PICOT Question Composition Paper

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Running head: CRITICAL APPRAISAL Critical Appraisal of Nursing Research 1 CRITICAL APPRAISAL 2 Critical Appraisal of Nursing Research Background of Study The two articles focus on the prospect of patient falls especially among the elderly populations. Falls can be detrimental to health and in some adults, falls can be lethal (LopezSoto, 2018). In exploratory research, Lopez-Soto, (2018), identifies some of the barriers that health professionals experience with regard to providing the most holistic of care to elderly adult patients. Apparently, there are no elaborate measures for dealing with falls among elderly adult patients. The research unveils the main barriers to include lack of proper analysis and categorizing of falls with their causes in order to establish more tentative measures for keeping the elderly from falling. Bargon, (2019) presents a special case of patients with dementia suggesting that the nature of the disease creates further challenge in preventing the falls. In Lopez-Soto, (2018) the respondents suggest that the nature of the patient’s capabilities will determine the nature of the fall. Elderly mainly face mobility incapacitation due to weak muscles and worn out bone tissue. Progressive terminal co`nditions also keep such patients from being able to function properly. Bargon, (2019) observes that elderly with conditions such as dementia that affects cognitive function will always rely on the support of a third party. The main perception among health professionals has to do with increased support and integration of services to identify the nature of falls, causes, and how to channel resources towards prevention. How do these two articles support the nurse practice issue you chose? CRITICAL APPRAISAL 3 The articles are effective in exploring the prospect of patient falls among the older adult population. The older adult population happens to be the most vulnerable to the most dangerous falls. The articles therefore show some important aspect of patient falls which has to do with the perspectives from healthcare professionals. The rationale is that such perspectives offer insights into the current situations whether there are any solutions or strategies meant for dealing with the case. Accordingly, Lopez-Soto et al., (2018) points out the challenges that current health providers face concerning patient falls. In the article the researchers interview health providers and derive that there is a need for more analysis of patient falls and better recording and categorizing of the fall cases. Bargon et al., (2019) on the other hand explains that there are cases such as dementia where prevention is challenging due to the nature of the condition. Nonetheless, both the articles suggest that it is possible to arrive at a solution with more interactive approaches, cooperation between concerned health stakeholders and availability of necessary resources. Method of Study Both the studies adopted a qualitative approach exploring the nature of patient falls and adopting conclusions from impressions by healthcare professionals. In Lopez-Soto et al., (2018) the researchers use an exploratory design for their research. The research objectives are rather ambiguous and the exploratory approach is most appropriate and involves the barriers to the documenting, evaluating and preventing falls among elderly patients. In the exploratory study, the researchers use recorded interviews and information from analyses of the records guides the criteria for making the main conclusions. CRITICAL APPRAISAL In the other article, the researchers focus on dementia as a condition among elderly patients. The researchers therefore identified a particular target sample for responses and used a structured interview. As such, one may consider the research more cross sectional taking a random sample and using the immediate outcomes to inform research concerns. The researchers also used qualitative approaches for analyzing information from the interviews and derived the various impressions concerning provision of support and fall prevention for patients with dementia among health professionals. Both the research studies used thematic analyses to better present the results from the surveys and thus the findings were based solely on information collected in the field. Results of Study The two articles collected information on the health professional perspectives and made analyses of the results to derive some recommendations with regard to the situation. Lopez-Soto et al., (2018) found that there were no proper methods established for recording and analyzing patient falls deterring initiatives for effective prevention measures. Accordingly, the research reviewed the interview responses and also found that the main barriers that they perceived included lack of data concerning fall records preventing identification of causes. Further health professionals lacked motivation or unaware of patient falls due to inconsistent registration systems for fall cases. The general notion was that health providers did not gain the data in manageable condition or lacked time or energy resources to deal with patient falls. The other research involved 19 semi structured interviews on ten nurses, five physiotherapists, three occupational physiotherapists and one psychiatrist. The interviews 4 CRITICAL APPRAISAL 5 focused on the experience of falls among elderly dementia patients. Thematic analyses of the data from respondents suggested that there was a need for further interventions with regard to patients with special needs for care such as dementia victims. Accordingly, the health professionals offered solutions such as more visual aids in exercise interventions (Bargon et al., 2019). The research also found cognitive impairment problems to require further support in the form of longer interventions, extensive supervision including by support workers to facilitate effective interventions yet resources still lacked. Implications for nursing practice involve improved approaches for caring for the elderly. Caring for the