NURS 6052 EBP Part 3: Critical Appraisal of Research on the Prevention of Patient Falls

NURS 6052 EBP Part 3: Critical Appraisal of Research on the Prevention of Patient Falls

NURS 6052 EBP Part 3: Critical Appraisal of Research on the Prevention of Patient Falls

Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research
Realtors rely on detailed property appraisals—conducted using appraisal tools—to assign market values to houses and other properties. These values are then presented to buyers and sellers to set prices and initiate offers.

Research appraisal is not that different. The critical appraisal process utilizes formal appraisal tools to assess the results of research to determine value to the context at hand. Evidence-based practitioners often present these findings to make the case for specific courses of action.

In this Assignment, you will use an appraisal tool to conduct a critical appraisal of published research. You will then present the results of your efforts.

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To Prepare:

Reflect on the four peer-reviewed articles you selected in Module 2 and the four systematic reviews (or other filtered high- level evidence) you selected in Module 3.
Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3.
Review and download the Critical Appraisal Tool Worksheet Template provided in the Resources.
The Assignment (Evidence-Based Project)

Part 3A: Critical Appraisal of Research

Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template. Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest in Module 2 and Module 3.

Note: You can choose any combination of articles from Modules 2 and 3 for your Critical Appraisal. For example, you may choose two unfiltered research articles from Module 2 and two filtered research articles (systematic reviews) from Module 3 or one article from Module 2 and three articles from Module 3. You can choose any combination of articles from the prior Module Assignments as long as both modules and types of studies are represented.

Part 3B: Critical Appraisal of Research

Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research

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EBP Part 3: Critical Appraisal of Research on the Prevention of Patient Falls

Part A: Critical Appraisal of Research Matrix

Full APA formatted citation of selected article.	Article #1	Article #2	Article #3	Article #4
	Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly rounding and patient falls. Nursing, 45(2), 25-30. https://doi.org/10.1097/01.nurse.0000459798.79840.95	Guirguis-Blake, J., Michael, Y., Perdue, L., Coppola, E., & Beil, T. (2018). Interventions to prevent falls in older adults. JAMA, 319(16), 1705. https://doi.org/10.1001/jama.2017.21962	Kojima, G., Kendrick, D., Skelton, D., Morris, R., Gawler, S., & Iliffe, S. (2015). Frailty predicts short-term incidence of future falls among British community-dwelling older people: a prospective cohort study nested within a randomized controlled trial. BMC Geriatrics, 15(1). https://doi.org/10.1186/s12877-015-0152-7	Mileski, M., Brooks, M., Topinka, J.B., Hamilton, G., Land, C., & Mitchell, T., Mosley, B., & McClay, R.  (2019). Alarming and/or alerting device effectiveness in reducing falls in long-term care (LTC) facilities? A systematic review. Healthcare, 7(1), 51. https://doi.org/10.3390/healthcare7010051
Evidence Level * (I, II, or III)	Level II	Level I	Level II	Level I
Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**	This is not explicit in the study. Implicitly, it is that frequent monitoring of elderly patients at risk of falls is likely to forestall any such eventuality.	Not mentioned in the article but implied. It is that significant morbidity and mortality in older patients can be reduced if measures are put in place to prevent falls.	Implied: Frailty is a significant contributory factor in te occurrence of accidental patient falls among the older patient population.	Implied and not explicit: Technology can help in mitigating the effects of accidental patient falls among the elderly.
Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	A prospective pilot study with pre- and post-implementation evaluation. Inclusion criterion: Being a patient in the medical stroke unit and hematology/ oncology unit of Christian Hospital between September 23 and October 20, 2013.	Systematic review. Inclusion criteria: Randomized controlled trials of fall prevention interventions for community-dwelling older adults aged 65 years and older.	Prospective cohort study within a randomized controlled trial. Inclusion criteria: Age >65 years, being a community-dweller, no history of > 3 previous falls.	Systematic review. Inclusion criteria for studies: Peer review, English language, and publication between 2011 and 2018.
Sample/Setting The number and characteristics of patients, attrition rate, etc.	Sample: n = 75 patients (both units) Setting: The medical stroke unit and hematology/ oncology unit at Christiana Hospital in Newark, Delaware.	Sample: 62 RCTs with a total participant population of n = 35,058. Setting: Research databases.	Sample: n = 248 participants Setting: An on-going RCT study.	Sample: n = 28 articles. Setting: Research databases.
Major Variables Studied List and define dependent and independent variables	Independent variable: Hourly rounding by nurses. Dependent variable: Occurrence of a fall incident.	Independent variable: Fall prevention intervention. Dependent variable: Occurrence of a fall incident.	Independent variable: Frailty. Dependent variable: Frequency of accidental falls.	Independent variable: Use of technological aids such as bed alarms. Dependent variable: Occurrence of falls.
Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done).	·         Mann-Whitney test ·         Wilcoxon-signed rank test ·         Regression analysis	Random-effects meta-analyses using the DerSimonian and Laird method.	·         Logistic regression models.	·         PRISMA guidelines ·         Affinity matrix tabling
Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data).	·         The fall rate of 1.3 falls per 1,000 patient days in the intervention unit. ·         Fall rate of 2.5 falls per 1,000 patient days during piloting in the control unit.	Multifactorial interventions and exercise trials showed a reduction in falls. Vitamin D supplementation showed mixed results.	·         Frailty index (FI) of ≥ 0.25 associated with higher risk of future falls. ·         FI predicts risk of future falls accurately with area under ROC curve of 0.62	Observed: ·         118 facilitation factors (48%) ·         Barriers (52%)
Findings and Recommendations General findings and recommendations of the research	There was a significant reduction in the baseline fall rate in the intervention unit from 3.9 falls/ 1,000 patient days to 1.3 falls/ 1,000 patient days. Hourly rounding should be used to prevent accidental falls.	Bundled fall prevention measures are effective in preventing accidental patient falls and should therefore be used.	Frailty is an important predictor of future falls. Frailty should therefore be factored in any prevention strategies.	Bed alarms alone are ineffective and they must be used in combination with other preventive measures.
Appraisal and Study Quality Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?	This study is important for evidence-based clinical practice. The strength is that it is a primary study of experimental design. The limitation is that the sampling was convenient and could be prone to selection bias. The risk of implementing the recommendation is that too much nursing resources may be diverted to hourly rounding leaving other areas exposed to even more clinical problems. The application of these findings in practice is very feasible.	The study is important for clinical practice. The strength is that it is a level 1 evidence systematic review of RCTs. The limitation is that it is not primary research. The only risk of applying the recommendations is that significant nursing resources may be diverted from other deserving clinical areas. The recommendations are feasible to apply in practice.	This study is invaluable in its value to clinical practice. Its strength is that it is a primary study with primary original data. The limitation is that the prospective cohort study was done within an existing RCT and therefore may incorporate methodological errors from the original RCT. There is no obvious risk in implementing these recommendations. The study results are feasible in terms of implementation in practice.	The study is adding to EBP knowledge. Its strength is in its evidentiary value as a level 1 evidence source. Its limitation is that it is not a primary source of evidence. The risk of implementation is that fall rates may increase with a false sense of reliance on bedside alarms alone. The recommendation of using a bundled approach including bed alarms is feasible.
Key findings	Hourly rounding reduced accidental falls by more than half.	A multi-pronged approach to fall prevention is efficacious.	Frailty predicts future falls.	Bed alarms alone cannot prevent patient falls.
Outcomes	Lower patient fall rates.	Reduced fall rates.	Increased falls with frailty.	Increased incidence of patient falls with the use of bed alarms alone.
General Notes/Comments	The study enriches evidence-based practice (Melnyk & Fineout-Overholt, 2019).	The study builds EBP (Melnyk & Fineout-Overholt, 2019).	The study is a source of EBP.	The study is invaluable in adding to best practice.

