Literature Review: Use of Virgin Coconut Oil in Prevention

Decubitus Wounds in Immobility Patients

Jesica G. Rukmana 1 , Renata Komalasari 2 , Shinta Yuliana Hasibuan 3

1. Students of the Faculty of Nursing and Health Sciences
2. Lecturer at the Faculty of Nursing and Health Sciences, Pelita Harapan University
3. Clinical Educator, Faculty of Nursing and Health Sciences, Pelita Harapan University
Karawaci 15811 Tangerang
E-mail: jessica.rukmana@gmail.com

ABSTRACT
Virgin Coconut Oil (VCO) is pure coconut oil which contains fatty acids that can soften the skin
and act as a moisturizer that can increase skin hydration. This literature review aims to review
the effectiveness of using virgin coconut oil in the prevention of pressure sores in immobility
patients. This research method is a literature review. Keywords used to conduct literature
search included virgin coconut oil, decubitus wounds, immobility patients, virgin coconut oil,
decubitus ulcers , immobility patients . The databases used are the Garuda Portal and Google
Scholar. Of the xxx articles identified, five eligible articles for review. The analysis method used
was thematic analysis: simplified approach . The results of this study identified four themes,
including massage methods that were effective in preventing pressure sores, the use of VCO to
prevent the incidence of pressure sores, the use of VCO to reduce the effects of friction and
pressure and the use of VCO to inhibit fungal and bacterial infections. In conclusion, VCO is
effective in preventing pressure sores in immobility patients. Further research can be carried
out research to investigate the factors that influence the effectiveness of VCO in the prevention
of pressure sores.

Keywords : Decubitus Wounds, Immobility Patients, Virgin Coconut Oil

ABSTRACT
Virgin Coconut Oil (VCO) is a pure coconut oil which contains fatty acids that can soften the skin
and serve as a moisturizer that can improve the hydration of the skin. This literature review was
aimed at exploring the application of virgin coconut oil in the decubitus ulcer prevention for
immobile patients. The keywords used consisted of pure coconut oil, decubitus ulcers, immobile
patients (immobility patients), virgin coconut oil. The databases included Portal Garuda and,
Google Scholar. Of xx Total articles identified, five were reviewed. The method of analysis used
thematic analysis: simplified approach. The results of this study found four themes, namely
effective massage methods to prevent decubitus ulcers, the use of VCO to prevent the incidence of
decubitus ulcer, the use of VCO reduces the effects of friction and pressure and the use of VCO
inhibits candidas and bacterial infections. It can be concluded that VCO is effective to prevent
sores in immobile patients. Future study is needed to identify factors affecting VCO effectiveness in
the prevention of decubitus ulcers.

Keywords: Decubitus Ulcer, Immobility Patients, Virgin Coconut Oil

PRELIMINARY One of the integrity of the skin is

A situation where a person cannot pressure ulcers or pressure sores
move actively or freely due to (Asmadi, 2008).
conditions that interfere with Rismawan (2014) revealed that
activity can be called immobility or several conditions can lead to
bed rest (Rismawan, 2014). The immobilization, including joint and
negative impact of immobility on the bone disorders, diseases related to
physical is damage nerves,

62 Nursing Current Vol. 5 No. 1, January 2017 - Ju

associated with heart
respiration as well as critical illness
that requires bed rest. Decubitus is
often found in patients with bed rest
or immobility for a long
(Rubenstein et al , 2007).
Potter & Perry (2013) revealed that
pressure sores, pressure sores or
bedsores are a disturbance in the
integrity of the skin associated with
prolonged and unrelenting pressure
. Decubitus or pressure sores are the
conditions most often experienced
by individuals with prolonged
immobility (Marrelli, 2007). Pressure
and tissue tolerance can
pressure sores or pressure sores
(Setiani, 2014). Bryant (2007) states
that the pathophysiology of the
formation of pressure sores
primarily due to prolonged constant
external pressure. Areas
pressure sores are common are bony
ridges that are under pressure or
pressure. Decubitus ulcers
above the bony prominence of the
pelvis as much as 95% (Marrelli,
2007).
Several attempts can be made as an
intervention to prevent pressure
sores, such as wound care, topical
drugs, therapeutic mattresses and
education (Mutia et al, 2015). Caring
for the skin is a
Nursing Current Vol. 5 No. 1, January 2017 - June 2017
and skin care measures that are at risk of
damage to skin integrity, especially
in areas that experience pressure or
protrusions (Uliyah & Hidayat, 2008).
time Caring for the skin by providing a
topical which functions to
moisturize the skin in areas at risk
of pressure sores.
Virgin Coconut Oil (VCO) is pure
coconut oil that is produced from the
processing of coconut flesh without
heating or heating at low
temperatures so as to produce oil
with a clear color and free from free
radicals due to heating (Handayani
et al , 2011). Lucida et al (2008)
cause
revealed that the content of fatty
acids (especially lauric and oleic
acids) in VCO has properties that can
soften the skin. VCO is effectively
is used as a moisturizer for the skin so
that it can increase skin hydration
where and accelerate healing of the skin
(Agero & Verallo-Rowell, 2004;
Lucida et al , 2008).
occur
Based on the author's observations
during his practice in the Intensive
Care Unit of Siloam Hospitals Kebon
Jeruk, almost all of the patients
treated were immobility or
prolonged bed rest.
63
The length of stay in the ICU varies, METHODOLOGY
from a week to three months of This research is a quantitative study
treatment days. The disease literature review with experimental
conditions experienced by the Kebon design in order to obtain the
Jeruk ICU patients are bone injuries, effectiveness of using virgin coconut

