Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example

Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example

Patient falls are a major global health issue that has a negative impact on health outcomes. The most frequent adverse events in healthcare delivery are patient falls, with between 2% and 17% of hospitalized patients in the US experiencing falls. Notably, difficulties associated with falls are more common in elderly persons (those 65 years of age and above) (Vaishya & Vaish, 2020). A common risk factor for falls among the elderly in a hospital setting includes aging difficulties, such as impaired vision and hearing, decreased reflexes, dementia, age-related muscle loss, and comorbidities like hypertension and diabetes.(Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

Accordingly, nurses are essential providers who can prevent falls among elderly patients in hospitals. While providing the security required to ensure that patients do not face medical issues while receiving care, nurses provide care to hospitalized patients (Appeadu & Bordoni, 2022). Therefore, nurse-led interventions will be essential to reducing the risk of falls among senior hospital patients and enhancing their health outcomes. One of the key methods for preventing falls has been advocated: evidence-based hourly rounding. Hourly rounding enhances the interactions between patients, clinicians, and patients, enhancing safety and patient outcomes. The intervention entails routine observation of patients and their surroundings to spot potential dangers while keeping tabs on their health. This paper critiques qualitative research articles selected as literature support for the research topic and PICOT question.(Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

PICOT Question

Among elderly patients (65 years and above) (P), does hourly rounding (I) compared to the use of bed alarms (C) lead to few to zero fall incidences (O) during hospitalization (T)? (Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

Background of Studies

Oncu and Intepeler (2021) and Racine et al. (2020) are qualitative studies that support the research topic and PICOT question. Oncu and Intepeler’s (2021) explored nurses’ implementation of nurse-led evidence-based fall interventions. The research asserts that although fall events are preventable, a lack of evidence-based interventions has continued to pose adverse patient outcomes. Poor health outcomes lead to decreased quality care, prolonged hospitalization, and immense health costs. Oncu and Intepeler (2021) claim that implementing evidence-based interventions allows nurses to provide the best available and scientifically proven practices to curb patient falls. The research aims to evaluate nurses’ views on implementing evidence-based interventions toward fall prevention to improve the quality of care and patient safety. The study’s question seeks to identify and understand nurses’ views on adopting evidence-based interventions towards fall prevention.(Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

Racine et al. (2020) focus on the multifactorial risk factors that lead to falls and their complications. The research claims that multifactorial fall risk assessments will be vital to preventing falls. Failing to identify fall risk factors has been a major problem in devising appropriate interventions. Thus, the research is relevant for nurses to conduct multifactorial fall risk assessments to reduce falls. The assessment includes gait, balance, muscle weakness, osteoporosis, and visual impairment. The research aims to use the multifactorial risk assessment to reduce falls among older people in the community and improve their quality of life. The research question explores the effects of multifactorial risk assessment on fall prevalence among older people in the community.(Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

Zadvinskis et al. (2019) and Anu (2021) have been selected as quantitative literature support for the research topic and PICOT question. Zadvinskis et al. (2019) investigate how nurse-sensitive structures and processes, including work engagement, fall risk frequency, purposeful rounds frequency, and patient falls, are related. The researchers inquire whether purposeful rounding and patient risk of falls discussion and work engagement lead to decreased falls. The article hypothesizes that strong work engagement is linked to a better nurse-assessed quality of care. The study also recognizes that previous research adopted self-reported outcome measures, limiting research generalizability and internal validity. With increasing falls and fall-related injuries in healthcare facilities, exploring potential risk factors and interventions is imperative. Nurses would benefit more from more evidence-based interventions, stressing the significance of this research study. (Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

Anu (2021) explores the relationship between hourly rounding and fall prevention among older patients in long-term care. The researcher seeks to answer whether education on hourly rounding provided to nursing staff compared to no education on hourly rounding reduces the number of falls among residents in the LTC units over ten weeks. According to Anu (2021), long-term care facilities are experiencing an increased rate of falls and fall-related injuries, raising the cost of care and hospitalization rates. The researcher considers hourly rounding a proactive, evidence-based intervention that can help nurses identify patients’ needs early. Early identification and intervention are integral to improved fall prevention outcomes. The primary aim is improving patient safety through effective education and hourly rounding. This article is significant to nursing as it offers insights into an evidence-based intervention to help reduce falls and fall-related injuries that impact care quality and safety.     (Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

