Research Critique & PICOT Statement Proposed Evidence-Based Practice Change ( Final Paper). Discuss the link between the PICOT statement, the research art

Research Critique & PICOT Statement Proposed Evidence-Based Practice Change ( Final Paper).

Discuss the link between the PICOT statement, the research articles, and the nursing practice problem (Prevention and management of fall among adult/Geriatric Patient) you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.

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Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the Topic 1, 2, and 3 assignments and the guidelines below.

PICOT Statement

Revise the PICOT statement you wrote in the Topic 1 assignment.

Research Critiques

In the Topic 2 and Topic 3 assignments you completed a qualitative and quantitative research critique. Use the feedback you received from your instructor on these assignments to finalize the critical analysis of the study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest ( Prevention and management of fall among adult/Geriatric Patient) that is the basis for your PICOT statement.

Refer to “Research Critique Guidelines.” Questions under each heading should be addressed as a narrative in the structure of a formal paper.

Prepare this assignment according to the 6th APA guidelines found in the APA Style Guide and using the Template format provided for writing the paper.

Please follow instruction Appropriately.

Do not exceed word count , NO PLAGIARISM.

Attached is the resources for writing the Paper. Running head: PICOT STATEMENT AND LITERATURE SEARCH
PICOT Statement and Literature Search
Student
university
2/24/19.
1
PICOT STATEMENT AND LITERATURE SEARCH
2
X
The issue of falls among the geriatric patients has become common and is causing nearly
to 750,000 hospitalizations as well as 25,000 deaths on a yearly basis in the United States. There
are a number of reasons which leads to the rise of the cases related to the geriatric patient falls.
Some of the factors leading to the increase in the falls among geriatric patients are related to the
practices within healthcare facilities. For example, there is a lack of effective equipment such as
hip protectors and exercise program to help in the prevention of fall. Other factors are related to
the poor healthcare environment which might be due to the overcrowding of the patients or the
small sizes of healthcare facilities; lack of risk factor screening; and lack of proper interventions
for the prevention of such falls.
Prevention and Management fall among Geriatric patient
The prevention and the management of fall among geriatric patients are necessary in a
healthcare facility to help in the reduction of the death cases caused by falls. The PICOT statement
on the prevention and management of fall among the geriatric patients is tackled through using the
PICOT questions below:
•
What role do exercise program and other interventions play towards the prevention of fall?
•
Should modification of the physical environment be utilized for the prevention of the fallrelated injuries among geriatric patients?
•
What role does risk factor screening play towards the prevention of fall-related injuries
among geriatric patients?
Literature Review
PICOT STATEMENT AND LITERATURE SEARCH
3
Shier, V., Trieu, E., & Ganz, A. D. (2016). Implementing exercise programs to prevent falls: a
systematic descriptive review. Injury Epidemiology, 3(1), 16.
Authors of this article aimed at looking at the aspect of implementing the exercise program
for or the prevention of the falls. It is a recommendation by the United States Preventive Services
Task Force for the exercise program to be utilized for the prevention of the falls within the
community. This was a qualitative approach study which involved reviewing of literature to help
in the determination of how exercise programs for the prevention of falls are being implemented
from the point of vantage of the healthcare setting. There was a synthesis of descriptive information
related to each program and data on those particular program features as well as the
implementation challenges and promoting factors.
The outcome of this study revealed that the programs which are under the sponsorship of
primary caregivers are helping in the recruitment for the exercise programs. The primary
caregivers have the opportunities of identifying individuals who are at risk and then encourage
their participation because the majority of these geriatric individuals regularly visits and make an
inquiry about the exercise from the doctors. Exercise programs related to the Home-based and
group-based tend to be operational in the prevention of the falls, nevertheless, there are limitations
and the advantages related to each program. The home-based program involves individuals who
are not willing to attend the group-based programs. Therefore, this implies that they can be tailored
individually. However, this offers less opportunity when it comes to socialization with other group
members as well as for the supervision procedures.
Authors of this study concluded that despite the fact that there is an increased focus to the
population-based in managing health within the United States, physicians, and the healthcare front-
PICOT STATEMENT AND LITERATURE SEARCH
4
runners requires knowledge on the means of connecting patients to the healthcare systems through