diseases related to nerves, diseases oil in the prevention of pressure

related to the heart and respiration, sores in immobility patients. The

and critical illnesses that require rest keywords used to search the

such as sepsis. Since the first time I literature in the database were the

served in the ICU (08 May 2017) until first key "Decubitus Wounds AND
Pure Coconut Oil AND Immobility
now (30 June 2017), the author has
Patients" and the second keyword
observed after every shower and
"Decubitus Ulcer AND Virgin Coconut
changing the right-to-left tilt position
Oil AND Immobility Patients" . The
(every two hours), the back of each
database used includes the Garuda
patient is always smeared with VCO.
Portal and Google Scholar . Result of
Some patients use lotion or olive oil,
but nurses in the ICU use VCO more literature search will author
document it into the PRISMA chart.
because it is available in the ICU
room at Siloam Hospitals Kebon
The inclusion criteria in this
Jeruk.
literature review are articles in
full-text , Indonesian and English
Several researchers have proven the
languages published in the last 10
effectiveness of virgin coconut oil for
years (2007-2017), articles using
preventing pressure sores in
quantitative research methods and
patients in the Intensive Care Unit
(Setiani, 2014) and in patients the study sample is adult patients

treated with immobilization who are immobility and do not have

(Sihombing et al, 2016). decubitus sores . The exclusion
criteria were articles that were
These considerations have attracted
the authors to conduct a study on the expert opinions or expert comments,

effectiveness of using virgin coconut literature reviews and research

oil in preventing pressure sores in samples were pediatric patients.
immobility patients.

64 Nursing Current Vol. 5 No. 1, January 2017 - Ju

According to Wager and Wiffen
(2011), there are several ethical
standards when conducting
literature reviews. First,
duplicate publications by selecting
the same articles in each database
used to prevent double counting . The
author includes a literature review
in the title to show that the research
carried out is a literature review.
Second, avoid plagiarism by citing
the results of other
research. The author uses in-text or
end-text citation and
references using the APA
provisions to prevent plagiarism.
Third, it ensures that published data
is extracted accurately and that
there is no indication to try to lean
the data in a particular direction.
Fourth, transparency
describing everything that happens
during the research clearly and
openly, for example in terms of
funding or the reasons why the
author prefers one article
another (Wager & Wiffen, 2011). The
author will use this ethical standard
to conduct a literature review .
In making this literature review, the
author does not use retrieval
Nursing Current Vol. 5 No. 1, January 2017 - June 2017
data from respondents or
participants. This literature review is
the result of evaluation and analysis
avoid of various literatures obtained by
the authors from various databases .
Therefore, the author received a
legality permit from the Faculty of
Nursing, Pelita Harapan University
through an ethical test of Research
Community Service and Technical
Service .
people's
After developing a search strategy
includes
and ethical research considerations,
style
the authors determined a method
for analyzing data in order to
answer research questions from this
literature review . Data analysis in
the literature review begins with
Aveyard's critical appraisal (2010).
To do a critical appraisal , the writer
is by
needs an instrument to assess
the articles that the author uses. In
this study, the authors used seven
questions from Woolliams et al in
Aveyard (2010) to perform a critical
over
appraisal .
The approach used in analyzing the
data that has been criticized in this
study is the simplified approach .
According to Aveyard (2010), this
approach is an approach that aims
to conclude quality articles with
different methods of use
65
 answer literature review research
questions for beginners, that is
usually
used by students or undergraduate to
conduct literature reviews in the
health and social fields.
RESULTS
The literature review was conducted
from mid-November 2017 to early
January 2018. The total articles
obtained from searching using the
first and second keywords through
three databases were 143 articles
and the articles analyzed were five
articles. The search results are also
presented in the chart form below as
suggested by PRISMA (2009).

