SUMMARY

My journal is entitled A randomised controlled clinical trial of repositioning, using the 30 tilt, for the prevention of
pressure ulcers proposed by Zena Moore, Seamus Cowman and John Posnett. This was conducted across 12 long-
term cares of the older person hospitals in both urban and rural locations in Ireland and was published on January
2011. The aim of this study is to compare the incidence of pressure ulcers among older persons nursed using two
different repositioning regimens. This is a cluster randomised controlled clinical trial (RCT) involving 99
participants for experimental group and 114 participants for control group. All participants were Irish and white,
among them 77% were women and 65% aged 80 years or older. The experimental group was repositioned every 3
hours at night, using the 30 tilt while the control group was repositioned every 6 hours at night, using the 90
lateral rotation over a 4-week period. Pressure redistribution devices in current use on the bed and on the chair
were continued, as were all nutritional interventions. Furthermore, repositioning continued as per nursing
activities and was undertaken during toileting regimens, changing of incontinence pads, preparation for feeding
and for sleep periods (using the 30 tilt). Thus, during the day, patients positions were altered every 23 hours.
Data were collected using the EPUAP (European Pressure Ulcer Advisory Panel) minimum data set and the EPUAP
pressure ulcer grading system.

Data from the study revealed that three patients (3%) in the experimental group and 13 patients (11%) in the
control group developed a pressure ulcer. All pressure ulcers were grade 1 (44%) or grade 2 (56%). Mobility and
activity were the highest predictors of pressure ulcer development. The study therefore concluded that
Repositioning older persons at risk of pressure ulcers every three hours at night, using the 30tilt, reduces the
incidence of pressure ulcers compared with usual care. The 30 tilt, three-hourly repositioning has been shown to
result in better outcomes in terms of pressure ulcer incidence. It was recommended in the study that this method
of repositioning appears to be a low technological yet effective method of pressure ulcer prevention.

Related literatures of the same author and study revealed that repositioning every 3 hours, using 30 tilt, has been
shown to be more effective in less costly in terms of nurse time compared with standard care in the journal An
economic analysis of repositioning for the prevention of pressure Ulcers. Therefore it is not only an effective
method but also cost-effective. Another study which supports this journal said that it reduces risk of pressure
ulcers, repositioning of immobile patients is a standard nursing practice; however, research into how different
lying positions
effect tissue microcirculation is limited thats why Different lying positions and their effects on tissue blood flow
and skin
temperature in older adult patients was conducted which revealed that the blood flow over the bony prominence
areas was most influenced in the superficial skin and especially in the 30_ lateral position, where the blood flow
decreased significantly in comparison with the supine positions. Therefore repositioning does not only reduce risk
of having pressure ulcer but also improves circulation. However, since other studies claimed that minimizing skin-
support surface interface pressure is important in pressure ulcer prevention, but the effect of standard patient
repositioning on skin interface pressure has not been objectively established, a study was made by Peterson
(2010) which revealed that Standard turning by experienced intensive care unit nurses does not reliably unload all
areas of high skin-bed interface pressures. These areas remain at risk for skin breakdown, and help to explain why
pressure ulcers occur despite the implementation of standard preventive measures. Support materials for
maintaining lateral turned positions can also influence tissue unloading and triple jeopardy areas. Another study
also says otherwise, Effectiveness of turning with unequal time intervals on the incidence of pressure ulcer
lesions by Vanderwee (2006) concluded that More frequent repositioning on a pressure-reducing mattress does
not necessarily lead to fewer pressure ulcer lesions and consequently cannot be considered as a more effective
preventive measure.

REACTION:

IN the Philippines, hospital stay and its cost is everybodys concern because not all patients can afford to face
another financial concern regarding complications brought about by their health condition such as post-stroke
patients who are at risk of developing pressure ulcer.
To us student nurses, based from the study, assessment is very important to prevent complications. So lets do our
part to help our patient and make more comprehensive assessment to lessen the hospital stay and cost of our
beloved patients.

To the patient, this study is very helpful since it was cost-effective, improves circulation and significantly reduces
risk of pressure ulcer. This study can be used as a basis for health teaching to the significant others of the patient
since the patient cannot do the repositioning by himself.

To the nursing practice, nurses may have difficulty to attend to these situations since in the Philippines, we have a
one nurse is to ward scenario. This may guide them to have an effective time management.

Therefore , I recommend this Journal to be used in our hospital setting so that we can provide quality care to our
patients.