NR 439 Week 5 Silicone Foam Dressing Evidence Matrix Example

Course	NR 439 RN Evidence-Based Practice
Week	5
Paper type	Evidence matrix
Length	About 1,090 words, 8 pages
Format	APA 7 student paper
School	Chamberlain University
Program	RN-to-BSN
Updated	October 2026

Free sample paper for NR 439 Week 5

Prophylactic Sacral Silicone Foam Dressings for Critically Ill Adults: An Evidence Matrix

Student Name

College of Nursing, Chamberlain University

NR 439: RN Evidence-Based Practice

Instructor Name

Month Day, Year

What this page is doingThe title names the intervention, where it goes, who receives it and the document type, so a reader knows the pages that follow are appraised rows rather than a narrative review. Student APA 7 format, no running head.

Prophylactic Sacral Silicone Foam Dressings for Critically Ill Adults: An Evidence Matrix

The Question Behind the Matrix

This matrix appraises the evidence for one PICOT question: in critically ill adults admitted to an intensive care unit, does a prophylactic multilayer silicone foam dressing applied to the sacrum on admission, in addition to standard prevention, compared with standard prevention alone, reduce the incidence of hospital-acquired sacral pressure injury during the intensive care stay? The practice problem comes from a composite 18-bed medical-surgical intensive care unit that turns patients every two hours and uses pressure-redistributing mattresses, yet still records sacral injuries in patients on vasopressors and prolonged ventilation, the group in whom turning is least reliable. Those patients are also the ones in whom a new injury is hardest to heal, because the same low perfusion that makes turning unsafe slows repair of the tissue once it breaks down.

Four sources were retained from the search for appraisal. Levels of evidence below use the seven-level scale published by Melnyk and Fineout-Overholt (2023), where Level I is a systematic review of randomized controlled trials, Level II a single well-designed randomized controlled trial, and Level VII the opinion of expert committees. Rows run from the highest level to the lowest, so entries in each column can be compared down the page and the synthesis next week can start from the strongest evidence.

What this page is doingThe matrix is tied to one question and one named hierarchy before any row appears. Stating the order of the rows up front matters, because the level column is the one a grader reads down first, and sorting by level makes it comparable at a glance.

Row 1: Moore and Webster (2018)

Purpose: To assess whether dressings and topical agents used on intact skin prevent pressure ulcers in people of any age in any care setting.

Design: Systematic review of randomized controlled trials.

Sample and setting: Trials of dressings, creams and other topical agents across hospitals, intensive care and long-term care; the silicone dressing trials were a subset, several of them in intensive care.

Findings: Silicone dressings applied to at-risk skin were associated with fewer pressure ulcers than no dressing.

Level of evidence: Level I.

Limitations (appraisal): The review graded the certainty of the silicone dressing estimate as low, mainly because of risk of bias in the included trials, including a lack of blinding in outcome assessment. A dressing is hard to blind, and a nurse who can see the dressing may also be the person staging the skin underneath it. The review therefore supports the direction of effect and not its size, which is the distinction a unit adopting the dressing needs to keep in view.

What this page is doingEach cell holds an appraisal phrase rather than a copied sentence from the abstract. The level column assigns Level I from the design, and the limitations cell then explains why a Level I source can still be low certainty. That judgment, in the writer's own words, is what earns full points on a matrix.

Row 2: Santamaria et al. (2015)

Purpose: To test whether soft silicone multilayer foam dressings applied to the sacrum and heels in the emergency department prevented pressure injuries in critically ill trauma patients.

Design: Randomized controlled trial.

Sample and setting: 440 adult trauma and critically ill patients at one Australian tertiary hospital, with dressings applied in the emergency department and kept on through the intensive care stay.

Findings: Pressure injuries developed in about 3% of the dressing group and about 13% of the control group, a significant difference.

Level of evidence: Level II.

Limitations (appraisal): The design is strong and the effect is large, but outcome assessors were not blinded, and the trial ran at one center with a trauma-heavy population. Trauma patients are often younger and immobilized for different reasons than medical intensive care patients on vasopressors, so the size of the effect may not transfer directly. Applying the dressing in the emergency department also means the intervention started earlier than this unit could start it.