the use of suitable community programs.
Nicklett, J. E., Lohman, C. M., & Lee, S. M. (2017). Neighborhood Environment and Falls among
Community-Dwelling Older Adults. International Journal of Environment Research and Public
Health, 14, 175
According to the World Health Organization (WHO), there are four types of risks for falls
among geriatric patients. These factors are related to the biological risk factors; behavioral factors;
social and economic risk factors; and the environmental risk factors. This study was aimed at
examining the link between the fall and the events at the neighborhood factors. The collected data
were analyzed from the 9259 participants of the study. The outcome of this study revealed that an
increase in the single unit in the community social interrelation which was linked with the 4 percent
lower odds of going through multiple falls. There is also an increase in the physical environment
scale. This was connected with 4 percent of the lower odds of being subjected to a single fall with
5 percent lower odds of multiple falls within the adjusted models. The conclusion in this study is
that physical and the social community environment might influence fall risk amongst the elderly
patients.
Renfro, M., Maring, J., Brainbridge, D., & Balir, M. (2016). Fall Risk Among Older Adult HighRisk Populations: a Review Of Current Screening and Assessment Tools. Curr Geri Rep.
Falls is considered to be the leading cause of the injury as well as accidental deaths among
the older patients. This is common among high-risk populations like individuals who are
experiencing logical and developmental disabilities, and multiple sclerosis among others. Authors
of this article provided an outline of the concerns which are related to the falls belonging to the
PICOT STATEMENT AND LITERATURE SEARCH
5
population above. Authors of this article provides an illustration of the general fall risk screening
tools, as well as the fall risk tests and measurements, was made. Application of the risk screening
instruments to the high-risk populations was done. The study was concluded by providing
guidance on the mechanism through which healthcare providers can utilize the present tools to
carry out suitable fall risk prevention screening and the undertakings that are involved in the
assessment process resulting in the choice of the evidence-based fall preventive measures or
programs for the geriatric patients.
Spears, G. V., Roth, C. P., Mike-Lye, I. M., Saliba, D., Shekelle, P. G., & Ganz, D. A. (2013).
Redesign of an electronic clinical reminder to prevent falls in older adults. Med Care, 51(3), S37S43.
According to this study, falls are considered to be the leading unintentional injury among
the older patients of the United States. There are guidelines which recommend for the screening
of the individuals who are risk of falling and promotion of the exercise programs for patients
suffering from gait and the balance issues. In this study, electronic clinical reminder was designed
to help in improving the process of identifying and managing the veterans at high risk for falls.
A review of the clinical reminder reports was also done followed by the processes of
interviewing the nurses, the primary care providers, and a direct observation of the clinic activities
while watching the nurses and the primary care providers using the clinical reminder with the
bogus patient record to help in the determination of the areas which needed urgent improvements.
The outcome of this study reveals that out of 162 veterans who were having gait, balance, and the
problems related to strength on evaluation, 39 of them were offered physical therapy, the primary
care providers and nurses were of different opinions concerning the clinical reminder ad the
PICOT STATEMENT AND LITERATURE SEARCH
6
project. Primary caregivers were more negative as compared to nurses. The conclusion of this
study was that it is possible to incorporate a fall prevention clinical reminder into normal
operations of healthcare. A low referral rate to the exercise programs is an indication for the need
to make quality improvement cycles.
Clemson, L., Singh, F., Cumming, R. G., Manollaras, K., O’Loughlin, P., & Black, D. (2012).
Integration of balance and strength training into daily life activity to reduce the rate of falls in older
people (the LIFE study): randomized parallel trial. BMJ, 345, e4547.
The goal of this research work was to find out whether a lifestyle incorporated approaches
to the balance and strength training is in effect in the reduction on the of falls among high-risk
individuals staying at home. The design of this research involved the use of three arms, a
randomized parallel trial for the evaluation at baseline and after six and 12 months. The
randomization was performed through the use of computer-generated random block which is
stratified by sex and the history of the fall then obscured by an autonomous protected website.
The study was carried out in metropolitan Sydney in Australia. Individuals aged 70 years
and above were used as the subjects of the study. These participants had experienced two or more
falls and injuries for the past year. The exclusion criteria were moderate to serious cognitive
challenges, lacking the ability to ambulate independently, gait, and the mobility which influenced
