Rough Draft Quantitative Research Critique and Ethical Considerations

The nursing practice problem under consideration is falls among patients, and particularly the elderly ones. Falls among hospital patients is a major nursing concern due to the serious risk posed to patient safety. The prevalence of falls is attributed to a variety of causes, including insufficient staffing levels, changes in medications, confusion and disorientation among elderly patients, and cognitive deficits. It is essential that nurses take proactive steps to ensure their patients’ safety by assessing their risk for falls and implementing fall prevention strategies such as positional shift reminders and education on mobility assistance. Additionally, through the use of monitoring systems such as bed alarms and environmental surveys, nurses can safely monitor high-risk populations and intervene before falls occur. By taking these preventative measures, nurses are able to reduce patient falls and create a smoother experience for patients in the healthcare system. The purpose of this assignment is to write a critical appraisal that demonstrates comprehension of two quantitative research studies identified in topic 1.

PICOT Question: Among older adults aged 65 years and above in nursing homes and residences (P), does the implementation of TIPS framework (I) compared to normal safety measures (C), reduce and prevent fall by 60% and associated effects (O) within six months (T)?

 

Background of Studies

The two quantitative studies identified in topic 1 include, Article 4, “Effect of a fall prevention strategy for the older patients: A quasi‐experimental study” by Guo et al., (2023) and Article 5, “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” by Duckworth et al., (2019).

The main problem in article 4 is the increasing cases of fall among patients in healthcare. This article is significant to nursing. As discussed, falling has tremendous implications for patient safety and financial implications for healthcare budget; this is what makes this research paper an important study for the nursing practice. The primary objective of the article was to determine the effects of fall prevention strategies among older patients by employing a patient engagement design approach (Guo et al., 2023). After rigorous analysis of several experiments, it was found that engaging with patients led to a statistically significant reduction in fall occurrences. The purpose of the article was to explore the impact of a fall prevention strategy among older patients founded on the patient engagement design (Guo et al., 2023). The main research question from the article is: Does engagement of patients reduce and prevent the occurrence of falls among elderly patients or individuals?

The main problem in article 5 is patient falls in healthcare facilities. The study is highly pertinent to the field of nursing due to its focus on patient falls in healthcare facilities. Through the implementation of a Fall Tips modality, this research was able to assess its effects on patient engagement, as well as determine its efficacy in a three-step fall prevention process (Duckworth et al., 2019). The purpose of the study was to assess the effects of Fall TIPS modality on patient engagement in a three-step fall prevention process and gauge efficacy. The primary objective of this groundbreaking study was to examine the impacts of Fall TIPS modality, and the results were extremely telling – it has been demonstrated time and time again that education on ways to prevent falls are highly effective in keeping patients safe and sound (Duckworth et al., 2019). The main research question was: Does the Fall TIPS modality affect patient engagement using a 3-step fall prevention process and efficacy?

How Two Articles Support the Nursing Practice Problem Chosen

The two articles will be used to answer the PICOT question by providing evidence on the effectiveness of fall prevention strategies among older adults. The first article (Duckworth et al., 2019) shows that the Fall TIPS framework is effective in reducing and preventing falls among diverse patients, even in their homes. The second article (Guo et al., 2023) illustrates the effectiveness of using a fall prevention approach tailored to patient needs. Both articles provide evidence on the efficacy of patient-centered fall prevention strategies, which is relevant to the PICOT question. The interventions and outcomes in the articles can be compared to those in the PICOT question to determine the most effective approach to fall prevention in nursing homes and residences.

The interventions in the articles are similar to the TIPS framework identified in the PICOT question. The comparison groups in the articles are also similar to the normal safety measures identified in the PICOT question. In both articles, the interventions were compared to usual care or standard safety measures. The outcomes in the articles, such as reduced falls and improved patient safety, are also similar to the outcomes identified in the PICOT question. However, the samples in the articles are different from the PICOT question, as the articles focused on hospitals and healthcare settings, while the PICOT question focuses on nursing homes and residences.

Details:

Use the practice problem and a quantitative, peer-reviewed research article you identified in the Topic 1 assignment to complete this assignment.

In a 1000-1,250 word essay, summarize the study, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.

