Evidence Based Practice Research Paper (ANSWERED)

QUESTION

Instructions

The final research paper must be 5-7 pages in length, double-spaced,not counting the cover page and the reference pages. You must use at least 5 scholarly sources (current in the last 5 years) for your paper beyond the course textbook. Professional journal articles found in the Virtual Library will be key sources in researching your topic.  All sources used, including the textbook, must be referenced and paraphrased; any quoted material must be placed in quotes, and must have accompanying  APA  style in-text citations.

For this assignment, think about a clinical topic, problem or question that interests you and/or from your personal, professional, or clinical experiences. Come up with a paper approaching the problem/question using the five evidence-based practice guidelines discussed below. The problem/question will be related to nursing practice in some way. In other words, there needs to be nursing implications to addressing your question. Overall guidelines for each part of the project include:

***The Five Steps of Evidence Based Practice***

STEP ONE: Ask a clinical question which may interest you in PICO format. For example, are there pharmacologic interventions that have been effective in decreasing allergy symptoms in children? OR In children, what is the effect of pharmacologic interventions on allergy symptoms?

P= Population you are interested in (e.g., children under 5 years of age)

I= Intervention or interest (e.g., use of the drug Singular for allergies)

C= Comparison intervention or group (e.g., comparison of the drug Singular with control and another allergy medication)

O= Outcome (e.g., 20% decrease in allergy symptoms for experimental group as compared to control group).

Define your question using PICO. Your question should be used to help establish your search strategy. Submit the following information for your clinical question. First provide the following (use the below format):

Patient/Problem: __________________________

Intervention: __________________________

Comparison: __________________________

Outcome: __________________________

Then write out your PICO question (IF relevant to your question, add “T” for time frame) Template for Asking PICOT Questions

INTERVENTION In ____________________

(P), how does ____________________

(I) compared to ____________________

(C) affect _____________________

(O) within ___________

(T)? DIAGNOSIS OR DIAGNOSTIC TEST

In ___________________

(P) are/is ____________________

(I) compared with _______________________

(C) more accurate in diagnosing _________________

(O)? PROGNOSIS/PREDICTION In ______________

(P), how does ___________________

(I) compared to _____________

(C) influence __________________

(O) over _______________

(T)? Short Definitions of Different Types of Questions: Intervention: Questions addressing the treatment of an illness or disability. Diagnosis: Questions addressing the act or process of identifying or determining the nature and cause of a disease or injury through evaluation. Prognosis/Prediction: Questions addressing the prediction of the course of a disease.

SAMPLE PICO QUESTIONS

Intervention: In African American female adolescents with hepatitis B

(P), how does acetaminophen

(I) compared to ibuprofen

(C) affect liver function

(O)?

Diagnosis: In middle-aged males with suspected myocardial infarction

(P), are serial 12-lead ECGs

(I) compared to one initial 12-lead ECG

(C) more accurate in diagnosing an acute myocardial infarction

(O)? Prognosis/Prediction: For patients 65 years and older

(P), how does the use of an influenza vaccine

(I) compared to not received the vaccine

(C) influence the risk of developing pneumonia

(O) during flu season

(T)?

(Copyright, Ellen Fineout-Overholt, 2006)

*Be sure you include “compared to” in your clinical question using PICO.

STEP TWO: Conduct a literature search. Be sure to include also systematic reviews (e.g., the Cochrane Database of Systematic Reviews) and evidence-based practice guidelines (www.guideline.gov) in your search strategy.

STEP THREE: Review and Critically Appraise the evidence. Describe the problem and purpose of each research study. Describe the research methods, including process of data collection, sampling, and data analysis, for each research study What were the results of the study? Summarize the major findings and conclusions of each research study Critique the strengths and weaknesses of the research methods. The expectation is that you also cite your textbook, when describing research methods or criteria for evaluating research. Are the results valid? To answer this question, you need to critique the studies for validity-based on your critical appraisal of the literature, are the results valid? Are the findings clinically relevant to patient(s) identified? Do you believe this will work in practice?

STEP FOUR: Integrate evidence to implement a decision.

STEP FIVE: Evaluate the outcome. Students will not be evaluating the outcome in this assignment. This occurs in clinical practice.

