Nursing Research

Course Project: Part 2Literature Review

Course Text: Polit,D.F., Beck, C.T.(2012). Nursing Research Generating and Assessing Evidence for Nursing Practice.p.94-125.(chapter 5). Please read before proceeding with paper.

Use only scholarly journals and articles found in University Database for Literature Review.

The literature review is a critical piece in the research process because it helps a researcher determine what is currently known about a topic and identify gaps or further questions. Conducting a thorough literature review can be a time-consuming process, but the effort helps establish the foundation for everything that will follow. For this part of your Course Project, you will conduct a brief literature review to find information on the question that you developed in Week 2. This will provide you with experience in searching databases and identifying applicable resources.

To prepare:

Review the information in Chapter 5 of the course text, focusing on the steps for conducting a literature review and for compiling your findings.

Using the question that you selected in your Week 2 Project (Part 1 of the Course Project), locate 5 or more full-text research articles that are relevant to your PICO question. Include at least 1 systematic review and 1 integrative review if possible. Use the search tools and techniques mentioned in your readings this week to enhance the comprehensiveness and objectivity of your review. You may gather these articles from any appropriate source, but make sure at least 3 of these articles are available as full-text versions through Walden Librarys databases.

Read through the articles carefully. Eliminate studies that are not appropriate and add others to your list as needed. Although you may include more, you are expected to include a minimum of five articles. Complete a literature review summary table using the Literature Review Summary Table Template located in this weeks Learning Resources.

Prepare to summarize and synthesize the literature using the information on writing a literature review found in Chapter 5 of the course text.

To complete:

Develop a 2- to 3-page literature review that includes the following:

A synthesis of what the studies reveal about the current state of knowledge on the question that you developed

o Point out inconsistencies and contradictions in the literature and offer possible explanations for inconsistencies.

Preliminary conclusions on whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address your inquiry

Your literature review summary table with all references formatted in correct APA style

Note: Certain aspects of conducting a standard review of literature have not yet been covered in this course. Therefore, while you are invited to critically examine any aspect of the studies (e.g., a studys design, appropriateness of the theoretic framework, data sampling methods), your conclusion should be considered preliminary. Bear in mind that five studies are typically not enough to reflect the full range of knowledge on a particular question and you are not expected to be familiar enough with research methodology to conduct a comprehensive evaluation of all aspects of the studies.

Wound V.A.C. Therapy

Introduction

           

Course Project: Part 2Literature Review

Course Text: Polit,D.F., Beck, C.T.(2012). Nursing Research Generating and Assessing Evidence for Nursing Practice.p.94-125.(chapter 5). Please read before proceeding with paper.

Use only scholarly journals and articles found in University Database for Literature Review.

The literature review is a critical piece in the research process because it helps a researcher determine what is currently known about a topic and identify gaps or further questions. Conducting a thorough literature review can be a time-consuming process, but the effort helps establish the foundation for everything that will follow. For this part of your Course Project, you will conduct a brief literature review to find information on the question that you developed in Week 2. This will provide you with experience in searching databases and identifying applicable resources.

To prepare:

Review the information in Chapter 5 of the course text, focusing on the steps for conducting a literature review and for compiling your findings.

Using the question that you selected in your Week 2 Project (Part 1 of the Course Project), locate 5 or more full-text research articles that are relevant to your PICO question. Include at least 1 systematic review and 1 integrative review if possible. Use the search tools and techniques mentioned in your readings this week to enhance the comprehensiveness and objectivity of your review. You may gather these articles from any appropriate source, but make sure at least 3 of these articles are available as full-text versions through Walden Librarys databases.

Read through the articles carefully. Eliminate studies that are not appropriate and add others to your list as needed. Although you may include more, you are expected to include a minimum of five articles. Complete a literature review summary table using the Literature Review Summary Table Template located in this weeks Learning Resources.

Prepare to summarize and synthesize the literature using the information on writing a literature review found in Chapter 5 of the course text.