neurological conditions. The interventions in this study included three home-based interventions.
There was a substantial decrease in falls rate (31 percent) for the LIFE program in comparison to
the controls. The conclusion of the study was that the LIFE program is capable of providing an
alternative to the customary exercise for fall prevention. It is also important to consider the
PICOT STATEMENT AND LITERATURE SEARCH
7
functional based exercise for the protection of the older and high-risk individuals from falling and
improve as well as help in the maintenance of the functional therapy.
Renfro, M. O., & Fehrer, S. (2011). Multifactorial screening for fall risk in community-dwelling
older adults in the primary care office: development of the fall risk assessment & screening tool. J
Geriatr Phys Ther, 34(4), 174-183.
The article was aimed at giving a description on the content choice and the process of
developing a simple administer, multifactorial, Fall Risk Assessment and Screening Tool
(FRAST) which is particularly designed to be applied within the primary care settings for the
identification of the geriatric patient who are at risk of fall. Authors of this article developed a
multifactorial FRAST to be used in the 5-part process i.e. identification of the risk factors to fall;
reviewing of the perfect proof, choosing of the items, development of the scoring grid, and the
process of developing a proposed action plan. The outcome of this study shows that Fall Risk
Assessment and Screening Tool has been and is still being developed in many healthcare facilities
to help in the assessment of the risk of fall. The conclusion of the study is that fall risk among the
geriatric individuals within the community is imperative, multifactorial, and still remains a public
health issue of concern. Primary caregivers can use the screening tool to help the situation. This
tool is important in allowing for a safer, speedy, and cheaper for the administration of the trained
office staff with the understanding as well as the follow-up process by the primary caregivers.
The Evidence-based Problem Solution and the Conclusion sections are missing from this
assignment. This is why the template for the assignments should be followed so that none of
the required sections are left out or incorrectly stated. Dr Pavela
PICOT STATEMENT AND LITERATURE SEARCH
8
References
Clemson, L., Singh, F., Cumming, R. G., Manollaras, K., O’Loughlin, P., & Black, D. (2012).
Integration of balance and strength training into daily life activity to reduce the rate of falls
in older people (the LiFE study): randomized parallel trial. BMJ, 345, e4547.
Nicklett, J. E., Lohman, C. M., & Lee, S. M. (2017). Neighborhood Environment and Falls among
Community-Dwelling Older Adults. International Journal ofEnvironment Research and
Public Health, 14, 175.
Renfro, M. O., & Fehrer, S. (2011). Multifactorial screening for fall risk in community-dwelling
older adults in the primary care office: development of the fall risk assessment & screening
tool. J Geriatr Phys Ther, 34(4), 174-183.
Renfro, M., Maring, J., Brainbridge, D., & Balir, M. (2016). Fall Risk Among Older Adult HighRisk Populations: a Review Of Current Screening and Assessment Tools. Curr Geri Rep.
Shier, V., Trieu, E., & Ganz, A. D. (2016). Implementing exercise programs to prevent falls: a
systematic descriptive review. Injury Epidemiology, 3(1), 16.
Spears, G. V., Roth, C. P., Mike-Lye, I. M., Saliba, D., Shekelle, P. G., & Ganz, D. A. (2013).
Redesign of an electronic clinical reminder to prevent falls in older adults. Med Care,
51(3), S37-S43.
Running head: QUANTITATIVE ARTICLE
1
Quantitative Research Critique and Ethical Consideration
student
Introduction to Nursing Research
3/10/19.
QUANTITATIVE ARTICLE
2
Quantitative Research Critique and Ethical Consideration
Introduction
Prevention of fall has become an important issue across the hospitals and health care facilities. In
2004, the World Health Organization created an awareness on the importance of promoting
patient safety for hospitalized patient (Bittencourt, Graube, Stumm, Battisti, Loro, &
Winkelmann, 2017). Regardless of effort used in healthcare facilities to prevent these incidents,
falls among hospitalized adult patient is not a rare event and it continues to be a major health
complication for adult patients.
Background of the Study
The clinical problem in the study was the safety of adult patients in hospitals. The
research problem identified and attempted to be solved by the study was the risk of falls for
hospitalized adult patients. The authors identify this as a problem form a World Health
Organization 2004 initiative that sought to increase awareness on the need to improve patient
safety for hospitalized patients (Bittencourt, Graube, Stumm, Battisti, Loro, & Winkelmann,
2017). The authors mention that guaranteeing patient safety, especially for vulnerable patients
such as elderly patients is an important dimension when it comes to the focus of quality care. The
authors identified the importance of the study by highlighting the rate of falls in Brazilian
hospitals based on 1000 days of stay. According to the authors, the rate of falls in Brazilian
hospitals was at the rate of 1.37 to 12.6% per every 1000 patients every day. Another issue raised