Diagram 1
Flow diagram of literature search results and study selection. Source Moher D, Liberati A, Tetzlaff J, Altman
DG, the PRISMA Group (2009).

Garuda Portal (4)   UPH Library (1) Google Scholar (138)

     

Exclusion articles:

Articles (n = 143) Title and abstract are not

according (n = 114)

Full text screening Exclusion articles:

(n = 29) non full-text (n = 18)

Exclusion articles (n = 6):

• 5 case reports
11 eligible articles
• 1 article without
journal name, volume
number and page
number

5 full-text articles
reviewed

66 Nursing Current Vol. 5 No. 1, January 2017 - Ju

In the process of searching for This literature review uses four

articles, there were 114 articles that research articles with a quasi-
 did not match the title and purpose
of the study, 18 articles that were not
full-text , which were then removed
from the list of articles to be studied,
so that there were 11 full-text articles
to be studied from the abstract and
titles with criteria inclusion. Based
on the results of the study, 6 full-text
articles were issued, namely five
case reports and one article without
the journal name, volume number
and page number.
selection, five full-text articles that
match the inclusion criteria were
obtained and will
conducting a literature review.
experimental design and one study
with an experimental longitudinal
design . Four studies were conducted
on the Indonesian population and
one in the Indian population. The
total sample involved in the study
was 188 participants. The themes
found are based on the statements of
research results that answer the
literature review questions that the
author has summarized in the first
After the
stage of the simplified approach
analysis in the literature review
results table .
be used in

Table 1
Results of the Literature Review

   
Use of VCO Use of VCO
Yang Massage Method   Use of VCO
Researcher, Prevent   Reducing Effects Get in the way
    Effective Prevent          
Year, Title Injury incident Friction and Fungal Infection and
    Decubitus sores    
Bacteria
 
 
 
 
 
 
 
  Decubitus    
  Pressure    
                   
Author :   Effleurage massage Not occur wound VCO   could Acid fat
Setiani. (2014) with VCO at press on used as antiseptic on

   
area scapula, respondents.  
lubricant so that oil coconut
Title:  
sacrum and heels.    
could reduce help  

Effectiveness          
effect friction and prevent infection
Massage with        
pressure.  
fungi and bacteria.
Virgin Coconut Oil                  

To                    

Prevention Wound                  

Press on Intensive                  

Care Unit                    

                     

Nursing Current Vol. 5 No. 1, January 2017 - June 2017 67

Author:      
Massage Effleurage Not occur wound Content in V
Handayani
   
et
   
al . in the scapular area, press  
on VCO could
 
c
(2011) sacrum, and heels. respondents. help i
                    
reduce effect a
Title:                
friction and l
Prevention Wound        
pressure.   n
Press Through Massage              

Use                

Virgin Coconut Oil              

                     
Author :       Massage back There was an injury press      

Sihombing  
et al . with  
as much 5      

(2016)        
using VCO respondents of 25      

           
lower risk total respondents.      

Title:        
the occurrencewound          

The Effectiveness press.            

Of Back Massage              

Using    
Virgin              

Coconut Oil and              

White Petroleum              

Jelly To Prevent              

Pressure Sores                

                     
Author:      
Massage back Not occur wound      

Dhikhil, et al . with  
press on      

(2014)        
use respondents.        

           
VCO.            

Title                      

Effect of Coconut              

Oil Usage in Risk              

of Pressure Ulcers              

Among Bedridden              

Patients of Selected              

Hospitals in North              

India                      

68 Nursing Current Vol. 5 No. 1, January 2017 - Ju

Author :  
Massage using Not occur wound    

Marina et al . (2013) VCO on point press on    

   
protrusion  
bone, respondents.      

Title :  
that is leaf ear,        

Prevention scapula,  
elbow,        

Incident Wound sacrum, buttocks,        

Press Through hip,  

knee,        
Massage Virgin wrist feet
 Coconut Oil On and heels.
Patient with    
Immobilization      
DISCUSSION
Massage Methods That Are Effective
Decubitus sores
In this literature review, there are
five articles that discuss the types of
massage using virgin coconut oil .
There are two research articles
which reveal that the intervention
carried out is effleurage massage
with VCO (Setiani, 2014 & Handayani
et al , 2011). Two research articles
reporting on that intervention
carried out namely back massage
using VCO (Sihombing et al , 2016
& Dhikhil et al , 2016). There is one
article which states
intervention carried out is massage
at the points of bone prominence
(Marina et al , 2013).
Mituhu et al (2011) stated that back
massage measures can change the
pressure and improve
circulation in stressed areas so as to
prevent
Nursing Current Vol. 5 No. 1, January 2017 - June 2017
Rasyid & Misbach, 2015). Immobility
patients are particularly susceptible
to exposure to urine or fecal sweat
because of the inability to move.
Virgin Coconut Oil can be given as a
           
