| Course | NURS 716 Applications of Evidence-Based Care (NURS716) |
|---|---|
| Module/Week | 3 |
| Assignment | Assignment 2: Initiating the Literature Review |
| Paper type | Literature synthesis table (10 peer-reviewed articles) with implications for practice |
| Length | about 719 words, 3 double-spaced pages plus title page and references. Course guide: an analysis of ten peer-reviewed journal articles no older than three to five years addressing the PICO question from Assignment 1, presented in a synthesis table with levels of evidence, followed by a discussion of implications for practice |
| Format | APA 7 student paper |
| Points | 150 |
| School | Liberty University Online |
| Program | DNP |
| Where it sits | Module/Week 3 in Liberty's published NURS 716 course guide; current sections can differ |
| Updated | October 2026 |
Free sample paper for NURS 716 Week 3
Initiating the Literature Review: A Ten-Article Synthesis Table on Prophylactic Dressings and Perioperative Pressure Injury, With Levels of Evidence and Implications for Practice
[Student Name]
School of Nursing, Liberty University
NURS 716: Applications of Evidence-Based Care
Assignment 2: Initiating the Literature Review
[Instructor Name]
[Date]
The scenario is a composite carried from Assignment 1; the ten articles are real.
Initiating the Literature Review: A Ten-Article Synthesis Table on Prophylactic Dressings and Perioperative Pressure Injury, With Levels of Evidence and Implications for Practice
PICO Question and Leveling Approach
Assignment 1 produced a PICO question about patients whose operations run three hours or more: does protecting the sacrum and heels with a soft silicone foam dressing before positioning, cut the number of sacral and heel injuries seen in the first 72 hours, relative to the current routine of gel pads and positioning? Levels follow the seven-tier scheme presented by Melnyk and Fineout-Overholt (2015): pooled analyses of randomized trials sit at level I, well-designed randomized trials level II, controlled trials without randomization level III, cohort and case-control studies level IV, systematic reviews of descriptive or qualitative studies level V, single descriptive or qualitative studies level VI and expert opinion level VII.
Synthesis Table
| Article | Design and level | Sample and setting | Key findings | Limitations |
|---|---|---|---|---|
| Fu et al. (2025) | Meta-analysis of 10 RCTs; I | 4,817 patients, mixed settings | Silicone foam reduced sacral and heel stage I and stage II or worse injuries | Mixed settings; few surgical-only trials |
| Al Jehani et al. (2026) | Network meta-analysis of 15 studies; I | 5,324 patients | Silicone dressings ranked most effective of six options | Includes older studies; varied materials |
| Latimer et al. (2026) | Cochrane systematic review; I | RCTs of repositioning in adults | Updated evidence on repositioning schedules and positions | Few perioperative trials |
| Wang et al. (2026) | RCT; II | 134 adults, elective surgery of 1 hour or more | Intraoperative injuries 3.0% with sacral dressing vs 19.4% control | Single center; sacrum only; stage I only |
| Eğilmez et al. (2026) | Non-randomized controlled study; III | 190 orthopedic surgery patients | Bundle evaluated for injuries, pain, fear of falling and comfort | Not randomized; unequal groups |
| Karaca and Okgün Alcan (2026) | Prospective observational; IV | 218 urology patients, lithotomy | Injuries in 26.1% at end of surgery, all stage I, mostly posterior legs | Single center; one position |
| Adıgüzel Akbaba et al. (2026) | Prospective descriptive; IV | 367 adults, surgery of 3 hours or more | Device-related injuries in 30%; age, BMI, position change linked | Device injuries only; one hospital |
| Hooper et al. (2026) | Retrospective exploratory; IV | Adult inpatient non-cardiac surgery, regional system | Risk tool less accurate than reported; ASA 3 or higher predicted injury | Retrospective records |
| Zhao et al. (2026) | Retrospective correlational; IV | 14,523 hip fracture surgery patients, national registry | 4.3% developed pressure injury; age over 70 a risk factor | Registry data; hip fracture only |
| Gao et al. (2026) | Qualitative; VI | 12 operating room nurses | Barriers and facilitators to implementing prevention mapped with CFIR | Small sample; one hospital |
Synthesis by Theme
Evidence on the Intervention
The strongest evidence comes from two level I syntheses and a recent randomized trial, and all three point in the same direction. The meta-analysis of ten randomized trials found that silicone foam dressings reduced both early and more severe pressure injuries at the sacrum and heels, with a relative risk of 0.18 for sacral stage I injuries (Fu et al., 2025). The network meta-analysis ranked silicone dressings as the most effective of the prophylactic options compared, ahead of polyurethane foam, films and hydrocolloids (Al Jehani et al., 2026). In the surgical setting specifically, a randomized trial found far fewer intraoperative injuries with a sacral silicone dressing than with standard care (Wang et al., 2026). Three independent lines of evidence, two of them syntheses of many trials, agree that silicone foam prevents pressure injuries, and the surgical trial shows the effect where our scenario needs it. The Cochrane review of repositioning reminds us that dressings supplement, rather than replace, attention to position and pressure (Latimer et al., 2026).
