While the implementation plan prepares students to apply their research to the problem or issue they have identified for the
While the implementation plan prepares students to apply their research to the problem or issue they have identified for their capstone project change proposal, the literature review enables students to map out and move into the active planning and development stages of the project.
A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence. Students will use the information from the earlier PICOT Question Paper and Literature Evaluation Table assignments to develop a 750-1,000 word review that includes the following sections:
- Title page
- Introduction section
- A comparison of research questions
- A comparison of sample populations
- A comparison of the limitations of the study
- A conclusion section, incorporating recommendations for further research
PICOT: Fall Prevention
Chungah Park
Grand Canyon University
NRS 493
Jazine Collins
3/13/2022
Patient falls are a significant problem prevalent in healthcare organizations that negatively impacts patient’s quality of care. Studies show that almost a million ailing individuals fall while receiving medical care in healthcare facilities. The issue is worth investigating because it may precipitate negative outcomes such as internal bleeding and fractures that may increase the duration of patients' stay in hospitals and inflate the cost of treatment (LeLaurin et al., 2018). Therefore, it is necessary to find evidence-based interventions that will enhance the safety of patients by preventing falls. The PICOT question that will aid in finding an effective intervention is: In geriatric Hispanic patients, how effective is screening patients for risk of falls compared to not screening them in reducing incidences of falls in a period of six months? Evidently, the PICOT question is a significant model that will help determine an evidence-based nursing intervention that will improve patient care and positively portray a healthcare agency and the nursing practice.
P: Hispanic population based on this organization’s demographic
I: Fall risk assessment using right tools and educate patients regarding fall risks
C: What is other organization’s policy regarding prevention of fall
O: Fall incidents less than 3
T: 6 months
Evidence-Based Solution
Members of the Hispanic population are vulnerable to chronic conditions such as high blood pressure and diabetes which may lead them highly likely to be hospitalized due to the conditions. Therefore, they are the population that is disproportionately impacted by falls in the healthcare setting and specifically to this organization. Studies show that screening patients for falls are an effective procedure that reduces falls in hospitalized patients (Guirguis-Blake et al., 2019). It helps identify the ailing individuals at a high risk of falling, such as those who has history of frequent falls, syncopal episodes, those with a poor posture, and those with a poor gait secondary to comorbidities. Adequate measures are then put in place to ensure that these vulnerable individuals do not fall, such as activate bed alarms, educate patients to use call lights, educate regarding fall risk and possible prolonged hospitalization secondary to fall.
Nursing Intervention
Nursing interventions such as screening patients for falls are effective models for preventing patient falls in the clinical setting. This is because nurses are the primary caregivers of patients; hence their role in ensuring their safety is fundamental (Guirguis-Blake et al., 2018). Therefore, instilling a measure that will place nurses at the forefront of preventing patient falls is guaranteed to elicit positive outcomes in the treatment process. It is important that a nurse utilizes the tool to assess patient’s mobility before ambulating a patient. A nurse can use a tool such as BMAT (Bedside Mobility Assessment Tool) to determine the appropriate patient handling and mobility equipment or device to safely move or mobilize the patient (Perez, n.d). It is also imperative to educate patients regarding fall risks to prevent further damage to patient and follow up with evaluation of education by instructing them to verbalize and demonstrate the teaching. Patients will also benefit from prevention of fall if a nurse orient a patient to the room when they first get admitted. A nurse can activate bed alarm, utilize care view monitor, instruct them on how to use a call light when need help, stay with a patient until their business is done, and be quick to answer call lights to further prevent falls.
Health Care Agency
Healthcare agencies are tasked with the critical role of caring for ailing individuals. They are required to ensure that patients elicit positive outcomes during treatment processes. However, aspects such as patient falls reduce the effectiveness of services provided by healthcare agencies. Therefore, it is necessary to use evidence-based protocols such as preventing patients' falls through interventions such as screening them for susceptibility to falls to prevent the negative occurrences and increasing the quality of care they receive (LeLaurin et al., 2019). The PICOT question will help unveil the evidence that can be applied in the clinical setting.