Refer to the resource “Research Critique Guidelines” for suggested headings and content for your paper.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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

NRS 433 Rough Draft Quantitative Research Critique And Ethical Considerations

Introduction

A heart failure condition, sometimes known as congestive heart failure, occurs when a patient experiences a condition where the heart muscles fail to pump blood effectively. In case of such a condition, the blood would backup, and the fluid could fill the lungs leading to shortness of breath (Li et al., 2019). The prevalence of heart failure conditions has risen recently, resulting in adverse outcomes in the healthcare system. The need to reverse this condition and improve the health of patients suffering from heart failure has resulted in various evidence-based programs to address this healthcare problem. Effective management of heart failure reduces the disease’s effect on patients and results in an improved quality of life (Nordfonn et al., 2019). Therefore, the purpose of this paper is to critallicaly appraise two quantitative research studies used in addressing heart failure.

PICOT question: For patients diagnosed with heart failure (P), does education on medication adherence and dietary restrictions (I) as compared to no education (C) reduce the incidences of rehospitalization (O) with exacerbation of their heart failure over a 6-month (T) period?

Background of Studies

Chew et al. (2021) did a study to examine the effectiveness of a nurse-led temporal self-regulation theory-based program on heart failure self-care in Singapore. This quantitative study adopted a randomized controlled trial carried out among 144 patients between September 2018 and July 2019. The results on the generally estimating equations showed an improvement in the heart failure condition in the intervention group compared to the control group. The program enrolled in this study was found to be effective in improving heart failure self-care and can be generalized to other chronic illnesses.

On the other hand, Seid et al., (2019) also carried out a relevant study addressing adherence to self-care recommendations and associated factors among adult heart failure patients attending Gondar University referral hospital from Feb to May 2017. This study was a cross-sectional quantitative study done on 310 adults with a heart failure condition. The study found that out of the 310 participants, only 22.2% of HF patients reported good adherence to their self-care recommendations. Again, the adherence to self-care recommendations was linked to the male gender. The study further ascertained that the overall heart failure patient adherence to the self-care options is poor and selective among the selected population.

How Do These Two Articles Support the Nursing Practice Problem You Chose?

Chew et al. (2021) address one of the recent directions nursing has been taking to solve some of the healthcare problems that have affected the quality of healthcare services. Self-management intervention is one of the recent approaches that many healthcare professionals give to chronic infections within the healthcare setting. While these self-care programs do not conflict with the clinical approach to treatment, they have effectively reduced the adverse effect of chronic diseases like heart failure on patients. Besides, a self-management program meant to treat a condition has a positive outcome on patients that affect their quality of life. Therefore, this article supports the nursing problem by proving that a nurse-led temporal self-regulation theory-based program on heart failure self-care is effective.

Seid et al. (2019) also commented that adhering to self-management programs in addressing heart failure condition impacts reducing the severity of the condition. The study focuses on making the self-care practice a routine among heart failure patients as it positively impacts the condition. The study’s findings show that adherence to self-care management practices among heart failure patients is low, calling for effective measures to correct this practice. While the study has outlined that adherence to self-care management practices is low among heart failure patients, it has provided a gap in nursing practice that should be addressed to increase the awareness of the self-care management practices among patients.

Chew et al. (2021) considered two groups in which the control group and the intervention group gave varying results. The intervention was important in improving heart failure conditions. The study addresses the role of nurse-led education programs on heart failure self-care, which is the central focus of the PICOT question. Conversely, Seid et al. (2019) found that adherence to self-care management practices is low among the patients leading to infective control of the heart failure condition. This article assesses how heart failure patients adhere to self-care recommendations, and the PICOT question also focuses on medical adherence and dietary restrictions in managing heart failure conditions.

Method of Studies

Chew et al. (2021) carried out a random controlled trial study on selected heart failure patients, while the second article used a cross-sectional study. While the RCTs compare an intervention between two distinct groups, the cross-sectional study method focuses on determining the prevalence. One of the benefits of RCTs is that it provides the most reliable evidence of the effectiveness of a program. However, it has the problem of generalizability as it cannot be generalized to other populations. On the other hand, a cross-sectional study allows data collection from a wide range of participants. However, it cannot analyze behavior of a population over time.

Results of Studies

Chew et al. (2021) reported poor heart failure self-care, and the program was effective in improving heart failure self-care, while Seid et al. (2019) found a low population of patients adheres to their self-care recommendations. The first article implies that self-management practices are significant in addressing heart failure. Besides, longer follow-up studies are in need to uncover the long-term benefits of the clinical outcomes. The second article implies that the self-care recommendations are poor among the studied population calling for a need to educate heart failure patients on the significant self-care recommendations.

