Brazil. In China, a study identified a
prevalence of 1.58% and incidence of 0.63%.2
In Iranian hospitals, two prevalence rates

were obtained in Intensive Care Units (ICUs):
26.7% for patients followed daily, and 19%
based on medical records reviewed.3 In India,
the prevalence was 3.1% in nursing wards.4
PUs represent a problem for hospital and
public health institutions.5 They incur
financial costs to health services, as for
example with industrialized dressings.6-7 They
also indicate the quality of health care
regarding patient safety, since low PU rates
are related to good care provided.8-9
Intensive care patients are prone to factors
strongly associated with PUs, such as: sepsis,
long hospital stay and high risk on the Braden
scale.10 They may lead to impairment of the
clinical condition of critically ill ICU patients.9
Individuals with PU need care from the
multiprofessional team working in the sector,

with emphasis to the Nursing Team, as this is
the one that stands out for the continuous
care 24 hours a day.6
Nursing plays an important role in the
prevention and treatment of PUs. In this
context, the use of indices to classify these
lesions has been associated to a quality
nursing care,11 and one form the nursing team
can act to help is by applying preventive
protocols to reduce high rates of PUs.9
In this context, considering the PU indexes
as a public health problem and an aggravating
factor for the health of ICUs patients, the
present study aimed to detect the prevalence
of PUs among patients hospitalized in ICUs of
a reference hospital in Rio Grande do Norte
(RN).

This is a cross - sectional study with
quantitative approach developed in an
emergency and trauma reference hospital in
the State of the RN, located in the eastern
sanitary district of the Municipality of
Natal/RN. The institution has five ICUs:
Cardiac ICU (10 beds); Bernadete ICU (10
beds); General ICU (9 beds); Emergency ICU
(10 beds); and Pediatric ICU (6 beds).
The inclusion criteria for detecting the
prevalence of PUs in patients admitted to the
ICUs were: hospitalization for at least 24
hours; signing of the Informed Consent Form
(ICF) by a responsible person in the case of
unconscious patients; age equal or above 18
years. Exclusion criteria were: time of
hospitalization less than 24 hours due to
discharge; death or transfer to a sector other

than ICU; pediatric ICU; and patients aged less
than 18 years.
Four ICUs were included in the research.
They have 39 beds intended for the care of
patients with varied etiologies and clinical and
surgical conditions.
Data collection was done by completing a
structured form. The collection was
conducted by the researchers at the moment
when the nursing professionals were bathing
the patient in the bed, a proper moment for
identification, evaluation and classification of
ulcers.
The collected data was transferred to a
Microsoft Excel 2007 worksheet and exported
for analysis in the Statistical Package for
Social Science, version 15.0 (SPSS) to be
analyzed, and stratified into figures, Figures

and tables.
The prevalence of PUs was determined
according to the following calculation:
Number of patients with PU in the ICUs
Prevalence = ____________________________ x 100
Number of patients admitted to the ICUs
The prevalence coefficient can be defined
as the ratio of known cases of a given disease
and population. Thus, the result is multiplied
by the referential base of the population,
which is power of 10.12
The research respected the ethical
precepts of Resolution 446/2012 of the
National Health Council13, and after receiving
approval from the Ethics and Research
Committee (REC) of the University Hospital
INTRODUCTION

METHOD
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97553-1-RV.1107201707
Onofre Lopes - HUOL/UFRN under Opinion nº
1,255,711 and CAAE: 46268715.8.0000.5292.
On November 4, 2015, 37 of the 39 beds
were occupied, one was vacant and the other
was unavailable due to maintenance. The
study sample consisted of 29 bedridden
patients; two patients were aged less than 18
years, two had been hospitalized for less than
24 hours and four patients were unconscious
patients whose responsible caregivers refused

to participate in the study.
Among the 29 (100%) selected patients, 20
(69%) presented at least one PU, and nine
(31%) had none. These data show a prevalence
of 69% of PUs in patients admitted to the four
ICUs.
Based on the overall prevalence of this
study, we stratified the results per ICU
studied. Nine (100%) patients from the Cardiac
ICU participated in the study; four
(prevalence of 44.4%) had PUs, and five
(44.6%) had no lesions. Seven (100%) patients
from the Bernadete ICU participated in the
study; six (prevalence of 85.7%) had PUs and
one (14.3%) had no lesions.
At the General ICU, five (100%) patients
participated in the study; three (prevalence of
60%) had PUs and two (40%) had no lesions.

