Article: A narrative review of patients' lived experience of having a pressure injury
Year Published: 2024
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How does this article compare to our practice, policy and/or procedures and what are the advantages and disadvantages to the proposed recommendations in this article?:
ReplyDeleteAs a bedside nurse, pressure injury (PI) prevention and treatment is a daily, at times hourly, consideration. Per our policies at PSJMC, great care is taken to prevent PIs and treatment involves multiple disciplines including dietary/nutrition, medication, pain management, PT, positioning, incontinence care, etc. However, the research focus is on social implications of a PI. This aspect is less considered in the hospital setting. Patient's feelings of social isolation due to a wound and lack of control is not often discussed. Providing more education to patient and family could be away for patients to feel more in control of the healing process. Also, providing alternative ways for patients to gain social interaction through alternative methods, such as FaceTime, may help to reduce social isolation.
This entry is by Karen Caneday, RN, 6NE
DeleteDiscuss the research question or main problem discussed in the study:
ReplyDeleteThe authors wanted to know how pressure injuries (PIs) affected patients across various domains. The areas they look at were: emotional and psychological effects, physiological effects and social effects. Some examples of emotional/psychological effects were: depression about being bedridden, despair and despondence about lack of autonomy, hopelessness about recovery. Physiological effects ranged from ongoing pain and discomfort to loss of mobility and independence. Social effects of PIs listed were physical restrictions and social isolation. For future articles, the authors suggested including and evaluating financial consequences as well.
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital:
ReplyDeleteOne of the things that stood out to me was how humiliating it can be to have multiple people looking at the wound at a time and the lack of privacy we sometimes provide. The authors suggest educating caregivers on providing quality, individualized care that respects the patient's autonomy. Pain is another aspect that we may not always take into account. While we usually premedicate for wound care, the authors state that it is imperative to use a pain assessment tool to assess the intensity of the pain. Many patients also suffer from social isolation to which the authors advise encouragement of social systems for the patients.
2nd question: What are the advantages and disadvantages of implementing the article recommendations on our unit and/or hospital?
ReplyDeleteThe advantages include a multi disciplinary approach to wound care. This is done in the hospital setting, however, when the patient is discharged either home or to a nursing facility, it is unclear if the same orders are carried out and if and how wound care is followed up in the outpatient setting. Preferably, the patient would continue with a wound care specialist. While in the hospital, all attempts are made to prevent further damage to skin, patients aren't always compliant with the recommendations and orders of the providers. This is due to a number of factors, including, pain or frustration or embarrassment from the patient. These issues need to be taken into account when assessing a patient's wound care plan.
Karen Caneday, RN, 6NE
1. Describe the method used by the author of the study.
ReplyDeleteThe authors employed a qualitative narrative review method complemented by thematic analysis to explore patients' lived experiences with pressure injuries. This approach aimed to provide unbiased and comprehensive insights into the holistic views of patients, aligning with the inductive methodology recommended by Braun and Clarke (2023). It also aimed to provide a comprehensive understanding of how pressure injuries affect patients across different settings, including acute care, community, and care homes.
2. Discuss the research question or main problem discussed in the study?
The research question addressed in the study focuses on understanding patients' experiences living with pressure injuries. The main problem discussed is the multifaceted impact of pressure injuries on individuals' lives, encompassing various dimensions such as psychological, emotional, psychological, and social effects.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe research question is to review the patients' experience with living with a pressure injury. Through all the articles, there are three major themes that were identified with patients with living with pressure injury: physiological, emotional and psychological, and social affect. Patients with pressure injuries affect their life physiologically by losing their autonomy. The pain with pressure injuries can cause immobility and immense pain. All the things they were able to do before, they can longer do. Emotionally and psychologically has the biggest impact in terms of anxiety and depression. They have many things to worry about and increased fears and anxiety about being hospitalized and being bedridden for treatment. As negative emotions towards their situation increases, their feeling of self worth decreases. Lastly, it affects their social life. The feeling of embarrassment from having odors and appearance of wounds can affect patients in wanting to socialize with even their family and friends. Also having to rely on family and friends for assistance can cause patients to withdraw from social activities.
Describe the method used by the author of the study
The author uses qualitative narrative and qualitative research. The method used was to gain unbiased approach on patient's experience with pressure injuries. There were six electronic databases used to search for 3570 studies. Ultimately, only 69 articles were used due to removing duplications and screening based on title, abstract, inclusions and exclusions criteria. Then after further review, only six article were retrieved. A critical appraisal skills programme (CASP) tool was used for trustworthiness, value, and relevance.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe study discusses the lived experiences of patients suffering from pressure injuries, a significant global health issue that largely affects the elderly due to factors like frailty and immobility. Pressure injuries not only increase morbidity and mortality rates but also impose a heavy economic burden on healthcare systems, costing billions annually in the UK and the US alone. The review combines findings from nine qualitative studies involving 244 participants across various settings, highlighting the physical, emotional, psychological, and social impacts of pressure injuries. Key themes identified include the pain and discomfort experienced by patients, loss of mobility and independence, and social isolation. The review highlights the importance of patient-centered care and calls for further research into the experiences of younger adults and the financial implications of living with pressure injuries.
Describe the method used by the author of the study
The study used a narrative review method to explore the lived experiences of patients with pressure injuries. The review combined data from nine qualitative studies, which involved a total of 244 participants across various settings. The focus of the review was on understanding the physical, emotional, psychological, and social impacts of pressure injuries on patients. Through an analysis of the studies, key themes were identified, including the constant pain and discomfort experienced by patients, the near total loss of mobility and independence, and the resulting social isolation. The review specifically included studies that provided in-depth data on patient experiences. The study also highlighted the need for further research, particularly concerning the experiences of younger adults and the financial burden of living with pressure injuries.
1. Describe the method used by the author of the study
ReplyDeleteThe authors of the article stated that this study is a qualitative narrative review with thematic analysis and an inductive approach to understand, more holistically, patients’ lived experience having a pressure injury. Upon research on the definitions of these research methods, I concluded that the article is a qualitative narrative review, or a study of several different articles on narratives of patient experience living with a pressure ulcer. The thematic analysis is analyzing qualitative data in these articles that were chosen for the study. And the inductive approach they used was a method of choosing the articles based on specific inclusion and exclusion criteria, which they listed, and then generalizing their findings to conclude that this is what most paients’ lived experience having a pressure injury is.
