Free Nursing Dissertations - Literature Review Although The Bulk Of This Review Is To Be On Pressure
Literature Review
Although the bulk of this review is to be on pressure sore treatment, there is a clear emphasis on the importance of the evidence base in treatment. We shall therefore begin this review with a comment relating to the analysis of the role of the nurse in evidence based research as perceived by Pearson. (Pearson A 2000). This article is an exemplary tour de force of the arguments both for and against the need for an evidence base in nursing and the research that underpins it. Pearson points to the division between lay nursing and professional nursing which is demarcated by the application of research based practices. It traces the watershed of management provided by Nightingale’s reforms through to the 70s and 80s where theoretical constructs of practice began to evolve and be adopted, through to the current evolution of the nurse specialist and nurse practitioner whose professional status is centrally evidence based.
To consider the evolution of the evidence based review in the area of pressure sores we should perhaps begin with a historical note of scientific interest. Sir James Paget is recorded in 1862 as making the comment that
Elderly patients with femoral neck fractures and other high risk groups develop them (pressure sores) early, "chiefly in the first week," and then made the observation They often appear on the day of operation. It is not just the patient, but every part of his or her body, that must survive the operation.(Bliss MR 1992).
Here we have a classic example of a clinical comment which may, of course, be absolutely true, but has no evidence base whatsoever other than the author’s own opinion. It may be completely biased and have no basis in statistically provable fact. It clearly won’t have been subjected to the scrutiny of a randomised controlled trial but will have doubtless been accepted without question by countless numbers of healthcare professionals over the years.
Having outlined the central importance of the evidence base in this review we shall make a rather more contemporary analysis with the Vohra paper (Vhora RK et al 1986). The paper is now 20 years old and, in many ways is a paper which exemplifies the thrust of this review. It is, in itself, an excellent and comprehensive overview of the pathophysiology, aetiology and management of the pressure sore. The paper appears to be very authoritative and cites nearly 70 references, and yet its value as a suitable evidence base is severely restricted. (MacLean DS 2003).
A critical analysis of the references quoted show that very few of these references are actually study based (as opposed to opinion based), and only one of these is a properly constructed randomised controlled trial which has proper statistical analysis and minimal possibilities for bias.
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