And in the Emergency ICU, eight patients
(100%) participated in the study; seven
(prevalence of 87.5%) had PUs and one (12.5%)
had no injury. Figure 01 presents the overall
prevalence of PUs and the prevalence per ICU.
Figure 1. Overall prevalence of PUs in hospitalized patients,
and prevalence
per ICU. Natal (RN), Brazil, 2015.
Regarding the sex of these patients, 24
(82.76%) individuals were male and five (17,
24%) were female. Analyzing males alone, 17
(70.8%) out of the of the 24 (100%) patients
presented PU and seven (29.2%) did not
present lesions. Among the five (100%)
women, three (60%) presented PU and two
(40%) did not present lesions.
Regarding the age group of the 29 (100%)

patients who presented or not PUs, the results
were as follows: three (10.3%) patients in the
age group between 18 and 25 years presented
PUs; two (6.9%) patients in the age group
between 26 and 33 years had PUs and two
(6.9%) had no lesion.
One patient in the age group between 34
and 41 years (3.5%) had PUs and another
patient (3.5%) had no lesions; there were no
patients between the ages of 42 and 49; two
(6.9%) patients in the age group between 50
and 57 years had developed the lesion and
two (6.9%) had not; 12 (41.3%) patients in the
age group equal to or greater than 58 years
were found with PUs and four (13.8%) were
not. The Figure 02 below presents the
incidence of PUs per age group.

Figure 2. Frequency of patients with and without PUs per age
group. Natal
(RN), Brazil, 2015.
RESULTS
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97553-1-RV.1107201707
Regarding the length of hospitalization:
among patients hospitalized for 1 to 15 days,
10 (34.5%) had PUs and eight (27.5%) had no
lesions; among patients hospitalized for 16 to
30 days six (20.7%) had PUs and one (3.5%)
had no lesions; among patients hospitalized
for 31 to 45 days, one (3.5%) had PUs; among
patients hospitalized more than 46 years,

three (10.3%) were identified with UPs. Figure
03 presents the frequency of patients with
and without PU in relation to the length of
hospitalization in the sectors discussed.
Figure 3. Frequency of patients with and without PUs in relation
to
the length of hospitalization. Natal (RN), Brazil, 2015.
In the evidence of the prevalence of PUs, it
was possible to quantify and classify these
lesions. Forty-two (100%) PUs were identified:
nine (21.4%) stage I PUs; 23 (54.8%) stage II
PUs; eight (19%) stage III PUs; and two (4.8%)
stage IV PUs.
The Sacrococci region was affected by 11
(26.2%) PUs. Of these, there were: one stage I
PU, two stage II PUs, six stage III PUs and two
stage IV PUs. In the Trochanter region, one

(2.4%) stage I PU was found.
In the Occipital region, there were six
(14.3%) stage II PUs; in the middle Ankle were
found two (4.7%) PUs, one stage I PU and one
stage II PU; in the Elbow region, two (4.7%)
PUs were found, one stage I PU and one stage
III PU.
Calcaneus PU corresponded to 18 (42.9%)
lesions, six of them being stage I PUs and 12
stage II PUs; there was also one case of PU in
the penis (2.4%), being a stage II PU; and the
ear region presented one (2.4%) stage II PU.
Figure 4 shows the frequency of PUs in
relation to their location.
Figure 4. Frequency of PUs in relation to their location. Natal
(RN),
Brazil, 2015.

A study carried out in a university hospital
in the city of Botucatu/SP analyzed the 332
hospitalized patients from September 2007 to
August 2008 and indetified a prevalence of
PUs of 17.79%(14). In a city in the state of Rio
de Janeiro, the prevalence found was 22.9%
among 109 hospitalized patients from March
to May, 2010, in a federal hospital15
The research that presented the most
similar results to our present data, but still
with a notable difference, was the one
performed in a public hospital in the Federal
District. The total prevalence was 57.89%
among 19 patients on April 13, 2007. The
authors found the following prevalences per
DISCUSSION

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97553-1-RV.1107201707
each subunit: 50% in a general unit, and 87.5%
in a unit specialized in trauma. The result
found in the trauma unit of this study is
similar to the result of the current survey,
which also showed a prevalence of 87.5% in
the emergency ICU.6
Likewise in the current study, in the
research developed at the university hospital
of the city of Botucatu/SP, males were the
most affected by PUs. Among the patients
with PUs, 55% were male and 45% were
female.14 The age group equal to or greater
than 58 years presented the largest number of
people affected with PUs in the present study.

