Assignment: Evidence-based Project Critical Appraisal Part 3

Assignment: Evidence-based Project Critical Appraisal Part 3

Assignment: Evidence-based Project Critical Appraisal Part 3

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Use this document to complete Part 1 of the Module 2 Assessment, Evidence-Based Project, Part 1: Identifying Research Methodologies

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Full citation of selected article	Article #1	Article #2	Article #3	Article #4
	Struggling to meet your deadline ? Get assistance on Assignment: Evidence-based Project Critical Appraisal Part 3 done on time by medical experts. Don’t wait – ORDER NOW! Meet My Deadline King, B., Pecanac, K., Krupp, A., Liebzeit, D., & Mahoney, J. (2018). Impact of Fall Prevention on Nurses and Care of Fall Risk Patients. The Gerontologist, 58(2), 331–340. https://doi.org/10.1093/geront/gnw156	Radecki, B., Reynolds, S., & Kara, A. (2018). Inpatient fall prevention from the patient’s perspective: A qualitative study. Applied nursing research: ANR, 43, 114–119. https://doi.org/10.1016/j.apnr.2018.08.001	Dykes, P. C., Carroll, D. L., Hurley, A., Lipsitz, S., Benoit, A., Chang, F., Meltzer, S., Tsurikova, R., Zuyov, L., & Middleton, B. (2010). Fall prevention in acute care hospitals: a randomized trial. JAMA, 304(17), 1912–1918. https://doi.org/10.1001/jama.2010.1567	Thomas, E., Battaglia, G., Patti, A., Brusa, J., Leonardi, V., Palma, A., & Bellafiore, M. (2019). Physical activity programs for balance and fall prevention in elderly: A systematic review. Medicine, 98(27), e16218. https://doi.org/10.1097/MD.0000000000016218
Why you chose this article and/or how it relates to the clinical issue of interest (include a brief explanation of the ethics of research related to your clinical issue of interest)	I chose this article because of the too many lives that have been affected due to hospital acquired injuries gotten from falls. This article is a qualitative article that considers subjective input from patients to come up with solutions to better serve them(patients).	The purpose of this research was to aid in the development of patient-centered solutions by providing a description of fall prevention from the patient’s point of view within the context of acute care.	There is little evidence that short-stay hospital-based fall prevention techniques reduce patient falls, even though hospitalization significantly raises the risk of falling. The purpose of this study is to determine if a health information technology (HIT)-based fall prevention tool kit (FPTK) reduces the number of falls that occur among hospitalized patients.	This is a quantitative research article That uses numbers throughout the experiment to obtain applicable results.  It would be interesting to know the difference in methodology between quantitative and qualitative research modules.
Brief description of the aims of the research of each peer-reviewed article		Uses the strengths and weaknesses from a patient’s perspective related to causes of fall to devise a safety method that is practical and realistic based on patients’ hospital experience when ill/ admitted.	The purpose of this study is to determine if a health information technology-based fall prevention tool kit reduces the number of patients falls while hospitalized.	The aim of this article was to systematically review literature for evidence-based activities that can improve balance in elderly adults.
Brief description of the research methodology used Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.	This research is a qualitative research article that seeks to devise a strategy to stop falls in the hospitals. This article is not a mixed-method approach, but one-way research that is focuses on non-numerical data to used in gathering data to resolve a difficult challenge within an organization.	This qualitative research led to the discovery of three significant themes: the nurses and healthcare crew, fall interventions in place, and patients view. The views that patients have regarding their own fall risk are categorized under the overarching topic which also covers the subthemes of awareness, acceptance/rejection, implications, emotions, and personal plan to manage these falls in our hospital systems today.  