What this page is doingDirection and size appear as numbers, and the limitations cell separates two questions students tend to merge: whether the design can be trusted, and whether the population resembles the one in the PICOT. The cell also notices that the dressing started in the emergency department, a timing difference that would change what this unit could expect.

Row 3: Kalowes et al. (2016)

Purpose: To test whether a five-layer soft silicone foam dressing on the sacrum reduced pressure injuries in adult intensive care patients.

Design: Randomized controlled trial.

Sample and setting: 366 adult patients in the intensive care units of one hospital in the United States.

Findings: Fewer sacral pressure injuries developed in the dressing group than in the standard care group, and injuries in the dressing group appeared later in the stay.

Level of evidence: Level II.

Limitations (appraisal): The closest match to this unit: a United States intensive care population with the dressing started on admission to the unit. The number of injuries in both groups was small, so the difference rests on few events and a handful of cases either way would change its significance. As in the other trials, the staff assessing the skin knew which patients had dressings. The trial also reports the product used, and a unit adopting its finding should buy a comparable multilayer silicone dressing rather than any foam available.

What this page is doingThe most direct study in the set is not automatically the most persuasive, and the cell explains why: few events. Noting that the effect belongs to a specific kind of dressing turns the appraisal into something a unit could act on, which is the purpose of the limitations column.

Row 4: Black et al. (2015)

Purpose: To set out recommendations on the use of prophylactic dressings as an addition to pressure injury prevention.

Design: Expert consensus panel.

Sample and setting: An international panel of wound care clinicians and researchers reviewing the evidence available at the time.

Findings: The panel recommended prophylactic dressings as an adjunct in high-risk patients, never as a replacement for turning, support surfaces and skin inspection, and advised lifting the dressing to inspect the skin at least daily.

Level of evidence: Level VII.

Limitations (appraisal): Consensus cannot establish that the dressing works; it relies on the trials above. Its value in this matrix is practical: it supplies the conditions for use, including inspection under the dressing and continued turning, that the trials assumed but did not test. Several panel members had ties to industry, and the paper should be read with that in mind.

What this page is doingA consensus paper is kept and labeled for what it is. The findings cell records its practical rules and the limitations cell states plainly that it cannot show effect, then names a conflict of interest, which is an appraisal move many students skip.

Reading Down the Columns

Read by column, the matrix is consistent in direction: every source favors the dressing in high-risk patients, and both randomized trials found fewer injuries with it. The level column shows the evidence reaching Level I, yet the limitations column shows why that is not the end of the question: the review grades its own certainty as low, and every trial shares the same weakness of unblinded skin assessment. The matrix also shows what no source measured, namely whether the dressing still helps when turning is done reliably every two hours, which is the practice already in place on this unit. That gap, together with the cost of the dressings, is what the synthesis will have to weigh.

For now the matrix supports one narrow statement: in adults whose condition makes repositioning unreliable, a multilayer silicone dressing on the sacrum is likely to reduce injuries, provided the skin underneath is still inspected every day and turning continues whenever the patient can tolerate it.

What this page is doingThe closing reads the matrix by column, which is how it is meant to be used. It names the shared weakness across rows and the gap no study filled, which prepares next week's synthesis without starting it early.

References

Black, J., Clark, M., Dealey, C., Brindle, C. T., Alves, P., Santamaria, N., & Call, E. (2015). Dressings as an adjunct to pressure ulcer prevention: Consensus panel recommendations. International Wound Journal, 12(4), 484-488. https://doi.org/10.1111/iwj.12197

Kalowes, P., Messina, V., & Li, M. (2016). Five-layered soft silicone foam dressing to prevent pressure ulcers in the intensive care unit. American Journal of Critical Care, 25(6), e108-e119. https://doi.org/10.4037/ajcc2016875

Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing and healthcare: A guide to best practice (5th ed.). Wolters Kluwer.

