Assignment: NRS 445 Rough Draft – Research Critiques and Evidence-Based Practice Proposal

Assignment: NRS 445 Rough Draft – Research Critiques and Evidence-Based Practice Proposal

Assignment: NRS 445 Rough Draft – Research Critiques and Evidence-Based Practice Proposal

Assessment Traits

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Assessment Description

The purpose of this assignment is to synthesize a literature review that will be used to draw conclusions in order to propose an evidence-based practice change to address your identified nurse practice problem.

Using the “Literature Evaluation Table” assignment in Topic 1, and accompanying faculty feedback, you will synthesize the information created for your PICOT question into a literature review and evidence-based proposal.

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In a 1,500-1,750-word paper, provide an overview that illustrates the research related to your particular PICOT question.

Use the following components from the “Literature Evaluation Table” to complete the assignment:

Identified practice problem

Two qualitative peer-reviewed research articles

Two quantitative peer-reviewed research articles

Use the “Research Critiques and Evidence-Based Practice Proposal Guidelines” document to organize your paper.

You are required to cite a minimum of four peer-reviewed sources to complete this assignment. Sources must be published within the past 5 years, appropriate for the assignment criteria, and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Attachments

NRS-445-RS-ResearchCritiquePICOT

A Sample Of This Assignment Written By One Of Our Top-rated Writers

NRS-445: Research Critiques and Evidence-Based Practice Change Proposal

Diabetes Mellitus is a persistent metabolic condition marked by high blood glucose levels and a lack of insulin production. The majority of individuals diagnosed with DM, namely over 90%, have type 2 diabetes (Taylor et al., 2024). Unfortunately, complications in these individuals might lead to a decrease in life expectancy. Complications such as retinopathy and polyneuropathy may result in visual impairment and reduced quality of life. Diabetic neuropathy is a significant risk factor for falls in older persons, with a prevalence rate of up to 40%. Effective risk factor management is essential since falls are a primary contributor to both fatal and non-fatal injuries in those aged 65 and above (Halén et al., 2021). Nevertheless, there is a dearth of research examining the variables linked to falls in older persons with diabetes mellitus and diabetic peripheral neuropathy. This paper aims to consolidate a review of existing research and derive conclusions to suggest a practice change based on evidence to address falls in older individuals with type 2 diabetes.

PICOT Question

In older adults with type 2 diabetes (P), how does integrated (resistance, strength, and balance) weekly training (I) compared to no physical exercises (C) affect the incidence of falls (O) within 10 weeks (T)?

Method of Studies

The research conducted by Cederbom et al. (2020) sought to examine the viewpoints of physical therapists about the efficacy of the Outpatient Rehabilitation Program in clinical settings for older individuals who live at home and need official home care. The study conducted semi-structured interviews with 17 physical therapists and used qualitative theme analysis for data processing. On the other hand, the research conducted by Pettersson et al. (2021) examined self-determination in older individuals living in the community. They used a self-managed digital fall prevention exercise called the Safe Step program. The research design included a qualitative approach, including open-ended questionnaires and individual and focus group interviews. The program, collaboratively designed with users, underwent four months of use, including 25 participants in a feasibility study. The program was accessible on PCs, cellphones, and tablets and had complete self-management capabilities.

Additionally, the research conducted by Dierick et al. (2022) was a pilot quasi-experimental study that intended to assess the practicality and possible advantages of an intervention using voluntary non-targeted side-stepping exercises in nursing home patients with a high frequency of falling. The trial had 22 individuals, who were randomized at random to either the STEP intervention group or the normal physiotherapy treatment group. Finally, the research conducted by Rikkonen et al. (2023) sought to ascertain if a year-long enrollment in a city’s recreational sports facilities, including a regularly supervised gym and Tai Chi classes, leads to decreased falls and associated injuries. The research included 914 women between the ages of 76.5 and 84.8, randomly assigned to either the exercise intervention or the control group. The intention-to-treat study documented a total of 1,380 instances of falls, of which 92.8% were confirmed by telephone verification.