2. Discuss the sample size used in the study.
I think that based on the methods of retrieving data and the inductive approach applied to obtaining data really narrowed down the sample size in this study. The inductive approach narrowed down the articles used in this study to only 9. And the author even explains in the conclusion that the age range that they were originally planning to study was 18 and older, but ended up as being 21-101 years old after the 9 articles were chosen. The author even writes that there is a bias toward males after review of these 9 articles. When reading about the patients’ experiences in each of there articles included, I do think that there is enough information to generalize what it’s like to live with a pressure ulcer. This includes the amount of pain one might be in, immobility and independence issues, the many emotional and psychological impacts, and even financial consequences that may happen. Although, every patient and situation is different, the sample size in the study really highlighted these impacts on someone’s life and will help me in my practice because I will remember that someone can be affected in all aspects of their life if they get a pressure ulcer, and can range from young people to old people.
Sabrina Ittidecharchoti, RN, 6NE
1. How does this article compare to our practice, policy and/or procedures and what are the advantages and disadvantages to the proposed recommendations in this article?:
ReplyDeletePressure injury (PI) treatment and prevention are daily, sometimes even hourly, concerns for a bedside nurse. At PSJMC, we take great care to prevent pressure injuries (PIs). Treatment plans include PT, medicine, diet and nutrition, pain management, and incontinence care, among other disciplines. Nonetheless, the social effects of a PI are the main subject of the study. Less thought is given to this factor in hospital settings. It is uncommon to talk about patients' experiences of social isolation brought on by a wound and a lack of control. Giving patients and their families additional education may help them feel more in charge of their recovery. Reducing social isolation may also be achieved by offering patients alternate avenues for social engagement, such as FaceTime.
2. Discuss the research question or main problem discussed in the study?
The study's main goal is to better understand the experiences of people who have pressure injuries. The primary issue raised is the complex impacts of pressure injuries on people's life, which include psychological, emotional, psychological, and social ramifications.
Luna Chowdhury
4 North
1. What are the advantages and disadvantages of the proposed recommendations in the article?
ReplyDeleteThe proposed recommendations offer a thorough understanding of how pressure injuries affect patients in various ways, including physical pain, emotional distress, and social isolation. This highlights the need for patient-centered care and the use of evidence-based tools to manage pain and assess risks effectively. However, there are some downsides, like the potential for bias due to the subjective nature of qualitative data and the limited applicability of the findings to different patient groups and settings. Additionally, the financial implications of pressure injuries and the experiences of younger patients remain underexplored, suggesting a need for more diverse research.
2. Discuss the research question or main problem discussed in the study?
The main research question of the study focused on understanding the experiences of patients living with pressure injuries and the impact of these injuries on their lives. The study aimed to address the gap in patient-centered research by exploring how pressure injuries affect individuals' physical, emotional, psychological, and social well-being. The study shows that living with pressure injuries is complicated and involves many challenges, like chronic pain, loss of mobility, social isolation, and emotional distress. By combining findings from different settings, the research aims to better understand the real-life difficulties patients face and stresses the need for care strategies that address not just the medical aspects but also the emotional and social effects of the condition.
Elin Danelian
3 North
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe study discusses a huge issue for the vulnerable population: the elderly. Due to frailty and immobility this study seeks to describe the lived experiences of patients suffering from pressure injuries. Pressure injuries are painful and also increase morbidity and mortality rates. Additionally, the economic burden on the healthcare system is staggering - costing billions.
1. Describe the method used by the author of the study
This is a qualitative narrative/meta analysis that uses a thematic analysis and inductive approach which sought to ascertain patients’ lived experience of having a pressure injury. From the qualitative data, themes were extracted. Specific inclusion and exclusion criteria were recruited in the article selection process which supports the inductive approach. The result was what the researchers concluded was the lived experience of patients living with pressure injuries
Discuss the research question or main problem discussed in the study?
ReplyDeleteExperiences of individuals living with pressure injuries and the profound impact on their physical, emotional, psychological, and social domains of life.The emotional and psychological impacts of living with pressure injuries were evident across the reviewed studies. Many participants frequently expressed despair and despondency about the emotional and psychological effects of pressure injuries
Discuss the sample size used in the study:
ReplyDeleteThematic synthesis was used to identify themes to present a coherent and nuanced understanding of patients' experiences of living with pressure injuries.
Nine studies involving 244 participants, aged 21 to 101, with pressure injuries, met the inclusion criteria. Three key themes emerged using thematic analysis: physiological, emotional and psychological, and social effects. Within these themes, subthemes such as endless pain and discomfort, loss of mobility and independence, and social isolation were dominant in all aspects of the lives of patients living with pressure injuries.
A narrative review of patients' lived experience of having a pressure injury
ReplyDeleteDiscuss the limitations of the article: limited sample size, design flaws, and/or author bias
The limitations of this study was the age of the patient population which was 21 to 101. Financial consequences were not explored further in this article. This article states future research should address the experience of younger adults living with pressure injuries.
How does this research article compare to our practice, policy and/or procedure?
The key points in this research article is similar to our practice at the hospital. One of the key points is that pain significantly impacts the quality of life for patients with pressure injuries. It is in our practice to pre-medicate the patient before wound care and to repositions to a more comfortable position in bed to decrease their pain.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe problem that the article is describing is the physical, emotional and psychosocial that pressure injures have in the quality of life on the person affected by it. Pressure injuries are underlying injures that occur on over a bony area they are caused by different factors such as age, immobility and shear/ pressure caused by laying in the same position for long periods of time. Pressure injuries not only can be debilitating but also painful. some participants in the study stated that when cleaning the wounds it feels like needles .
How does this research article compare to our practice, policy and/or procedure?
At St joseph hospital we strive to prevent pressure ulcers upon admission the patient is given a Braden score that alerts the provider to utilized the necessary equipment to off lode pressure points. If the patient has a pressure ulcer pictures are taken to keep progress of the wound while admitted and a wound consult is place for further care. we have created a swat team that meets once a week to monitor that we are not missing any pressure ulcers.