Age appears as a contributing factor for the
development of these lesions. It is notable
that aging slows the healing process and
vascularization, as well as decreases the
function of collagen; as an example, quick
healing of similar wounds is observed in
children as compared to an older people.16
According to the Figure 03 of the present
study, at least one patient hospitalized from
16 to 30 days did not present PUs, but no
patient in the group of 31 to 45 days remained
without injury. Thus, it can be said that a long
hospitalization time is a risk factor for the
development of PUs.10
As for the region most frequently affected
by PUs in the present study, the Calcanal
region prevailed (42.9%), followed by the
sacral region (26.2%). Another study identified

that the most affected area was the calcaneal
region, with nine occurrences, followed by the
malleolar and sacral regions with four and
three occurrences respectively. The data of
this research in relation to the most affected
site are comparable to those of current
research, presenting the calcaneal region as
the most affected, as well as the presence of
PU in the penile region, as well as in the
current study.6
The prevalence of PUs found in this study is
considered high in comparison to research
carried out in ICUs from other hospital
institutions in the country. This may be a
reflection of the quality of healthcare
provided at the institution or the lack of
implementation of preventive strategies, as

standard protocols.
The existence of PUs has repercussions on
stressful situations for health professionals,
specifically for the nursing team, as they are
responsible for the daily dressings and
preventive measures to maintain the patients'
skin integrity. All this responsibility, besides
other activities such as drug administration
and bathing in the bed, causes an excess of
work for this team and can represent a factor
that contributes to the formation of the
lesions. An overwhelmed professional may not
perform his duties with quality.
PUs affect the patient's health in physical,
psychic and emotional aspects; cause concern
among the family members regarding the
consequences that these lesions may have on
the affected individual; and incur a high

financial cost to the institution, which invests
in products for treatment.
Among the regions affected by PUs, the
lesion found in the penis is notable. No
research shows theoretical basis for the
formation of this type of ulcer, although this
lesion was mentioned in one study.6 The PU in
the penis can lead to consequences such as
penile dysfunction and partial loss of the
organ, depending on the staging of the lesion.
These consequences may cause negative
feelings and future frustrations to te patient.
In this study, we raise the hypothesis that
the lesion in the penis is the result of the
continuous use of a device for collecting
urine. More research on PUs in penile regions
is necessary in order to list which causes lead
to the occurrence of this type of injury.

Early use of plaque covers for protection in
the sacral region was observed and this area
was not predominant in the study. It is
possible to raise the hypothesis that the other
areas did not receive this preventive measure
and for that reason they developed PUs. The
calcaneal region was the most affected, and
during the collection of the data, the
erroneous form of cushion disposition for
protection of the calcaneus was observed.
These were placed directly in the region and
not letting the feet float.
Studying PU is always necessary, since this
injury is a frequent public health problem and
can influence the recovery of hospitalized
patients, specifically in ICUs. Further research
is needed to ascertain the magnitude of the
occurrence of these lesions in Brazil, because

scientific basis is fundamental to apply
optimal conducts for prevention and
treatment.
1. National Pressure Ulcer Advsory Panel. NEW
2014 Prevention and Treatment of Pressure
Ulcers: Clinical Practice Guideline [Internet].
2014 [cited 2016 Jan 29]. Available from:
http://www.npuap.org/wp-
content/uploads/2014/08/Quick-Reference-
Guide-DIGITAL-NPUAP-EPUAP-PPPIA-
Jan2016.pdf.
2. Jiang Q, Li X, Qu X, Liu Y, Zhang L, Su C, et
al. The incidence, risk factors and
REFERENCES
CONCLUSION
http://www.npuap.org/wp-content/uploads/2014/08/Quick-
Reference-Guide-DIGITAL-NPUAP-EPUAP-PPPIA-
Jan2016.pdf

Jan2016.pdf
Jan2016.pdf
Jan2016.pdf
English/Portuguese
97553-1-RV.1107201707
characteristics of pressure ulcers in
hospitalized patients in China. Int J Clin Exp
Pathol [Internet]. 2014 Apr [cited 2016 Jan
17];7(5):2587–94. Available from:
http://www.ijcep.com/files/ijcep1402017.pd
f
3. Sari AA, Doshmanghir L, Neghahban
Z, Ghiasipour M, Beheshtizavareh Z. Rate
of Pressure Ulcers in Intensive Units and

General Wards of Iranian Hospitals and
Methods for Their Detection. Iran J Public
Health [Internet]. 2014 Jun [cited 2016 Jan
15];43(6):787-92. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC4475597/pdf/IJPH-43-787.pdf
4. Babu A, Madhavan K, Singhal M, Sagar
S, Ranjan P. Pressure Ulcer Surveillance in
Neurotrauma Patients at a Level One Trauma
Centre in India. Oman Med J [Internet]. 2015
Nov [cited 2016 Feb 24];30(6):441-6. Available
from:
https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC4678450/pdf/OMJ-D-15-00117.pdf
5. Miyazaki MY, Caliri MHL, Santos CB.
Conhecimento dos profissionais de
enfermagem sobre prevenção da úlcera por
pressão. Rev Latino-Am Enfermagem