Moore, Z. E. H., & Webster, J. (2018). Dressings and topical agents for preventing pressure ulcers. Cochrane Database of Systematic Reviews, 2018(12), Article CD009362. https://doi.org/10.1002/14651858.CD009362.pub3

Santamaria, N., Gerdtz, M., Sage, S., McCann, J., Freeman, A., Vassiliou, T., De Vincentis, S., Ng, A. W., Manias, E., Liu, W., & Knott, J. (2015). A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: The Border trial. International Wound Journal, 12(3), 302-308. https://doi.org/10.1111/iwj.12101

What the NR 439 Week 5 assignment asks for

The Week 5 matrix has you appraise the research you found and organize it in a table. The assignment sheet tends to list a column for purpose, design, sample and setting, findings, level of evidence and limitations, along with a brief summary, all in APA. Tie the matrix to your PICOT question and name the hierarchy you use before any row appears. Fill each cell with a short appraisal phrase rather than a copied abstract sentence. Report findings with direction and size. Assign levels from the design. Use the limitations column for your own judgment, separating whether the design can be trusted from whether the population matches yours. Close by reading down the columns.

Inside the NR 439 Week 5 example

The question section states the PICOT question on silicone dressings applied on ICU admission and names the seven-level scale. Row 1 summarizes Moore and Webster's review of dressings and topical agents, assigns Level I and explains why its certainty was graded low. Row 2 reports Santamaria and colleagues' Australian trial in the emergency department, Level II, with unblinded assessors and a trauma-heavy population. Row 3 gives Kalowes and colleagues' United States ICU trial, Level II, with few events. Row 4 records Black and colleagues' consensus recommendations, Level VII, and its practical rules about lifting the dressing to inspect skin. The final section notes consistent direction, the shared weakness of unblinded outcomes and the narrow conclusion supported.

Reading the NR 439 Week 5 grading rubric

Evidence matrix rubrics usually reward a clear link to the question, accurate extraction across columns, correct levels of evidence, critical appraisal in the limitations column, consistency between rows, a summary and APA. Critical appraisal is the row most students lose, and this matrix keeps it by writing judgments the authors did not make, such as the effect belonging to a specific dressing. Levels are credited because each is assigned from the design using the named scale. Extraction scores for findings with numbers. Consistency earns points because every row answers the same questions. The summary reads by column and states one narrow conclusion. Five references, including the hierarchy source, complete APA.

NR 439 Week 5 help from the desk

The commonest loss on this matrix is a limitations column copied from the paper's own limitations paragraph, which records what the authors admitted rather than what you judged. Another is assigning levels by journal or reputation instead of design. Students also mix outcome measures without saying so, leave consensus papers unlabeled or write a summary that repeats each row. Qualitative studies can go in the same matrix with their own level. Studies using different outcome measures need a note so readers do not compare them directly. If your search found different studies, send the list and an NR 439 matrix can be appraised row by row.

Get a NR 439 Week 5 example written to your instructions

Send the Week 5 instructions, the matrix template your section issues and your PICOT question, and a custom example is filled into your own columns and returned inside 24 to 48 hours. The first one is free. Which studies you include, and which you leave out, stays your call.

More NR 439 papers and RN-to-BSN samples

NR 439 Week 5 questions, answered

How is this different from the evidence table in other courses?

The columns overlap but the purpose does not. A capstone table asks whether a study supports a change you intend to make, so it ends in applicability. This matrix asks what kind of evidence each study is and how far it can be trusted, so it ends in level and limitations. Written for the wrong purpose, either one reads as filled in without thinking.

What if the studies use different outcome measures?

Record them as they are and let the difference show. A matrix whose outcome column contains three incompatible measures is telling you something real about the literature, and that observation belongs in the synthesis later. Forcing them into one wording to make the column look tidy hides the exact problem the appraisal exists to surface.

Can qualitative studies go in the same matrix?

Usually yes, with the level column handled the way your section specifies, since most hierarchies rank qualitative work differently or separately. The sample and findings columns still work if you enter participants and themes. Say which hierarchy your assignment names when you send it, because the level entries depend entirely on that choice.

Where can I find a free NR 439 Week 5 sample paper?

This page shows the complete Week 5 matrix on sacral silicone dressings, all four appraised rows with levels, the column reading, the narrow conclusion and five references.

Which study in the NR 439 Week 5 matrix best matches the writer's unit?

Kalowes and colleagues' trial of 366 adult ICU patients in a United States hospital, with the dressing started on unit admission, though its small number of injuries limits how persuasive it is.