           
                 
decubitus. The use of VCO with
massage can not only increase
muscle relaxation and increase
circulation, but can also increase the
absorption of VCO biological content
through the skin (Handayani et al ,
2011 & Sihombing et al , 2016).
Use of VCO to Prevent Incidents
Decubitus sores
Based on the results of the study on
the five research articles, it was
found that the average range of
incidence of decubitus sores was
zero (0) respondents to five (5)
that the
respondents. Four articles stated that
there were no pressure sores in the
VCO group respondents. One
research article stated that there
were five (5) respondents out of a
total of 25 respondents who had
blood pressure sores.
Decubitus sores can be caused by
exposure to sweat, blood, urine and
feces (Al
69
Use of VCO Reduces Effects
Friction And Pressure
In this literature review, there are
two articles that discuss the use of
VCO to reduce the effects of friction
 topical ingredient which functions as
a moisturizer to prevent dry skin
and as a topical ingredient
minimize exposure to excessive
sweat, urine or feces because of its
nature as an oil that cannot be
mixed with water (Setiani, 2014).
National Guideline Clearinghouse
(NGC) & Institute for Clinical Systems
Improvement (ICSI) (2010)
reveal that one
prevention of pressure sores is to
provide topicals such as creams,
lubricating oils or ointments needed
to protect and treat intact skin, or to
treat non-intact cells. Lucida et al
(2008) also stated that the content of
fatty acids (especially lauric and
oleic acids) in VCO has properties
that can soften the skin. In addition,
the small medium chain fatty acids
(MCFA) molecules in VCO are easily
absorbed by the skin surface
(Handayani et al , 2011).
70
fungi and bacteria (Setiani, 2014 &
Handayani et al , 2011). Research by
Rajan et al (2016) explains that virgin
coconut oil is extracted and purified
by a filtration method which proves
that virgin coconut oil can inhibit
and pressure (Setiani, 2014 &
Handayani et al , 2011). According to
to the National Guideline Clearinghouse
(NGC) & Institute for Clinical Systems
Improvement (ICSI) (2010), one of the
prevention of pressure sores is to
minimize or eliminate friction and
pressure. Periodically, use
hypoallergenic lubricating oils ,
creams or lotions that can reduce
pressure and friction ( National
Guideline Clearinghouse & Institute
for Clinical Systems Improvement ,
2010). Virgin coconut oil
can be used as a topical prevention
of pressure sores because
various content. The process of
making VCO which is processed with
minimal heating or no heating at all
can produce coconut oil with a soft
texture and clear color and aroma of
fresh coconut (Handayani et al ,
2011).
Use of VCO Inhibits Infection
Fungi and Bacteria
In this literature review there are two articles
which discusses the use of VCO on
immobility patient to inhibit infection
Nursing Current Vol. 5 No. 1, January 2017 - Ju
quantitative with experimental and
quasi experimental longitudinal designs
.
In this literature review, it was found
that the average range of incidence of
decubitus sores in immobility patients
using VCO was zero to five
respondents. This shows that virgin
fungal development. According to
Setiani (2014), the fatty
contained in coconut oil do not
directly function as anti-microbes
but will react with skin bacteria to
form free fatty acids such as those
contained in sebum (sebum contains
uric acid and lactic acid). In this
theme, it was concluded that topical
VCO could inhibit fungal
bacterial infections in preventing
pressure sores.
CONCLUSION
This literature review research has
reviewed five articles obtained from
three databases using several
keywords. From the search results,
there were 143 articles which were
then re-checked using inclusion and
exclusion criteria, leaving five articles.
All articles used in this literature
review describe the research
which uses research methods
coconut oil is effective in preventing
pressure sores in immobility patients
acids
because it can reduce the effects of
friction and pressure. In addition, VCO
can be an inhibitor for fungal and
bacterial infections to prevent
infection. Based on the conclusion of
the literature review, virgin coconut oil
is recommended for use in immobility
patients with low, medium and high
risk of falling.
and
SUGGESTION
Further research can be carried out
research to investigate the factors
that influence the effectiveness of
VCO in the prevention of pressure
sores. Based on this review, it is
necessary to make an SOP for the
prevention of pressure sores using
VCO in immobility patients in
Indonesia because it can prevent the
incidence of pressure sores, thereby
reducing the length of stay and
treatment costs.

Nursing Current Vol. 5 No. 1, January 2017 - June 2017 71

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