ANSWER

Problem Statement

Falls among the geriatric population pose a severe issue in hospital settings. In the U.S., hospital falls are approximately 700,000 to 1,000,000 annually. Elderly population falls pose a serious health risk as they are the second leading cause of unintentional deaths worldwide. Approximately 684,000 patients die from falls annually. Falls lead to physical injuries such as fractures which reduce mobility, decrease physical fitness, and lower quality of life. In addition, falls lead to psychological issues such as anxiety, fear of losing, and distress. Patient falls highlight the quality of patient care as 37.3 million falls require medical attention annually. Falls are preventable, as one-third of falls can be preventable. Fall prevention comprises addressing a patient’s underlying risk factors for falls and altering the hospital environment.

PICOT Question

(P) The elderly and older adult population in hospital, (I) single healthcare interventions, © A multi factorial fall intervention program (O) reducing inpatient falls among the population. PICO question states, among the elderly patient population, determine the efficacy level of multi factorial interventions compared to individual nursing interventions in decreasing inpatient hospital unit falls. Elderly patient falls are considered a critical issue affecting patients’ safety in hospitals. 3% of all hospitalized patients fall during their hospital stay, where 30% of these falls result in injury. Falls delay treatment, thus leading to more extended hospital stays and increased costs. Falls and fall-related injuries are common among the elderly, especially those over 65, with one-third of persons over 65 falling at least once a year.

Literature Review

A literature review was conducted electronically from PubMed, Google Scholar, Cochrane Library, JSTOR, and CINAHL. The literature review entailed highlighting index keywords used to articulate an article. The literature review included scholarly articles that emphasized the research’s keywords and index phrases. The keywords used include fall prevention interventions, decreasing falls, inpatient falls, geriatric patients, and fall risk factors. The articles used are peer-reviewed as they give credibility to the information. In addition, the literature review emphasized the use of articles less than five years old as they provide the latest development regarding the problem research.

Literature Evaluation

According to the research by Najafpour, Godarzi, Arab, and Yaseri (2019), patient falls pose a significant risk to Patients’ safety in hospitals, as they can result in serious injuries or even death extended hospital stay, and inflated hospital bills. This study looks at the links between risk variables and falls in contrast to the control group. A nested case-control study technique was used in the research conducted in a general hospital. The data was collected between 2016 and 2017. The study was conducted on 185 patients who fell and 1,141 in the control group. Data collection entailed secondary research from medical records, observations, and interviews. The data was analyzed through time-based matching using multilevel analysis. The results of the study show that hospital falls have multiple etiology.

Some factors increase the risk of Patients falls, such as longer hospital stays, clinical factors such as visual disability, urinary un restraint, and unbalanced gait. In addition, the use of medication such as sedatives and antihistamine also increase the risk of Patient falls (Najafpour, Godarzi, Arab, & Yaseri, 2019). In addition, the risk of repeated falls is higher in patients with a fall history. The study’s limitations include using a general hospital which led to the generalization of the population. In addition, there was under reporting of fall cases due to the language barrier. Furthermore, the large number of samples led to bias due to a lack of data on age and gender.

Different intervention methods have been developed to help prevent falls among the geriatric population. Fall prevention strategies are grouped into two; multi factorial and individual interventions. The study’s goal is to determine the benefits and drawbacks of a multi factorial intervention for avoiding falls among elderly individuals (Hopewell, Adedire,  Copsey, Boniface,  Sherrington, Clemson, & Lamb, 2018). The research used meta-analysis, including 62 randomized trials involving 19,935 geriatric patients. The researchers analyzed the impact of multifaceted treatments on falls in older persons. The quasi-randomizations method was excluded from the study. Multi factorial interventions where components are matched to a patient’s risk factors reduce the fall rate compared to individual intervention. The results show that multi factorial interventions comprising exercise, psychological intervention, medication, and social environment reduced the rate of falls among the geriatric population.

The research by Hopewell, Copsey,  Nicolson, Adedire, Boniface, and Lamb (2020) seeks to investigate the long-term impact of multi factor therapies for preventing falls among the geriatric population. In addition, the study explores whether modifiable risk factors are associated with enhanced prevention effects. Multi factorial interventions are recommended as a primary strategy in fall prevention and involve tailoring interventions to an individual’s risk factors. The study implemented a systematic review with a meta-analysis research technique. The research methods included randomized controlled trials with a 12-month follow-up program.

The study compared the effects of multi factorial intervention with usual care in preventing falls among the elderly population. Forty-one randomized controlled trials comprising 19,369 participants were used. The results concluded that multi factorial intervention reduces the rate of falls, particularly recurrent falls (Hopewell et al., 2020). The strength of this study entails the comprehensive search, duplicate assessment of eligibility, and use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the caliber of evidence. On the other hand, the study limitation entails using heterogeneous trials, leading to bias.