Roxana 5s
Discuss the research question or main problem discussed in the study
Delete1. The research was conducted to explore the patients experience of living with a pressure injury. It identified 3 main issues in patients with pressure injuries. These are physiological, emotional, and psychological and social effects. It describes pain and discomfort, loss of mobility and loss of independence in this population. The cost of pressure injuries was not addressed in this study, however it is significant. Identified as the most prominant issue I would say is pain caused from pressure injuries.
2. Advantages and disadvantages of of proposed recommendations: Advantages of using a Bundle are prevention and treatment. At PSJMC we assess skin upon admission, whenever a patient transfers to a different unit. We have a wound team to assess, photograph, document and design a treatment plan. We make an effort to pre medicate out patient prior to wound care, and try to focus on mobility of the patient, incontenence care, and all contributing factors to aid in wound healing such as nutrition, P.T. patient and caregiver participation and education.
The only disadvantage to having a "Bundle" is having the resources, supplies, staff training, compliance and consistency.
Describe the method use by the author of the study.
ReplyDeleteThe authors of this study chose to extrapolate qualitative data from several electronic data bases in order to explore the experiences patients had while living with pressure injuries throughout several countries. This article is a qualitative review of six electronic databases.
The data was whittled down from hundreds of studies and ultimately resulted in 244 participants. Several resources were utilized for data gathering including the CASP tool, the PRISMA checklist and the Joanna Briggs Institute (JBI) tool.
Discuss the sample size used in the study.
After establishing the focus of the research, the authors of this study were able to yield 69 articles from a large database of 3501. Those 69 articles were then further analyzed, removing duplicates and nonsense, and the dates of articles were expanded to ultimately yield nine articles. This resulted in 244 patients from 21 to 101 years old. The territories covered included France, IK, Belgium and the United States.
1. 1. Describe the method used by the author of the study
ReplyDeleteThe method of study that the author use is looking up electronic data base. The study is base on patients experiences who is living with pressures ulcers injuries. A few countries that was involve in this studies was UK, US, Belgium, and France. Base on thousands of case that was found in the data base 9 qualities studies was being selected. The resources that they used to utilized the data were PRISMA flow diagram for systematic reviews ([35]) dated between January 2000 and October 2022 and The CASP tool is recommended by Cochrane and the World Health Organization as an evidence-based health-related research checklist
2. Discuss the sample size used in the study.
The study include nine studies involving 244 participants, aged 21 to 101, with pressure injuries. The three key themes emerged using thematic analysis: physiological, emotional and psychological, and social effects. The studies also include pain and discomfort, loss of mobility and independence, and social isolations for patients who is living with pressure injuries.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe main problem discussed in this article is how the lives of individuals living with pressure injuries are affected physiologically, emotionally and psychologically, and socially. Based on the interviews conducted on the participants, the study shows that they experienced varied levels of pain and discomfort from the pressure injury, performing activities of daily living and during treatment. This affected the physical aspects of their lives, causing further immobility, loss of independence creating dependency on others, which may lead to feelings of hopelessness, fear and anxiety of being bedridden. Physical restrictions and loss of privacy become hindrances to their social life, which may lead to social isolation.
How does this research article compare to our practice, policy and/or procedure?
Comparing the recommendations in the study to our practice, policy/procedure in our institution, I can say that they are very similar. We have assessment tools in place to address the key points of the study. We utilize a pain assessment tool to assess and manage the pain of patients so that we can make sure that there is no or less pain during treatment, during patient care and ADL's. Included in our daily assessments are behavioral and emotional assessment to assess patient's emotional status and encourage verbalization. We also use risk assessment tools to determine the risk factors of patient's developing pressure injury or preventing further injuries. We can develop a care plan, specifically focused on skin integrity, for prevention and treatment of pressure injuries.
(1)Describe the method used by the author of the study
ReplyDelete-Study Design: The study is a quality improvement (QI) project designed to evaluate the effectiveness of a skin care bundle on the management of incontinence-associated dermatitis (IAD).
-Intervention: The authors developed and implemented a comprehensive skin care bundle specifically aimed at reducing the incidence and severity of IAD. The bundle likely included various elements such as:
Skin Cleansing: Improved methods or products for cleaning the skin.
Moisture Management: Use of barrier creams or other products to protect the skin from moisture.
Incontinence Products: Changes or improvements in the types of absorbent products used.
Staff Education: Training for healthcare staff on best practices for managing and preventing IAD.
-Implementation--Pre- and Post-Intervention Comparison: The study employed a pre- and post-intervention design to assess the impact of the skin care bundle. Data on IAD rates were collected before and after the implementation of the bundle. Data Collection--Data were gathered through clinical assessments, chart reviews, or potentially other forms of documentation to measure the incidence and severity of IAD. Analysis--The study used statistical methods to compare IAD outcomes before and after the intervention, evaluating whether the bundle led to significant improvements.
(2) Discuss the research question or main problem discussed in the study?
-The main research question addressed in the study is: "What is the impact of a skin care bundle on the incidence and severity of incontinence-associated dermatitis in an acute care setting?"
-Main Problem: The study addresses the problem of managing incontinence-associated dermatitis (IAD) in clinical settings. IAD is a prevalent issue among patients with incontinence, causing discomfort, potential complications, and affecting overall patient care quality. The research aims to determine whether implementing a structured skin care bundle can effectively reduce the occurrence and impact of IAD, thereby improving patient outcomes and providing a more systematic approach to skin care in acute settings.
In summary, the study evaluates a quality improvement intervention designed to address a common and challenging problem in patient care, seeking to provide evidence on the effectiveness of a targeted skin care bundle.
1. Describe the method used by the author of the study
ReplyDeleteIbeh and Hambridge (2024) conducted a narrative review that synthesized and analyzed various original qualitative research to gain a holistic insight on participants’ lived experiences with pressure injuries (PIs). The SPIDER tool (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) aided in the creation of the research question. To be included in the narrative review, evidence-based articles were searched across six electronic databases: CINAHL, Web of Science, Medline, Embase, Scopus and Google Scholar. Ibeh and Hambridge (2024) searched for studies that included a sample population of patients with “lived experience with pressure injuries/pressure sores/pressure ulcers in both hospital and community settings.” They finalized nine studies but in order to determine the grade of the studies’, the authors used the Critical Skills Appraisal Programme (CASP) tool, an evidence-based health checklist recommended by Cochrane and the World Health Organization, to assess the reliability of the qualitative studies.
