NURS FPX 8030 Assessment 3

NURS FPX 8030 Assessment 3 Critical Appraisal of Evidence-Based Literature

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Evaluating the quality, legitimacy, and relevance of research articles constitutes a foundational process in assessing evidence-based literature within the healthcare domain. It involves the assessment of the authors’ findings and the method, data analysis, and research design. This comprehensive evaluation will help healthcare practitioners scrutinize the quality of the evidence, any prejudices or restrictions, and the relevance and broad applicability of findings to clinical application. Ultimately, a thorough examination of the literature, aligned with evidence, ensures that medical choices are supported by high-quality research, fostering efficient and secure patient care. The primary aim of the evaluation is to scrutinize the literature concerning patient falls.

Analysis of Patient Safety Problem

Fall in a patient is a major risk in modern healthcare systems especially in the aged. Recent data and academic studies show that the risk of falls in healthcare facilities increases with age as well as with polypharmacy, which is common among the elderly, and the complexity of health problems (Zaninotto et al., 2020). The harm falls bring more than just physical as they bring psychological pain, long hospital stays, and additional medical costs (Vaishya & Vaish, 2020). The incidence of falls is still very high with the employment of standard fall prevention tools such as bed alarms and bed rails, for instance. Therefore, to effectively diminish fall hazards and enhance patient safety in hospitals, an assortment of fall prevention approaches should be researched and applied, including regular assessments, patient education, and environmental improvements.

Revised PICO(T) Question

Is there a statistically significant difference in the fall rates among the older patients who use multimodal fall prevention strategies (I) during a six-month hospital stay at the University of Washington Medical Center (UWMC) (T) compared with a control group that uses standard fall prevention measure (C) and the independent variable remains alongside the dependent (O) as is the norm in PICO?.

Thesis Statement

Multicomponent fall prevention approaches should be employed to decrease falls among elderly patients during hospital stays, such as routine evaluations, patient education, and environmental changes. It will enhance patient safety and reduce the adverse effects of falls.

Critical Appraisal Tool

I’ve opted to utilize the Johns Hopkins Nursing Evidence-Based Practice Research Evidence Appraisal Tool during the literature critical evaluation process. The tool’s rigorous and systematic methodology for assessing the quality and strength of research evidence has made it highly regarded and respected in the nursing profession (Glasofer & Townsend, 2020). The organized method provided by the Johns Hopkins Assessment Tool enables a thorough examination of the research design, methodologies, data interpretation, and overall credibility. The selection of this specific critical assessment instrument arises from its commitment to evidence-based practice principles and its suitability for meeting the demands of nursing practice. It pays special attention to the specific challenges and conditions that go with the use of research findings in practical clinical environments. Also, the instrument establishes explicit criteria and systems of grading that ensure objective and unbiased judgment of data from different studies (Smith et al., 2022). I can provide an even and stringent way of assessing the quality of the literature by using the Tool. This ultimately aids in crafting well-informed, evidence-centered strategies and interventions to tackle the pressing challenge our profession confronts.

Annotated Bibliography

Bhasin, S., Gill, T. M., Reuben, D. B., Latham, N. K., Ganz, D. A., Greene, E. J., Dziura, J., Basaria, S., Gurwitz, J. H., Dykes, P. C., McMahon, S., Storer, T. W., Gazarian, P., Miller, M. E., Travison, T. G., Esserman, D., Carnie, M. B., Goehring, L., Fagan, M., & Greenspan, S. L. (2020). A randomized trial of a multifactorial strategy to prevent serious fall injuries. New England Journal of Medicine, 383(2), 129–140. https://doi.org/10.1056/nejmoa2002183

The research aimed to evaluate the impact of a multifaceted intervention delivered by nursing professionals to reduce the likelihood of falls among elderly individuals. The practical cluster-randomized survey was conducted in 86 primary care offices that belong to 10 different healthcare systems. Participants who were 70 years and above and were more susceptible to injuries caused by falls were given personalized risk assessments and approaches. Or, the control group participants were provided with upgraded usual care. The first major fall injury was detected as the main outcome by time-to-event analysis. The study anticipated that the occurrence rate within the intervention cohort would be 20% lower than that of the control group.

The results indicated that the frequency of initial adjudicated severe fall injuries did not exhibit a significant discrepancy between the intervention and control cohorts. Relative to the control cohort, the intervention participants demonstrated a reduced frequency of self-reported fall injuries. The hospitalization and fatality frequencies of both cohorts remained steady. Despite implementing the multifaceted intervention, there was no notable decrease in confirmed severe fall injuries. This suggests that more research or changes to intervention approaches are needed to effectively prevent injury related to falls in the aged, thus furthering our understanding of community-based fall prevention techniques.