Ethical Considerations

Various ethical considerations guide studies to ensure that the study does not violate the rights of the selected sampled respondents. Despite the varying ethical considerations, one of the common ethical issues is gaining the respondents’ consent. The researcher has to gain the respondents’ informed consent to ascertain that all the participants are willing to participate in the study. Confidentiality is also a common ethical issue that all research studies consider as it approves the safety of the data collected from the respondents. The selected articles were studied within the ethical framework by gaining informed consent from the respondents and adhering to the effective confidentiality measures in the collected data.

Conclusion

Drawing conclusions from the above analysis of the articles, it suffices to agree that these articles significantly impact the PICOT question. The studies’ results effectively understand the effectiveness of an intervention and an outcome that would be seen without the intervention. Therefore, the two quantitative studies form an essential part of addressing the heart failure self-care interventions in patients.

References

Chew, H. S. J., Sim, K. L. D., Choi, K. C., & Chair, S. Y. (2021). Effectiveness of a nurse-led temporal self-regulation theory-based program on heart failure self-care: A randomized controlled trial. International Journal of Nursing Studies, 115, 103872. https://doi.org/10.1016/j.ijnurstu.2021.103872

Seid, M. A., Abdela, O. A., & Zeleke, E. G. (2019). Adherence to self-care recommendations and associated factors among adult heart failure patients. From the patients’ point of view. PLoS One, 14(2), e0211768. https://doi.org/10.1371/journal.pone.0211768

Li, C. C., Chang, S. R., & Shun, S. C. (2019). The self‐care coping process in patients with chronic heart failure: A qualitative study. Journal of Clinical Nursing, 28(3-4), 509-519. https://doi.org/10.1111/jocn.14640

Nordfonn, O. K., Morken, I. M., Bru, L. E., & Husebø, A. M. L. (2019). Patients’ experience with heart failure treatment and self‐care—a qualitative study exploring the burden of treatment. Journal of Clinical Nursing, 28(9-10), 1782-1793. https://doi.org/10.1111/jocn.14799

NRS-433 Topic 3 DQ 1

In an experimental design, researchers have control over the settings and context of the study, and samples are randomly assigned. Moreover, the sample size must be large enough to represent the population being studied. Clinical drug trials are examples of quantitative experimental designs in nursing. In experiments, participants who pass certain criteria are selected and put in two groups that are called the study groups and the control groups While the study groups are subjected to the treatment under study, the control group does not get the treatment to enable the comparison of the two groups and see the effects of the treatment on the sample in the study group. Non-experimental designs in nursing research include correlational and descriptive designs. A descriptive study may include a case study or a control study. Predictive and descriptive correlational studies are both correlational designs.

In non-experimental research, an independent variable is not controlled. There is a random assignment of subjects to conditions or condition orders, or even both. something like surveys and case studies (Cook & Cook, 2008). In experimental studies, the researcher manipulates the criteria of care and requires the various classes to undergo various therapies or the same care and exposure to multiple variables. The benefits of experimental research are, it will enable the manipulation of experimental conditions and finds the cause effect relationship such as randomized controlled studies. Also, the most highly controlled quantitative design is experimental research design. It exhibits the highest degree of control and has the least amount of bias. In non-experimental research designs, however the researcher does not intervene or interfere with the experimental conditions. Rather, they observe and establish the influencing factors. Such studies cannot also establish a cause effect. Non experimental designs have the least control since the researcher is trying to understand how the variables impact each other.

Reference

Cook, B. G., & Cook, L. (2008). Nonexperimental Quantitative Research and Its Role in Guiding Instruction. Intervention in School and Clinic, 44(2), 98-104. doi:10.1177/1053451208321565

Quantitative Research

Introduction

This paper is a critique of the two quantitative articles on the proposed evidence-based project on reducing fall in inpatient settings through patient education and awareness. Patient falls are a major issue that occurs in the inpatient setting and an important aspect of healthcare which involves implementing strategies and interventions to reduce the risk of fall and improve patient safety ( Xue et al, 2021).The paper reviews quantitative articles and demonstrates the significance of the PICOT question or framework.the purpose of this study is to evaluate an existing support on evidenced based practice program on reducing falls in inpatient setting by provision of education and awareness to patient.