2. How does this research article compare to our practice, policy and/or procedure?
The narrative review of patients’ lived experience with pressure injuries (PIs) provided great insight on the patients’ experience with PIs in this topic through qualitative studies. Physiologic effects of living with PIs were studied across the qualitative studies where participants mentioned PIs caused them significant debilitating pain and dependency on assistance. According to Ibeh and Hambridge (2024), participants across three studies shared that their pain was undermined and was unrecognized by their doctors, hence the analgesic options available to them were ineffective. Recognizing the importance of the physiologic effects of PIs, staff nurses can learn from this narrative review by addressing the pain patients feel from their wounds at Providence St. Joseph Medical Center (PSJMC). At PSJMC, the professional practice model (PPM) is based on two complementary nursing theories developed by Jean Watson and Patricia Benner. The PPM incorporates the theory of human caring into practice and serves as a reminder that nurses should act as patient advocates and communicate patient needs to the interdisciplinary team as part of nursing care. By advocating for patients at PSJMC as part of nursing practice, staff nurses can significantly impact and improve the quality of life for patients hospitalized with PIs so that their wounds can heal and patients can regain more of their independence.
What are the advantages / disadvantages to the proposed recommendations?
ReplyDeleteAdvantages:
Patient-centered approach: The recommendations emphasize understanding patients' lived experiences and providing holistic, individualized care. This can lead to better patient outcomes and satisfaction.
Focus on pain management: The article highlights the significant impact of pain on quality of life and recommends targeted strategies to alleviate pain. This can improve overall patient wellbeing.
Disadvantages:
Resource intensive: Implementing a holistic, multidisciplinary approach with individualized care plans may require significant time, staffing and financial resources that some healthcare settings may struggle to provide.
Complexity of implementation: Coordinating care across multiple disciplines and addressing various aspects of a patient's life may be logistically challenging in practice.
The main research question or problem discussed in this study is to explore and understand patients' lived experiences of having pressure injuries (also known as pressure ulcers or bedsores).
Specifically, the narrative review aimed to synthesize and analyze qualitative studies on patients' experiences of living with pressure injuries. The authors sought to gain insight into how pressure injuries affect various aspects of patients' lives, including physical, emotional, psychological, and social domains.
Key aspects of the research problem include:
Understanding the impact of pressure injuries on patients' quality of life.
Exploring the physical effects, particularly pain and mobility issues, associated with pressure injuries.
Investigating the emotional and psychological consequences of living with pressure injuries.
Examining the social implications, such as isolation and changes in relationships, resulting from pressure injuries.
Identifying patterns and common themes across multiple qualitative studies to provide a comprehensive view of patients' experiences.
Addressing the gap in patient-led research on pressure injury experiences, as noted by the authors: "there is a paucity of 'patient-led' research on patient experiences living with pressure injuries."
The study aimed to provide healthcare professionals, policymakers, and researchers with valuable insights into the patient perspective of living with pressure injuries. By focusing on patients' lived experiences, the research sought to inform and improve care strategies, interventions, and support systems for individuals affected by pressure injuries.
This approach aligns with the growing emphasis on patient-centered care and the recognition that understanding patients' experiences is crucial for developing effective treatment plans and improving overall care quality.
1. Discuss the research question or main problem discussed in the study?
ReplyDeleteThe study explored the experiences of patients living with pressure injuries, highlighting their extensive impact on daily life. The main problem addressed is the multifaceted nature of these impacts, including severe pain, emotional distress, and social isolation. Patients describe the pain as intense and persistent, which diminishes their independence and increases reliance on caregivers. Emotionally, they experience significant stress and frustration, while socially, they face isolation due to symptoms like odor and limited mobility. The study emphasizes the need for patient-centered care and a multidisciplinary approach, advocating for future research into the experiences of younger adults and the financial consequences of pressure injuries.
2. Discuss the sample size used in the study.
The study included nine qualitative studies with a total of 244 participants aged 21 to 101. This sample size helps provide a broad view of the experiences of individuals living with pressure injuries, though it may limit the generalizability due to its relatively small scale and the age and gender distribution of participants.
1) Discuss the research question or main problem discussed in the study:
ReplyDeleteThe study is to explore on how incontinence-associated dermatitis (IAD) caused by urine and/or feces has negative effects on patients' quality of life and that it can occur in any age group. Older adults are more vulnerable to IAD due to changes in skin integrity. Based on the study, incontinence was associated with being female, more dependent, having possible cognitive impairment, poor mobility, and a high risk of pressure ulcers.
2) Discuss the sample size:
The sample size used was 191 residents in Ireland who consented to participate in this study. Age ranged from 69 yrs. to 101 years old with male accounting for 42% of the population. Data gathered were based on patient's level of independence, cognitive impairment, pressure injury risk assessment, mobility and skin moisture.
Describe the method used by the author of the study.
ReplyDeleteThis article presents a qualitative narrative review with thematic analysis using an inductive approach to gain unbiased and deep insights into patients' lived experiences. The research question was structured using the SPIDER tool (Sample, Phenomenon of Interest, Design, Evaluation, and Research type). Nine studies involving 244 participants, aged 21 to 101, with pressure injuries, met the inclusion criteria
Discuss the research question or main problem discussed in the study?
The thematic synthesis of nine qualitative studies provides a comprehensive understanding of patients' experiences with pressure injuries, highlighting that pain related to these injuries significantly impacts their overall quality of life. Pain from pressure injuries has significant impact on mobility, prevents from moving and being independent. It has emotional and psychological effects, participants reported feeling frustrated, miserable and depressed. Lastly, there is social effects such as feelings of social isolation due to physical restrictions or wound treatment and embarrassed of the unpleasant odor of the wound.
1. Describe the method used by the author of the study.
ReplyDeleteThis study used a qualitative narrative review with thematic analysis, conducted using and inductive approach to gain unbiased and deep insights into patients' lived experiences. the research question was structured using the SPIDER tool (sample, Phenomenon of Interest, Design, Evaluation and Research type). A study search from 2003-2022 was undertaken across 6 databases. A tool was adopted to systematically assess and ensure the included studies trustworthiness, value and relevance. The CASP tool is used as an evidence based health-related research checklist. Each study was screened multiple times, both electronically and manually.