Evidence on Who Is at Risk and Why
Four observational studies help define the population most likely to benefit. Injuries were common at the end of surgery in the lithotomy position, affecting about a quarter of urology patients, though all were stage I (Karaca & Okgün Alcan, 2026). Device-related injuries affected 30% of adults in surgeries of three hours or more, linked to age, body mass index and repositioning after induction (Adıgüzel Akbaba et al., 2026). In a national registry of 14,523 hip fracture repairs, 4.3% developed pressure injuries, with older age a risk factor (Zhao et al., 2026). A perioperative risk instrument performed less well than expected, while patients with an anesthesia risk class of three or above were more likely to be injured (Hooper et al., 2026). Together they suggest targeting long surgeries, older patients, higher anesthesia risk scores and positions such as lithotomy, and adding attention to device contact points.
Evidence on Implementation
Evidence on effectiveness does not guarantee adoption. A dozen operating room nurses, interviewed with an implementation framework as the guide, described what helps and what hinders evidence-based prevention in their theaters (Gao et al., 2026), and the orthopedic bundle study suggests that packaging prevention steps together may support consistent practice (Eğilmez et al., 2026).
Strength of the Evidence
The body of evidence for the intervention is strong: two level I syntheses and a level II trial agree. Its main gap is that few trials were conducted exclusively in operating rooms, and the surgical trial applied dressings only to the sacrum. The observational studies are level IV and VI, appropriate for describing risk and context but not for testing the intervention. Several were conducted in Türkiye and China, so practice patterns may differ from those of a US hospital, which the proposal should acknowledge. Most outcomes were early, stage I injuries, so the evidence says less about preventing the deeper injuries that cause the most harm.
Implications for Practice
The evidence supports placing silicone foam over the sacrum, and, given the pooled trial results, over the heels as well, for adults undergoing surgeries of three hours or longer, with priority for older patients, those with higher anesthesia risk scores and those positioned in lithotomy. Dressings should be applied before positioning, checked at the end of surgery and continued into the postoperative period according to the manufacturer's guidance. Because many intraoperative injuries are device-related, the bundle should include padding and checks at device contact points. Implementation will require supplies in every operating room, staff education and a clear owner for application, and outcomes should be measured as injuries within 72 hours. Cost should be tracked as well, since a dressing costs a few dollars while a single stage III injury can cost thousands to treat.
References
Adıgüzel Akbaba, M., Uslu, Y., Aytar, F., & Eren, E. (2026). Intraoperative device-related pressure injuries in patients undergoing prolonged surgery. Advances in Skin & Wound Care. Advance online publication. https://doi.org/10.1097/ASW.0000000000000510
Al Jehani, M., Al Mazrou, F., Bafail, A., Alhwsawi, H., Albalawi, I., Alanazi, G., Halawani, I., Alhije, F., & Alalola, R. (2026). Prophylactic dressing in the prevention of bedsore: A network meta-analysis. Journal of Surgical Research, 317, 235-243. https://doi.org/10.1016/j.jss.2025.09.065
Eğilmez, H., Yava, A., & Koyuncu, A. (2026). Investigation of the effect of a pressure sore care bundle in reducing the development of operating room pressure injury in patients undergoing orthopedic surgery: A non-randomized controlled study. BMC Musculoskeletal Disorders, 27(1). https://doi.org/10.1186/s12891-026-10039-0
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
Gao, Y., Chen, J., Guang, W., Xu, W., Wei, Z., & Yang, H. (2026). A qualitative study of facilitators and barriers to intraoperative acquired pressure injury prevention implementation in operating room nurses based on the CFIR framework. Frontiers in Health Services, 6, Article 1877556. https://doi.org/10.3389/frhs.2026.1877556
Hooper, V., LaFond, C., & Perez, A. C. (2026). The performance of the Scott Triggers instrument in predicting perioperative pressure injury (PPI) development. Journal of PeriAnesthesia Nursing. Advance online publication. https://doi.org/10.1016/j.jopan.2026.06.012
Karaca, M., & Okgün Alcan, A. (2026). Lithotomy position and intraoperative-acquired pressure injury: A prospective observational study. Advances in Skin & Wound Care, 39(8), 420-423. https://doi.org/10.1097/ASW.0000000000000501
Latimer, S. L., Chaboyer, W. P., Probst, S., Thalib, L., Palipana, D., Lapkin, S., McInnes, E., Downes, M. J., & Gillespie, B. M. (2026). Repositioning for pressure injury prevention in adults. Cochrane Database of Systematic Reviews, 2026(6), Article CD009958. https://doi.org/10.1002/14651858.CD009958.pub4
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
Zhao, Y., Alderden, J., Missbrenner, N., Quon, A., & Tivis, L. J. (2026). Risk factors associated with hospital-acquired pressure injuries in patients undergoing surgical hip fracture repair. Journal of Wound, Ostomy, and Continence Nursing, 53(5), 369-375. https://doi.org/10.1097/WON.0000000000001311
What the NURS 716 Week 3 instructions ask
The second NURS 716 assignment begins the formal literature review for the PICO question developed in Week 2. The student finds ten refereed articles, none older than three to five years, that speak to the question, using the scenario the course provides, and analyzes them in a synthesis table that gives in-depth information about each article, including its level of evidence. The assignment closes with a discussion of implications for practice. Because the table becomes the evidence base for the two-part proposal later in the course, it should record what the proposal will need: design, sample, intervention, outcomes, key findings, limitations and level. A clear hierarchy, named at the start, keeps the leveling consistent from the first row to the last.