On the other hand, what interventions have been put in place to help patients feel safe about ambulating again. Some of the interventions include alarms that notify staff that inmate is out of bed, chair or toilet. This method also seeks to find out if patients would adhere to fall prevention plan as well as maintain safety precautions put in place to manage the falls.	The method of research used in this article is a cluster randomized controlled trial (RCT), participants are assigned to treatment groups rather than individuals. Specifically, a cluster randomized trial is practically the only valid approach for evaluating certain types of intervention including those used in health promotion and educational interventions. While randomized studies of individuals are easier to plan and carry out, cluster trials present their own unique challenges. Furthermore, a cluster trial’s design may leave it especially susceptible to a variety of threats that can introduce bias.	This study is a qualitative synthesis of evidence through a systematic review of literature in Medline-NLM, Pubmed, ScienceDirect, and SPORT Discuss that have analyzed balance and physical activity in healthy elderly over 65 years of age during the last decade.
A brief description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.	This research is not realistic because it is a zero-fall policy. A conceptual model to show how nurses are affected by strong directives from management to reduce the number of falls among their elderly patients, how they respond to those directives, and what happens as a result for both the nurses and their patients. Nurses developed a dread of falls, protected themselves and their units, and restricted patients at high risk of falling as a means of stopping the hospital’s relentless messaging and achieving its objective of zero falls. Negative effects of fall prevention messaging on nurses and older adult patients are revealed in this research. Nurses’ care for patients at risk of falls is complex, and more study is required.	Most fall prevention programs prefer to have clinicians lead the creation and implementation of preventive plans. The focus of patient fall assessments should move away from clinicians and more toward the patients themselves. To better comprehend a patient’s requirements, nurses are required to cultivate relationships with that patient. It is possible that the development of these patient-centered programs may lessen the over-reliance on bed alarms and make it possible to deploy initiatives aimed at mitigating modifiable risk factors that lead to falls.	This research article demonstrated the role of application, the fall prevention tool kit (FPTK) combined already established communication and workflow processes. The FPTK software was able to design fall prevention interventions to target the specific factors of fall risk for individual patients based on the results of a valid fall risk assessment scale that was completed by a nurse. The FPTK developed bed posters that consisted of brief text with an accompanying icon, patient education handouts, and plans of care, all of which communicated patient-specific warnings to important stakeholders. In comparison to the standard care that was provided, the implementation of a fall prevention tool kit in hospital units resulted in a much lower number of patients falling.	This article includes 200 participants. This large sample size reduces the margin of error and lowers standard deviation, hence improving reliability of results. The inclusion of randomized control studies reduces bias supporting an external validation of results obtained.
General Notes/Comments				This review article provides sufficient evidence to support a positive outcome on balance of elderly adults who engage resistance and aerobic exercise, balance training, T-bow and wobble board training, aerobic step, and stability ball training, adapted physical activity and Wii Fit training.