[Internet]. 2010 Nov [cited 2016 Jan
23];18(6):[10 telas]. Available from:
http://www.scielo.br/pdf/rlae/v18n6/pt_22
6. Matos LS, Duarte NLV, Minetto RC.
Incidência e prevalência de úlcera por pressão
no CTI de um Hospital Público do DF. Rev Eletr
Enf [Internet].2010 [cited 2016 Feb
20];12(4):719-26. Available from:
https://www.fen.ufg.br/fen_revista/v12/n4/
pdf/v12n4a18.pdf
7. Lima ACB, Guerra DM. Avaliação do custo
do tratamento de úlceras por pressão em
pacientes hospitalizados usando curativos
industrializados. Ciênc saúde colet. [Internet]
2011 Jan [cited 2016 Feb 14];16(1):267-77.
Available from:
http://www.scielo.br/pdf/csc/v16n1/v16n1a2
9.pdf

8. Santos CT, Oliveira MC, Pereira AGS, Suzuki
LM, Lucena AF. Indicador de qualidade
assistencial úlcera por pressão: análise de
prontuário e de notificação de incidente. Rev
Gaúcha Enferm [Internet]. 2013 Mar [cited
2016 Jan 19];34(1):111-118. Available from:
http://www.scielo.br/pdf/rgenf/v34n1/14.pd
f
9. Rogenski NMB, Kurcgant P. Incidência de
úlceras por pressão após a implementação de
um protocolo de prevenção. Rev. Latino-Am.
Enfermagem [Internet]. 2012 Mar [cited 2016
Feb 13];20(2):[07 telas]. Available from:
10. Gomes FSL, Bastos MAR, Matozinhos FP,
Temponi HT, Velásques-Meléndez G. Fatores
associados à úlcera por pressão em pacientes
internados nos centros de terapia intensiva de

adultos. Rev Esc Enferm USP [Internet]. 2010
Dec [cited 2016 Feb 26];44(4):1070-6.
Available from:
http://www.scielo.br/pdf/reeusp/v44n4/31.p
df
11. Silva MRV, Michels NR, Martini DAC.
Incidência de úlcera por pressão como
indicador de qualidade na assistência de
enfermagem. Rev Enferm UFSM [Internet].
2012 Mai [cited 2016 Jan 27];2(2):339-346.
Available from:
https://periodicos.ufsm.br/reufsm/article/vie
w/5238/3758
12. Lima JRC, Pordeus AMJ, Rouquayrol, MZ,
Medida da Saúde Coletiva. In: Rouquayrol MZ,
Siva MGC. Epidemiologia & Saúde. 7th ed. Rio
de Janeiro: Medbook; 2013. p.37-82.
13. Resolução Nº 466 do Conselho Nacional de

Saúde, de 12 de dezembro de 2012 (BR).
Aprova as diretrizes e normas
regulamentadoras de pesquisas envolvendo
seres humanos [Internet]. Available from:
http://conselho.saude.gov.br/resolucoes/201
2/Reso466.pdf
14. Palhares VC, Neto AAP. Prevalência e
incidência de úlcera por pressão em uma
unidade de terapia intensiva. Rev enferm
UFPE [Internet]. 2014 Out [cited 2016 Feb
28];8(2):3647-3653. Available from:
http://www.revista.ufpe.br/revistaenfermage
m/index.phd/revista/article%20/downloud/50
39/10634
15. Costa P, Goldstein EA, Ribeiro NPA,
Cerqueira FA, Izu M. Prevalência de úlceras
por pressão em um centro de terapia
intensiva. R pesq cuid fundam [Internet].2010

Out [cited 2016 Jan 25];2(Ed. Supl.):11-114.
Available from:
http://www.seer.unirio.br/index.php/cuidad
ofundamental/article/view/830/pdf_96
16. Oliveira N, Reis LA. Caracterização das
úlceras de pressão em idosos hospitalizados.
Revista Enfermagem Contemporânea
[Internet]. 2013 Dez [cited 2016 Feb
28];2(1):146-156. Available from:
https://www5.bahiana.edu.br/index.php/enf
ermagem/article/view/289/224
http://www.ijcep.com/files/ijcep1402017.pdf
http://www.ijcep.com/files/ijcep1402017.pdf
http://www.ncbi.nlm.nih.gov/pubmed/?term=Doshmanghir%20L