elderly entails diverse responsibilities and roles as elder patients tend to face increased vulnerabilities and are delicate patients. Falls are the main and far most detrimental health problem for the elderly and can be lethal. The main advantage of the research is that it reveals the challenge of falls as a nursing care problem when dealing with elderly patients. By exploring the experiences and perspectives from health professionals, the research is successful in creating opportunities to improve interventions or for identifying the challenging aspects of care provision. Ethical Considerations Ethical considerations when conducting research have to do with the integrity of the data collection process and accuracy. The integrity of the data collection has to do with ensuring that all the considerations with regard to due process are made when collecting data. For instance, the data collection should not involve activities with adverse effects or life altering effects on the sample. Here the sample is human and the researchers ensure that they respect the privacy of the CRITICAL APPRAISAL respondents and health facilities. The research is also not increasingly invasive taking too much time or too committing for the respondents but rather allows the sample to continue with their day to day activities even as the research continues. Accuracy of the data collection involves the fact that the researchers attempt as much as possible to acquire responses as they are directly from the sample. After acquiring the information as it is, the researchers subject the data to its different analytic procedures. As such, the researchers maintain the accuracy and integrity of their results which thus means that the outcomes and conclusions are reliable. 6 CRITICAL APPRAISAL 7 References López-Soto, P. J., García-Arcos, A., Fabbian, F., Manfredini, R., & Rodríguez-Borrego, M. A. (2018). Falls suffered by elderly people from the perspective of health care personnel: a qualitative study. Clinical nursing research, 27(6), 675-691. Burgon, C., Darby, J., Pollock, K., van der Wardt, V., Peach, T., Beck, L., … & Harwood, R. H. (2019). Perspectives of healthcare professionals in England on falls interventions for people with dementia: a qualitative interview study. BMJ open, 9(2), e025702. Running head: FALL PREVENTION AMONG THE ELDERLY 1 Fall Prevention among the Elderly Fall Prevention among the Elderly Background Falls, a common term in the nursing profession, is an elderly syndrome that occurs commonly and they in most cases cause mortality, reduced functionality, morbidity, and impulsive FALL PREVENTION AMONG THE ELDERLY 2 nursing admission. Falls are caused by several inclining factors that make the diagnosis, management, also preclusion a medical problem. However, cases of falls can be a sign of a person with an acute problem, normal age-related problems like loss of vision, or lack of strength. According to Tinetti (2003), one-third of persons aged 65 years and above experience a fall each year of which many of them are recurrent. PICOT Question Composition Paper. As well, several of the falls result in an injury like soft tissue injury, hip fracture, and head injury among others thus accounting for 10% of emergency cases among the elderly. Although few falls are deemed to result from one cause, the majority of the falls are due to long-term inclining factors also short-term triggering factors in the older people’s environment. The aim of the research critique is to define the frequent causes of falls among the elderly and the objective is to find intervention measures or ways that can be implemented to ensure a gradual reduction of falls and other fall-related injuries among the aging in a nursing perspective. PICOT Question Composition Paper. PICOT: What evidence-based practice nursing intervention can reduce falls also fall-related injuries among the elderly? Articles Rubenstein and Josephson (2006) have concentrated their research on the literature review to show the evidence on the falls and prevention intervention among elderly people. This is a major reason why the article is essential in answering the research PICOT question on the evidencebased practice in the nursing profession that can help reduce fall and fall-related injuries. The article begins by providing epidemiology of fall among the elderly through analyzing the statistics of people with 65 years and older living in the United States. The author proceeds to provide causes FALL PREVENTION AMONG THE ELDERLY 3 and risk factors to falls and finally, the article has provided intervention measure that can be used by the community and local hospitals in the reduction of falls and other fall injuries. PICOT Question Composition Paper. On the other hand, Tinetti (2003) has provided a clinical problem of a 79-year old woman with a chronic diseases history among other beings arthritis and depression is reported to have fallen twice in six months. Therefore, the author in the article tries to answer the question of the measure that can be implemented to prevent future falls. The author provides an assessment, intervention approach, and recommendation constituents of clinical valuation and organization for elderly people living in the community. These aspects make the article important in this research by answering to the PICOT question and the discussed group compares to the group in the research question. Method of Study The first article by Rubenstein and Josephson (2006) has used a review of the past materials in making empirical conclusions to the issue of falls among the elderly. The article has detailed information from several resources that focus on falls among the elderly. For instance, in the cause and risk factors section, the authors have provided statistical evidence from 12 studies conducted among the institutionalized population. However, this method is limited because the findings of these studies are restricted by, for instance, classification methods and patients recall. Nevertheless, the benefit in the method the authors used is that wide and extensive research information on the issue in question has