2. How does this research article compare to our practice, policy and/or procedure.
Here at Providence Saint Joseph Medical Center, we use an assessment tool such as Braden scoring upon patients admission as well as every shift. Pressure injury treatment and prevention is a part of our patient care, as a nurse we advocate for patients safety, which including for patient not to develop any Pressure injury during our care and during patients hospital stay. Developing Pressure injury is detrimental to patients health and total well being. As what it is discussed in this study it affects patients quality of life. It affects physiological, emotional and psychological impacts of living with Pressure injuries. Many patient experience pain and discomfort, patients expressed despair and despondency about the emotional and psychological effects of pressure injuries.
1. Discuss the research question or main problem discussed in the study.
ReplyDeleteThe main problem discussed in this study was exploring patients’ experience with pressure injuries and the effect pressure injury pain had on their quality of life. In the key points section, the authors noted that risk assessment and valid assessment tools are crucial in managing pressure injuries. This role of assessment can be taken on by health professionals who can help address needs or pain in their patients with pressure injuries. This could include early pressure injury detection, pain management, and mobility assessment.
2. Discuss the method used by the author of the study.
The authors used a qualitative narrative review and thematic synthesis of qualitative research studies for this article. A qualitative narrative review refers to a literature review where researchers use lived experiences of the participants to create understanding of a certain topic. A thematic synthesis refers to a method of qualitative research that looks at multiple studies to find recurring themes in their data that can help find commonalities between them.
1. How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThis research article compares to our practice at PSJMC because unfortunately, there are patients who are admitted to the hospital with pressure injuries or they develop them in the hospital setting. As discussed in the article pain is an important factor to take into account when caring for patients who have pressure injuries. It is important to be mindful with patients and provide the emotional support necessary when caring for patients with wounds. At least as a part of my care, I work with patients and coordinate with them in providing wound care by providing pain medications and planning wound care that best works with their schedule. Additionally, providing patients with proper education about wound care and importance of Q2H turns can help them understanding the process of turning. I have had patients who have refused to turn; however, educating them has helped the process.
2. Describe the method used by the author of the study.
The method used for the study by the author is synthesizing and analyzing qualitative studies on patients who have been living with pressure sores. The qualitative studies used thematic analysis in order to identify, analyze, and report themes within the patient's live experiences to gain clear and detailed understanding of the patient's experiences. In order to conduct the qualitative study, six electronic databases were using the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation and Research type) tool in order to form the proper research question.
Describe the method used by the author of the study:
ReplyDeleteIn this article the author likely utilized a qualitative research method to gather and analyze data. The qualitative research provided a rich, detailed description of patients' experiences, as well as studies that meet specific quality standards.The author also placed the results into a narrative review article, presenting a detailed account of patients' experiences with pressure injuries, and potentially offering recommendations for clinical practice or future research.
Discuss the sample size used in the study:
ReplyDeleteThe sample of this study included 244 participants.The participants were aged between 21 and 101 years old. This broad age range demonstrates that the study considered experiences across a wide spectrum of adult ages, which can provide a more comprehensive understanding of the impact of pressure injuries on various life stages.
It was interesting to learn the psychological impact of pressure injuries, and found that pressure injuries affect the physical, emotional, psychological and social domains of life.
Describe the method used by the author of the study
ReplyDelete- This article presents a qualitative narrative review with thematic analysis using an inductive approach to gain unbiased and deep insights into patients' lived experiences. This article is a qualitative review of six electronic databases.
what are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
- Implementing recommendations from a narrative review of patients’ lived experiences of pressure injuries can significantly enhance patient-centered care, improve pain and symptom management, and foster better communication and support systems.
Describe the method used by the author of the study
Delete- This article presents a qualitative narrative review with thematic analysis using an inductive approach to gain unbiased and deep insights into patients' lived experiences. This article is a qualitative review of six electronic databases. the author included detailed accounts of patients experiences in the article with pressure injuries, and recommendations. The electronic databases used to conduct this review in October 2022 were CINAHL, Web of Science, Medline, Embase, Scorpus, and Google Scholar. Exclusions consisted of studies conducted before 2000, meta-analysis/quantitative research papers, unpublished articles, nurses or carers' experiences of pressure injuries, and chronic wounds/leg ulcers.
what are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
- Implementing recommendations from a narrative review of patients’ lived experiences of pressure injuries can significantly enhance patient-centered care, improve pain and symptom management, and foster better communication and support systems. I think another advantage to this is focusing on a more patient centered approach which can be different for each patient. this can include pain medication for wound care for patients that need it.
1. Discuss the research question or main problem in the study
ReplyDeleteThe study aimed to explore how incontinence-associated dermatitis (IAD)—caused by urine and/or feces—negatively impacts patients' quality of life. Key points of the article included: The impact of the IAD, whether it was the negative effects on quality of life or the vulnerability in older adults. There were also a variety of associated risk factors which include gender (with women being associated with a higher risk), the cognitive impairment of the patient, as well as if they have reduced mobility or even having a high risk of pressure ulcers as those patients are at a higher risk for an IAD.
2. Discuss the sample size in the study
The study involved a review of nine studies with a total of 244 participants, aged 21 to 101, who had pressure injuries. The analysis revealed three key themes regarding the impact of pressure injuries: physiological effects including the pain and discomfort experienced by pts with pressure injuries, the emotional and psychological effects, and the social effects which tries to explore the social isolation pts may feel with pressure injuries which may have resulted from reduced mobility. The thematic analysis underscores the multifaceted impact of pressure injuries, extending beyond physical symptoms to include significant emotional, psychological, and social challenges.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe study is to explore patients' experiences of living with pressure injuries. The study also discussed about the pain and discomfort that has been suffering the intensity of pain experienced varying degrees of pain and discomfort due to pressure injuries. Most participants reported pressure injury as significantly affecting the physical aspects of their lives, causing endless pain, immobility, dependency, and discomfort. It also included in the study the narrative review described individuals' vivid experiences of living with pressure injuries and the profound impact on their physical, emotional, psychological, and social domains of life.
Describe the method used by the author of the study
The method used by the author qualitative narrative review and qualitative narrative review with thematic analysis was conducted using an inductive approach to gain unbiased and deep insights into patients' lived experiences. The research question was structured using the SPIDER tool, this refers to a framework used to formulate research questions, particularly for qualitative or mixed- methods studies, where focus is on understanding experiences and attitudes rather than measurable data. This review aimed to minimize bias and aid reflexivity.
