Ward trial, 612 patients, six wards

Nursing research poster

A ward based trial of four hourly against two hourly repositioning on high specification foam, laid out as an A0 landscape board in four columns. It reports both outcomes a nursing trial has to report: whether patients were harmed, and how much nursing time the change gives back.

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The whole board

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Two hourly against four hourly repositioning on high specification foam: a ward based trial

D. Fernandes ¹, M. Osborne ¹ ², H. Rahman ²

1 Department of Nursing, Riverbend General Hospital · 2 School of Nursing, University of Northwood

ABSTRACT

Two hourly repositioning is standard on our wards and it consumes more nursing time than any other single preventive task. High specification foam mattresses were introduced across the trust in 2023, and the evidence that two hourly turning still adds anything on top of them is thin. We randomised 612 patients at moderate or high risk across six wards to two hourly or four hourly repositioning, all on the same foam mattress.

REFERENCES

1.Gillespie BM, et al. Cochrane Database Syst Rev 2020;6:CD009958.

2.Moore ZE, Cowman S. Cochrane Database Syst Rev 2015;1:CD006898.

3.Beeckman D, et al. Int J Nurs Stud 2019;97:24-33.

INTRODUCTION

The two hourly interval is not derived from trial evidence. It comes from mid twentieth century practice on mattresses that no longer exist on our wards, and it has survived into current guidance largely by repetition. High specification foam redistributes pressure continuously, which is the mechanism turning was meant to provide intermittently.

METHODS

Design. Pragmatic randomised trial, six wards, individual allocation, 14 day follow-up.

Participants. 612 adults at moderate or high risk on the Braden scale, expected stay over 3 days.

Arms. Repositioning every two hours or every four hours, day and night, all on the same foam mattress.

Outcome. New pressure ulcer, category 2 or above, assessed daily by a nurse blind to allocation.

Time. Repositioning time recorded by direct observation on 84 randomly sampled shifts.

PARTICIPANT FLOW

Screened

891

Excluded

279

Randomised

612

Each arm

306

Withdrew or died

Analysed

287

Figure 1. Difference in ulcer incidence at 14 days, four hourly minus two hourly, in percentage points, by baseline risk.

Source: Trial dataset, 2026.

RESULTS

Of 612 randomised, 574 were analysed at 14 days. New ulcers of category 2 or above occurred in 11 of 287 under four hourly (3.8%) and 12 of 287 under two hourly (4.2%), a difference of 0.3 percentage points (95% CI -2.4 to 3.0), which excludes the 3 point harm the trial was powered to detect. The result held in both risk strata: the four hourly arm was 0.3 points lower among high risk patients and 0.4 points lower among moderate risk, both well inside the confidence interval and neither close to significance. Direct observation on 84 shifts found repositioning took 51 fewer minutes per patient per day under four hourly (95% CI 44 to 58). Skin inspection was completed on schedule in 96% of four hourly patients against 91% of two hourly, which nursing staff attributed to having time to do it properly rather than in passing.

51 min

nursing time saved per patient day

95% CI 44 to 58, direct observation

DISCUSSION

On high specification foam we could not detect a benefit from the shorter interval, and the confidence interval rules out the size of harm that would matter clinically. That is a different claim from proving equivalence, and a larger trial could still find a small effect. The time finding is the one with immediate consequences. Fifty one minutes per patient per day is not saved time in the abstract; on the wards we observed it went into skin inspection and into earlier mobilisation, both of which are themselves preventive.

CONCLUSIONS

On high specification foam, four hourly repositioning matched two hourly on ulcer incidence and returned 51 minutes of nursing time per patient each day, most of which went back into skin inspection and mobilisation.

Incidence 3.8% four hourly against 4.2% two hourly

Difference 0.3 points, 95% CI -2.4 to 3.0

51 minutes per patient day returned to the ward

Skin inspection completed on time more often

Block by block

What each block on the board is for, in the order a reader walks it.