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A.-M., & Morris, M. E. (2020). Hospital falls prevention with patient education: A scoping review. BMC Geriatrics, 20(1), 1–12. https://doi.org/10.1186/s12877-020-01515-w

NURS FPX 8030 Assessment 3 Critical Appraisal of Evidence-Based Literature

The critical review assessed hospital patients fall education programs and their teaching styles. During the period January 2008 to February 2020, The research covered eight databases, including the grey literature, using the Arksey and O’Malley scoping review methodology and the Joanna Briggs Institute and PRISMA-ScR criteria. In the end, the analysis consists of 43 articles. Face-to-face teaching, education instrumentation, consumption goods, and adaptation of the healthcare system were applied. When two reviewers independently reviewed papers, data were thematically synthesized, and fall prevention education programs were assessed using a modified quality score.
The data suggests that education as part of hospital patient fall prevention programs may lower falls and injuries. The study highlights the importance of instructional material design, quality, and distribution style in achieving positive outcomes. Education programs that are well designed may enhance patient awareness and risk perception, thus allowing patients to evade falls while in the hospital. The study concentrated on the function of patient instruction in preventing falls and the need for more systematic and theoretically guided educational methods in healthcare.

Schoberer, D., Breimaier, H. E., Zuschnegg, J., Findling, T., Schaffer, S., & Archan, T. (2022). Fall prevention in hospitals and nursing homes: Clinical practice guideline. Worldviews on Evidence-Based Nursing, 19(2). https://doi.org/10.1111/wvn.12571

The research formulated a guideline for fall prevention in hospitals and long-term care facilities for the elderly. A meta-analyses’ findings were summarized, and GRADE graded the scientific literature. A Delphi panel provided the recommendations drawing on the expert opinions. Multifactorial, combined treatment with professionally supported physical exercise education and counseling were highly recommended. Non-accepted therapies were fall risk assessment instruments and fragile resident interventions. The research produced an elaborate practice directive for preventing falls among older individuals in hospital and LTC settings, contributing to the world. The guideline presents healthcare practitioners with evidence-based fall prevention strategies through the synthesis of several randomized controlled studies. The judgments of experts also ensure the feasibility of clinical recommendations. The study highlights different approaches and emphasizes contexts where some interventions may be ineffective, guiding healthcare providers in using evidence-informed tactics for preventing falls among elderly individuals in healthcare environments.

Shaw, L., Kiegaldie, D., & Farlie, M. K. (2020). Education interventions for health professionals on falls prevention in health care settings: A 10-year scoping review. BMC Geriatrics, 20(1). https://doi.org/10.1186/s12877-020-01819-x

The scoping study focused on the available options and quality for educating hospital health workers on fall prevention. The research used a scoping review methodology to analyze the publications in five stages, published from January 2008 to May 2019. Thirty-nine publications presented instructional lectures, interactive exercises, and printed materials. Analysis revealed that very few research employed complete education design principles or reporting structures to evaluate and record results. The research aims to bridge the discrepancy between the non-standardized design principles and reporting systems of the previous studies and the role of health professional education in fall prevention. This discrepancy creates problems in the evaluation and comparison of health education programs. Standardization of reporting in educational interventions could enhance clinical practice and enable preventive decision-making regarding falls based on evidence. This study highlights the importance of focusing future research on the development of criteria of rigorous design and reporting in the health professional fall prevention education targeted at hospital patient safety.

Vandervelde, S., Vlaeyen, E., de Casterlé, B. D., Flamaing, J., Valy, S., Meurrens, J., Poels, J., Himpe, M., Belaen, G., & Milisen, K. (2023). Strategies to implement multifactorial falls prevention interventions in community-dwelling older persons: A systematic review. Implementation Science, 18(1). https://doi.org/10.1186/s13012-022-01257-w

A comprehensive review assessed community-based multifactorial fall prevention interventions. The study aimed to determine methods of performing such treatments, even in spite of the recommendations. The authors found 23 papers from 18 research after a search in many databases. Sensitivity analysis and recommendations were applied to assess the quality of the report as well as the methods used in its implementation. Customization and education were important strategies for the people and the healthcare workers. The details on implementation techniques and framework, as well as the model and theory application, were scanty. This study outlines gaps in the literature regarding community fall prevention intervention. The discovery of identical approaches and the determination of factors could increase the adoption. The research also focuses on greater detail in implementation strategy reporting and frameworks to support implementation. The systematic examination offers a thorough evaluation of existing approaches and suggests avenues for future research and the development of interventions aimed at preventing falls among older adults residing in community settings.

Evaluation of Resources with Quality Appraisal Tool

Nursing practice and research should be reliable, valid, and applicable, which can be achieved by evaluating resources using a quality evaluation technique. To start with, the Vandervelde et al. (2023) systematic review of multifactorial fall prevention strategies in community-dwelling elderly is evaluated. The research is categorized as Level III by The Johns Hopkins Tool. A comprehensive systematic review of eighteen researches was carried out. The research was wide-scoped, but it did not have detailed execution plans and did not make use of an efficient framework, and this made its quality low.

