Assignment: NRS 433 Research Critiques and PICOT Statement Final Draft

Assignment: NRS 433 Research Critiques and PICOT Statement Final Draft

Assignment: NRS 433 Research Critiques and PICOT Statement Final Draft

Assessment Description

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

PICOT Question

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.

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The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

Research Critiques

In the Topic 2 and Topic 3 assignments, you completed qualitative, quantitative, and mixed methods research critiques on two articles for each type of study (four articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Use the “Research Critiques and PICOT Question Guidelines – Final Draft” document to organize your essay. Questions under each heading should be addressed as a narrative in the structure of a formal paper. Please note that there are two new additional sections: Outcomes Comparison and Proposed Evidence-Based Practice Change.

General Requirements

You are required to cite a minimum of three peer-reviewed sources to complete this assignment. Sources must be published within the last 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-433V-RS-T5-Research-Critique-PI

Research Critiques and PICOT Statement Final Draft – Rubric

LISTGRID

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Rubric Criteria

Total260 points

Criterion

1. Unsatisfactory

2. Insufficienty

3. Approaching

4. Acceptable

5. 5: Excellent

Evidence of Revision

Evidence of Revision

0 points

Final paper does not demonstrate incorporation of feedback or evidence of revision on research critiques.

19.5 points

Incorporation of research critique feedback and evidence of revision is incomplete.

20.54 points

Incorporation of research critique feedback and evidence of revision are present.

23.14 points

Evidence of incorporation of research critique feedback and revision is clearly provided.

26 points

Evidence of incorporation of research critique feedback and revision is comprehensive and thoroughly developed.

Introduction of Nursing Practice Problem, Purpose, and PICOT Question

Introduction of Nursing Practice Problem, Purpose, and PICOT Question

0 points

Introduction of the nursing practice problem and purpose of the essay is not included. PICOT question is not included.

9.75 points

Introduction does not include a clear description of the nursing practice problem or purpose of the essay. The PICOT question is not adequately or clearly written and is missing the necessary elements.

10.27 points

Introduction includes a basic description of the nursing practice problem and purpose of the essay. The PICOT question is present.

11.57 points

Introduction includes the nursing practice problem and purpose of the essay in a clear manner. The PICOT question is clear and includes all elements.

13 points

Introduction includes the nursing practice problem and purpose of the essay in a comprehensive manner. The PICOT question is concise, accurately written, and includes all elements.

Background of Studies

Background of Studies

0 points

Background of studies, including problem, significance to nursing, purpose, objective, and research questions, is not included.

9.75 points

Background of studies, including problem, significance to nursing, purpose, objective, and research questions, is not clearly written and lacks information.

10.27 points

Background of studies, including problem, significance to nursing, purpose, objective, and research questions, is partially complete and includes some relevant details and explanation.

11.57 points

Background of studies, including problem, significance to nursing, purpose, objective, and research questions, is complete and includes relevant details.

13 points

Background of studies, including problem, significance to nursing, purpose, objective, and research questions, is thorough with substantial relevant details and an extensive explanation.

Articles Support of Nursing Practice Problem

Articles Support of Nursing Practice Problem

0 points

A discussion on how articles support the PICOT question and how the interventions and comparison groups compare to those identified in the PICOT question is not included.

9.75 points

A discussion on how articles support the PICOT question and how the interventions and comparison groups compare to those identified in the PICOT question is unclear or lacking information. PICOT question or how the interventions and comparison groups compare to those identified in the PICOT question.

10.27 points

A discussion on how articles support the PICOT question is presented. The articles demonstrate general support in answering the proposed PICOT question. The interventions and comparison groups in the articles generally compare to those identified in the PICOT question.

11.57 points

A discussion on how articles support the PICOT question is presented. The articles demonstrate support in answering the proposed PICOT question. The interventions and comparison groups in the articles compare to those identified in the PICOT question.