%5BAuthor%5D&cauthor=true&cauthor_uid=26110149
http://www.ncbi.nlm.nih.gov/pubmed/?term=Neghahban%20Z%
5BAuthor%5D&cauthor=true&cauthor_uid=26110149
http://www.ncbi.nlm.nih.gov/pubmed/?term=Neghahban%20Z%
http://www.ncbi.nlm.nih.gov/pubmed/?term=Ghiasipour%20M%
http://www.ncbi.nlm.nih.gov/pubmed/?term=Beheshtizavareh%2
0Z%5BAuthor%5D&cauthor=true&cauthor_uid=26110149
http://www.ncbi.nlm.nih.gov/pubmed/26110149
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4475597/pdf/IJ
PH-43-787.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4475597/pdf/IJ
PH-43-787.pdf
http://www.ncbi.nlm.nih.gov/pubmed/?term=Babu%20A%5BAut
hor%5D&cauthor=true&cauthor_uid=26675523
http://www.ncbi.nlm.nih.gov/pubmed/?term=Madhavan%20K%5
BAuthor%5D&cauthor=true&cauthor_uid=26675523
http://www.ncbi.nlm.nih.gov/pubmed/?term=Singhal%20M%5B
Author%5D&cauthor=true&cauthor_uid=26675523
http://www.ncbi.nlm.nih.gov/pubmed/?term=Sagar%20S%5BAu
thor%5D&cauthor=true&cauthor_uid=26675523
http://www.ncbi.nlm.nih.gov/pubmed/?term=Sagar%20S%5BAu
thor%5D&cauthor=true&cauthor_uid=26675523
http://www.ncbi.nlm.nih.gov/pubmed/?term=Ranjan%20P%5BA
uthor%5D&cauthor=true&cauthor_uid=26675523
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4678450/pdf/O
MJ-D-15-00117.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4678450/pdf/O
MJ-D-15-00117.pdf
https://www.fen.ufg.br/fen_revista/v12/n4/pdf/v12n4a18.pdf
https://www.fen.ufg.br/fen_revista/v12/n4/pdf/v12n4a18.pdf
http://www.scielo.br/pdf/csc/v16n1/v16n1a29.pdf

http://www.scielo.br/pdf/csc/v16n1/v16n1a29.pdf
http://www.scielo.br/pdf/rgenf/v34n1/14.pdf
http://www.scielo.br/pdf/rgenf/v34n1/14.pdf
http://www.scielo.br/pdf/reeusp/v44n4/31.pdf
http://www.scielo.br/pdf/reeusp/v44n4/31.pdf
https://periodicos.ufsm.br/reufsm/article/view/5238/3758
https://periodicos.ufsm.br/reufsm/article/view/5238/3758
http://conselho.saude.gov.br/resolucoes/2012/Reso466.pdf
http://conselho.saude.gov.br/resolucoes/2012/Reso466.pdf
http://www.revista.ufpe.br/revistaenfermagem/index.phd/revista
/article%20/downloud/5039/10634
http://www.seer.unirio.br/index.php/cuidadofundamental/article/
view/830/pdf_96
http://www.seer.unirio.br/index.php/cuidadofundamental/article/
view/830/pdf_96
https://www5.bahiana.edu.br/index.php/enfermagem/article/vie
w/289/224
https://www5.bahiana.edu.br/index.php/enfermagem/article/vie
w/289/224
English/Portuguese
97553-1-RV.1107201707

Submission: 2016/05/06
Accepted: 2017/05/25
Publishing: 2017/07/01
Corresponding Address
Luan Nogueira Bezerra de Medeiros
Rua João Bianor Bezerra, 64, Ap, 305
Bairro Centro
CEP: 59200-000 − Santa Cruz (RN), Brazil
Copyright of Journal of Nursing UFPE / Revista de Enfermagem
UFPE is the property of
Revista de Enfermagem UFPE and its content may not be copied
or emailed to multiple sites
or posted to a listserv without the copyright holder's express
written permission. However,
users may print, download, or email articles for individual use.
N4325 Nursing Research
Submit by the due date and time listed in your syllabus.
Overview
This assignment will allow you to create an evidence-based
practice project that includes the development of a PICO
question and follows the initial steps of the Iowa Model. You
will share your findings using an APA formatted paper.
Submitting your assignment
· Save this document to your desktop as a Word document.
· Open the document from your desktop and review the
assignment instructions and grading rubric.

· Create a separate Word document for your paper.
· Return to the course and upload your paper and your nursing
research article that was approved by your coach in Module 2 to
the assignment submission link in Module Four. Please note:if
you forget to upload your nursing quantitative research article,
a 5 point penalty will be applied to your paper.
Grading Rubric
Use this rubric to guide your work the assignment. Points are
awarded for each section based on content and clarity of
expression.
Accomplished
(Maximum points awarded)
Proficient
(Points awarded based on content)
Needs Improvement
(Minimum points awarded)
Initial PICO question completed / nursing research article
selected.
Research article is a quantitative article, nursing focused, and is
5 years or less from current publication date.
Please note: if you forget to upload your nursing quantitative
research article, a 5 point penalty will be applied to your paper
5 to > 3 points
Research article is a quantitative article that is nursing focused
but is greater than 5 years old.
3 - >2 points