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Evidence-based Project Critical Appraisal Part 3

Patient falls are adverse events that pose significant safety concerns by leading to prolonged hospitalization, increased care costs, deaths, and preventable patient harm. According to Jähne-Raden et al. (2019), individual factors like gait and balance disorders, vigilance disorders, neurodegenerative conditions, such as dementia and Parkinson’s disease, and disorientation are primary risk factors for in-patient falls, especially in geriatric care settings. Equally, organizational issues, including the presence of slip hazards, a poorly-organized hospital environment, ineffective and deficient risk assessment practices, and a lack of patient monitoring activities can exacerbate incidences of patient falls. Since healthcare professionals have an ethical and professional obligation to ensure patient safety and avert harm, they should embrace evidence-based strategies for preventing patient falls. The current scholarly research identifies various organizational-level and nurse-led strategies for preventing in-patient and out-patient falls. As a result, this paper is a critical appraisal of four articles that provide justifiable and proven interventions for fall prevention in different clinical contexts.

A Critical Appraisal of the Selected Scholarly Articles

Critically appraising evidence is a profound step of evidence-based practice (EPB). The primary objective of appraising evidence is to ascertain its relevance, consistency, and validity consistent with foreground (PICOT) questions. The clinical question selected in the previous assessment entails exploring the duty of each geriatric nurse in implementing fall prevention techniques to reduce the number of patients falls. As a result, the identification of ideal evidence sources revolved around advanced and proven interventions for preventing falls. Upon leveraging keywords and subtitles to select scholarly articles, this search technique yielded four scientific studies; King et al. (2018), Radecki et al. (2018), Thomas et al. (2018), and Jähne-Raden et al. (2018). Each article provides insights into evidence-based strategies for preventing patient falls. They are current, peer-reviewed, and relevant to the foreground question. Finally, their findings are generalizable and transferable to different clinical contexts.

Best Practice that Emerges from the Reviewed Research

The reviewed research provides insights into different approaches for preventing patient falls. In a qualitative study, Radecki et al. (2018) describe the patient’s perspective on fall prevention in an acute care setting. According to the researchers, patient fall assessments are vital in identifying risk factors for falls. Nurses should develop meaningful relationships with patients during assessments and understand their priorities. Further, this study recommends the creation of patient-centered programs for assessing falls to reduce over-reliance on bed alarms. Other strategies identified in the study include maintaining safety precautions and alarms that notify clinicians about patients’ movement.

Thomas et al. (2019) conducted a literature review to identify physical activity programs effective in increasing balance in the elderly. According to the researchers, resistance and anaerobic exercise, balance training, T-bow and wobble board training, and stability ball are ideal physical therapies for enhancing stability and mobility for the elderly. Other physical approaches for improving physical fitness are a Wii Fit training program encompassing yoga, downhill skiing, heading soccer, and game balls.

In a qualitative study, King et al. (2018) explore nurses’ experiences with fall prevention in a hospital setting. According to the researchers, patient falls have multifactorial etiology, including gait instability, fall history, environmental hazards, and staffing ratios. After reviewing responses from 27 RNs and CNAs, King et al. (2018) identified intense messaging from hospital administration, restricting patients’ movement, and maintaining patients’ physical strength and mobility as profound interventions for preventing patient falls. The study recommends a contingency plan that incorporates all these interventions.

Finally, Jähne-Raden et al. (2019) focus on a highly specialized solution for fall prevention and detection. This article explores the application of technology in preventing and detecting falls. The INBED system is a modular prototype consisting of wearable devices for detecting rising events, restlessness, fall, and high-risk areas. This system sends signals to nursing staff and seeks to eliminate the over-reliance on belt systems or bed rails that limit the patient’s freedom of movement. This study recommends more research on the applicability of the INBED system to confirm its applicability in different clinical contexts.

Conclusion

Critical appraisal of evidence sources is a fundamental step for evidence-based practice because it allows researchers to understand the evidence’s relevance, consistency, validity, and usability. In this paper, the selected articles provide information regarding the best practices for preventing patient falls. These interventions include alarm systems, risk assessments, improving patients’ physical fitness and strength, and incorporating technological systems, such as the INBED system to alert clinicians of the imminent falls or restlessness events.

References

Jähne-Raden, N., Kulau, U., Marschollek, M., & Wolf, K. H. (2019). INBED: A highly specialized system for bed-exit detection and fall prevention on a geriatric ward. Sensors, 19(5), 1017. https://doi.org/10.3390/s19051017

King, B., Pecanac, K., Krupp, A., Liebzeit, D., & Mahoney, J. (2018). Impact of fall prevention on nurses and care of fall risk patients. The Gerontologist, 58(2), 331–340. https://doi.org/10.1093/geront/gnw156

Radecki, B., Reynolds, S., & Kara, A. (2018). Inpatient fall prevention from the patient’s perspective: A qualitative study. Applied nursing research: ANR, 43, 114–119. https://doi.org/10.1016/j.apnr.2018.08.001

Thomas, E., Battaglia, G., Patti, A., Brusa, J., Leonardi, V., Palma, A., & Bellafiore, M. (2019). Physical activity programs for balance and fall prevention in elderly: A systematic review. Medicine, 98(27), e16218. https://doi.org/10.1097/MD.0000000000016218