How the Articles Support the Nursing Practice Problem

Oncu and Intepeler (2021) and Racine et al. (2020) will help answer the PICOT question. Oncu and Intepeler (2021) will be vital in educating nurses and other healthcare professionals on the significance of evidence-based practice in improving care quality and patient safety. Although nurses are aware of evidence-based practice, some are not well-versed in implementing proposed evidence-based interventions. Thus, the article will create more awareness while improving nurses’ and other healthcare professionals’ knowledge about EBP. Secondly, Racine et al. (2020) will be used to implement a multifactorial fall risks assessment as a standard to identify fall risks during patient-provider interaction during hourly rounding. The interventions for both research articles are related to the PICOT. The goal is to implement evidence-based practice, while the multifactorial risk assessments will be specific intervention strategies nurses adopt during hourly rounding. Racine et al. (2020) patient populations are elderly, just like in my project.(Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

Zadvinskis et al. (2019) and Anu (2021) provide valuable insights into patient falls in healthcare facilities and the potential impact of hourly rounding in reducing falls and fall-related risks. The articles directly support the nursing practice problem and PICOT question because the studied research problem and selected interventions are aligned. Zadvinskis et al. (2019) explore the relationship between nurses’ structural process (work engagement and frequency of purposeful rounding) and outcome indicators. Anu (2021) explores the effectiveness of education on hourly rounding in reducing the number of falls. As a result, the findings of the two articles can directly help answer the PICOT question by demonstrating the effectiveness of hourly rounding in addressing patient falls.  (Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

Regarding how the intervention and comparison group compare, the PICOT question identifies hourly rounding as the intervention to address falls among older patients 65 years and above. Zadvinskis et al. (2019) select multiple independent variables, including work engagement, fall risk discussion, and purposeful rounds frequency in 41 nursing units from 7 hospitals. Anu (2021) selects hourly rounding as the intervention and staff members and residents as the study group. However, none of the selected studies focuses on falls among individuals 65 and older, although the selected interventions align with the PICOT question.    (Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

Method of Studies

Oncu and Intepeler (2021) adopted a qualitative descriptive design that utilizes semi-structured, in-depth, face-to-face interview approaches. On the other hand, Racine et al. (2020) is a qualitative study that uses semi-structured interviews, which are analyzed thematically, and each theme is mapped onto Theoretical Domain Frameworks to identify behavioral determinants. Racine et al. (2020) conducted six interviews among older adults that attended community-based multifactorial fall risk assessments, while Oncu and Intepeler (2021) interviewed 17 nurses. Semi-structured interviews promote two-way communication between the researchers and the participants, promoting in-depth data collection of the subject matter. However, the open-ended nature of semi-structured interviews can cause leading questions that cause research bias.(Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

Zadvinskis et al. (2019) adopt a descriptive, cross-sectional survey design in 41 nursing units from seven hospitals. A descriptive cross-sectional study allows the study of a condition and potentially related factors for a specific population at one point in time. The researchers shared a survey with nurses, including the Utrecht Work Engagement Scale. The study obtained fall data from the National Database of Nursing Quality Indicators reports. Anu (2021) adopted a process improvement approach that took ten weeks. The researcher collected data from staff members aged 18-60 years. The study also obtained data from 41 residents. Staff members obtained education on hourly rounding and hourly rounding log documentation before intervention implementation. The facilities’ falls database provided data regarding pre and post-fall rates. Zadvinskis et al. (2019) provide data that can help reduce patient falls and related complications, but the sample was selected from a single region, limiting inference to other areas. Anu (2021) provides valuable information to help improve the quality and safety of nursing care, but the sample size is small, limiting generalizability.     (Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