13 points

A thorough discussion on how articles support the PICOT question is presented. The articles demonstrate strong support in answering the proposed PICOT question. The interventions and comparison groups in the articles strongly compare to those identified in the PICOT question.

Method of Studies

Method of Studies

0 points

A discussion on the method of study for each article is not included.

9.75 points

A partial discussion of the method of study for each article and a comparison of study methods is presented. A benefit and a limitation of each method are omitted or incomplete. There are significant inaccuracies.

10.27 points

A general discussion on the method of study for each article and a comparison of study methods are presented. A benefit and a limitation of each method are included but the description is general.

11.57 points

A detailed discussion on the method of study for each article and a comparison of study methods are presented. A benefit and a limitation of each method are presented.

13 points

A thorough discussion on the method of study for each article and a comparison of the study methods are presented. A benefit and a limitation of each method are presented. The discussion demonstrates a solid understanding of research methods.

Results of Studies

Results of Studies

0 points

A discussion of the results of each study, including key findings and implications for nursing practice, is not included.

9.75 points

A discussion of the results of each study, including key findings and implications for nursing practice, is unclear and incomplete.

10.27 points

A general discussion of the results of each study, including key findings and implications for nursing practice, is included.

11.57 points

A discussion of the results of each study, including key findings and implications for nursing practice, is complete and includes relevant details and supporting explanation.

13 points

A discussion of the results of each study, including key findings and implications for nursing practice, is thorough with substantial relevant details and extensive explanation.

Ethical Considerations

Ethical Considerations

0 points

Ethical considerations when conducting nursing research are not included. Discussion of how the researchers accounted for ethical considerations is not included.

9.75 points

Ethical considerations when conducting nursing research are unclear. Discussion of how the researchers accounted for ethical considerations is incomplete.

10.27 points

Ethical considerations when conducting nursing research are discussed in basic manner. Discussion of how the researchers accounted for ethical considerations is included.

11.57 points

Ethical considerations when conducting nursing research are clearly discussed. Discussion of how the researchers accounted for ethical considerations is through.

13 points

Ethical considerations when conducting nursing research are comprehensively discussed. Discussion of how the researchers accounted for ethical considerations is thorough with substantial relevant details and extensive explanation.

Outcomes Comparison

Outcomes Comparison

0 points

Explanation of the anticipated outcomes for the PICOT question is not included. The outcomes of four articles and the comparison to the anticipated outcomes are not included.

29.25 points

Explanation of the anticipated outcomes for the PICOT question is unclear. The outcomes of four or less selected articles and the comparison to the anticipated outcomes are incomplete.

30.81 points

Explanation of the anticipated outcomes for the PICOT question is included in a general manner. The outcomes of the four selected articles and the comparison to the anticipated outcomes are basic.

34.71 points

Explanation of the anticipated outcomes for the PICOT question is clear and includes relevant details. The outcomes of the four selected articles and the comparison to the anticipated outcomes are thorough.
39 points

Explanation of the anticipated outcomes for the PICOT question is thorough with substantial relevant details and an extensive explanation. The outcomes of the four selected articles and the comparison to the anticipated outcomes are comprehensive.

Proposed Evidence-Based Practice Change

Proposed Evidence-Based Practice Change

0 points

The link between the PICOT question, the research articles, and the identified nursing practice problem is not included. The proposed evidence-based practice change is not included.

29.25 points

The link between the PICOT question, the research articles, and the identified nursing practice problem is not clearly identified. The proposed evidence-based practice change is incomplete.
30.81 points

The link between the PICOT question, the research articles, and the identified nursing practice problem is explained in a general manner. The proposed evidence-based practice change is basic.
34.71 points

The link between the PICOT question, the research articles, and the identified nursing practice problem is clearly explained. The proposed evidence-based practice change is clear with relevant details.
39 points

The link between the PICOT question, the research articles, and the identified nursing practice problem is substantially explained. The proposed evidence-based practice change is thorough with substantial and relevant details.

