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Literature Review

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Student’s name: Vladimir Andino

University affiliation: GCU

Date: 02/25/19

Literature Review


Pressure ulcers, also known as bedsores or decubitus ulcers are injuries which to the skin and the underlying tissues which result from too much pressure on the skin. There are different risk factors for pressure ulcers which are very crucial in determining the type of treatment or prevention to be administered to a patient. This includes poor mobility, poor blood flow, poor nutritional status, the patient support surfaces, age, and neuropathy among others. For each of these risk factors, there are different interventions which can be used by healthcare professionals to prevent and treat pressure ulcers. The purpose of this essay is to evaluate how different research questions can be developed focusing on the risk factor of poor nutritional status. Whereas the PICOT statement outlines the interest areas of this research, this report will analyze important components of different PICOT research questions.

Comparison of research questions

Poor nutrition is a significant risk factor for pressure ulcers. Even though there are a few researches which support this argument, the lack of proper nutrition increases the risk of patients developing pressure ulcers (Frykberg, & Banks, 2015). Based on evidence from credible sources, there are two distinct research questions which can be developed to investigate the relationship between nutrition and prevalence of pressure ulcers. The first question is whether providing necessary nutritional requirements to patients reduces their risk of developing pressure ulcers. The second question is whether providing additional nutritional supplementation to patients with pressure ulcers improve healing.

The first question relates directly to the PICOT statement and focuses on establishing whether the provision of certain nutrients to patients will prevent the incidence of the condition. As such this research would only be viable for patients who don’t have pressure ulcers. The second question, on the other hand, investigates whether enhancing the nutritional intake of patients helps in treating pressure ulcers. According to the National Institute for Health and Care Excellence (2014), there are different nutrients which are known to enhance pressure ulcer repair through collagen formation and development of connective tissue. These nutrients include vitamin C, protein, and zinc. This research is viable for patients who already have pressure ulcers. Even though each of these research questions aims at investigating the impact on nutrition on the prevalence of the condition, the second research question would be more effective. This is because in the first question other risk factors may have a huge impact on the research.

Comparison of sample populations

The population at high risk of developing pressure ulcers is adults who suffer from conditions such as spinal cord injury, stroke, or old age which makes them immobile. For each of the research, it would be important to identify a target population which shares a close similarity. This is because the incidence of pressure ulcers is dependent on the environment of the patient. For example, it may be difficult to identify early signs of pressure ulcers for a patient with a skin condition which affects the normal appearance of the skin. For the first research question, the sample population will only include patients who have not contracted pressure but are at risk of contracting the disease due to their health conditions. For example, patients who are admitted for bed rest for a long time. For the second research question, it will be important to sample patients who are initially under the same conditions and environments. For example, the research will primarily focus on patients with spinal injury in a particular from a particular nursing home. This means that each of the patients receives similar care service and is given the same foods or foods with similar nutritional values. The control group will then be introduced to foods with additional nutrients which are known to reduce the effect of pressure ulcers.

Comparison of the limitation of the study

For the first research question, the main limitation of the study is that it may be difficult to evaluate the effects of other risk factors on the outcomes of the research. For example, it may be challenging to determine whether a patient developed pressure ulcers due to poor nutrition or factors such as age, pain which may prevent patients from moving, or the condition of the supporting surface. The limitation of the second research, however, may be majorly science-based. For example, pressure ulcers are caused by both aerobic and anaerobic bacteria (Dana, & Bauman, 2015). As such, different nutritional requirements may be needed in order to destroy them. For both types of research, the major limitation is that the use of a small sample population may not represent all the patients and as such, the research can only be relevant to preventing certain cases of the disease.


Both presented research questions present valid approaches for investigating the relevance of nutrition in preventing and treating pressure ulcers. From each research study, the expected outcome will include a list of essential nutrients which are necessary for the prevention of the condition. Nonetheless, different patients have different health and nutritional needs which is related to their age, general body metabolism, or other factors. This may cause some irregularities of the results. As such, there is a need to include intensive scientific and clinical interventions during the project to ensure that causes of irregularities are identified and justified. This project can be used to improve further research to determine the specific nutritional needs which are needed to address the different kinds of pressure ulcers; either caused by aerobic or anaerobic bacteria.


Ali N. Dana, & William A. Bauman, (2015). Bacteriology of pressure ulcers in individuals with spinal cord injury: What we know and what we should know. J Spinal Cord Medicine; 38(2): 147–160. doi: 10.1179/2045772314Y.0000000234.

Frykberg, R. G., & Banks, J. (2015). Challenges in the treatment of chronic wounds. Advances in wound care4(9), 560-582.

National Institute for Health and Care Excellence (UK), (2014). The Prevention and Management of Pressure Ulcers in Primary and Secondary Care. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK333125/

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