Title band and authors: The trial title across the band with the hospital and university affiliations.
Abstract: Why the interval is being questioned, what changed on the wards to make the question live, the trial size and both outcomes.
Introduction: Where the two hourly interval came from, and why high specification foam changes the reasoning: the mattress redistributes pressure continuously, which is what turning was meant to do intermittently.
Methods as a labelled protocol: Design, participants with the risk criterion, the two arms, the blinded outcome assessment, and how repositioning time was observed.
Participant flow: Screened 891, excluded 279, randomised 612, then per arm 306 allocated, 19 withdrew or died and 287 analysed. Every step reconciles: 891 less 279 is 612, 612 split evenly is 306, 306 less 19 is 287, and two arms of 287 make the 574 the results analyse. The flow template draws one arm column, so the node is labelled each arm rather than showing both side by side.
Time saved and incidence figure: A stat block carrying the 51 minutes with its interval, above a figure showing the incidence difference overall and by baseline risk.
Results: Incidence in both arms with counts, 11 of 287 against 12 of 287, the result by risk stratum, the observed time saving, and the skin inspection completion rates. The strata, 0.3 points lower for four hourly among high risk patients and 0.4 points lower among moderate risk, bracket the overall difference of 0.35 points (1 in 287), so the pooled figure sits where any realistic risk mix would put it.
Discussion and limits: What the confidence interval rules out, why that is not the same as proving equivalence, and where the released time went on the wards: skin inspection and earlier mobilisation. The conclusions block and four checked points follow, and three short citations sit in the reference block on the left.
How to adapt this board: Wards go into Participants, with how many and what kind, because ward mix is the first thing another nurse will ask about. The timing of the intervention goes into its own protocol entry, since on a nursing trial the schedule is the intervention. Minutes saved belongs as the second result rather than a closing remark: a change that costs nothing and returns time is a different proposition from one that only avoids harm, and a ward manager reads for that. Keep the confidence interval beside every difference, because a null result without one says nothing at all.

What makes this board work

Time is reported as an outcome

Fifty one minutes per patient per day, measured by direct observation on 84 shifts rather than estimated. In nursing research the resource finding is often the one that changes practice, so it gets a stat block of its own.

It does not overclaim equivalence

The discussion says the interval rules out the size of harm that would matter, and that this is a different claim from proving equivalence. That distinction is what a careful reviewer checks first.

The claim is sized to the design

The results say the interval excludes the 3 point harm the trial was powered to detect, and the discussion adds that a larger trial could still find a small effect. Each sentence limits the finding to what 612 patients on one mattress type can support.

Questions people ask

What goes on a nursing research poster?

The clinical question in ward terms, the design and allocation, what each arm received, the patient outcome, the resource outcome, and the limits of the finding. Nursing time is a legitimate outcome, not a footnote: this board gives the 51 minutes per patient day its own stat block and says it was measured by direct observation on 84 shifts.

How do I report a negative result?

State the difference with its confidence interval and say what size of effect the interval rules out. A difference of 0.3 points with an interval from -2.4 to 3.0 is informative, because it excludes the 3 point harm this trial was powered to detect. The phrase no significant difference on its own is not, since a small underpowered trial can say it too.

Do I need a flow diagram if it is not a drug trial?

If patients were randomised, yes. This board shows screened 891, excluded 279, randomised 612, then 306 in each arm, 19 withdrew or died and 287 analysed per arm, and every step adds up. A flow is the first place a reviewer checks arithmetic, so every node needs its full count, and a board with room should name the exclusion reasons too.

Can I fit four columns on one poster?

At A0 landscape, comfortably. The four column layout suits a study with an abstract, methods, results and discussion of roughly equal length. This board runs abstract, references and introduction in the first column, methods and flow in the second, the figure and results in the third, and the stat, discussion and conclusions in the fourth.

Where does a nursing time saving go on a ward trial poster?

In the results as a measured outcome with an interval, and in a stat block if it is the finding a ward manager will act on. This board prints 51 minutes per patient day, 95% CI 44 to 58, from direct observation on 84 randomly sampled shifts, and the discussion says where the time went: skin inspection and earlier mobilisation.

Do the CONSORT counts have to add up?

Yes, every arrow. Screened minus excluded equals randomised, and randomised minus withdrawals equals analysed. Check with a calculator, because a reader will. On this board 891 screened less 279 excluded leaves 612 randomised, 306 per arm, and 306 less 19 withdrawals leaves 287 analysed in each arm, 574 in all; a gap at any step undermines every other number on a poster.

Can the four columns be resized?

Yes. Every block on the board can be dragged and resized on its own in the editor, so a long methods protocol can take more height and the abstract less. Check each column at full size afterwards, since longer text in a smaller block can crowd. What cannot change is the orientation: this layout is built for A0 landscape only.

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Sources

Written and checked by the OneCraft team. Last checked 29 September 2026.