To complete:

Develop a 2- to 3-page literature review that includes the following:

A synthesis of what the studies reveal about the current state of knowledge on the question that you developed

o Point out inconsistencies and contradictions in the literature and offer possible explanations for inconsistencies.

Preliminary conclusions on whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address your inquiry

Your literature review summary table with all references formatted in correct APA style

Note: Certain aspects of conducting a standard review of literature have not yet been covered in this course. Therefore, while you are invited to critically examine any aspect of the studies (e.g., a studys design, appropriateness of the theoretic framework, data sampling methods), your conclusion should be considered preliminary. Bear in mind that five studies are typically not enough to reflect the full range of knowledge on a particular question and you are not expected to be familiar enough with research methodology to conduct a comprehensive evaluation of all aspects of the studies.

Wound V.A.C. Therapy

Introduction

            Wound healing, particularly chronic wound healing, is an extremely dynamic and complicated process that involves an immediate cell migration sequence, which results to closure and repair. This sequence commences with debris removal, infection control, clearing inflammation, granulation tissue’s deposition, angiogenesis, contraction, connective tissue matrix’s remodeling, and maturation. Failure for a wound to undergo through this sequence results to a chronic wound that does not have functional or anatomical integrity. This paper is a literature review that aims at discussing the current knowledge, contradictions and inconsistencies, and conclusions from the evidence regarding whether wound V.A.C. therapy should be changed in regard to home health care of chronic wounds when its effectiveness is compared to traditional therapies.

Current state of knowledge

            In a retrospective study, Baier et al (2003) elaborated VAC utilization in ninety three patients for a period of more than four years. The patients were in need of open abdomen management for a number of conditions. A total of thirty eight surgical and fifty five traumatic injury patients had 171 dressing applied on them. After their analysis, the researches came to the conclusion that with keen subsequent management, desirable patient outcomes can be reached. They recommended VAC as the preferable treatment method for temporary abdominal closure and open abdomen management.

            As argued by Philbeck et al (1999), VAC can be combined with split thickness skin grafts for effective burns’ treatments. This is particularly applicable in body sites that have deep and irregular contours including axilla, hand, and perineum. In home health care setups, the vacuum is useful in holding the graft and wound bed together securely. This hinders tissue fluid’s pooling, which is likely to destabilize the graft.

            Blume et al (2008) assert that VAC is highly effective in treating donor sites especially in areas where controversial techniques are difficult to apply, for instance, radial forearm areas. These researchers reported that approximately one-third of all radial forearm free flap’s patients develop complications concerning exposed tendons. Therefore, the researchers recommend that these patients can benefit immensely from VAC therapy.

            In their research, Trueman et al (2008) elaborated how they utilized VAC together with skin grafts in treating four patients who had entirely lost the full thickness of their scalps after extensive carcinoma’s excision and burn injuries. Normally, if flaps cannot be used in the closure of such wounds, the skull’s outer surface is removed to gain punctate bleeding and one or two weeks later, a skin graft is used after granulation tissue starts forming. If this delay is ignored, there is an exceptionally poor graft take. When VAC is being used, a skin graft can be applied immediately after the operation starts.

Lyder et al (2004) found out that VAC can be used effectively in a wide array of chronic and non-healing wounds including pressure sores, suspected bites from the Brown Recluse Spider, leg ulcers, and recalcitrant that are below knee amputation wounds. This included thirty patients who had longstanding wounds that were not recommended for reconstructive surgery. Twenty six of the patients recovered successfully.

Contradictions and inconsistencies and their explanations

            Blume et al (2008) recommend that VAC is being used in donor site dressings, a particularly wound contact layer that is low adherent for instance paraffin or adaptic gauze can be used under the foam layer. There is no consensus regarding the use of VAC on sacral pressure ulcers that are near the anus as well as to multiple huge ulcers that are located on lower extremeties. According to the research articles used in this literature review, the following are the contraindications for using VAC in chronic wound treatment; anastomotic sites, unexplored and non-enteric fistulas, untreated osteomyelitis, exposed nerves, organs, veins, or arteries, necrotic tissues that have eschar, and malignant wounds but with palliative care exceptions that improves quality of life.