Results of Studies

Oncu and Intepeler (2021) claimed that nurses that participated in the study on fall prevention gained more knowledge on implementing evidence-based practice through fall prevention and training programs. Additionally, inadequate staffing was the primary barrier to implementing evidence-based fall prevention interventions. The nurses in the study claimed that implementing fall prevention training programs will be vital to reducing patient falls. Oncu and Intepeler (2021) show that nurses are mandated to implement evidence-based interventions to improve health outcomes. Continuing nursing education and training programs are vital to improving nurses’ fall prevention knowledge, skills, and competency.(Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

Racine et al. (2020) asserted that older persons attended multifactorial fall risks assessment as they felt it helped improve their health and well-being. The participants also reported that having a good relationship with health and community services improved their awareness about the fall assessment that encouraged them to attend. Having good social and family support, determination to maintain or regain independence, previous positive experience with health services, and fear of falling rendered the participants to attend the assessments. These results have positive implications for nursing practice. Racine et al. (2020) show that nurses and other healthcare should collaborate with the community to improve patient outcomes. For instance, positive relationships between providers, patients, and family and social support improve health-seeking behaviors.(Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

Zadvinskis et al. (2019) found that work engagement (WE) scores were high for nurses who participated more in purposeful rounding. Highly engaged nurses conducted more purposeful hourly rounding and fall risk discussions during the bedside report than minimally engaged nurses. However, there was a 6% increase in fall injuries post-frequent purposeful rounding. This result implies that work engagement was not associated with patient falls. Per the findings, nurses should follow the hourly purposeful rounding for improved outcomes in fall prevention.(Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

Anu (2021) found that hourly rounding grossly decreased falls by 36%. Post-intervention, the nursing homes experienced 15 falls compared to 41 falls pre-intervention. The relationship between hourly rounding and fall prevention was statistically significant (P-values = -<0.0001 and t-value = -5.81). The article is relevant to nursing practice as it offers insights into implementing hourly rounding programs to reduce falls and fall-related injuries that lower the quality of nursing services.(Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

Ethical Considerations

Research work follows ethical considerations, guidelines and principles that guide and inform research designs and practices. Research studies involving human participants should ensure voluntary participation by obtaining informed consent and protect participants from potential harm from physical and psychological factors and other factors like data breaches (Barrow et al., 2022). Informed consent involves giving participants vital research information, including potential risks and benefits, medical procedures or treatments, clinical trials, participants’ roles, data protection solutions, and engagement rules to help them make participation decisions. Protecting research participants’ rights elevates research validity and helps maintain scientific integrity.

Oncu and Intepeler (2021) consented to the university’s Non- Interventional Clinical Trial Ethics Committee to conduct the study. The nurses were also given voluntary participation, where the researchers explained the purpose of the study and provided them with written consent forms. Racine et al. (2020) also observed voluntary participation, where individuals that opted-in the study were followed up after granting the researchers full consent. Zadvinskis et al. (2019) and Anu (2021) obtained informed consent from the participating groups to ensure voluntary participation. The studies also avoided collecting personally identifying data to protect participants’ privacy and confidentiality.     (Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

Outcome Comparison

The PICOT question explores whether hourly rounding reduces fall incidences among in-patients compared to bed alarms. The anticipated outcomes are reduced fall and fall-related injuries among older in-patients 65 years and above. Oncu and Intepeler (2021) investigated evidence-based fall prevention interventions, such as effective training programs, and found them usable in hospitals. Racine et al. (2020) explored multifactorial fall risk assessments to lower falls among older individuals, including good relationships with health and community services and social and family support. They found them effective in reducing falls among older people. These findings align with the anticipated outcomes, reduced fall and fall-related injuries among older in-patients. Zadvinskis et al. (2019) found that work engagement (WE) scores were high for nurses who participated more in purposeful rounding. Per the findings, nurses should follow the hourly purposeful rounding for improved outcomes in fall prevention. Anu (2021) found that hourly rounding grossly decreased falls by 36%. The findings indicate that hourly rounding programs can help reduce falls and fall-related injuries that lower the quality of nursing services, aligning with the anticipated outcomes. (Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