Describe the method used by the author of the study.
ReplyDeleteThe design of this study was a qualitative narrative review with a thematic analysis based on subject’s experiences of living with pressure injuries. Six different electronic databased were searched and inclusion and exclusion criteria were selected for the study. Initially 3570 studies were found for the study but after inclusion/exclusion criteria and duplication of articles a total of 9 were selected. This study compared the outcomes of previous studies that had been completed.
Discuss the limitations of the article.
The biggest limitation that was found in this study was the lack of a second reviewer of the data analysis and thematic synthesis. This could result in a potential bias created by using only a single reviewer and could disrupt the reliability of the results. The second limitation could be the small sample size of previous articles found. A sample size of 9 could limit the research and results that were developed.
1. Discuss the research question or the main problem discussed in the article
ReplyDeleteThe research aimed to explore patients' experiences of living with pressure injuries through a qualitative narrative review and thematic synthesis of qualitative research studies. The study revealed several main themes related to patients' experiences with pressure injuries which are physiological, emotional, psychological and social effects. The findings emphasize the need for patient-centered care that addresses both the physical aspects of pressure injuries and their psychological and social effects. It also highlights the importance of integrating evidence-based tools for pain management and risk assessment.
2. Describe the method used by the author of the study
The study utilized a qualitative narrative review combined with thematic synthesis. Six electronic databases were searched, including Medline, CINAHL, Scopus, Web of Science, Embase, and Google Scholar. The search was conducted between October 2022 and April 2023. Nine studies were included, all focusing on patients' experiences with pressure injuries.
Mai Tran, 4N
1.) Discuss the research question or main problem discussed in the study.
ReplyDeleteThe main problem discussed in this study is to analyze individuals living with pressure ulcers that affect their physiological, emotional, psychological, and social well being. The study elaborates on “endless pain and discomfort,” mobility challenges, impact of negative emotions, and social isolations. These restrictions are highly individualized and could affect patient’s quality of life both physically and financially.
2.) Discuss the sample size used in the study.
The sample size used in this study consisted of “244 participants, aged 21 to 101” with pressure ulcers. These studies consisted more males than females per article. It was stated that future research is to be considered due to younger adults with pressure ulcers were less compared to older clients. These diverse settings were conducted from communities, hospital, skilled nursing and rehab facilities.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe main research question of the study revolves around examining and integrating patients' experiences of living with pressure injuries, a condition that profoundly impacts individuals on both physical and emotional levels. By emphasizing these lived experiences, the study seeks to reveal the complex effects of pressure injuries on overall quality of life, encompassing physiological, emotional, psychological, and social aspects. This investigation is prompted by the acknowledgment that previous research has often neglected patient perspectives, which are vital for shaping effective management and care approaches
Discuss the sample size used in the study.
The study examined nine qualitative research articles, which together included 244 participants aged 21 to 101, all dealing with pressure injuries. This sample size is large enough to capture a wide range of experiences from individuals of different ages and backgrounds, although it has limitations in representation, especially regarding younger adults. The thematic synthesis revealed three main themes—physiological, emotional and psychological, and social effects—alongside subthemes that highlight critical aspects of patients’ lives, such as pain, reduced mobility, and social isolation. These results highlight the intricate challenges of living with pressure injuries, reinforcing the need for a patient-centered approach to care that offers holistic support across various facets of well-being.
Valerie Dressman
ReplyDelete1. How does this research article compare to our practice, policy and/or procedure?
This research article relates to my practice as a bedside RN because it brings insight into the repercussions of pressure ulcers that could have happened during a stay in the hospital. This article highlights the importance of turning patients and properly offloading their pressure points. It also shows the importance of being mindful when caring for patients who have existing pressure injuries. We should be mindful of their pain and maintain their dignity.
2. Discuss the research questions or main problem discussed in the study?
This article explores the repercussions of pressure ulcers on patients' lives. Although we might not see all the effects it has on a patient's life and well-being, it is important to keep in mind when caring for our patients. The care we provide contributes to the outcome of patients and their lives after they leave the hospital. This article highlights all the areas that pressure ulcers might effect a patient's life.
Pressures injuries are a leading cause of preventable patient injury worldwide. They increase morbidity and mortality, and they account for significant increases in health care costs and litigation. Pressure injuries are injuries to the skin or underlying tissue that occur over a boney prominence. They are frequently caused by factors such as aging skin and shear. Preventive strategies have been implemented worldwide to combat the number occurrences and commonness of pressure injuries. However, recent evidence indicates a substantial rise in pressure injury cases.
ReplyDeleteThe goal of this narrative review is to synthesize and analyze qualitative studies on patients’ experiences who are living with pressure injuries. Research was conducted between October 2022 and April 2023. Six databases were researched from acute, community, and home care settings across the United Kingdom, France, Belgium, and the United States. The participant ages across all studies ranged from 21 to 101 years old, with majority being male. The PRISMA checklist for reporting systemic reviews was used.
I was pleased to see that the data collected included patients whose ages varied greatly, and whose disease processes varied greatly as well. However, what I found most significant about this study, was that a broad spectrum of countries that were involved. I believe that including data from abroad helps a great deal in reaching valid conclusions when analyzing the collected data.
Although, I was not terribly surprised with the described experiences of those poor souls dealing with pressure injuries. I fully expected that pain would be the predominate physiological effect despite access to prescribed analgesics. I feel that doctors in recent years are slow to properly manage pain due to the prescribed opiate uproar a few years ago. I also fully expected immobility, independence, and social isolation as part of their daily struggles. Please don’t mistake my remarks as being callused and cold hearted. In fact, I feel very sorry for them because I have been dealing with chronic pain issues myself over the past three years. And I am experiencing these exact same issues.
The bottom line is that a person’s quality of life can be completely compromised with pressure related injuries. As nurses, we all need to be much more vigilant in the prevention of pressure related injuries. I work in the Cardiac Cath Lab, and we always place padding where appropriate. Clearly, preventing the start of pressure related injuries is the best for all involved.
-Describe the method used by the author of the study. Was the correct method used? Why or why not?
