Benchmark Part B: Literature Review.

Benchmark Part B: Literature Review.


I would like for you to reference Part A from Order #225374. This paper is a continuation from the first order. If you have questions, please call me.

In Part A, you described the population and quality initiative related to your PICOT (Population/Problem, Intervention, Comparison, Outcome, and Time to achieve the outcome) statement. In this assignment, you will formalize your PICOT and research process. Benchmark Part B: Literature Review.


Use the GCU Library to perform a search for peer-reviewed research articles. Find five peer-reviewed primary source translational research articles.
In a paper of 1,250-1,500 words, synthesize the research into a literature review. The literature review should provide an overview for the reader that illustrates the research related to your particular PICOT. Include the following:
Introduction: Describe the clinical issue or problem you are addressing.
Methods: Describe the criteria you used in choosing your articles
Synthesize the Literature: Part A: Discuss the main components of each article (subjects, methods, key findings) and provide rationale for how this supports your PICOT; Part B: Compare and contrast the articles: Discuss limitations, controversies, and similarities/differences of the studies.
Areas of Further Study: Analyze the evidence presented in your articles to identify what is known, unknown, and requires further study.
You are required to cite five to 10 sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. Benchmark Part B: Literature Review.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.
Benchmark Information
This benchmark assignment assesses the following programmatic competencies:
MS Nursing: Public Health
MS Nursing: Education
MS Nursing: Acute Care Nurse Practitioner
MS Nursing: Family Nurse Practitioner
MS Nursing: Health Care Quality and Patient Safety
3.2: Analyze appropriate research from databases and other information sources to improve health care practices and processes.


Hospital-Acquired Pressure Ulcers (HAPUs) is an issue of public health significance across the globe and in the USA. In acute care settings, their prevalence and incidence range between 12%-18% and 0.4%-12% respectively (Qaseem et al, 2015).  In long-term care facilities (LTC), their prevalence and incidence range between 8.8% -53.2% and 2.2%-23.9% respectively. In the United States, the prevalence of HAPUs is estimated at 1.3-3 million. HAPUs incur the DHS (Department of Healthcare Services) approximately $2.2-3.6 billion every year (Qaseem et al, 2015). They also increase the nursing workload, cause mild to severe pain, poor QoL, and increased exposure to secondary infections. This ultimately increases mortality and morbidity rates. Benchmark Part B: Literature Review.

HAPUs harm the financial performance of healthcare organizations since the CMS (Centers for Medicare and Medicaid Services) decided not to reimburse hospitals for HAIs (healthcare-associated infections) such as HAPUs. It is for this reason that most hospitals including the author’s healthcare organization treat HAPUs as a measure of the quality of care delivered and implement measures to decrease their incidences (Qaseem et al, 2015). The most effective evidence-based prevention measure is implementing HAPU care bundles comprising of 3-5 elements with a multidisciplinary approach. Care bundles have been evidenced to be the most effective since it combines skincare, risk assessment, education, nutrition, and repositioning. Benchmark Part B: Literature Review.


The author conducted an initial search for literature in the electronic databases of PubMed, Cochrane, and Medline using the keywords; Hospital-acquired pressure ulcer (HAPU), care bundle, prevention bundle, HAPU, pressure ulcer, pressure injury, and prevention. For a more refined search outcome, the author used Boolean search operators ‘AND’ and ‘OR’ to transit between the key terms. The search included both full text and non-full text peer-reviewed articles published between the years 2015 to 2020 that addressed how to decrease the incidences of HAPUs using HAPU care bundles with the following outcome measures;  a decrease in the prevalence and incidence of HAPUs decreased healthcare costs, increased patient and nurse satisfaction.  The overall search yielded 120 articles. However, after applying the aforementioned search strategies, the final number of articles that were directly relevant to the change subject was five articles. Benchmark Part B: Literature Review.

Synthesize the Literature: Part A

The study by Barakat-Johnson et al (2019) was based on the background knowledge of HAIs as a healthcare quality indicator. The researchers highlight how there is limited evidence on nurses’ experiences in providing HAPU care in hospital settings. The purpose of the study was to understand nurses’ experiences in preventing and managing HAPUs (Barakat-Johnson et al, 2019). The researchers used a qualitative research design and a purposive sample of 20 nurses who worked in units that had high incidences of HAPUs in a  local hospital in  Sydney, Australia. Data was collected through individual and semi-structured interviews between May and 26th September. The researchers identified four major themes from nurses’ experiences as follows: ‘managing competing demands’, ‘successes, organizational expectations, and purpose clarification’, ‘the significance of skills and knowledge’, and ‘ethical challenges’. This study supports the PICOT question as it describes how to address potential barriers and challenges when implementing interventions to prevent pressure injury. Benchmark Part B: Literature Review.