Nursing Practice
Identifying a problem and implementing interventions to advocate for patients is one of the most important tasks in nursing practice. Using the PICOT question to obtain evidence that will be applied in preventing falls in the clinical setting is a significant aspect that will ensure that the nursing practice is identified as a dependable profession that ensures that ailing individuals are cared for well. It will show that the nurses are at the forefront of ensuring that the nation's health goals are met by using effective nursing interventions to ensure that patients receive quality care that aligns with their dynamic needs (Guirguis-Blake et al., 2018).
References
Guirguis-Blake, J. M., Michael, Y. L., Perdue, L. A., Coppola, E. L., & Beil, T. L. (2018). Interventions to prevent falls in older adults: updated evidence report and systematic review for the US Preventive Services Task Force. Jama, 319(16), 1705-1716.
LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: state of the science. Clinics in geriatric medicine, 35(2), 273-283.
Perez, A. (n.d.). BMAT- bedside mobility assessment tool – UCLA health. Retrieved March 13, 2022, from https://www.uclahealth.org/nursing/workfiles/ContinuingEducation2015/TeachBack/UmoveBMAT-TrainingPresentation.pdf
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Literature Evaluation Table
Student Name: Chungah Park
Change Topic (2-3 sentences): Fall is a health issue, which is common as well as devastation complication of health care, especially in elderly patients. Due to fall risk factors such as internal bleeding, there is a need to find evidence-based intervention for fall prevention. Fall prevention involves the process of managing patients from any underlying fall risks, by utilization health care facility design and environment.
|
Criteria |
Article 1 |
Article 2 |
Article 3 |
Article 4 |
|
Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article |
(Guirguis-Blake, J. M., et al, 2018). Journal article https://jamanetwork.com/journals/jama/article-abstract/2678103 |
Røyset, B., et al, Peer-reviewed article, |
Dykes, P. C., et al., Journal article. https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2773051 |
Radecki, B., Reynolds, S., & Kara, A https://www.sciencedirect.com/science/article/pii/S0897189718301757 |
|
Article Title and Year Published |
Interventions to Prevent Falls in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. Published on April 17, 2018 |
Effects of a fall prevention program in elderly: a pragmatic observational study in two orthopedic departments Published on, January 15, 2019. |
Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries. Published on November 17, 2020. |
Inpatient fall prevention from the patient's perspective: A qualitative study. Published on August 7, 2018. |
|
Research Questions (Qualitative)/Hypothesis (Quantitative) |
Q1- effect of fall prevention interventions on health outcome. Q2-the harm of the suggested intervention. |
What is the effect of the fall prevention program on rate of fallers, patient-centered safety and patient safety culture? |
– Is a fall-prevention tool kit that engages patients and families associated with a reduction in falls? |
Is the patient’s belief of fall risk linked to their perception of their ability to walk? |
|
Purposes/Aim of Study |
To systematically review various literatures on effectiveness as well as harms of interventions of fall prevention in community-dwelling elderly. |
The aim of this research is to assess the effects of fall prevention on patient’s culture, patient-centered safety and rate of fallers. |
The aim of this research is to assess if the fall-prevention tool kit, which engages families and the patient into the process of fall prevention through hospitalization is linked to decrease of fall and injurious falls. |
The purpose of this research is to describe the patient's perspective of fall prevention to aid in the design of patient centered strategies. |
|
Design (Type of Quantitative, or Type of Qualitative) |
Descriptive research design has been used to obtain various information that will systematically describe the phenomenon. Case study and archival research have been used in this article. |
Cross-sectional study design. |
Design used is stepped-wedge in this nonrandomized-controlled trial. |
Use of qualitative design through use of semi-structured interviews. |
|
Setting/Sample |
The sample used was from randomized clinical trials of fall-prevention intervention in adults aged 65 and above. |
The study was performed in two orthopedic departments in Mør og Romsdal Hospital Trust, in different cities. Parents aged above 64 years admitted with CD and ID with at least 24 hours duration participated. |
-The research was conducted in 14 medical units that were within three academic medical centers in New York and Boston between November 1, 2015 and October 31st 2018. The sample was from all inpatient-hospitalized adult. |