Research article is not nursing focused or is a qualitative
article, systematic review, meta-synthesis, meta-analysis, meta-
summary, integrative review, clinical information article or
“how-to” article.
No article uploaded.
2 to >0 points
Opening Paragraph
(Paragraph #1)
Introduction statement(s) present.
PICO question with all elements present.
Statement of importance with two facts such as costs,
morbidity, mortality, safety. Include related statistics with
citation and is 5 years or less from current publication date.
10 – >8 points
No introduction statement(s).
PICO statement is incomplete.
Statement of importance incomplete or missing.
Citation is incomplete or missing.
8 – >3 points
No introduction statement(s).
PICO statement grossly incomplete or missing.
Statement of importance missing.
No citation

3 - >0 points
Summary paragraph for your nursing quantitative research
article.
(Paragraph #2)
Three facts clearly identified from quantitative nursing research
article and is 5 years or less from current publication date.
A least two of the facts include information from the Results
and / or Discussion sections.
Facts clearly tied to PICO question.
Facts connected to your nursing practice.
10 - >8 points
Less than three facts clearly identified from quantitative nursing
research article.
Only one fact includes results or discussion sections.
Facts not clearly tied to PICO question.
Facts not clearly connected to your nursing practice.
8 - >3 points
No facts clearly identified from the article.
No facts from the results or discussion sections
No attempt to connect facts from the article back to the PICO
question.
No attempt to connect facts from the article back to your
nursing practice.
3 - >0 points
Reliability paragraph for your nursing quantitative research
article.

(Paragraph #3)
Definition of reliability offered with citation.
Discussion of reliability clearly connected to data collection or
measurement methods with examples from the student’s
research article.
Type of reliability is identified and named.
Hint: This information is covered in Chapter 10. Use Table 10-1
in your textbook to identify the type of reliability of the
measurement instrument / tool.
10 - >8 points
Vague or no definition of reliability.
Minimal reference to data collection or measurement methods in
discussion of reliability with no reference to specific
information from the student’s article.
Type of reliability is not clearly identified / named.
8 - >3 points
Vague statements about reliability made with no discussion of
data collection or measurement methods offered.
Type of reliability is not identified / named.
3 - >0 points
Validity paragraph for your nursing quantitative research
article.
(Paragraph #4)
Definition of validity offered with citation.
Discussion of validity clearly connected to data collection, or
measurement methods with examples from the student’s
research article.
Type of validity is identified and named.

Hint: This information is covered in Chapter 10. Use Table 10-1
in your textbook to identify the type of validity of the
measurement instrument / tool.
10 - >8 points
Vague or no definition of validity.
Minimal reference to data collection, or measurement methods
in discussion of validity with no reference to specific
information from the student’s article.
Type of validity is not clearly identified / named.
8 - >3 points
Vague statements about validity made with no discussion of
data collection or measurement methods offered.
Type of validity is not identified / named.
3 - >0 points
Two additional strengths or weaknesses from your nursing
quantitative research article.
(Paragraph #5)
Two strengths or two weaknesses or one strength and one
weakness are specifically identified from your nursing
quantitative research article.
The student choices for strengths / weaknesses must focus on
the methods used by the authors for sampling, measurement
methods used (ex. a questionnaire), or how the data was
collected (data collection) with examples from the student’s
research article.
10 - >8 points
Only one strength / or weakness explained well with second
strength / weakness only identified.

Strengths / weaknesses not based on sample, measurement
methods, or data collection.
8 - >3 points
Strength / weaknesses identified are not based on these three
critique skills.
No strengths / weaknesses identified.
3 - >0 points
Clinical practice guideline summary.
(Paragraph #6)
Name of the clinical practice guideline and specific website
identified. Guideline is the most recent version or published
within the past five years.
Three facts clearly identified that were found within the
guideline and relate to the practice of a BSN.
10 - >8 points
Name of the clinical practice guideline or website not clearly
identified.
Fewer than three facts clearly identified that were found within
the guideline or facts not specifically related to the practice of
the nurse.
Facts vaguely tied to PICO question.
Facts vaguely connected to your nursing practice.
8 - >3 points
Name of the clinical practice guideline or website not stated.
No clearly identified facts from the guideline.

Facts not tied to PICO question or nursing practice.
3 - >0 points
“Fourth resource” summary.
(Paragraph #7)
Three facts clearly identified from the fourth resource which is
5 years or less from current publication date.
10 - >8 points
Less than three facts clearly identified from the fourth resource.
Facts not clearly tied to PICO question.
Facts not clearly connected your nursing practice.
8 - >3 points
No facts clearly identified from the fourth resource.
No attempt to connect facts from the fourth resource back to the
PICO question.
No attempt to connect facts from the fourth resource back to
your nursing practice.
3 - >0 points
Closing Paragraph(s)
(Paragraph #8 and #9, if needed)
PICO question is restated.
A summary of what was learned (from all sources) is present.
Recommendations for practice are offered.