Thesis, Position, or Purpose

Communicates reason for writing and demonstrates awareness of audience.
0 points

The thesis, position, or purpose is not discernible. No awareness of the appropriate audience is evident.

13.65 points

The thesis, position, or purpose is unfocused or confused. There is very little awareness of the intended audience.

14.38 points

The thesis, position, or purpose is discernable in most aspects but is occasionally weak or unclear. There is limited awareness of the appropriate audience.
16.2 points

The thesis, position, or purpose is adequately presented. An awareness of the appropriate audience is demonstrated.
18.2 points

The thesis, position, or purpose is clearly communicated throughout and clearly directed to a specific audience.

Development, Structure, and Conclusion

Advances position or purpose throughout writing; conclusion aligns to and evolves from development.
0 points

No advancement of the thesis, position, or purpose is evident. Connections between paragraphs are missing or inappropriate. No conclusion is offered.

13.65 points

Writing lacks logical progression of the thesis, position, or purpose. Some organization is attempted, but ideas are disconnected. Conclusion is unclear and not supported by the overall development of the purpose.
14.38 points

Limited advancement of thesis, position, or purpose is discernable. There are inconsistencies in organization or the relationship of ideas. Conclusion is simplistic and not fully aligned to the development of the purpose.

16.2 points

The thesis, position, or purpose is advanced in most aspects. Ideas clearly build on each other. Conclusion aligns to the development of the purpose.
18.2 points

The thesis, position, or purpose is logically advanced throughout. The progression of ideas is coherent and unified. A clear and logical conclusion aligns to the development of the purpose.

Evidence

Selects and integrates evidence to support and advance position/purpose; considers other perspectives.

0 points

Evidence to support the thesis, position, or purpose is absent. The writing relies entirely on the perspective of the writer.

11.7 points

Evidence is limited or irrelevant. The interpretation of other perspectives is superficial or incorrect.

12.32 points

Evidence is used but is insufficient or of limited relevance. Simplistic explanation or integration of other perspectives is present.
13.88 points

Relevant evidence that includes other perspectives is used.

15.6 points

Specific and appropriate evidence is included. Relevant perspectives of others are clearly considered.

Mechanics of Writing

Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.
0 points

Errors in grammar or syntax are pervasive and impede meaning. Incorrect language choice or sentence structure errors are found throughout.
11.7 points

Frequent and repetitive mechanical errors are present. Inconsistencies in language choice or sentence structure are recurrent.

12.32 points

Occasional mechanical errors are present. Language choice is generally appropriate. Varied sentence structure is attempted.
13.88 points

Few mechanical errors are present. Suitable language choice and sentence structure are used.
15.6 points

No mechanical errors are present. Appropriate language choice and sentence structure are used throughout.

Format/Documentation

Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.
0 points

Appropriate format is not used. No documentation of sources is provided.

7.8 points

Appropriate format is attempted, but some elements are missing. Frequent errors in documentation of sources are evident.
8.22 points

Appropriate format and documentation are used, although there are some obvious errors.
9.26 points

Appropriate format and documentation are used with only minor errors.
10.4 points

No errors in formatting or documentation are present.

Assignment: NRS 433 Research Critiques and PICOT Statement Final Draft Sample

Healthcare facilities should be safe environments for all patients seeking medical assistance for different health conditions. Unfortunately, patient falls occur in varying magnitudes and affect health outcomes significantly. Statistics show that approximately 700,000 to 1,000,000 patient falls are recorded annually in U.S. hospitals (Ochoa, 2020). The impacts are far-reaching, prompting the need for sustainable, evidence-based interventions. Chandrasekaran et al. (2021) found that patient falls are a leading cause of physical injuries among patients, prolonged hospitalizations, mental anguish, and fear of falls. Risk factors include the patient’s age, conditions of the care environment, and conditions such as heart disease and foot problems affecting body balance. Preventing patient falls improves patient safety and care quality, improving health outcomes and high satisfaction. Nursing research has extensively explored the effectiveness of exercise-based therapy as an intervention for patient falls. Therefore, the purpose of this paper is to critique quantitative and qualitative studies on the suitability of exercise-based therapy in reducing patient falls among older adults.