Conclusions regarding the evidence- strong evidence for changing the practice or further research to address the inquiry adequately

            From the foregoing discussion, it is evident that wound V.A.C. therapy has been extremely beneficial in treating chronic wounds. In patients who are receiving health care from home, the therapy helps in reducing the time and improving healing of wounds when compared to traditional wound management approaches. Further research was necessary to identify whether there are any inconsistencies regarding the use of VAC to treat chronic wounds. However, the information gathered offers solid evidence regarding the continued use of VAC to treat chronic wounds.

Conclusions

            Vacuum assisted closure enhances wound closure and, therefore, faster wound healing. This minimizes pain and discomfort, which results to a higher well-being sense. Other chronic wound treatments necessitate a minimum of two daily dressing changes, which calls for unique techniques and skills to reduce infection risks. Being a closed system, VAC requires dressing changes every forty eight hours. Minimal wound exposure leads to lower infection risks and minimizes the need for qualified personnel and material considering that home health care is of key concern in this essay.

References

Baier, R., Gifford, D., Lyder, C., et al. (2003). Quality improvement for pressure ulcer care in the nursing home setting: the northeast pressure ulcer project. J Am Med Dir Assoc.4:291–301.

Blume, P.A., Walters, J., Payne, W., Ayala, J., & Lantis, J. (2008). Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter randomized controlled trial. Diabetes Care 31:631–636.

Lyder, C., Grady, J., Mathur, D., et al. (2004). Preventing pressure ulcers in Connecticut hospitals using the plan-do-study-act model for quality improvement. Jt Comm J Qual Patient Saf. 30:205–14.

Philbeck, T. E., Whittington, K. T., Millsap, M. H., Briones, R. B., Wight, D. G., & Schroeder, W. J. (1999).The clinical and cost effectiveness of externally applied negative pressure wound therapy in the treatment of wounds in home healthcare Medicare patients. Ostomy Wound Manage, 45(11):41-50.

Trueman, T. N., Flack, L. A.,  Loonstra, P. D., & Hauser, W. D. (2008). The feasibility of using V.A.C. Therapy in home care patients with surgical and traumatic wounds in the Netherlands. Int Wound J. 5(2):225-3

, particularly chronic wound healing, is an extremely dynamic and complicated process that involves an immediate cell migration sequence, which results to closure and repair. This sequence commences with debris removal, infection control, clearing inflammation, granulation tissue’s deposition, angiogenesis, contraction, connective tissue matrix’s remodeling, and maturation. Failure for a wound to undergo through this sequence results to a chronic wound that does not have functional or anatomical integrity. This paper is a literature review that aims at discussing the current knowledge, contradictions and inconsistencies, and conclusions from the evidence regarding whether wound V.A.C. therapy should be changed in regard to home health care of chronic wounds when its effectiveness is compared to traditional therapies.

Current state of knowledge

            In a retrospective study, Baier et al (2003) elaborated VAC utilization in ninety three patients for a period of more than four years. The patients were in need of open abdomen management for a number of conditions. A total of thirty eight surgical and fifty five traumatic injury patients had 171 dressing applied on them. After their analysis, the researches came to the conclusion that with keen subsequent management, desirable patient outcomes can be reached. They recommended VAC as the preferable treatment method for temporary abdominal closure and open abdomen management.

            As argued by Philbeck et al (1999), VAC can be combined with split thickness skin grafts for effective burns’ treatments. This is particularly applicable in body sites that have deep and irregular contours including axilla, hand, and perineum. In home health care setups, the vacuum is useful in holding the graft and wound bed together securely. This hinders tissue fluid’s pooling, which is likely to destabilize the graft.

