Ask an answerable question (PICO)：
Pressure injuries (PIs), which are accepted as quality indicators in health institutions, are important health problems affecting elderly individuals and their caregivers. Our unit is the homecare at the Northern District Hospital in Taiwan. A total of 345 cases were included, of which 86.4% were long-term bedridden and average incidence of PIs was 6.02%. Some studies have shown that essential fatty acids can improve skin hydration and elasticity. While olive oil contains a variety of fatty acids, whether it can prevent PIs is unknown. We wanted to investigate whether applying olive oil can prevent skin pressure in long-term bedridden patients.
The Method and Analysis of Literature Review：
In this study, we followed the first three steps of the evidence-based nursing 5As process; asking, acquiring, and appraising, to produce PICO questions. We used MeSH (Medical Subject Headings, MeSH) terms and set keywords of long-term bedridden, olive oil, virgin olive oil, pressure injury, decubitus ulcer, and studied strategies of OR connection and intersection between PICOs by Boolean logic and restricted to meta-analysis, systemic review (SR), and randomized controlled trial (RCT). A total of 57 studies from 2017 to 2021 were obtained; two studies in Cochrane Library, seven studies in PubMed, seven studies in Trip, 10 studies in CINAHL, 18 studies in Google scholar, 13 studies in EBSCO, and no studies in Airiti Library and NCL Taiwan Periodical Literature. We included three studies for further evaluation, excluding those with duplicate studies and did not explore the effect of skin pressure ulcers.
Critical Appraisal：
We used the Joanna Briggs Institute (JBI) 2020 SR and RCT critical appraisal tools to analyze the evidence level. In this study, the authors examined until March 2017 and included 18 trials, including only two studies comparing fatty acids and olive oil with no difference in the incidence of PIs. Both fatty acids and olive oil reduced the incidence of PIs; the evidence level was 1.a according to the JBI evidence level; recommended strength is B. Both the first and second RCTs showed that olive oil can reduce the incidence of PIs, the first RCT article was rated as 1.c according to the JBI evidence level; recommendation strength is A. The second RCT was then reduced to 1.d according to the JBI evidence level because the participants, treatment, and outcome assessors were not blinded, and intention-to-treat analysis was not used; recommendation strength was A. None of the three studies observed any adverse effects with olive oil.
Results, Conclusions and Recommendations：
The results showed that the application of olive oil in long-term bedridden patients can prevent the occurrence of skin PIs. Applying olive oil to the area on the bones of long-term bedridden patients are compressed; therefore, will not cause adverse effects on the skin, social ethical perception, and medical concerns. Provided as a reference in clinical practice.
陳頌云 侯春梅 陳淑暖 蔡衣帆*