PICOT Question

Among patients in inpatient settings(P), does patient education and empowerment (I), compared to normal safety measures (C), reduce and eliminate falls by 50% and related impacts (O), within three months (T).

Background

Patient falls in hospitals are a significant health concern, with US hospitals having a rate of 3.3 to 11.5 falls per 1000 patient days. Additionally, 25% of inpatient hospital falls lead to injuries. Duckworth et al., 2019, conducted a study to determine the effectiveness of engaging patients and family to reduce the risk of falls. The authors utilized the Tailoring Interventions for Patient Safety toolkit. This process involves conducting fall risk assessments, developing tailored prevention plans with evidence-based interventions, and consistently implementing the plan. To optimize its efficacy, engaging patients and families in all three steps is crucial. According to the study, the main problems associated with falls included prolonged hospital stay, increased healthcare costs, and psychological impacts on the patients. The study’s main objective is to assess the impact of three Fall TIPS modalities: the electronic health record (EHR) version, a laminated paper version with color-coded decision support, and a bedside display version. According to the study, Fall TIPS reduced patient falls by 25%, that is when family and patients are engaged. The nursing process aims to improve the quality of health through health promotion and disease prevention. Occurrence of falls reduces the efficiency of care provided by nurses; therefore, the article aims to provide valuable insights for nurses to implement evidence-based strategies to enhance patient safety in inpatient settings.

Another article by Montejano-Lozoya et al., 2020, assessed the impacts of nurses’ intervention in prevention of falls in hospitalized patients. According to the article, some of the problems caused by falls included pain, increased healthcare costs of 1.9-10 % of the annual income in hospitals, damage to hospital property and lack of confidence in the services offered by the hospital. The main objective of the study was to assess the impact of education provision to hospital nurses in fall prevention. The main research question was whether implementation of advanced and systematized assessment by nurse following patient’s admission to a hospital unit reduced fall incidences as compared to traditional assessment. Fall are a common problem in healthcare settings, and nurses play a critical role in implementing preventive measures to reduce fall incidents. Therefore, understanding the impact of nurses’ interventions on fall prevention can help nurses and healthcare organizations develop evidence-based strategies to enhance patient safety and reduce the burden of fall-related injuries.

Support of the Nursing Practice Problem

This article by Duckworth et al., 2019, directly supports the chosen nursing practice problem of reducing falls in inpatient settings. The PICOT question seeks to assess the effectiveness of patient education and empowerment compared to normal safety measures in reducing and eliminating falls by 50% and related impacts within three months. The article examines the Fall TIPS toolkit, which focuses on engaging patients and families in the three-step fall prevention process, and its impact on patient engagement and adherence to the prevention plan. The study’s findings demonstrate that all three Fall TIPS modalities effectively facilitated patient engagement, indicating that patient education and empowerment play a vital role in fall prevention. By providing evidence on the efficacy of patient engagement through different modalities, this article can inform the development of interventions for the intervention group that focuses on empowering patients through education and active involvement in their care. The comparison group in the article corresponds to normal safety measures, which can serve as a basis for comparison to evaluate the impact of the intervention group’s education and empowerment strategies in the PICOT question.

The article by Montejano-Lozoya et al., 2020, on the effect of an educational intervention on hospital nurses to assess the risk of falls will provide valuable insights to answer the PICOT question. The intervention in the article involved providing training to nurses on systematic risk assessment of falls, which aligns with the “patient education and empowerment” component of the PICOT question. The comparison group in the article is the control group that did not receive the educational intervention, similar to the “normal safety measures” group in the PICOT question. By comparing the incidence of falls between the intervention and comparison groups, the article’s findings can help determine whether patient education and empowerment can reduce and eliminate falls by 50% and related impacts within three months in an inpatient setting.

Method of Studies

Montejano-Lozoya et al., 2020 utilized a quasi-experimental study design on a non-randomized. They conducted their study in four care units, utilizing two groups, intervention and control group. The intervention group was formed by units of nephrology and traumatology, while the control group composed of those in medicine and neurosurgery/neurology.  Duckworth et al., 2019 utilized a case-control study to determine why patients who received education on Fall TIPS fell. They utilized random audits asking whether the patients or families were aware of their fall prevention plan. The random audits also evaluated the adherence to the protocols of fall prevention. The difference between these two methods is that a quasi-experimental study involves an intervention or treatment, but lacks random assignment to groups, while a case-control study compares individuals with and without the outcome of interest retrospectively.