The sample of twelve patients is used in the academic healthcare center. |
|
Methods: Intervention/Instruments |
Instruments used include drafts of review questions, analytic framework and inclusion and exclusion criteria was used. |
The intervention used was “In safe hands” as proposed by national patient safety campaign. |
The intervention included a nurse-led fall-prevention tool kit. |
Use of three major themes, which include, “How I see myself” “how I see the intervention” and “How I see us”. In addition, the study used subthemes in each theme. |
|
Analysis |
A random effects meta-analysis using DerSimonian-Laird method was used in calculating the pooled RRs (Relative risks). |
Fisher’s exact test, Mann-Whitney U-test and student’s t-test was used to analyze the comparison depending on various factors. |
-all the analysis in this research used the intent-to-treat principle. |
The interviews assisted in understanding patient perspective. The theme used provided patient beliefs, useful equipment as well as patient barriers in participating in fall prevention plan. |
|
Key Findings |
-Exercise and multifactorial intervention are associated with reduction in fall outcome – Exercise intervention is also associated with fewer patients experiencing fewer falls. |
– Fall prevention program that was used showed no significant effect on rate, patient safety culture or the patient-centered safety. |
-Patient-care partnerships seem to be beneficial for falls and fall-related injuries. -implementation of fall-prevention tool can reduce falls and fall related injuries. |
-majority of fall prevention programs support the clinical-led plan created and implemented. – Patient fall assess should be patient-centric instead of clinician-centric. |
|
Recommendations |
-further study on Vitamin D supplements intervention which is had mixed results. |
The study suggests that identifying new methods to reduce falls as well as improving patient observation such as environmental adaptations, intelligent sensor systems with videos, alarms and icons might be better preventive measures. |
Further investigation on fall-prevention tool kit, which is patient-care centered. |
Develop patient fall assessment and intervention that are patient-centric. |
|
Explanation of How the Article Supports EBP/Capstone Project |
-This article supports the Capstone project by presenting fall preventions, which will help improve patient care depending on hospital settings depending on their design, components and delivery. |
This article provides information on how some fall preventive intervention might be ineffective if not professionally researched thus supporting the capstone project. |
This article supports the capstone project by analyzing how the provide fall prevention tool kit can reduce the rates of fall through linking the specific patient risk factors to interventions that are most likely to prevent fall and its related injuries. |
This article provides information on fall intervention, which might have a significant impact on the caption project. |
|
Criteria |
Article 5 |
Article 6 |
Article 7 |
Article 8 |
|
Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article |
Montero-Odasso, M. M., et al, https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2787179 |
Mora Pinzon, M., et al, Journal article https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1273-1 |
Duckworth, M., et al, |
King, B., et al, peer-reviewed. https://academic.oup.com/gerontologist/article-abstract/58/2/331/2736326 |
|
Article Title and Year Published |
Evaluation of clinical practice guidelines on fall prevention and management for older adults: a systematic review. Published on December 15, 2021. |
“Pisando Fuerte”: an evidence-based falls prevention program for Hispanic/ Latinos older adults: results of an implementation trial. Published on September 18, 2019. |
Assessing the Effectiveness of Engaging Patients and Their Families in the Three-Step Fall Prevention Process across Modalities of an Evidence-Based Fall Prevention Toolkit: An Implementation Science Study. -Published on January 21, 2019. |
Impact of Fall Prevention on Nurses and Care of Fall Risk Patients. Published on April 2, 2018. |
|
Research Questions (Qualitative)/Hypothesis (Quantitative) |
The most common consistent recommendations in fall prevention clinical practice guidelines, across all settings, for adults 60 years or older? |
Is “Pisando Fuerte” program effective in fall prevention on Hispanic/ Latinos older adult? |
What is the variability in the ability to engage patients in the 3-step fall prevention process across the Fall TIPS modalities? |
What are the impacts of “zero falls” on nurses and patients? |
|
Purposes/Aim of Study |
The purpose of this research is to perform a systematic review of clinical practice guidelines for falls-prevention as well as management for adults 60 years or older in all settings such as community, acute care, and nursing homes evaluate agreement in recommendations, and identify potential gaps. |