How this NURS 716 Week 3 example is built
A short introduction restates the PICO question and the evidence hierarchy used to level each article. The synthesis table follows, one row per article, recording each study's design and level, who was studied and where, what it found and what weakens it. The narrative after the table does the synthesizing: it groups the articles into evidence on the intervention, evidence on who is at risk and why, and evidence on implementation, then compares what the groups say. A section on the overall strength of the evidence leads to implications for practice, including where the dressings should be placed, who should receive them and what else must accompany them. Margin notes explain each structural choice.
NURS 716 Week 3 grading rubric: where the points go
The literature review assignment is usually judged on whether ten appropriate, recent, peer-reviewed articles are included, whether the synthesis table is complete and accurate, whether levels of evidence are assigned correctly using a named hierarchy, whether the narrative synthesizes rather than summarizes, and whether implications for practice follow from the evidence. Graders reward tables that capture limitations as carefully as findings, since the proposal will depend on knowing how strong each source is. A narrative organized by themes that compares studies shows the move from summary to synthesis. Implications that name who, where and when show the student is already thinking about the proposal.
NURS 716 Week 3 help: mistakes that cost points
Students often fill the table with long abstracts, leaving no room to compare, or assign levels of evidence inconsistently because no hierarchy is named. Some include articles outside the date range or ones that do not address the PICO question. The implications section is frequently a single sentence recommending the intervention. Name the hierarchy you use, keep each cell short and specific, include a limitations column, group the articles into themes in the narrative, weigh the strongest evidence most heavily and write implications that say who, where, when and with what else. Recheck every date against the three-to-five-year window before submitting.
Related NURS 716 sample papers
Other NURS 716 weeks
- NURS 716 Week 1: Discussion Board Forum 1
- NURS 716 Week 2: Developing a Clinical Question
- NURS 716 Week 4: Discussion Board Forum 2
- NURS 716 Week 5: AGREE II Guideline Appraisal
- NURS 716 Week 6: EBP Proposal Part 1
- NURS 716 Week 7: Discussion Board Forum 4
- NURS 716 Week 8: EBP Proposal Part 2
More DNP sample papers
- NURS 700 Week 3: Research Article Critique
- NURS 711 Week 3: Neuro Paper: Trigeminal Neuralgia
- NURS 715 Week 3: Theory Presentation Part II
NURS 716 Week 3 questions, answered
What is NURS 716 Assignment 2?
The 150-point Initiating the Literature Review assignment in Module/Week 3, analyzing ten recent peer-reviewed articles on the PICO question in a synthesis table with levels of evidence and implications.
Where can I find a free NURS 716 Week 3 sample paper?
Everything in the NURS 716 Week 3 sample, the ten-row synthesis table on perioperative pressure injury, the levels of evidence and the implications, is open on this page without charge.
How old can the NURS 716 articles be?
No older than three to five years, according to the course guide, and all must be peer-reviewed and address the PICO question.
What evidence hierarchy is used to level articles?
A common hierarchy places systematic reviews and meta-analyses of randomized trials at level I, single randomized trials at level II, non-randomized controlled studies at level III and descriptive or qualitative studies lower.
Do silicone foam dressings prevent pressure injuries?
Meta-analyses of randomized trials found silicone foam dressings reduced sacral and heel pressure injuries, and a 2026 surgical trial found fewer intraoperative injuries with a sacral dressing.
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