Running head: REFLECTION PAPER 1

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1 Running head: REFLECTION PAPER 1 Reflection Paper: Pressure Ulcer Prevention Angelique Kinyon Ferris State University

2 REFLECTION PAPER 2 Abstract This paper will define nursing research, different types of studies, and what determines a credible source. This paper will also examine and discuss the credibility of three resources previously used in a research paper. The credibility will be examined based on whether or not it is nursing research, the author/source and their involvement/connection with the nursing profession, and contribution to nursing practice.

3 REFLECTION PAPER 3 Reflection Paper: Pressure Ulcer Prevention This paper will analyze and discuss the credibility of sources used in a paper previously written by this author. The purpose of this paper is to elaborate on what makes a source credible/reputable, and evaluate three previously used references based on this criterion. The references will also be evaluated based on their direct relation and significance to nursing practice and whether or not they were written/developed by nurses. When looking at nursing research, it is important to be able to determine the appropriate resources while supporting and enriching the nursing practice with evidence-based information. Review Nursing research appears to be a difficult concept to define. One broad definition is: the systematic, objective process of analyzing phenomena of importance to nursing. (Nieswiadomy, 2012, p. 3). Regardless of the exact definition, it is necessary to nursing as a profession to encompass its own body of knowledge. In order to do so, research is needed to refine and build on said knowledge. In research, there are two basic types of studies: qualitative and quantitative. Both are essential in the development and continuation of nursing research. Qualitative research is a subjective study concerned with quality or experiences based on individual subjects. Whereas quantitative research is the more traditional type of study in which the data is objective, it is often referred to as hard science (Nieswiadomy, 2012, p. 6). In an effort to ensure quality information during research, one must understand what constitutes a credible source. When conducting nursing research, the source should be compiled or written by nurses. In the case of selecting journal articles, a nursing specific journal should be selected when possible. The credibility of the journal can be assessed by the impact factor (IF) (Nieswiadomy, 2012, p. 265). This is a number rating that is determined depending on how often

4 REFLECTION PAPER 4 articles are cited from the journal in one year s time. One other aspect to look for when reviewing a journal is whether or not it is peer-reviewed, indicating that other professionals in the field have read, reviewed, and provided feedback on the article prior to publishing. This is often referred to as the gold standard of scientific publishing. (Nieswiadomy, 2012, p. 265). If the source is not an article from a journal, the authors/editors should be researchable and professional experts with appropriate credentials in the subject matter being discussed. Article 1 The first article under review is Preventing Pressure Ulcers and Skin Tears published in Evidence-based Geriatric Nursing Protocols for Best Practice which is a best practice book. This particular article was published in the 3rd edition of the book in Although this is not a nursing journal, it is a nursing publication that nurses may look to in an effort to enhance their practice and is noted to be a credible source. The article was rather a set of guidelines developed after a review of previous studies, A literature search was conducted to find the best available evidence for each clinical question addressed. The results were rated for level of evidence and sent to the respective chapter author(s) to provide possible substantiation for the nursing practice protocol being developed (Ayello & Sibbald, 2008). The article was accessed through the Agency for Healthcare Research and Quality (AHRQ) website which is a credible source as it is a division of US Department of Health and Human Services (USDHHS). The main editors of the book are Elizabeth Capezuti PhD, RN, FAAN and DeAnne Zwicker, DrNP, APRN, BC. The article itself was written by Elizabeth Ann Ayello, PhD, RN, ACNS-BC, CWON, ETN, MAPWCA, FAAN and R. Gary Sibbald BSc, MD, FRCPC (Med) (Derm), MACP, FAAD, M.Ed., MAPWCA. The majority of people involved are in fact part of the nursing profession and the source is directly related to nursing as it discussed nursing