Multi factor approaches reduce falls in acute care hospitals. However, there is a paucity of evidence on fall-related injury prevention in hospitals. The study by Dykes, Burns, Adelman, Benneyan, Bogaisky, Carter, and Bates (2020) aims to determine whether a fall prevention strategy that includes patients and families correlates with decreased falls and injuries during hospitalization. The research used a non-randomized controlled trial. The study was conducted within three academic medical centers. The data were analyzed using Poisson regression and entailed the association between intervention and patient fall rate per 1,000 days in the hospital. The study results indicate that hospital-based prevention interventions comprising patient and healthcare team partnerships reduce fall risk rates (Dykes et al., 2020). The strength of this study includes the use of three clinical research centers with a varied patient population which augmented the research quality.

The research by Dellinger (2017) goal is to identify fall risk factors and effective solutions for reducing the prevalence of falls and preventing related injuries. The study utilized quantitative research methods and secondary data collection methods. The results highlight risk factors such as sedative medications, vision impairment, gait disorders, vitamin D deficiency, and foot problems (Dellinger, 2017). In addition, home and environmental hazards play a role in increasing fall rates among the older population. Evidence-based intervention methods include multi factorial interventions such as stopping the sedative medication, vitamin D supplements, cataract surgery, and home modifications

Multi factorial Intervention

Interventions to reduce patient fall rates in hospitals should entail integrating multi factorial techniques. Multi factorial interventions start at the point of care where a patient reveals fall risk factors. Identifying fall risk factors is vital in determining the type of intervention applicable to each patient. First, physicians should review each patient’s medication to ensure the prescription does not interfere with mobility leading to falls. The hospital should also make it easy to identify high-risk patients by using bracelets, red socks, and a visual cue outside patients’ doors. Therefore, healthcare professionals are quick to initiate protocols to reduce the risk of patient falls. Patient education is also vital as it ensures correct protocols are used to summon physicians.

Patients should have adequate information regarding call bells when the patient wants to use the bathroom or toilet and should wear non-slip footwear. In addition, bed alarms should alert nurses regarding mobility issues in patients who require supervision. The toilets should also be raised and incorporate grab bars. In addition, hospitals should use low beds on fall-risk patients to reduce the rate of falls. The beds should be low when the patient is resting and raised during care activities and transfers. Nurses should also act as safety companions to observe and aid patients during safety rounds. Safety rounds on high-risk patients effectively reduce patient falls as the nurse checks that all safety precautions are in place. Negligence of risk factors during patient checkups increases the risk of falls; thus, hourly rounds are vital, ensuring high-risk patients have required assistance. Most falls happen when patients are alone; thus, assistance by nurses reduces the rate of falls since they prevent falling due to environmental elements. In addition, nurses assist high-risk patients during walks and bathroom visits to prevent falls. These interventions demonstrate that interventions involving patients and nurses help reduce patient falls. In hospital settings, multi factorial interventions should be used because they considerably lower the rate of falls among the elderly and improve their quality of life.

 

References

Dellinger A. (2017). Older Adult Falls: Effective Approaches to Prevention. Current trauma reports, 3(2), 118–123. https://doi.org/10.1007/s40719-017-0087-x

Dykes, P. C., Burns, Z., Adelman, J., Benneyan, J., Bogaisky, M., Carter, E., … & Bates, D. W. (2020). Evaluation of a patient-centered fall-prevention tool kit to reduce falls and injuries: a non-randomized controlled trial. JAMA network open, 3(11), e2025889-e2025889.

Hopewell, S., Adedire, O., Copsey, B. J., Boniface, G. J., Sherrington, C., Clemson, L., … & Lamb, S. E. (2018). Multifactorial and multiple component interventions for preventing falls in older people living in the community. Cochrane database of systematic reviews, (7).

Hopewell, S., Copsey, B., Nicolson, P., Adedire, B., Boniface, G., & Lamb, S. (2020). Multifactorial interventions for preventing falls in older people living in the community: a systematic review and meta-analysis of 41 trials and almost 20 000 participants. British journal of sports medicine, 54(22), 1340-1350.

Najafpour, Z., Godarzi, Z., Arab, M., & Yaseri, M. (2019). Risk Factors for Falls in Hospital Inpatients: A Prospective Nested Case-Control Study. International journal of health policy and management, 8(5), 300–306. https://doi.org/10.15171/ijhpm.2019.11

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