ReplyDeleteThe author used a qualitative narrative review for this study and the research question used the SPIDER tool to help structure the question. Six electronic databases were used in finding the data for the study. I believe this was the correct method as the data was able to capture a comprehensive review of the patients' experience with a pressure injury.
-Discuss the sample size used in the study. How does this impact the study?
Nine studies were ultimately used for the review. Although only 9 articles, the types of articles and sample sizes did provide insightful data. The age range was from 21-101, with men (n=155), and women (n=89). Despite the study size being higher in men, and the sample size from the 9 articles to be 244, there was enough information to generalize as there were common themes that came out of the studies - emotional and physical pain, social effects. The study was able to offer insightful data on how pressure injuries affect patients and their lives. Due to the lack of a second reviewer for this systemic analysis, there is potential bias in the articles choices and also reliability of the results.
Discuss the research question or main problem in the study.
ReplyDeletePressure injuries are injuries to the skin or underlying tissues that occur over a bony prominence. They are caused by intrinsic factors (such as ageing and immobility) and extrinsic factors (such as pressure and shear). The aim of the study was to explore patients' experiences of living with pressure injuries.
Describe the method used by the author of the study.
A qualitative narrative review and thematic synthesis of qualitative research studies. Data sources: Six electronic databases were searched: Medline, CINAHL, Scopus, Web of Science, Embase, and Google Scholar (for grey literature). The search was conducted between October 2022 and April 2023. Setting: Acute, community and care home settings across the UK, France, Belgium and the US. Review methods: The PRISMA checklist for reporting systematic reviews was used. The included studies were evaluated for quality using the CASP tool. The Joanna Briggs Institute data extraction tool was used to extract data from the included studies. Thematic synthesis was used to identify themes to present a coherent and nuanced understanding of patients' experiences of living with pressure injuries. Results: Nine studies involving 244 participants, aged 21 to 101, with pressure injuries, met the inclusion criteria. Three key themes emerged using thematic analysis: physiological, emotional and psychological, and social effects. Within these themes, subthemes such as endless pain and discomfort, loss of mobility and independence, and social isolation were dominant in all aspects of the lives of patients living with pressure injuries.
How does this research article compare to our practice, policy and/or procedure?
ReplyDelete-We treat many people with pressure injuries. Often times, the patient’s express their humiliation when asked to assess and treat their skin. They are often in pain. What we don’t see is the after – how these patient’s cope when they leave our icu setting. Reading this article, I realized that many experience social isolation. We have all these tools in place at PSJMC to identify patients at risk for developing pressure ulcers and we implement these protocols to prevent such injuries from happening to our patients not only physically but emotionally as well. This article helped me acknowledge that is painful for patients both physically and emotionally, and I will continue to be diligent in preventing and also managing pain for our patients.
Discuss the sample size used in the study.
-This sample size included 244 participants. Their ages ranged from 21 – 101 years, with 155 of them being men and 89 being women. This study included many settings – from communities to nursing homes, hospitals and rehab centers in the UK, US, France, and Belgium.
1. Discuss the research question or main problem discussed in the study?
ReplyDeleteThe main purpose of this study was to discuss the impact that pressure ulcers have on the everyday life of people who live with them. The main issues discussed in this study included pain and discomfort, loss of independence, quality of life, and the psychological impact it has on a person. Although these issues are individualized, when combined, they can create even bigger challenges to caring for this patient population, but with this study it allows us to get a better understanding of each issue and how we might go about caring or treating each one.
2. Discuss the sample size used in the study.
In this study, there were a total of 9 study groups focused on the life and impact of patients with pressure ulcers. The ages ranged from 21 to 101, with a total participation count of 244 people. The study groups were taken from the USA, UK, Belgium, North Ireland, England and France. The sample sizes of the groups ranged from 5 participants to 131 participants allowing for a large amount of data to be collected on these patients living with pressure injuries.
1. Discuss the research question or main problem discussed in the study?
ReplyDeleteIn the narrative review by Ibeh and Hambridge, the research question centers on understanding the lived experiences of patients with pressure injuries. The main problem addressed is the significant emotional, psychological, and physical impact of pressure injuries on patients, which often extends beyond the clinical aspects of treatment.
Key Points of the Research Question:
Patient-Centered Perspective: The study seeks to highlight how patients perceive their experiences with pressure injuries, including their feelings, challenges, and coping mechanisms.
Impact on Quality of Life: The review aims to explore how pressure injuries affect patients' daily lives, social interactions, and mental health, emphasizing the broader implications for patient well-being.
Barriers to Care: The research also addresses barriers patients face in receiving adequate care and support, shedding light on the gaps in the healthcare system that contribute to their experiences.
Implications for Nursing and Care Practices: By focusing on patients’ narratives, the study aims to inform healthcare providers about the importance of empathy and tailored interventions in managing pressure injuries.
Overall, the main problem highlighted in the review is the need for a deeper understanding of the patient experience with pressure injuries, which can inform better practices in prevention, management, and support.
2. Discuss the sample size used in this study.
In the narrative review by Ibeh and Hambridge, the sample size consisted of 244 participants from nine studies that met the inclusion criteria. Here’s a deeper analysis of the implications of this sample size:
Significance of the Sample Size:
Diversity of Experiences: The inclusion of 244 participants allows for a range of perspectives on living with pressure injuries, covering ages from 21 to 101. This diversity enriches the understanding of how different age groups experience and cope with pressure injuries.
Cross-Contextual Insights: The studies were drawn from acute, community, and care home settings across multiple countries (UK, France, Belgium, and the US). This geographical variety helps ensure that the findings are not limited to a single healthcare system or cultural context, enhancing the generalizability of the insights.
Thematic Depth: With a reasonable sample size, the thematic synthesis can uncover nuanced themes related to physiological, emotional, psychological, and social effects of pressure injuries. A larger pool of qualitative data typically allows for richer thematic development and more robust conclusions.
Quality and Rigor: The review utilized established quality assessment tools (CASP) and data extraction methods (Joanna Briggs Institute), which adds credibility to the findings derived from the 244 participants. This methodological rigor helps ensure that the insights accurately reflect the lived experiences of patients.
Limitations:
Variation in Individual Studies: The experiences captured may still vary widely due to differences in study designs, participant demographics, and healthcare contexts within the included studies.