been provided. In contrast, Tinetti (2003) has used a case as a method of study. The article has detailed a clinical problem of an elderly woman who has suffered from falls resulting from medication. This method of study is essential and beneficial since it provides a detailed assessment of her problem, intervention approach, and some areas of uncertainties. Nevertheless, the limitation in the method FALL PREVENTION AMONG THE ELDERLY 4 of study is that the clinical problem inclines the article to one side of the causes of falls among the elderly. Both articles have a different method of study but the articles provide essential information that will be useful during the research. Results of Study Tinetti (2003) in her article provides the causes of falls in the elderly woman in the case study to associated with her depressive symptoms, antidepressant medications, and carrying laundry. However, the most important aspect is the use of medication like sleep and allergy pills, which have high chances caused the falls the woman experienced. The author has also provided recommendations for the woman such as adequate hydration, and muscle strengthening exercises. The findings also show that the woman might have been suffering from a deficiency in calcium and vitamin thus taking supplements will be a beneficial intervention to reduce risks of falls. Then again, Rubenstein and Josephson (2006) in their findings provide that the possibility of identifying a person with a risk of sustaining fall and related injuries is usually high. Therefore, due to the several risk factors, it is easier to modify and eliminate the risks with targeted prevention and intervention strategies. In their finding, the most promising intervention strategy is using Multidimensional Fall-risk Assessment exercise. Irrefutably, the two articles show how essential nursing practice is important in the prevention of falls. It is in agreement that a safe environment contributes to the prevention of falls, therefore, the nursing practice is important in ensuring the elderly in the community are regularly evaluated for probable environmental hazards. Outcome Comparison What evidence-based practice nursing intervention can reduce falls also fall-related injuries among the elderly? FALL PREVENTION AMONG THE ELDERLY 5 The above is the research PICOT question. Therefore, the anticipated outcome from the question includes: 1. Establishing fall safety and intervention programs 2. PICOT Question Composition Paper. Increasing nursing and community awareness of risks associated with falls 3. Developing evidence-based practice among the nurses 4. Implementing fall risk screening tools and prevention program policy 5. Establishing an interdisciplinary falls group in the community Conclusively, the outcome of the articles is the same as stated since the main objective of the two articles is to provide intervention strategies on how to reduce the fall risks and associated injuries. The articles have achieved their anticipated outcomes since they outlined assessment tools and intervention programs. Some of the mentioned fall-prevention strategies include; exercise programs, home hazard assessment by the nurses, and polypharmacy (reducing or withdrawing medications) among other strategies outlined. References Rubenstein, L. Z., & Josephson, K. R. (2006). Falls and their prevention in elderly people: what does the evidence show?. Medical Clinics, 90(5), 807-824. Tinetti, M. E. (2003). Preventing falls in elderly persons. New England journal of medicine, 348(1), 42-49. FALL PREVENTION AMONG THE ELDERLY 6 Research Critique Guidelines To write a critical appraisal that demonstrates comprehension of the research study conducted, address each component below for qualitative study in the Topic 2 assignment and the quantitative study in the Topic 3 assignment. Successful completion of this assignment requires that you provide a rationale, include examples, or reference content from the study in your responses. Qualitative Study Background of Study: • Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem. • How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem. • Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims. • List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers. PICOT Question Composition Paper. • Were the purpose and research questions related to the problem? Method of Study: • Were qualitative methods appropriate to answer the research questions? • Did the author identify a specific perspective from which the study was developed? If so, what was it? • Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include? • Are the references current? For qualitative studies, the author may have included studies older than the 5-year limit typically used for quantitative studies. Findings of older qualitative studies may be relevant to a qualitative study. • Did the author evaluate or indicate the weaknesses of the available studies? • Did the literature review include adequate information to build a logical argument? • When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings? Results of Study • What were the study findings? • What are the implications to nursing? • Explain how the findings contribute to nursing knowledge/science. Would this impact practice, education, administration, or all areas of nursing? Ethical Considerations • Was the study approved by an Institutional Review Board? • Was patient privacy protected? • Were there ethical considerations regarding the treatment or lack of? Conclusion • Emphasize the importance and congruity of the thesis statement. • Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice. • Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice. • Integrate a summary of the knowledge learned. Quantitative Study Background of Study: • Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem. • How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem. • Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims. • List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers. • Were the purpose and research questions related to the problem? PICOT Question Composition Paper