One benefit of the quasi-experimental study by Montejano-Lozoya et al., 2020, is that it did not randomly assign participants to groups, therefore, it makes it more feasible and practical in real-world settings. However, one limitation stated in the article is that is randomized the hospital units instead of the study subjects themselves, patients. The case-control study showed a benefit if studying rare outcomes like the fall in hospitalized patients. The limitation of the design is its potential for recall bias when patients self-report interventions received after fall incidents.

Results

Duckworth et al 2019 assessed the effectiveness of engaging patients and family in fall prevention through utilization of Fall TIPS. They found out that Fall TIPS was effective in preventing fall in hospitalized patients. According to their results they concluded that all units achieved high patient engagement rates (>80%), suggesting that each modality is effective. Institutions can customize their implementation approach based on automation levels and factors like technology capability and resources.The study by Montejano-Lozoya et al., 2020 utilized a quasi-experimental intervention with hospital nurses to assess the impact of systematic risk assessment training on reducing patient falls. The total incidence of falls was 1.2%, lower than in other studies. Falls were more common in patients aged 65 and older, and all fall patients had catheters. The intervention group, who received the training, had a significantly lower probability of falling compared to the control group. The study emphasizes the importance of advanced training for nurses to improve patient safety and reduce falls.

The study by Montejano-Lozoya et al., 2020, highlights the importance of advanced training for nurses in systematic risk assessment to reduce patient falls, improve patient safety, and optimize the care plan based on identified risks. The study by Duckworth et al 2019, suggests that implementing Fall TIPS modalities can effectively engage patients in fall prevention. Nurses can utilize these evidence-based strategies to enhance patient safety and reduce fall rates in healthcare settings.

Ethical Considerations

One ethical consideration is the informed consent researchers must ensure that participants are fully informed about the study’s purpose, procedures, risks, and benefits before agreeing to participate. The second one is confidentiality and privacy whereby researchers must maintain the confidentiality of participants’ personal information and ensure their privacy is protected throughout the study.

The researchers likely ensured participants provided informed consent, explaining the study’s purpose and risks. Confidentiality and privacy were maintained by safeguarding participants’ identities and personal data. These ethical practices respect participants’ autonomy and protect their sensitive information, upholding ethical standards in the study.

Conclusion

Patient falls remain a critical patient safety issue that should be addressed by all stakeholders especially nurses and physicians. The use of education and empowerment of patients will help patients manage their situations and reduce their susceptibility to fall as it will help in identifying inherent risks to falls (Severo et al., 2018). The intervention also requires effective participation of nurses through their own education sessions before they can develop relevant interventions for nurses to reduce and prevent falls.

 

 

                                                      References

Duckworth, M., Adelman, J., Belategui, K., Feliciano, Z., Jackson, E., Khasnabish, S., Lehman, I-Fong. S., Lindros, M. E., Mortimer, H., Ryan, K., Scanlan, M., Berger Spivack, L., Yu, S. P., Bates, D. W., & Dykes, P. C. (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. Journal of Medical Internet Research, 21(1), e10008. https://doi.org/10.2196/10008

Montejano-Lozoya, R., Miguel-Montoya, I., Gea-Caballero, V., Mármol-López, M. I., Ruíz-Hontangas, A., & Ortí-Lucas, R. (2020). Impact of Nurses’ Intervention in the Prevention of Falls in Hospitalized Patients. International Journal of Environmental Research and Public Health, 17(17), 6048. https://doi.org/10.3390/ijerph17176048

Severo, I. M., Kuchenbecker, R. de S., Vieira, D. F. V. B., Lucena, A. de F., & Almeida, M. de A. (2018). Risk factors for fall occurrence in hospitalized adult patients: a case-control study. Revista Latino-Americana de Enfermagem, 26(0). https://doi.org/10.1590/1518-8345.2460.3016

Xue, L.,Boudreau,R.M., Donohue,J.M.et al. Persistent polypharmacy and fall injury risk: the health, Aging and Body composition study.BMC Geriatric 21,710(2021) https://doi.org/10.1186/512877-021-02695-9