Melding Clinical Practice and Research: Investigating Hospital Acquired Pressure Ulcer Development and the Association with Nutritional Status

Topic:  Nutritional evaluation is an important component in assessing risk for pressure ulcer development. However, limited evidence exists regarding solid indicators for such an evaluation (Doughty, 2008). Experience in the clinical setting further affirms that nurses, even with adequate training, have difficulty in conducting nutritional assessments.

Purpose: The absence of systematic and reliable indicators for nutritional assessment in clinical practice may cause misdirection of resources to patients who do not require nutrition services, at the expense of those who are most in need. Therefore, determination of factors associated with improving measurement efficiency may increase opportunities for nurses to identify appropriate interventions for pressure ulcer prevention and management when they occur. Reports from other studies (Chan, et al., 2009; Cho & Noh, 2009; Stotts and Gunningberg, 2007) and observations of inaccuracies in clinical application of nutritional assessments by direct care nurses provide the rationale for our study of hospital acquired pressure ulcers and nutritional status.

Objectives: This presentation describes components essential to initiating and developing applied clinical research. One component is assembling a team and optimizing their unique qualities. The multidisciplinary team is described, including a certified wound, ostomy, and continence nurse; a nutrition support dietician with advanced clinical nutrition knowledge; a registered nurse with responsibilities in quality and informatics; and a doctoral nurse with a background in nursing education and research. Collaboration needed for data extraction from the electronic medical record and consultation with statisticians is also presented.

Outcomes: The strengths and challenges of starting applied clinical research are shared. Nuances related to “startup costs” beyond the financial aspects and leveraging the qualities and skills of a clinically focused team in order to accomplish the overall research objectives are presented. Evidence from the initial stages of this project demonstrates that continual refinements and adjustments are essential to advancing the agenda.