Results of Studies/Key Findings

In the study conducted by Cederbom et al. (2020), it was discovered that the Outcome-Based Program positively impacted clinical practice. The program enhanced physical function, mood, self-efficacy, and social participation in older adults, as reported by physical therapists. Consequently, in the study conducted by Pettersson et al. (2021), it was discovered that support for autonomy, competence, and relatedness influenced motivation and behavior change techniques. Autonomy was highly regarded, contingent upon the participants’ competence level and technology utilization. The clarity of the program and the availability of exercise videos were crucial for providing effective performance support.

Furthermore, in the study conducted by Dierick et al. (2022), it was discovered that the STEP group exhibited noteworthy enhancements in various measures, including the Timed Up and Go, 6-minute walking test, Berg Balance Scale, and Mini motor test, after eight weeks in comparison to their initial baseline. Nevertheless, during the follow-up period, there was a notable decline in the Tinetti Performance Oriented Mobility Assessment and Berg Balance Scale scores in the STEP group, while no significant differences were found at the corresponding time intervals. Finally, in the study conducted by Rikkonen et al. (2023), it was discovered that the exercise group experienced a significant decrease in fall rates, with a reduction of 14.3% compared to the control group. Approximately 50% of the falls resulted in injuries of a moderate or severe nature. The exercise group experienced a significant decrease in fracture rates, particularly in falls, resulting in severe injury and pain.

Outcomes Comparison

My PICOT question examines the impact of weekly integrated training (resistance, strength, and balance) on the incidence of falls, compared to a lack of physical exercise. Regular physical activity has been shown to enhance overall health and lower the likelihood of developing conditions such as type 2 diabetes, osteoporosis, cardiovascular disease, and certain forms of cancer (Taylor et al., 2024). Therefore, ensuring that strength and balance training for older adults is progressively challenging and personalized to their functional ability is crucial. Additionally, it is important to provide adequate training to achieve the desired results. To prevent falls, engaging in exercise programs that offer a significant challenge to balance, have a substantial dose, involve a gradual increase in intensity over time, and are continuous is crucial.

The four articles I reviewed support my expected result that exercise programs effectively decrease the risks and prevent falls in older adults, even those with various health conditions such as type 2 diabetes. For instance, in the study by Cederbom et al. (2020), it was discovered that the OEP has proven advantageous in primary care settings, effectively enabling older adults to maintain their independence and reside in their homes for longer. Pettersson et al. (2021) also introduced the Safe Step program, which aims to facilitate exercise routines while addressing fundamental psychological needs. The study conducted by Dierick et al. (2022) also demonstrated that the intervention significantly improved mobility and balance over eight weeks. However, further research involving larger sample sizes and randomized control trials must validate these findings. Finally, a study conducted by Rikkonen et al. (2023) discovered a community-based approach to effectively decrease falls, fractures, and fall-related injuries among aging women.

Proposed Evidence-Based Practice Change

All the research I reviewed to answer my PICOT inquiry emphasized that Exercise is a very effective intervention for preventing falls in older individuals. One well-recognized example of such exercise is the Otago Exercise Program (Cederbom et al., 2020). Nevertheless, there is a shortage of user-centric understanding of its practicality in real-life scenarios. Several behavior modification approaches have been recommended to enhance adherence. However, there is a lack of uniformity in how they are reported. A taxonomy has been devised to enhance uniformity in research, including behavior modification strategies. An exercise program called side-stepping has been evaluated in community-dwelling persons in their seventies, but its effectiveness has not been assessed in nursing home patients. Public exercise programs can potentially reduce falls and injuries, while the availability of pragmatic studies is restricted.

Based on the study’s results, I suggest implementing physical exercise as an evidence-based practice change. This is because physical activity is essential for promoting health and well-being, lowering the likelihood of developing diseases, and managing chronic disorders such as arthritis, diabetes, heart problems, and respiratory difficulties. The American Council on Social Medicine and the American Heart Association advise that older individuals should engage in aerobic exercise of moderate or high intensity, do 8-10 strength-training exercises, practice balancing exercises, and follow a physical activity plan (Zhang et al., 2021). Balance training is crucial for preventing falls since muscular strength decreases progressively beyond age 40, and weakened lower limb muscles increase the chance of falling. Effective fall prevention programs prioritize the development of muscular strength in the lower limbs and the ankles and feet.