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PICOT Question: among hospitalized older adults (P), can exercise-based therapy (I) compared to usual care (C) reduce patient falls by 50% (O) in six months (T)?

Background of Studies

Patient falls are a severe practice problem affecting patients’ health adversely and lowering their quality of life. A higher proportion of older adults will be at risk of falls as time advances since the population of adults over sixty years will double by 2050 (Rikkonen et al., 2023). The problem is significant in nursing since patient falls inhibit achieving the desired health outcomes. Besides, they increase health management costs and the risk of readmissions (Cook et al., 2023). In response, Ehrari et al. (2020) studied the potential of engaging older adults in playful exercise to increase physical balance. The study’s objective was to evaluate the feasibility of an exercise-based intervention in reducing patient falls among older adults. The research question guiding the study was: how does playful exercise affect physical activity and balance among older adults? In another quantitative study, Chittrakul et al. (2020) examined the effectiveness of a multi-system physical exercise (MPE) program among pre-frail older adults. The study’s primary objective was to determine how the program could prevent falls and improve the quality of life among the participants. The research question guiding the study was: what is the effect of MPE on falls and quality of life among pre-frail older adults? Based on their purpose and study variables, the two articles focus on the same problem affecting a unique population and requiring the support of healthcare professionals.

Qualitative research (Cederbom et al., 2022; Arkkukangas et al., 2021) also demonstrates patient falls as a severe problem whose prevention should be prioritized in care facilities. The effects of patient falls, including functional deterioration, morbidity, and increased healthcare spending, underline its significance in nursing (Rikkonen et al., 2023; Cederbom et al., 2022). To drive evidence-based practice in nursing, Cederbom et al. (2022) evaluated physical therapists (PTs) experiences with applying the Otago Exercise Program (OEP) among home-dwelling older adults. Researchers aimed to answer the question: what is the applicability of OEP among home-dwelling older adults depending on formal care? In a different qualitative study, Arkkukangas et al. (2021) explored older adults’ experiences with a mobile application for fall prevention exercises. The objective of the two studies was to determine the outcomes associated with fall prevention programs and how they can be improved. Arkkukangas et al. (2021) aimed to answer the question: what are older persons’ experiences with a mobile health application for fall prevention exercise? Both articles focus on the experiences of users and care providers as a major theme.

Articles Supporting the Nursing Practice Problem

As highlighted in the PICOT, exercise-based therapy could reduce patient falls among hospitalized older adults. Ehrari et al. (2020) answer the PICOT by demonstrating how playful exercise improves balance and increases motivation to engage in similar exercises. Chittrakul et al. (2020) answer the PICOT by showing the difference between participants of a multi-system physical exercise intervention and non-participants. In the qualitative studies, Cederbom et al. (2022) answer the PICOT question by establishing the benefits of exercise-based therapy (Otago Exercise Program) among older adults at risk of falls. Arkkukangas et al. (2021) answer the PICOT question by exploring outcomes and positive experiences associated with fall prevention exercises.

Interventions and comparison groups help researchers to determine relationships between variables. In the intervention group, older adults participate in different moderate exercise programs for a period determined by researchers. The objective is to improve balance and strength, among other outcomes. The comparison groups involve older adults not engaging in exercise-based therapy but continuing with usual care. The intervention (moderate physical exercises) is similar to what is proposed in the PICOT question. The groups are also similar since participants are older adults at risk of patient falls.