The aim of this study is to describe the implementation of PF at two community organizations in Wisconsin. |
The purpose of this study is to examine whether Fall TIPS modality affects patient engagement in the 3-step fall prevention process. |
The purpose of this study is to examine the effects of fall prevention experiences on nurses providing care to fall risk patients. |
|
Design (Type of Quantitative, or Type of Qualitative) |
A qualitative systematic review research design was used. |
The qualitative research design used in this clinical trial is the single arm clinical trial. |
Research design used was audit question in qualitative criteria. |
Qualitative design using the Grounded Dimensional Analysis. |
|
Setting/Sample |
Sample used are older adults from 60years and above from all settings. |
The setting was on two community organizations, which serves Latino and Hispanic communities in Wisconsin. The sample was where self-Identification as Hispanic or Latino, 65 years old or more, living independently, had fallen in the past year or reported a fear of falling, without history of dementia. |
The study was conducted at Brigham and Women’s Hospitals, New York-Presbyterian hospitals and Montefiore Medical Center. |
The data was collected from two hospitals, which are in Wisconsin. It was conducted on patients older than 65 years and varied from the patient’s number of days and bed capacity. |
|
Methods: Intervention/Instruments |
Meta-analyses (PRISMA) reporting guideline and preregistered in PROSPERO (CRD42020173597). |
-use of a trained leader and a peer-leader followed a booster session at three months. -guest speakers were also used. |
– Instruments used include audit and different communication channels. |
Instruments used include flayers, e-mail invitations and study announcement in unit meetings. |
|
Analysis |
In this review, in 198 of the recommendations across 15 selected guidelines, majority of guidelines recommended assessment tools, fractures management, medication review etc. agreement was high on certain clinical practice guidelines but certain area were not addressed often. |
-RE-AIM framework was used to evaluate the implementation of the program. Data was collected through survey and descriptive statistics reported for participants fidelity measures, demographics, FaB, maintenance and TUG. In addition, the content analysis was used in analyzing the interview’s transcripts. |
– each unit regardless of the site and modality reached a clinically significant rate of above 80% of patient engagement as well as the adherence with sign protocol to decrease fall and fall related injuries rate. |
-Data was analyzed using selective, axial and open coding. |
|
Key Findings |
-The 15 selected guideline had high-quality AGREE-II total score – The strength for recommendation was inconsistence for fall prevention education, vitamin D supplementation and addressing cognitive thinking. |
– Pisando Fuerte improves the behaviors associated with decrees fall frequencies. -the program showed promising reduction on fall similar to Stepping on implementation. |
-there is little difference in the ability to engage the patients in the three FALL TIPS modalities. – No significant difference between the three modalities in ability to engage patients. |
– Fall prevention protocol targeted in risk reduction for fall is not available in almost every unit. -Nurses feel intense pressure in meeting the hospital goals of “Zero Falls” especially without the protocol. -there is lack of strong evidence-base for care delivery for patients with fall risk. |
|
Recommendations |
-future guidelines should address the applicability of their clinical recommendation and include patient and other stakeholder’s perspective. |
– need to value conduction rigorous evaluation on implementation metrics, which consist of cultural adaption of behavior change intervention. |
– providing the three FALL TIPS modalities will be an effective as well as flexible approach for adoption promotion. |
-this article recommends development of patient-centered and unit-based interventions, which prevent patient falls as well as preserve patient function. |
|
Explanation of How the Article Supports EBP/Capstone |
This article supports the capstone project by providing the most common and consistent recommendations that can incorporated in fall clinical practice guidelines in all settings. |
-This article present an intervention, which is specifically for certain race, thus supporting the PICO question in the Capstone project. |
-This article presents the effectiveness of FIT FALL modalities, which are evidence-based fall prevention intervention, which relates and supports the capstone. |
The article support the Capstone project by presenting factors that need to be considered while developing fall prevention intervention and are likely to affect this project unless considered. |
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