Posted at 10.06.2018
When working as a nurse, clinical questions appear regarding which is the best way to look after our patients. To help nurses make effective professional medical decisions, they may use evidence-based research in their decision-making process. To be able to seek out the best facts, it is important to build up research questions from the scenario and search for research facts to answer the clinical questions. This understanding of evidence-based medical can help me make prepared decisions and how to be prepared for future troubles as a nurse.
According to Registered Nurses' Connection of Ontario (2005), falls are the number one cause of harm in Canadian hospitals in people over this 65 and take into account over half hospital admissions. Comes can cause serious accidental injuries like hip fractures or loss of life, and financial strain on health care. It is important to look into this problem and find out how to lessen the chance of comes.
An example that I've encountered, while employed in the hospital, is about a retired, indie woman called Eleanor. She is in reasonable health, but the fatality of her man and a few friends has considered a toll on her life. She remains lively by volunteering and playing bingo at the neighborhood hall. She's three children that call regularly and live an hour drive away. Recently, Eleanor was diagnosed with arthritis, protecting against her from doing a few of her daily activities. One day she dropped in the bathtub breaking her hip and has been admitted to a healthcare facility after slipping at home.
After starting hip surgery, Eleanor stayed in the hospital for one week and treatment for 90 days to make a full recovery. She is now being discharged from medical center and is concerned about dropping again. Eleanor lives alone and one of her daughters has decided to improve the transition of moving back home. The nurse on the floor is concerned about the amount of elderly patients who've been readmitted to the hospital and wonder if implementing a fall protection program prior to release will help decrease falls. To be able to help Eleanor, the nurse decides to execute a literature explore the issue and grows two types of questions.
Using the four elements of a question: Human population, Intervention, Evaluation, and Results (PICO), a question can be produced to help search for proof easier (Cullum, Ciliska, Haynes, & Markings, 2008).
P- Seniors who acquired a fall
I- Falls protection program with standard care
C- Regular care
O- Lower falls
In elderly people who experienced a fall, will implementing a comes elimination program with typical care decrease amount of falls in comparison with usual attention?
I framed my qualitative question using the Patient and Situation (PS) model.
P- Seniors people
S- Take on fall prevention
What is the view of seniors on fall reduction?
After setting up a quantitative and qualitative question, the next step is to choose a study design. The analysis design that I've chosen to fit for the quantitative question is the randomized controlled trial (RCT) because the question targets preventing recurrent comes in the elderly using the falls prevention program compared with usual care and attention.
As identified in Cullum et al. (2008), an RCT is employed for questions concerning an intervention which has a good outcome. RCT arbitrarily allocates people to get a experimental treatment or a normal intervention. To evaluate the results of the intervention participants are used over a period. Within the RCT experiment, elderly people are randomly allocated to receive a falls reduction program or regular care. The individuals who adopted the experimental involvement are weighed against the regular intervention to see if there is a notable difference in amount of falls between the two teams.
Falls reduction program No change
Elderly people with usual care
who experienced a fall Cut down falls
Figure 1 Randomized controlled trial design.
A qualitative research design is suitable to work with with my qualitative research question because a small test size would be used to explore the encounters and views of the elderly in focus communities or interviews. The qualitative research design I've chosen to best fit my qualitative question is the phenomenology theory. Phenomenology studies the experience of people by performing interviews to acquire information (Cullum et al. , 2008). Information can be collected from seniors experiences of falling which may include concern with falling, difficulties in day to day activities, and depression. Both of these analysis designs that I have chosen will help answer my research questions and proficiently search for the most appropriate evidence.
To start my books search in finding the best proof that answers my quantitative and qualitative questions, I'll use the 6S hierarchy of pre-processed research from Dicenso, Bayley, and Haynes (2009). Near the top of the pyramid is the systems level that involves "all relevant and important research evidence about a specialized medical problem and would automatically link, through an digital medical record, a specific patient's circumstances to the relevant information" (Cullum et al. , 2008, p. 25). I will begin at the summaries level, since systems are not at this level yet. In the Best Practice Recommendations, I searched for my quantitative question using the whole sentence. This article Prevention of Falls and Fall Injury in the Old Adult was second in the list and I came across the response to my question but it didn't give the research.
The next level is named The Synopses of Synthesis and I researched in Repository Abstracts Overview of Results (DARE) to find no searches that matched my question. I used the complete word of my question to find 0 queries and used key words elderly fall protection program to get 3 irrelevant articles. I QUICKLY looked the Evidence-Based Nursing database and found the article "A discharge planning intervention improved outcomes in older people admitted to medical center for hip fracture after a semester" that clarified my question completely. The search process was an extended process and required two hours to get the appropriate article. I used different keywords, established boundaries and read several articles. See appendix 1 for complete search strategy.
The review by Doucette (2006) used a randomized handled trial of 145 patients older than 65 admitted with a hip fracture scheduled to a land. Fifty percent of the participants had an intensive discharge planning intervention program and the spouse had usual care. To answer fully the question, "In seniors who got a fall, does implementing a falls avoidance program with standard care decrease variety of falls when compared to usual good care?" Results proved a decrease in falls as well as hospital readmission, hospital remains, death, and a rise of self-reliance with activities of daily living.
For my qualitative question, I started at the Synopses of Sole Studies level and searched the Evidenced-Based Medical Data source and found no articles that replied my question. Next, I visited One Studies and searched in PubMed. I found 1 article that was irrelevant to my circumstance and improved my search methods by using different key phrases, limits and combining my searches. See appendix 2 for complete search strategy. The final search found the article, "Older people's views of advice about comes prevention: a qualitative study" and was third in the list.
The research article replied my qualitative question, "What is the view of seniors on fall reduction?" Focus communities and interviews were conducted with 66 participants, older than 61. The findings found that members, "do not reject falls prevention advice because of ignorance of these risk of falling, but because they view it as a potential menace to their id and autonomy" (Yardley, Donovan-Hall, Francis, & Todd, 2006).
In realization, effectively developing professional medical research questions and successfully looking for research facts has helped me to understand the value of locating the best evidence established articles to aid my questions. By working with patients, in my own nursing profession, I will be in a position to provide better look after my patients and better understand their needs as they get older. Also, I will feel convenient in responding to questions to improve my control role as a RN.