5 REFLECTION PAPER 5 interventions and their effectiveness. There is a level of borrowed knowledge as Doctor Sibbald was involved. However, the information was still directly related to nursing practices. Overall, this is a credible source with evidence-based information directly related to nursing practice and nursing interventions (Ayello & Sibbald, 2008). Article 2 The next article reviewed is Guideline for Prevention and Management of Pressure Ulcers (Publication No. 2). It was published by the Wound, Ostomy, and Continence Nurses Society (WOCN) which is a professional nursing organization. The guidelines were accessed through the AHRQ website which as previously discussed is a credible resource. This resource was developed by nurses and the information provided relates directly to the improvement of nursing practice. The guidelines were developed by: (a) A panel of nurses from the WOCN membership, representing a wide range of experience and clinical practice backgrounds, was convened to plan the guideline format; (b) a topical outline was designed and specific questions about pressure ulcers were proposed to guide the search of the literature for evidence, and (c) studies reporting primary data relevant to pressure ulcers and specific therapies or diagnostic modalities were included in the review. The panel developed eleven questions related to the prevention and management of pressure ulcers to guide the evidence-based review of the literature. (WOCN, 2010). The evidence was then reviewed by the committee. Eventually after discussions and conferences, the evidence was compiled into the guidelines (WOCN, 2010). This resource overall is credible, reliable, and directly related to and beneficial to nursing practice.

6 REFLECTION PAPER 6 Article 3 The final resource to be examined is an Implementation Guide: Goal 4: Reducing High Risk Pressure Ulcers which was published by Advancing Excellence in America s Nursing Homes in This resource is not as directly related to nursing research and nursing practice but rather to the quality improvement of nursing homes. This in turn can be related back to nursing practice such as it was with this implementation guide. However, it is not coordinated by or developed by nurses. The source is not well known, but is associated with professional organizations such as the Centers for Medicaid & Medicare Services (CMS), American Association for Long Term Care Nursing (AALTCN), and The American Association of Homes and Services for the Aging (AAHSA) (Advancing Excellence in America s Nursing Homes, 2010). However, association does not prove credibility and the information provided should be verified through other more credible sources. When this source was selected, it was done so with the intention of merely using it as a framework to implement the information provided by more credible sources into everyday nursing practice. Reflection Two of the previously mentioned resources were unquestionably credible information from reputable sources that related directly to nursing practice and the nursing profession as a whole. These sources and the information provided should be utilized by all nurses as adjunct to their professional practice. The last resource discussed has a questionable credibility, but it was not used as a source of primary information. When the information was originally obtained by the author, the level of understanding regarding credibility and evidence was not as advanced as it is at present time. The source was not discredited as it appeared to be comparable to similar programs of its type, but rather it was utilized and changed to meet the needs of the author. The

7 REFLECTION PAPER 7 information was utilized in an effort to organize and implement the previously mentioned guidelines into a daily practice at a long-term care facility (LTCF). The information and framework were successfully implemented as an updated protocol resulting in a significant decrease in pressure ulcer prevalence in the LTCF. This shows that although the source was not knowingly credible, the source was used cautiously and compared to other credible sources to assess for consistency in the presented data. This led to the successful utilization of the source. Understanding nursing research and building on the nursing knowledge is essential to the advancement of individual nurses and to the profession as a whole. Nurses can utilize research in order to not only improve the nursing practice and patient care, but also to build on the nursing knowledge as nursing becomes an increasingly autonomous profession. With the increased autonomy comes increased accountability. This is yet another reason to have a strong evidencebased practice as it will aid in more favorable outcomes and fewer errors (Nieswiadomy, 2012). In an effort to not fall stagnant as individual nurses and as a profession, it is up to nurses themselves to drive nursing research and understand the research in order to build on one s practice and provide the best patient care possible. If it is driven by another medical discipline, it is no longer nursing research; it will merely be medical research, leaving nursing to regress back to merely a vocation rather than a profession (Nieswiadomy, 2012).

8 REFLECTION PAPER 8 References Advancing Excellence in America s Nursing Homes. (2010). Implementation guide: Goal 4: Reducing high risk pressure ulcers. Retrieved October 10, 2012, from Advancing Excellence in America s Nursing Homes website: Ayello, E. A., & Sibbald, R. G. (2008). Preventing pressure ulcers and skin tears. Evidencebased Geriatric Nursing Protocols for Best Practice, Retrieved from Nieswiadomy, R. M. (2012). Foundations of nursing research (6th ed.). Upper Saddle River, NJ: Pearson Education, Inc. Wound, Ostomy, and Continence Nurses Society [WOCN]. (2010, June). Guideline for prevention and management of pressure ulcers (Publication No. 2). Retrieved from