by the authors that shows the importance of the claim is that patient characteristics and hospital
characteristics influence the risk of patients’ falls during hospitalization. The authors also point
QUANTITATIVE ARTICLE
3
out that different factors act as decisive as well as predisposing factors for the prevalence of falls
(Bittencourt et al., 2017). The major problem identified by the authors is the difficulty by health
professionals to identify intrinsic and extrinsic factors and how they influence patient safety.
According to the authors, the prevalence of falls is an indicator of the quality of care given the
patients, as well as one of the leading goals in patient safety. On that note, the authors note that
the importance of studying the topic derives from the fact that falls are a leading cause of
complications in the hospitalization settings and could lead to further costs for the patient and the
hospital.
Purpose of the study
The purpose of the study was to determine the intrinsic and extrinsic factors that influence the
risk of falls, which enable in establishing a sound diagnosis, as well as to determine an
intervention in preventing falls for elderly patients. The sole goal of the study was to assess the
factors that increase the risk of falls among hospitalized adult patients (Bittencourt et al., 2017).
The study authors do not identify the research questions to be answered by the study. However,
two questions abound from the research. The research questions are as follows.
Research Questions
•
What are the intrinsic/ personal risks factors that influence the prevalence of falls in
hospitals?
•
What are the extrinsic/ hospital risk factors for falls of adult or elderly patients in
hospitals?
•
How does the knowledge of extrinsic and intrinsic falls influence clinical practice in
patient safety interventions?
QUANTITATIVE ARTICLE
4
The purpose of the study was related to the problem at hand because the researchers were
interested in the factors that increase patient falls in a hospital environment.
Methods of study
There were no benefits or risks identified in the study. However, the authors might have
mentioned the risk of fall for the elderly participants, but there is no such information in the
article. The authors pointed out that all ethical regulations governing research involving human
beings have been adhered to in the study. One of the tenets of such ethical regulation is free
consent and voluntary participation in a study. Voluntary consent was one of the ethical
standards sought by the researchers during data collection. For unresponsive patients, the
researchers sought the consent from their next of kin (Bittencourt et al., 2017).
There is no information on whether the authors sought for authorization from the internal review
board to conduct the study. However, owing to the magnitude of the study and its significance in
the research, it would be safe to assume that such an authorization was sought by the researchers
(Bittencourt et al., 2017).
The independent variables of the study were participant characteristics and hospitalization
characteristics. On the same note, the risk of falls was the dependent characteristic.
Data Collection methods: data collection was conducted by the researcher assisted by six pretrained nursing students. Data collection used a protocol that contained the operational
definitions of the assessed variables, the data collection instruments, and the subject guidelines.
The Morse Scale and social-demographic variables were also tools used in data collection for
research (Bittencourt et al., 2017). The Morse scale was an important part of this study because it
QUANTITATIVE ARTICLE
5
has six topics that were relevant to the topic at hand. The six topics were, the history of falls,
walking assistance, secondary diagnosis, gait or mental state and endovenous therapy.
The authors did not give any rationale for the use of the data collection method. However, the
use the data collection tool such as the Morse Scale and the sociodemographic variables allowed
the researchers to identify both the intrinsic and the extrinsic factors contributing to falls of
adults or seniors during hospitalization (Bittencourt et al., 2017).
The authors do not give any period for data collection.
The instruments of data collection were applied on the individual patient within the patients’
hospitalization unit and in their bed after the explanation about research and the signing of the
Informed Consent Form in duplicate (Bittencourt et al., 2017).
Descriptive statistical methods were used in the research for characterization of the sample in
data analysis. The researchers also used the chi-square test in bivariate analysis to determine the
association between extrinsic and intrinsic factors, the reason for hospitalization, comorbidities,
type of hospitalization, and risks of falls. The authors also used the Statistical Package for Social
Sciences (SPSS) software for statistical analysis (Bittencourt et al., 2017).
The authors do not mention how the rigor of the study was maintained. There is no mention of
whether the researchers maintained a paper trail. Additionally, there was no mention of how
important critical decisions of data analysis were made. However, as aforementioned the authors
used the SPSS for accuracy. The fact that more than one researcher c…
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