On the other hand, a scoping review of patient teaching in the hospital fall prevention has Level III evidence. The Heng et al. (2020) database search retrieved 43 publications. It suggested that educational design principles and theories were not applied, which undermined the efficacy of fall prevention educational initiatives. The research showcases the efficiency of patient education interventions; however, it lacks methodological precision, and this affects its rating.

A trial of multimodal fall prevention interventions for elderly people is Level I evidence. A practical, cluster-randomized experiment with a focus on primary care practices was performed by Bhasin et al. (2020). Evidence is robust in the study. Although the intervention was well executed, it failed to reduce adjudicated major fall injuries by much, suggesting further research or intervention changes. Evidence level III comprises a scoping review of fall prevention education strategies for health professionals. Shaw et al. (2020) identified thirty-nine articles; however, they mentioned a lack of design principles and reporting guidelines. The study focuses on health professional education but has limitations that hinder the analysis of its quality.

In the end, hospital and nursing facility fall prevention clinical practice recommendations have Level I evidence. Schoberer et al. (2022) support multimodal treatments backed by a number of randomized controlled studies. Expert comments were also included to guarantee clinical applicability and quality for health professionals. The Johns Hopkins Nursing Evidence-Based Practice Research Evidence Appraisal Tool found that each source presents valuable fall prevention perspectives; however, their methodological strengths and limitations vary, impacting their quality scores.

Proposed Interventions

The literature review of evidence-based literature, best practices, and expert opinions recommends several interventions for fall prevention aiming at improving the safety of patients. The community should implement multifaceted prevention programs that are suitable to the needs of the elderly. The approach is in line with that of Vandervelde et al. (2023), who suggest targeted interventions to tackle the determinants of falls. Risk assessment and action plans focused on the individual are helping healthcare workers to meet patient-specific needs and, therefore, improving the effort that was put into fall prevention.

Formulate and execute the hospital fall prevention patient education programs using educational design and theory. Heng et al. (2020) argue that well-designed education programs empower patients to prevent falls. Grown-up learning principles, or health behavior modification frameworks, will aid healthcare practitioners in crafting educational resources and interventions that will convey messages efficiently, enhance patient awareness of fall risks, and induce behavioral change. Develop uniformity in fall prevention training for healthcare professionals through strict design and reporting standards. A standardized education and reporting system is recommended by Shaw et al. (2020) to improve the quality and consistency of the teaching of healthcare professionals. Organized and evidence-based fall prevention training for staff would ensure that healthcare companies address patient security apprehensions in hospitals and extended-stay care facilities.

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Conclusion

Critical evaluation of evidence-grounded literature uncovers the hurdles of intervention implementations of hospital fall prevention interventions. The existing research gives some useful findings concerning the winning strategies; however, there is paucity of intervention execution and design. Furthermore, individualized, comprehensive strategies that include specific therapy, patient education, and standardized training of healthcare professionals are required. Healthcare companies can address the areas to enhance patient safety and minimize falls.

References

https://doi.org/10.1056/nejmoa2002183

Glasofer, A., & Townsend, A. B. (2020). Determining the level of evidence. Nursing Critical Care, 15(2), 22–26.

https://doi.org/10.1097/01.ccn.0000654792.71629.00

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A.-M., & Morris, M. E. (2020). Hospital falls prevention with patient education: A scoping review. BMC Geriatrics, 20(1), 1–12.

https://doi.org/10.1186/s12877-020-01515-w

https://doi.org/10.1111/wvn.12571

Shaw, L., Kiegaldie, D., & Farlie, M. K. (2020). Education interventions for health professionals on falls prevention in health care settings: A 10-year scoping review. BMC Geriatrics, 20(1).

https://doi.org/10.1186/s12877-020-01819-x

Smith, L. C., Watson, H., Fair, L., Carter, G., Mackay, P., Lykens, K., Bradstock, J., Arnold, K., & Whalen, M. (2022). Evidence-based practices in developing and maintaining clinical nurse preceptors: An integrative review. Nurse Education Today, 117, 105468.

https://doi.org/10.1016/j.nedt.2022.105468

Vaishya, R., & Vaish, A. (2020). Falls in older adults are serious. Indian Journal of Orthopaedics, 54(1), 69–74.

https://doi.org/10.1007/s43465-019-00037-x

https://doi.org/10.1186/s13012-022-01257-w

Zaninotto, P., Huang, Y. T., Di Gessa, G., Abell, J., Lassale, C., & Steptoe, A. (2020). Polypharmacy is a risk factor for hospital admission due to a fall: Evidence from the english longitudinal study of ageing. BMC Public Health, 20(1).

https://doi.org/10.1186/s12889-020-09920-x

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