            Blume et al (2008) assert that VAC is highly effective in treating donor sites especially in areas where controversial techniques are difficult to apply, for instance, radial forearm areas. These researchers reported that approximately one-third of all radial forearm free flap’s patients develop complications concerning exposed tendons. Therefore, the researchers recommend that these patients can benefit immensely from VAC therapy.

            In their research, Trueman et al (2008) elaborated how they utilized VAC together with skin grafts in treating four patients who had entirely lost the full thickness of their scalps after extensive carcinoma’s excision and burn injuries. Normally, if flaps cannot be used in the closure of such wounds, the skull’s outer surface is removed to gain punctate bleeding and one or two weeks later, a skin graft is used after granulation tissue starts forming. If this delay is ignored, there is an exceptionally poor graft take. When VAC is being used, a skin graft can be applied immediately after the operation starts.

Lyder et al (2004) found out that VAC can be used effectively in a wide array of chronic and non-healing wounds including pressure sores, suspected bites from the Brown Recluse Spider, leg ulcers, and recalcitrant that are below knee amputation wounds. This included thirty patients who had longstanding wounds that were not recommended for reconstructive surgery. Twenty six of the patients recovered successfully.

Contradictions and inconsistencies and their explanations

            Blume et al (2008) recommend that VAC is being used in donor site dressings, a particularly wound contact layer that is low adherent for instance paraffin or adaptic gauze can be used under the foam layer. There is no consensus regarding the use of VAC on sacral pressure ulcers that are near the anus as well as to multiple huge ulcers that are located on lower extremeties. According to the research articles used in this literature review, the following are the contraindications for using VAC in chronic wound treatment; anastomotic sites, unexplored and non-enteric fistulas, untreated osteomyelitis, exposed nerves, organs, veins, or arteries, necrotic tissues that have eschar, and malignant wounds but with palliative care exceptions that improves quality of life.

Conclusions regarding the evidence- strong evidence for changing the practice or further research to address the inquiry adequately

            From the foregoing discussion, it is evident that wound V.A.C. therapy has been extremely beneficial in treating chronic wounds. In patients who are receiving health care from home, the therapy helps in reducing the time and improving healing of wounds when compared to traditional wound management approaches. Further research was necessary to identify whether there are any inconsistencies regarding the use of VAC to treat chronic wounds. However, the information gathered offers solid evidence regarding the continued use of VAC to treat chronic wounds.

Conclusions

            Vacuum assisted closure enhances wound closure and, therefore, faster wound healing. This minimizes pain and discomfort, which results to a higher well-being sense. Other chronic wound treatments necessitate a minimum of two daily dressing changes, which calls for unique techniques and skills to reduce infection risks. Being a closed system, VAC requires dressing changes every forty eight hours. Minimal wound exposure leads to lower infection risks and minimizes the need for qualified personnel and material considering that home health care is of key concern in this essay.

References

Baier, R., Gifford, D., Lyder, C., et al. (2003). Quality improvement for pressure ulcer care in the nursing home setting: the northeast pressure ulcer project. J Am Med Dir Assoc.4:291–301.

Blume, P.A., Walters, J., Payne, W., Ayala, J., & Lantis, J. (2008). Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter randomized controlled trial. Diabetes Care 31:631–636.

Lyder, C., Grady, J., Mathur, D., et al. (2004). Preventing pressure ulcers in Connecticut hospitals using the plan-do-study-act model for quality improvement. Jt Comm J Qual Patient Saf. 30:205–14.

Philbeck, T. E., Whittington, K. T., Millsap, M. H., Briones, R. B., Wight, D. G., & Schroeder, W. J. (1999).The clinical and cost effectiveness of externally applied negative pressure wound therapy in the treatment of wounds in home healthcare Medicare patients. Ostomy Wound Manage, 45(11):41-50.

Trueman, T. N., Flack, L. A.,  Loonstra, P. D., & Hauser, W. D. (2008). The feasibility of using V.A.C. Therapy in home care patients with surgical and traumatic wounds in the Netherlands. Int Wound J. 5(2):225-3

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