Potential Bias: As with any qualitative research, the interpretation of themes can be subjective, depending on the researchers' perspectives and the quality of the original studies.
Focus on Specific Groups: While the sample size includes a range of ages, the review may not fully capture the experiences of younger adults or those with unique circumstances, as noted in the conclusion.
Overall, the sample size and methodological approach used in this narrative review provide a solid foundation for understanding the complex lived experiences of individuals with pressure injuries, highlighting the need for patient-centered care and tailored interventions.
Describe the method used by the author of the study
ReplyDeleteOlder adults' experiences due to age related skin change by fragile skin which is prone to injury, collagen and elastin loss, Ultraviolet (UV) radiation damage, dry skin, or medications.
Incontinence-associated dermatitis (IAD) is a moisture-associated skin damage related to incontinence of both urine and fecal incontinence by age-related symptoms. The method used by the author of the study was a descriptive, cross-sectional, multi-site study for Incontinence-associated dermatitis (IAD), which is a skin inflammation caused by contact with urine, feces, or both, in older adult in three residential care facilities in Ireland. The patients were of the age from sixty-nine to one hundred years old, males and females, in July 2019. Data collected by two clinical nurse specialists used the Scottish Excoriation and Moisture Related Skin Damage Tool when used in this study to identify the existence of IAD from clinical observation and thorough skin inspections. The statistics were analyzed by using SPSS.
Aging and IAD, negatively affect older people for well-being physically and mentally.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
The limitations of the article where the study provides the first analysis of this empirical data on the circumstances of IAD in Ireland in the year 2019. Although the point prevalence of IAD across the total population was 11.5% (n=22/191) and incontinent population was 13.3% (n=22/164) without a statistical variation between males and females. Then notably, more variable materials are needed to manage and tend to this condition.
- Discuss the research question or main problem discussed in the study?
ReplyDeleteThe research question/main problem discussed in the study is to look into the experiences of those who have lived with or who are currently living with a pressure injury (PI). Researchers focused on addressing the overall negative effects that a PI can have on one's wellbeing, consisting of one's physical, mental, emotional, social wellbeing. The study aims to gain an understanding of the individual experience of those who have lived with a PI through qualitative studies that have been synthesized in this research article. With this article, new implementations in prevention, management, and overall care can help pioneer a better outcome for these patients.
- Describe the method used by the author of the study
The method used by the author(s) of this study was a qualitative narrative review. While thematic analysis was implemented, it helps readers to gain a more personal and humanized approach to those that have lived with a PI. Instead of these people being another statistic, it helped to address the needs by focusing on a holistic point of care.
Paolo Largoza, 3N
1.Discuss the research question or main problem discussed in the study?
ReplyDelete-The narrative study evaluated the experiences of patients living with pressure injuries. The focus was on 3 major themes: physiological, emotional & psychological & social effects.
2. Describe the method used by the author of the study
- The study used a qualitative narrative review & thematic synthesis of qualitative research studies. The research question itself was created using the SPIDER tool (sample, phenomenon of interest, design, evaluation & research type).
Discuss the research question or main problem discussed in the study?
ReplyDeletePressure injuries are a significant health issue due to the economic impact and health burden on healthcare and the patient. Pressure injuries are avoidable in most cases and can be prevented. Pressure injuries can turn into sepsis and sever infections can lead to mortality. This study mentions that despite various prevention strategies implemented worldwide to reduce the incidence and prevalence of pressure injuries, recent evidence indicates a substantial rise in pressure injury cases
Discuss the sample size used in the study.
This narrative review aimed to synthesise and analyse qualitative studies on patients experiences of living with pressure injuries. A qualitative narrative review with analysis was conducted using an inductive approach to gain unbiased and deep insights into patients' lived experiences. ach study was screened multiple times, both electronically and manually, and read thoroughly so that the authors were familiar with the content and to ensure relevance and accuracy before extraction. An initial advanced search from 2003 to 2022 was done across six databases that lead to 3570 studies. After screening based on title and inclusion/ exclusion criteria, less than 100 articles were left to review. In my opinion, the sample size was rather small.
Discuss the research question or main problem discussed in the study?
ReplyDeleteAssessing the patient experience of living with a pressure injury is the main problem discussed. The physiological, emotional, and social effect of pressure injuries were investigated. Physiologically, patient autonomy is compromised. The inability to completely activities of daily living, such as making bowel movements, eating, and mobility, reduces autonomy tremendously. From an emotional standpoint, concerns over hospitalization and bed bound status can take a daily toll on a patient. The social effect on a patient is in regards to limiting their interactions with others due to their malodorousness and appearance of their wounds.
Describe the method used by the author of the study
Qualitative narratives and research methods were mainly used for this study. Patient experiences with pressure injuries were sifted through in 6 electronic databases, which included 3570 studies. Based on rigorous inclusion/exclusion criteria, such as titles and abstracts, 6 articles were used. Then, a critical appraisal skills program (CASP) was used to detect trustworthiness, value, and relevance to the main question at hand.
Describe the method used by the author of the study.
ReplyDeleteIn the article "A Narrative Review of Patients' Lived Experience of Having a Pressure Injury," the author employs a qualitative narrative review methodology. The purpose of this method is to synthesize the findings of various qualitative research studies related to the experiences of patients living with pressure injuries. The review involved a thematic synthesis of studies that were identified through a systematic search of six electronic databases, including Medline, CINAHL, and Web of Science.
The methodology followed the PRISMA checklist to ensure comprehensive reporting, and the included studies were assessed using the CASP (Critical Appraisal Skills Programme) tool for quality evaluation. Data extraction was done using the Joanna Briggs Institute's tool. Thematic synthesis was then used to identify recurring themes, such as the physical, emotional, and social impacts of pressure injuries on patients' lives
Discuss the sample size used in the study.
ReplyDeleteThe sample size is not limited to a specific number of participants, as it is a narrative review rather than a primary research study. Instead of collecting new data from individual patients, the author reviewed and synthesized existing qualitative studies that explore the lived experiences of patients with pressure injuries. The studies included in the review varied in their individual sample sizes, depending on the scope of each research project.
By analyzing a range of studies, the review captured broad themes related to patients' physical, emotional, and social challenges of living with pressure injuries. This approach allowed the author to draw comprehensive conclusions from multiple perspectives, rather than focusing on a single dataset