10 - >8 points
Missing one or more of the following elements:
PICO question.
A summary of what was learned.
Recommendations for practice.
8 - >3 points
No PICO question.
Poor or no attempt to summarize information from the
resources.
No / vague recommendations for practice are offered.
3 - >0 points
APA Style and Formatting
APA formatting for this paper will follow the guidelines for
general formatting, in text-citations, margins, headings (if
desired) alignment and line spacing, font type and size,
paragraph indentation, page headers, and the reference page as
explained in the 2nd edition of APA the Easy Way or the 6th
edition of the APA Manual.
Helpful Hints:
· Do not use 1st person in a formal paper.
· Do not use direct quotes, instead summarize and paraphrase
what you are reading. Multiple quotes (more than two) will
receive multiple point deductions.
· Please do not forget to use the approved CONHI cover page.
· Check your references format before submitting your paper. A
ten-point deduction will be applied to your paper if the

References page is omitted.
The first time an APA error is discovered, it will be pointed out
to you and a point will be deducted from your paper. Maximum
number of points deducted for APA errors: 15 points
Instructions for Completing Your Assignment
· Step one:Using the topic you chose for Module 2 Searching
for a Quantitative Nursing article, identify a nursing clinical
practice question that you would like to explore.
· Step two: Complete the readings from Module Four. Use the
readings from Module Four to put your nursing clinical practice
question into a PICO format.
· Step three: Search for a nursing quantitative research article
(or two) that relates to your PICO question using Academic
Search Complete, CINHAL, Pubmed, Google Scholar, or any
other database that contains nursing research articles. Please
note: you may be able to use the article that you submitted in
Module Two to meet this requirement.
· The article you will find must meet the following mandatory
requirements:
· It must be based on the topic list attached here.
· It must be from a nursing research journal or have a nurse as
an author.
· It must be no more than 5 years old from the current
publication year.
· It must include implications and / or interventions that are
applicable to nursing practice.
· It may not be a qualitative article, systematic review, meta-
synthesis, meta-analysis, meta-summary, integrative review or a
retrospective / quality improvement study. For more information

on how to recognize these types of article see Grove & Gray
(2019) pp. 21-23.
· It may not be a clinical information article or “how-to” article.
· Step four: If you have questions about your PICO question
formatting or the nursing quantitative research article that you
found, post them to the Q & A discussion board for feedback
from your peers.
· Self-check: if you choose the wrong type of nursing
quantitative research article for your paper (the one that you
will be using to write paragraph 2, 3, 4, & 5) the best grade you
could make is a 55. Yikes!!! Please make sure that you have
selected a nursing quantitative research article that meets the
criteria for this assignment and ask for help if you are not sure.
Please note: you may be able to use the article that you
submitted in Module Two to meet this requirement.
· Step Five: Collecting More Evidence (Do the research)
· Find a resource published within the past 5 years that provides
you with at least two facts (ex. costs, morbidity, mortality,
safety, or other related statistics) for why your clinical problem
is important (provide statistics). (The internet is a great place
to get this information…just don’t forget to cite this
information and add it to your reference page).
· Find a clinical practice guideline at
https://www.ahrq.gov/gam/index.html that relates to your
question. It must have information that relates to the role of the
nurse. Guideline is the most recent version or published within
the past five years. (It is true that guidelines are not always
updated within 5 years so you will need to discuss this.)
· Find a clinical “how-to” article, a nursing professional
practice website, a systematic literature review, a meta-analysis,
or a manufacturer’s website published within the past 5 years
that relates to your practice question.

· Hint: Did you notice that you will be finding a total of four
different sources of information for your PICO question? To
re-cap, these four sources are:
· Statistics you are reporting in paragraph one.
· Nursing quantitative research article for paragraphs 2, 3, 4,
and 5.
· Clinical Practice Guideline (paragraph 6)
· A source of your choosing (paragraph 7)
· Step Six: Write up your findings in APA format and submit
them to assignment portal by the due date and time listed in
your syllabus. Here’s how to write up your findings:
· Start with a UTA CONHI approved cover page.
· Paragraph #1: This is your opening paragraph. Start with an
introduction statement. What is your PICO question? Describe
why was it important (share the dollars, morbidity / mortality,
statistics, safety stats you found with citation)?
· Paragraph #2: What did your nursing quantitative research
article add to your knowledge on this topic? Share at least three
facts (two must be from the Results or Discussion sections) that
you found within the article in this paragraph that is relevant to
your PICO question and your practice as a nurse.
· Paragraph #3: Define reliability as it is used in your textbook.
Critique the reliability of the nursing quantitative research
article you used. Go back to what you learned in your article
critique about measurement methods and data collection in
Module 3 to make sure you are being thorough in your
assessment. Use Table 10-1 in your textbook to identify the type
of reliability for your measurement instrument / tool. Be
specific, so that your instructor, if reading the article, can find
them too.
· Paragraph #4: Define validity as it is used in your textbook.

