NURS 716 Week 2 Assignment 1: Developing a Clinical Question Example

From a Red Sacrum in Recovery to a Researchable Question: Scripture, the Iowa Model and a PICO Question on Preventing Pressure Injuries in Long Surgeries

Scripture and the Imperative to Use Current Evidence

Christians sometimes treat faith and evidence as separate domains, but Scripture gives at least three reasons why a Christian nurse is obligated to practice from the best current evidence. The first is stewardship. In the parable of the talents, the servants who invested what they had been given were commended, while the one who buried his talent out of fear was condemned (English Standard Version Bible, 2001/2016, Matthew 25:14-30). Clinical knowledge is a talent entrusted to the profession. A nurse who continues a practice out of habit, when better knowledge is available, buries what has been given.

The second reason is love of neighbor. Jesus summarized the law in love of God and love of neighbor (English Standard Version Bible, 2001/2016, Matthew 22:37-39), and love that is sincere seeks the neighbor's actual good, not merely a well-meant gesture. A pressure injury acquired on the operating table causes pain, delays recovery and can lead to infection; if evidence shows a better way to prevent it, love requires that we learn it. The third reason is the pursuit of truth. Proverbs urges the reader to buy truth and not sell it, and to seek wisdom, instruction and understanding (English Standard Version Bible, 2001/2016, Proverbs 23:23). Evidence-based practice is, at its heart, a disciplined search for what is true about care. Melnyk and Fineout-Overholt (2015) describe evidence-based practice as integrating the best evidence with clinical expertise and patient values; for a Christian nurse, that integration is one expression of faithfulness. Using outdated practice when better evidence exists is not neutral; it is a failure to love the patient with the knowledge God has made available.

The Clinical Scenario

The scenario describes a 350-bed regional hospital where the surgical services quality report shows that 14 of 220 adults who had surgeries lasting three hours or longer in the last quarter developed a hospital-acquired pressure injury within 72 hours, most on the sacrum or heels, and most first noticed as non-blanching redness in the post-anesthesia care unit. Current practice uses gel pads and standard positioning, with no prophylactic dressing and no skin reassessment until arrival in recovery.

Applying the Iowa Model

The revised Iowa Model guides clinicians from a triggering issue to a sustained practice change through a sequence of steps and decision points (Iowa Model Collaborative, 2017). The first steps fit this scenario directly.

Identify the Triggering Issue

The Iowa Model separates triggers that come from problems, such as quality data or incidents, from triggers that come from new knowledge such as a guideline. This scenario's trigger comes from a problem: an incidence of about 6.4% in long surgical cases, documented in the quality report, and a pattern of injuries first seen in recovery.

State the Question or Purpose

The purpose is to determine whether adding a prophylactic soft silicone multilayer foam dressing to the sacrum and heels of adults undergoing long surgeries reduces hospital-acquired pressure injuries compared with current practice.

Is the Topic a Priority?

The next decision point in the model concerns organizational priority, and here the answer is clearly yes. Hospital-acquired pressure injuries are a nurse-sensitive quality indicator, they extend length of stay and they carry financial penalties when they reach advanced stages. The surgical services director has named pressure injury reduction as a goal for the year, which provides the leadership support the model treats as essential.

Form a Team

The Iowa Model recommends an interprofessional team. The proposed team includes two perioperative nurses, a post-anesthesia care unit nurse, a wound and ostomy nurse, an anesthesia provider, a surgeon champion, a supply chain representative and the DNP student as project lead.

Is There Evidence?

A preliminary search shows that evidence exists and is promising. In a 2026 randomized controlled trial of 134 adults having elective surgery under general anesthesia, intraoperative pressure injuries occurred in 3.0% of patients who received a sacral soft silicone foam dressing compared with 19.4% of those who received standard care, and all injuries were stage I and resolved within 48 hours (Wang et al., 2026). A meta-analysis of ten randomized trials involving 4,817 patients found that silicone foam dressings reduced stage I and more severe pressure injuries in both sacral and heel regions (Fu et al., 2025). The next assignment will synthesize this evidence formally.

Building the PICO Question

Each element was chosen to be specific and searchable. Limiting the population to long surgeries focuses the question on the group with the highest risk in the scenario. Naming soft silicone multilayer foam distinguishes the intervention from thin films and hydrocolloids. The comparison reflects what the hospital actually does now. The outcome includes all stages because early injuries are the most common and the most preventable, and the 72-hour window captures injuries that appear after the patient leaves the operating room.

Search Terms Derived From the Question

Turning the question into a search plan confirms that it is researchable. The population block combines terms such as surgical patients, intraoperative, perioperative and operating room. The intervention block combines prophylactic dressing, silicone foam, multilayer foam and the subject heading for occlusive dressings. The outcome block combines pressure injury, pressure ulcer and the subject heading for pressure ulcer. Limits will include adults, English and publication within the last five years, with older landmark trials added by hand if the course allows. A trial search using these blocks in two databases returned a manageable set of studies, including randomized trials, meta-analyses and implementation studies, which is the mix the next assignment requires.

Patient Values and Clinical Expertise

Evidence-based practice integrates evidence with clinical expertise and patient values (Melnyk & Fineout-Overholt, 2015), so the question must also fit the people involved. Patients are rarely asked about pressure injury prevention before surgery, yet most would choose a dressing that reduces the risk of a painful wound if it carries little burden. Clinical expertise matters too: perioperative nurses know which positions and procedures threaten particular skin areas, and their input will shape where dressings are placed and when they are removed.

The Final PICO Question

In adult surgical patients whose procedures last at least three hours (P), does applying a multilayer soft silicone foam dressing prophylactically over the sacrum and both heels (I), compared with standard positioning and gel padding alone (C), reduce the incidence of sacral and heel hospital-acquired pressure injuries within 72 hours after surgery (O)?

The question is researchable because each element maps onto controlled vocabulary and keywords in nursing and medical databases, and because the outcome is routinely documented. It is important because it addresses a measurable harm in the scenario's own data with an intervention that randomized evidence suggests could work.

Conclusion

Scripture calls Christian nurses to steward knowledge, love their neighbors through competent care and seek truth, which makes evidence-based practice a matter of faithfulness. The revised Iowa Model turned the scenario's quality data into a priority, a team and a focused PICO question about prophylactic silicone foam dressings in long surgeries. The literature review in the next assignment will test whether the body of evidence is strong enough to justify changing practice.

References

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Fu, T., Wu, X., & Yu, B. (2025). Efficacy of silicone foam dressings in preventing pressure injuries in the sacral and heel areas of patients: A meta-analysis. Frontiers in Medicine, 12, Article 1644290. https://doi.org/10.3389/fmed.2025.1644290

Iowa Model Collaborative. (2017). Iowa Model of Evidence-Based Practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. https://doi.org/10.1111/wvn.12223

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing and healthcare: A guide to best practice (3rd ed.). Wolters Kluwer.

Wang, C. Y., Liao, H. H., Hsieh, M. Y., & Lee, C. H. (2026). Soft silicone foam dressing for preventing intraoperative pressure injuries: A randomized controlled trial. Journal of PeriAnesthesia Nursing. Advance online publication. https://doi.org/10.1016/j.jopan.2026.08.022