Frank et al (2017) purposed to assess how a HAPU bundle impacted care in pediatric hospitals. They used the Children’s Hospitals Solutions for Patient Safety (SPS) Network to prevent HAPUs. They analyzed the changes in the rates of HAPUs through binomial analyses and used funnel charts to evaluate the relationship between rates of HAPUs and reliable implementation of HAPU bundles. The findings revealed that, among 33 hospitals that took part in the SPS intervention, there was a significant decrease in the rates of HAPUs stage 3 per 1000 patient days (P < 0.001, 0.06 to 0.03 ) (Frank et al, 2017). HAPUs stage 4 also decreased (P = 0.02, 0.01 to 0.004). Of the 78 hospitals that took part in phase 1 and, there was an 80% bundle compliance for hospitals that adopted each care bundle element with significantly low rates of HAPUs. In relation to the PICOT question, this study   describes an active team-based care model   for detecting and implementing HAPUs bundles to reduce   HAPUs associated harms among children

Lavallée et al. (2019) acknowledge HAPUs as painful and negative influencers of healthcare costs and HRQL (healthcare-related quality of life) and highlight patients in long term care facilities as those at the highest risk .Using a mixed-methods study design, the researchers conducted a study on the use of a HAPU care bundle (skin inspection, support surfaces, and repositioning) in a nursing home based in North England (Lavallée et al., 2019). The researchers collected quantitative data on HAPUs prevention behaviors from staff in the nursing home and the incidences of HAPUs for 5 weeks before bundle implementation. During implementation, the researchers collected data for additional 9 weeks while assessing participants’ adherence and experiences. Benchmark Part B: Literature Review. Qualitative and quantitative data were collected as analyzed using a deductive framework and descriptive statistics. Before implementation, the researchers managed to collect data from 462 participants with five new HAPUs incidences and repositioning was the only documented HAPU prevention behavior. In the intervention phase, researchers collected data from 1181 residents with no new HAPUs incidences, and the documented HAPU prevention interventions were checking support surfaces, repositioning, and skin inspection (Lavallée et al., 2019). This study highlights several issues in recruiting, retaining, collecting data, and implementing HAPUs care bundles with regards to the PICOT. It particularly describes how researchers can improve nursing staff responsiveness and acceptance of a HAPU care bundle. Benchmark Part B: Literature Review.

The objective of the study by Chaboyer et al (2016) was to evaluate the usefulness of a HAPU bundle to prevent HAIs among high-risk patients. Using a cluster RCT design, the researchers stratified 1600 patients aged ≥18 years old and at high risk of HAPU to eight tertiary referral hospitals based on current HAPUs incidences to either standard care or a HAPU prevention care bundle. The total number of patients who were randomized to four clusters was 799 corresponding to an intraclass correlation coefficient of 0.035. The hazard ratio post-implementation was 0.5895% (p = 0.198) with no reported adverse events Chaboyer et al (2016).  This paper highlights how nursing staff can collaborate with patients as a positive reinforcement measure towards preventing HAPUs. Benchmark Part B: Literature Review.

The study by Gupta et al (2020) aimed at decreasing the incidences of pressure injuries in an ICU in Doha by 60% through increasing awareness of the significance of HAPU prevention measures. The researchers tested and implemented a HAPU prevention bundle (skin inspection, nutrition, support surfaces, incontinence, and keep moving). The primary outcome measures were HAPU incidences (primary counts of HAPU incidences) and prevalence (the number of HAPUs per 100 patients) (Chaboyer et al, 2016). Data collected was analyzed using statistical independent t-tests which targeted the significance of potential differences in the incidences of HAPUs pre and post-implementation. The findings of the study revealed that HAPU incidences decreased to 1.1/1000 from 6.1/1000 patient-days (83.5%) decrease.  Based on the hospital’s quarterly survey, the prevalence of HAPUs decreased to 2.0/100 from 9.7/100 surveyed patients (73.4% decrease) (Chaboyer et al, 2016). This study highlights how researchers can use the Plan-Do-Study-Act change model with a multidisciplinary approach to implementing HAPU care bundles in healthcare organizations. Benchmark Part B: Literature Review.

Part B: Compare and Contrast the Articles

Although Frank et al (2017) conducted this study as a quality improvement collaborative; the researchers used multiple interventions with varied penetrance in the area of study. Therefore, it was difficult to make conclusions on the rates of HAPUs in individual hospitals as compared to hospitals’ compliance to care bundles. As a result, it can easily be concluded that the five bundle components are effective when implemented together but it may be difficult to point specific outcomes to particular bundle elements.

The quantitative findings of the study by Lavallée et al. (2019) supported the qualitative findings. However, a major limitation of this study is that the researchers used a small sample and depended on self-reported participant behaviors to collect data. Therefore, the participants were aware that the researchers were monitoring their HAPU prevention behaviors increasing the likelihood of outcome bias. However, the findings there are supported by the findings of the study by Barakat-Johnson et al (2019) which reveals that; a positive attitude towards HAPU prevention bundles, good communication, and increasing awareness on HAPU prevention practices promotes a decrease in the incidence and prevalence of HAPUs. To promote a better understanding of the feasibility issues encountered during the implementation of HAPU prevention bundles, Frank et al (2017) and Lavallée et al. (2019) recommend that, future studies should focus on identifying ways to improve recruitment,  retention, data collection, and adherence of staff to HAPU bundles. Benchmark Part B: Literature Review.

Based on the findings of the study by Chaboyer et al (2016) and Gupta et al (2020), a pressure injury (PI) is an area of localized injury to underlying tissue or skin over a bony prominence due to pressure. Since they vary based on severity, PIs can be categorized into stages. Both studies emphasize the essence of patients to work closely with healthcare providers in understanding and developing individualized HAPUs prevention plans. The study by Chaboyer et al (2016) adds that nursing staff can use gold-standard skin inspection methods for detecting PUs. This study’s main limitation is its low statistical power due to small clusters. Similarly, Gupta et al (2020) used a small population sample size in their study. However, both researchers acknowledge that, although the findings have no statistical significance, they are clinically significant. The major lesson from both studies was stakeholder involvement through multidisciplinary collaboration, using the PDSA cycle to implement change, and the need for frontline staff to be fully aware of their unit data. It is for this reason that both Gupta et al (2020) and Chaboyer et al (2016) recommend that, further studies should focus on using large population samples. Benchmark Part B: Literature Review.