Method of Studies

Besides objectives and study populations, the articles differ in research methods. Ehrari et al. (2020) conducted an experimental study (randomized controlled trial) among twenty-six independently living older adults. The intervention group engaged in playful exercises for ten weeks (twice weekly) while the control group continued with regular daily activities. Chittrakul et al. (2020) also experimented through a randomized controlled trial among seventy-two adults aged 65 and above. The intervention group received multi-system physical exercise training consisting of muscle strengthening, balance training, and proprioception for three days weekly for 12 weeks, as the control group continued with routine care. In the qualitative studies, Cederbom et al. (2022) conducted a phenomenological study to summarize individual experiences with a fall prevention intervention. In the other article, Arkkukangas et al. (2021) conducted a descriptive inductive qualitative study using focus group interviews.

Study methods have varying benefits and limitations. Experimentation through randomized controlled trials (RCTs) reduces bias through randomization since RCTs enable researchers to evaluate the causal relationships between the treatment and outcome (Zabor et al., 2020). However, the findings of RCTs may not effectively represent the broader population since only a small proportion participates in the study. Phenomenological research allows researchers to explore how humans experience phenomena and make sense of experiences (Cederbom et al., 2022). Its main limitation is length since it is time-consuming. A qualitative inductive design gives a broad view of the studied phenomena since researchers are not limited to what they already know. However, such studies may lack analysis rigor if researchers are inexperienced.

Results of Studies

Key Findings

Ehrari et al. (2020) found a significant difference between the intervention and control groups since functional balance in the intervention group improved by 5.02 points compared to 2.58 points in the control group. The program also increased participants’ motivation to engage in physical exercises. Chittrakul et al. (2020) found a statistically significant difference between the intervention and control groups in critical aspects like fall risk, muscle strength, and reaction time (p<0.001). The quality of life also increased significantly in the intervention group. In the qualitative articles, Cederbom et al. (2022) found the Otega Exercise Program effective in fall prevention since it improved patients’ physical function, self-efficacy, and mood. Arkkukangas et al. (2021) found the mobile health application a useful tool for helping older adults engage, get motivated, and adhere to fall prevention exercises.

Implications in Nursing Practice

Healthcare facilities should continually evaluate practice problems and address them through evidence-based interventions. From the summarized findings, it is evident that exercise-based therapy is an effective intervention for patient falls among older adults. As a result, similar programs should be embraced in nursing practice. Benefits include improved balance, better physical function among older adults, high self-efficacy, and more desire to engage in similar exercises independently.  

Ethical Considerations

Nursing research can pose considerable risks to participants depending on data collection methods, information privacy, and other factors. Informed consent is among the primary ethical considerations in nursing research, which involves ensuring voluntary participation with complete information about the research (Xu et al., 2020). Critical information includes potential risks, benefits, and research objectives. Anonymity is another dominant ethical consideration in nursing research. Hoft (2021) described anonymity as protecting participants’ identities when collecting, analyzing, and reporting data. Researchers in the four articles obtained written informed consent from the subjects to ensure they participated willingly. Besides, identifiable information was not collected or appropriately coded to keep participants anonymous.

Outcomes Comparison

Nurses implement evidence-based projects seeking to achieve positive outcomes. The anticipated outcome for the PICOT question is a significant fall reduction (by 50%) among hospitalized older adults. This reduction would be achieved by implementing an exercise-based therapy. Reducing patient falls improves patient safety, satisfaction, and confidence in care providers (LeLaurin & Shorr, 2019). The outcomes in the four articles are similar to the anticipated outcomes in the PICOT since they underscore the effectiveness of exercise-based interventions in preventing patient falls among older adults in various facilities. The positive outcomes and experiences among patients and care providers show that similar programs can be implemented in other areas for improved patient experience.