Proposed Evidence-Based Practice Change

            The nursing practice problem is falls among older in-patients. The PICOT question explores hourly rounding compared to bed alarms as an intervention to address falls among older in-patients. The four articles investigate hospital-based interventions to help reduce falls among older patients. Oncu and Intepeler (2021) investigated evidence-based fall prevention interventions such as effective training programs. Racine et al. (2020) explored multifactorial fall risk assessments to lower falls among older individuals, including good relationships with health and community services and social and family support. Zadvinskis et al. (2019) and Anu (2021) investigated the effectiveness of hourly rounding in reducing falls among older individuals. Therefore, the nursing practice problem falls among older patients is consistent with the PICOT questions and the four articles. Moreover, the PICOT intervention, hourly rounding, is consistent with Zadvinskis et al. (2019) and Anu (2021), who investigated the effectiveness of hourly rounding in reducing falls among older patients. This analysis proposes hourly rounding as an evidence-based practice change at the practice site to help address falls among older in-patients. Nurses will adopt the standard Ps: potty, pain, position, possessions and peaceful environment during hourly rounds with patients. It will allow them to proactively address the most typical patient needs associated with fall risk.       (Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

Conclusion

Purposeful hourly rounding has been proposed as a potential intervention to prevent falls and fall-related injuries. According to Oncu and Intepeler (2021), using evidence-based interventions enables nurses to offer the best strategies for preventing patient falls that are currently available. This study aims to assess nurses’ opinions on applying evidence-based fall prevention treatments to enhance patient safety and care quality. Focusing on the multifaceted risk factors for falls and associated sequelae, Racine et al. (2020) assert they will be essential to preventing falls. The inability to pinpoint fall risk variables has made it challenging to develop effective remedies. Zadvinskis et al. (2019) and Anu (2021) adopted hourly rounding to address falls among hospitalized patients and residents. Zadvinskis et al. (2019) explored the relationship between nurses’ structural process (work engagement and frequency of purposeful rounding) and outcome indicators. They found that work engagement scores were high for nurses who participated more in purposeful rounding. Anu (2021) explored whether education on hourly rounding would help reduce the number of falls among residents. These articles are relevant to the research topic. They will help answer the PICOT question as they offer evidence on the effectiveness of hourly rounding programs to reduce falls and fall-related injuries that lower the quality of nursing services. Per the findings, hourly rounds are proposed as an evidence-based practice change to help address falls among older in-patients in the practice setting. (Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

References

Anu, J. A. (2021). Hourly Rounding and fall prevention among the elderly in long-term care: a change process. Journal of geriatric medicine, 3(1), 1-5. https://doi:10.30564/jgm.v3i1.2614(Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

Appeadu, M. K., & Bordoni, B. (2022). Falls and fall prevention in the elderly. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560761/(Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

Ayhan Oncu, Y., & Seren Intepeler, S. (2022). Nurses’ view of implementation evidence-based fall prevention interventions: A qualitative study. Journal of nursing management, 30(1), 234–242. https://doi.org/10.1111/jonm.13480

Barrow, J. M., Brannan, G. D., & Khandhar, P. B. (2022). Research ethics. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459281/

Racine, E., Soye, A., Barry, P., Cronin, F., Hosford, O., Moriarty, E., O’Connor, K. A., Turvey, S., Timmons, S., Kearney, P. M., & McHugh, S. M. (2020). ‘I’ve always done what I was told by the medical people: a qualitative study of the reasons why older adults attend multifactorial falls risk assessments mapped to the Theoretical Domains Framework. BMJ open, 10(2), e033069. https://doi.org/10.1136/bmjopen-2019-033069(Qualitative and Quantitative Studies on Patient Falls Comprehensive Nursing Essay Example)

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 Zadvinskis, I. M., Carr, J., Schweitzer, K. E., Patil, N., Clifton, W. D., & Ebert, K. E. (2019). The impact of nursing work and engagement on patient falls. JONA: The Journal of Nursing Administration, 49(11), 531-537. https://doi: 10.1097/NNA.000000000000080