Ask an answerable question (PICO)：
Dry skin is prone to epidermal tears or pressure injuries, thereby increasing the risk of infection. In severe cases, not only is the quality of life affected, but the accompanying itch can also disrupt sleep cycles and mood, with the elderly being a commonly affected high-risk group. Literature indicates that skin integrity can serve as a basis for indicators of nursing quality. Therefore, maintaining and improving skin hydration is an essential aspect of nursing practice that cannot be overlooked. Currently, the market is flooded with various products like lotions, baby oils, and moisturizing creams, which are often expensive and vary significantly in clinical efficacy. Moreover, they provide only short-term effects and may increase the production of skin flakes. According to the literature, linoleic acid found in sunflower seed oil (SSO) not only enhances epidermal defense but also ameliorates dry skin. Additionally, its high vitamin E content (609 mg/kg) prevents excessive oxidation in the body, contributing to the mitigation of skin oxidation and repair (Arianto & Cindy, 2019). This raises the empirical question of whether sunflower seed oil can improve skin hydration in the elderly.
The Method and Analysis of Literature Review：
The literature search encompassed three bilingual databases: PubMed, Embase, and the CEPS Online Library. Keywords were developed using the PICO framework—P: elderly, I: sunflower seed oil, O: skin hydration level. These were combined with MeSH terms and synonyms following Boolean logic principles. Keywords, synonyms, and MeSH terms were connected using the operators OR and AND in an unrestricted date range search to broaden the scope. Cross-referencing was employed to introduce additional keywords, enhancing the search's breadth. Included studies primarily comprised systematic reviews (SR), randomized controlled trials (RCT), and meta-analyses.
Critical Appraisal：
The literature search yielded 28 articles, from which duplicates, interventions, and studies not aligning with the objectives were excluded, resulting in the inclusion of one Randomized Controlled Trial (RCT) for appraisal. The evidence level of the selected study, according to the Oxford CEBM 2011 Levels of Evidence, is classified as Level 2. The study's aim was to compare the skin care effects of olive oil and sunflower seed oil. It targeted participants without active symptoms of atopic dermatitis within the last six months, with no restrictions on age or gender. This single-blind randomized trial spanned one month and found that sunflower seed oil effectively reduced skin dryness and enhanced moisture retention regardless of the presence of atopic dermatitis. However, demographic data collection was simplistic, and the amount of oil applied was only quantified in drops. The study did not explicitly address how external factors were controlled during the application process. Therefore, meticulous execution is essential when translating these findings into clinical practice.
Clinical Application of Evidence：
Using the seven-step process for evidence-based knowledge translation, a clinical study was conducted in the thoracic intensive care unit of a medical center in northern Taiwan. The study included participants aged 65 and older and took place over a period of nine weeks from October 7, 2022, to December 12, 2022. The intervention involved the application of approximately 5ml of a substance on the skin of the same side of a single lower limb. Measurements were then taken at 1, 10, 30, and 60 minutes after application using the Overall Dry Skin Rating Scale and a skin testing device.
Evaluation of Effectiveness：
The study enrolled 25 participants, of whom 76% were male, with an average age of 73.7 ± 9.6 years. Measurements of skin hydration in the elderly participants' single lower limb showed significant improvement following the application of sunflower seed oil. One-minute post-application, hydration increased to 27.2 ± 4.37, remained stable at 10 minutes, rose to 28.0 ± 4.62 at 30 minutes, and reached 28.76 ± 5.05 after one hour. The Overall Dry Skin (ODS) score also decreased from 1.52 (0.77) pre-intervention to 0.52 (0.65) post-intervention, indicating that sunflower seed oil effectively moisturizes and prevents dryness in elderly skin. Gender-specific differences observed one-hour post-application include an increase in skin hydration by 1.18% (24.37 ± 3.70), a decrease in oiliness by 0.54% (55.47 ± 1.43), and an improvement in elasticity by 2.74% (43.26 ± 2.62) in males. In contrast, females showed a hydration increase of 5.22% (27 ± 5.22), oiliness improvement of 2.05% (54.58 ± 2.05), and elasticity increase of 3.33% (44.33 ± 3.33), suggesting a faster absorption of sunflower seed oil in female skin. Differences between genders were approximately 1%, but these outcomes may vary with the number of participants. It is recommended that future studies extend the enrollment period to enhance the completeness of data collection.
Conclusions and Recommendations：
Using sunflower seed oil as an intervention, a 500 ml bottle costs approximately 170 New Taiwan Dollars, and a 150ml opaque plastic bottle costs around 20 New Taiwan Dollars. The total expense is under 200 New Taiwan Dollars. On average, a container lasts between three to five days, making it a cost-effective and economical option. Moreover, it is safe to use, can reduce skin dryness, and increase moisture levels. Participants reported enhanced overall comfort, and the initiative has been highly endorsed by department heads and nursing staff due to its effectiveness and benefits. It is hoped that sharing this experience will provide clinical staff with a variety of care applications, thereby increasing patient comfort.