To evaluate the result of the suggested alteration, we will use incident reports to monitor the frequency of falls and gather data about falls. These reports document the incident and details of a fall, including the loss of balance leading to either falling on the floor or colliding with an object. The factors contributing to falls include the time of day, the location, the activity being performed, orthostasis, and incontinence (Sherrington et al., 2019). Examining this data enables physicians, administrators, and risk managers to determine fall risk levels, specific variables, and general trends. It is essential to standardize the rates at which falls occur and the severity of resulting injuries to monitor fall prevention programs in particular clinical contexts effectively. Systematic data analysis will enable nurses to evaluate assumptions and enhance patient safety.

Conclusion

The impact of falls on older individuals is substantial, placing a heavy burden on healthcare providers, systems, and the community. Exercise plays a vital role in preserving balance and mobility and preventing falls as individuals age. Individuals who engage in regular physical activity are less likely to experience falls. However, to effectively prevent falls, engaging in targeted exercises that challenge balance for extended periods is necessary. This focused strategy helps decrease fall-related injuries and the overall burden on public health.

References

Cederbom, S., Bjerk, M., & Bergland, A. (2022). A qualitative study exploring physical therapists’ views on the Otago Exercise Program for fall prevention: a stepping stone to “age in place” and to give faith in the future. Physiotherapy Theory and Practice, 38(1), 132-140. https://doi.org/10.1080/09593985.2020.1731895

Dierick, F., Bouché, A. F., Guérin, S., Steinmetz, J. P., Federspiel, C., Barvaux, V., & Buisseret, F. (2022). Quasi-experimental pilot study to improve mobility and balance in recurrently falling nursing home residents by voluntary non-targeted side-stepping exercise intervention. BMC Geriatrics, 22(1), 1006. https://doi.org/10.1186/s12877-022-03696-y

Halén, C., Gripenberg, S., Roaldsen, K. S., Dohrn, I. M., & Halvarsson, A. (2022). “A manageable and challenging fall prevention intervention with impact on society”-older women’s perspectives on participation in the Stay Balanced training program. Physiotherapy Theory and Practice, 38(13), 2806-2816. https://doi.org/10.1080/09593985.2021.1972498

Pettersson, B., Janols, R., Wiklund, M., Lundin-Olsson, L., & Sandlund, M. (2021). Older Adults’ experiences of behavior change support in a digital fall Prevention Exercise Program: Qualitative study framed by the Self-determination Theory. JMIR. Journal of Medical Internet Research/Journal of Medical Internet Research, 23(7), e26235. https://doi.org/10.2196/26235

Rikkonen, T., Sund, R., Koivumaa-Honkanen, H., Sirola, J., Honkanen, R., & Kröger, H. (2023). Effectiveness of exercise on fall prevention in community-dwelling older adults: a 2-year randomized controlled study of 914 women. Age and Ageing, 52(4), afad059. https://doi.org/10.1093/ageing/afad059

Sherrington, C., Fairhall, N. J., Wallbank, G. K., Tiedemann, A., Michaleff, Z. A., Howard, K., Clemson, L., Hopewell, S., & Lamb, S. E. (2019). Exercise for preventing falls in older people living in the community. Cochrane Library, 2019(1). https://doi.org/10.1002/14651858.cd012424.pub2

Taylor, L. M., Parsons, J., Moyes, S. A., Binns, E., Cavadino, A., Taylor, D., Lord, S., Del Din, S., Klenk, J., Rochester, L., & Kerse, N. (2024). Effects of an exercise program to reduce falls in older people living in Long-Term care: a randomized controlled trial. Journal of the American Medical Directors Association, 25(2), 201-208.e6. https://doi.org/10.1016/j.jamda.2023.10.022

Zhang, Q., Liu, Y., Li, D., Jia, Y., Zhang, W., Chen, B., & Wan, Z. (2021). Exercise intervention for the risk of falls in older adults. Medicine, 100(5), e24548. https://doi.org/10.1097/md.0000000000024548