 

Part B: Emerging Best Practice Recommendations from the Critical Appraisal of Research

            The critical appraisal of research above reveals studies that are well-conducted and peer-reviewed. Two of the studies are level 1 evidence studies in the form of systematic reviews. The other two are a prospective cohort study within a randomized controlled trial (RCT) and a prospective pilot study. These last two are level 2 evidence studies that are also very important in terms of evidentiary value. The best practice that emerges from this critical appraisal is therefore as follows:

1. Hourly rounding that is intentionally done by unit nurses is effective in reducing the incidence of accidental patient falls by more than half (Goldsack et al., 2015). For this reason, it should always be part of any bundled approach to preventing accidental patient falls in any healthcare setting. However, it will require the addition of more nursing resources in terms of full-time equivalents or FTEs. This means more fiscal resources needed.
2. A single intervention is unlikely to prevent patient falls. For this reason, a multi-pronged approach to fall prevention is the only efficacious strategy (Guirguis-Blake et al., 2018). Any strategy must therefore adopt a nurse-led bundled approach to fall prevention.

• Frailty is an important predictor of future falls (Kojima et al., 2015). Elderly at-risk patients who are frail must be frequently assessed for fall risk by priority using tools like the Morse Fall Scale.

1. Bed alarms alone are ineffective in the prevention of patient falls (Mileski et al., 2019). They must therefore be used together with the other measures such as hourly rounding to have any significant impact.
   

References

Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly rounding and patient falls. Nursing, 45(2), 25-30. https://doi.org/10.1097/01.nurse.0000459798.79840.95

Guirguis-Blake, J., Michael, Y., Perdue, L., Coppola, E., & Beil, T. (2018). Interventions to prevent falls in older adults. JAMA, 319(16), 1705. https://doi.org/10.1001/jama.2017.21962

Kojima, G., Kendrick, D., Skelton, D., Morris, R., Gawler, S., & Iliffe, S. (2015). Frailty predicts short-term incidence of future falls among British community-dwelling older people: a prospective cohort study nested within a randomized controlled trial. BMC Geriatrics, 15(1). https://doi.org/10.1186/s12877-015-0152-7

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4^th ed. Wolters Kluwer.

Mileski, M., Brooks, M., Topinka, J.B., Hamilton, G., Land, C., & Mitchell, T., Mosley, B., & McClay, R.  (2019). Alarming and/or alerting device effectiveness in reducing falls in long-term care (LTC) facilities? A systematic review. Healthcare, 7(1), 51. https://doi.org/10.3390/healthcare7010051