Proposed Evidence-Based Practice Change

As stated in the PICOT question, exercise-based therapy could help to reduce patient falls among hospitalized older adults. The research articles confirm the effectiveness of exercise-based programs in preventing patient falls, implying that they can be used to address the nursing practice problem (patient falls) to improve the patient care experience. Based on this information, an exercise-based therapy involving moderate exercises should be implemented in the current setting to reduce patient falls by 50%, as projected in the PICOT question. Potential outcomes include improved balance, physical strength, and motivation for exercises (Ehrari et al., 2020). Older adults should engage in these exercises two times weekly for six weeks to realize the expected outcomes. Continuous monitoring, support, and guidance from healthcare professionals are vital to ensure older adults at risk of falls can engage in moderate physical exercises independently.

Conclusion

Healthcare facilities should be safe settings for all patients. Due to the high potential of patient falls to hamper health outcomes, nurses should implement appropriate interventions depending on the magnitude of the falls and the affected population. As discussed throughout this paper, exercise-based therapy is a reliable intervention for preventing falls among older adults. This critical goal is realized by guiding and encouraging older adults to exercise moderately to improve balance and physicality. Therefore, similar outcomes would be realized in the current setting and broader nursing practice through exercise-based programs targeting older adults at risk of falls.

References

Arkkukangas, M., Cederbom, S., Tonkonogi, M., & Umb Carlsson, Õ. (2021). Older adults’ experiences with mHealth for fall prevention exercise: Usability and promotion of behavior change strategies. Physiotherapy Theory and Practice, 37(12), 1346-1352. https://doi.org/10.1080/09593985.2020.1712753

Cederbom, S., Bjerk, M., & Bergland, A. (2022). A qualitative study exploring physical therapists’ views on the Otago Exercise Programme 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

Chandrasekaran, S., Hibino, H., Gorniak, S. L., Layne, C. S., & Johnston, C. A. (2021). Fear of Falling: Significant barrier in fall prevention approaches. American Journal of Lifestyle Medicine, 15(6), 598–601. https://doi.org/10.1177/15598276211035360

Chittrakul, J., Siviroj, P., Sungkarat, S., & Sapbamrer, R. (2020). Multi-system physical exercise intervention for fall prevention and quality of life in pre-frail older adults: a randomized controlled trial. International Journal of Environmental Research and Public Health, 17(9), 3102. https://doi.org/10.3390/ijerph17093102

Cook, A., Swindall, R., Spencer, K., Wadle, C., Cage, S. A., Mohiuddin, M., … & Norwood, S. (2023). Hospitalization and readmission after single-level fall: a population-based sample. Injury Epidemiology, 10(1), 49. https://doi.org/10.1186/s40621-023-00463-4

Ehrari, H., Larsen, R. T., Langberg, H., & Andersen, H. B. (2020). Effects of playful exercise of older adults on balance and physical activity: a randomized controlled trial. Journal of Population Ageing, 13, 207-222. https://doi.org/10.1007/s12062-020-09273-8

Hoft, J. (2021). Anonymity and confidentiality. The Encyclopedia of Research Methods in Criminology and Criminal Justice, 1, 223-227. https://doi.org/10.1002/9781119111931.ch41

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing Falls in hospitalized patients: state of the science. Clinics in Geriatric Medicine, 35(2), 273–283. https://doi.org/10.1016/j.cger.2019.01.007

Ochoa, D. (2020).  Fall prevention in observation patients. St. Joseph Hospital. https://digitalcommons.psjhealth.org/cgi/viewcontent.cgi?article=1060&context=sjo-ebp

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

Xu, A., Baysari, M. T., Stocker, S. L., Leow, L. J., Day, R. O., & Carland, J. E. (2020). Researchers’ views on, and experiences with, the requirement to obtain informed consent in research involving human participants: a qualitative study. BMC Medical Ethics, 21(1), 1-11. https://doi.org/10.1186/s12910-020-00538-7

Zabor, E. C., Kaizer, A. M., & Hobbs, B. P. (2020). Randomized controlled trials. Chest, 158(1S), S79–S87. https://doi.org/10.1016/j.chest.2020.03.013