Critique the validity of the nursing quantitative research article
you used. Go back to what you learned in your article critique
about measurement methods, and data collection to make sure
you are being thorough in your assessment. Use Table 10-1 in
your textbook to identify the type of validity for your
measurement instrument / tool. Be specific, so that your
instructor, if reading the article, can find them too.
· Paragraph #5: Using the skills you have learned in your
critique of a research article, describe two strengths or two
weaknesses (or one strength and one weakness) that you found
as you read this article. Go back to what you learned in your
article critique about sampling methods, measurement methods
(ex. questionnaires), and data collection (how did they collect
the data to make sure you are being thorough in your
assessment. Be specific, so that your instructor, if reading the
article, can find them too. Do not re-state the limitations
provided by the authors of your study unless they have to do
with the study’s sampling, measurement methods, or data
collection. Do not discuss the descriptive or inferential
statistics used by the authors as a strength or weakness of the
study, as this is not related to with the study’s sampling,
measurement methods, or data collection.
· Paragraph #6: What is the name and website of the clinical
practice guideline that you found? Share at least three facts
that you found within the guideline that is relevant to the PICO
question and your practice as a BSN nurse and cite the guideline
appropriately.
· Paragraph #7: Identify the fourth resource you found (clinical
“how-to” article, a nursing professional practice website, a
systematic literature review, a meta-analysis, or a
manufacturer’s website) that relates to your practice question.
Share at least three facts that you found within this source that
is relevant to the PICO question and your practice as a nurse,
and cite appropriately.

· Paragraph #8 (and #9 if needed): re-state your PICO question
and briefly summarize what you have learned through your
search. What would you recommend, if anything, as a change in
practice for nurses? Why? Remember, this is your closing
paragraph(s).
· Note to students about writing up your findings:
· This is a formal APA paper. Look at the Rubric for more APA
information for this paper.
· Don’t forget to use your APA resources that were reviewed in
Module Two!
· Don’t forget to use the Module Four discussion board for
additional questions about your paper.
· Turn your paper (as a word document) and article (in pdf
format) that you used for paragraphs 2, 3, 4, & 5 in to the
assignment submission link in Module Four at the due date and
time listed in your syllabus.
· Possible points for this assignment: 100 points
Module 4: Evidence Based Practice Project: Finding the
Evidence

PAGE
©2017 UTA School of Nursing
Page 6 of 7
PICO(T) Worksheet
First, identify each element of your PICO on the line below,
then take a look at the templates below to help you formulate a
PICO(T) question.
P: Population/disease ( i.e. age, gender, ethnicity, with a certain
disorder)
P:
_____________________________________________________
_______________
I: Intervention or Variable of Interest (exposure to a disease,
risk behavior, prognostic factor) Note: Not every question will
have an intervention (as in a meaning question – see below).
I:
_____________________________________________________
_______________
C: Comparison: (could be a placebo or "business as usual" as in
no disease, absence of risk factor). Note: This is not used in a
meaning question – see below.
C:
_____________________________________________________
_______________
O: Outcome: (risk of disease, accuracy of a diagnosis, rate of
occurrence of adverse outcome)
O:
_____________________________________________________
_______________

T: Time: The time it takes to demonstrate an outcome (e.g. the
time it takes for the intervention to achieve an outcome or how
long participants are observed). This is an optional “add-on” for
a PICO question.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
For PICO questions about a nursing intervention/therapy:
In _______(P), what is the effect of _______(I) on ______(O)
compared with _______(C) within ________ (T)?
For PICO etiology questions:
Are ____ (P) who have _______ (I) at ___
(increased/decreased) risk for/of_______ (O) compared with
______ (P) with/without ______ (C) over _____ (T)?
For PICO questions involving prevention:
For ________ (P) does the use of ______ (I) reduce the future
risk of ________ (O) compared with _________ (C)?
For PICO questions that predict:
Does __________ (I) influence ________ (O) in patients who
have _______ (P) over ______ (T)?
For PICO questions that want to know more about the meaning
of…..
How do ________ (P) diagnosed with _______ (I) perceive
______ (O) during _____ (T)?
Based on Melnyk B., & Fineout-Overholt E. (2010). Evidence-
based practice in nursing & healthcare. New York: Lippincott
Williams & Wilkins.

Medeiros LNB de, Silva DR da, Guedes CDFS et al. .docx

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