Literature Review Nursing Assignment

Literature Evaluation Table

Student Name: Anna Uka

Change Topic: Hourly rounding is an effective fall prevention strategy

 

Criteria	Article 1	Article 2	Article 3	Article 4
Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article	https://journals.lww.com/nursing/Fulltext/2015/02000/Hourly_rounding_and_patient_falls__What_factors.10.aspx	https://academic.oup.com/gerontologist/article/58/2/331/2736326/	https://pdfs.semanticscholar.org/0bb0/1bd16c44a8a490e0712ca66fe1478e65fcfa.pdf	https://epostersonline.com/ons2018/node/1002
Article Title and Year Published	2015	2016	2018	2018
Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study	Does engaging in interdisciplinary team through leadership and unit champion’s result to reduction in fall rates?   The article seeks to find out those factors that boosts success and prevents patient falls due to nurse rounding’s.	To explore a nurses experience with fall prevention in hospital settings. To determine the effects of those experience on how nurses provide care for the risk patients. Does intense messaging from nursing administration to prevent patient falls, actions taken by nurses to address message and consequences to nurses and older patients	What are some of the effects of purposeful hourly rounding on the incidence of patient falls?	The purpose of the article was to determine if implementation of strategic hourly rounding can reduce falls.
Design (Type of Quantitative, or Type of Qualitative)	Quantitative	Qualitative	Quantitative	Quantitative
Setting/Sample	30-day prospective pilot study was conducted in pre- and post-implementation units.	27 registered nurses and certified nurses Two hospitals located in Wisconsin	241- bed acute care facility in south eastern United States	Hourly rounding was conducted during 4-8 am time frame was implemented on all the patients.
Methods: Intervention/Instruments	Lean Six Sigma process was used to determine improvement in the project	In-depth interviews were conducted. Open, axial and selective coding was used in data analysis.	Data was collected through retrospective data review to determine fall incidence in one year before and after implementation of hourly rounding program.	An UAMS EBP model was utilized in the project. An hourly rounding during the 4- 8 am was implemented on all the patients and it continued throughout the day. The hourly rounding’s addressed the 4 p’s these are possessions. Position. Hygiene and personal. Staffs were educated on rounding through the use of staff meetings, unit council meetings, daily audits and one- on one instruction.
Analysis	On the units where staffs were engaged through leadership and unit champions there was a significant reduction in fall rates in Unit 1.	In most hospital settings, nursing staff have been placed directly to prevent falls. As such, nurses feel an increasing pressure to meet hospital objective of zero falls.	The study illustrates that total falls occurred before and after implementation of purposeful hourly rounding. In the study evidence-based standardized prevention resulted to decrease in falls though it was not statistically significant.	Using analysis of variance in identification of the times when patients were more vulnerable to falling. Hour rounding for high risk patients who were vulnerable to falling decreased
Key Findings	The authors found out that active involvement of front-line staff and leadership in program design and as unit champions during the period resulted to reduction in inpatient fall rates.	The authors found out that nurses experience negative consequences as and when they are placed on intense pressure to prevent falls. As a result nurses adjust the care they deliver and restrict patient mobility and optimal patient progress.	Purposeful hour settings can effectively prevent falls. The challenging factor is its implementations in health care settings.	Hourly rounding’s decreases patient falls. Ensuring clinical support through HDS to drive care and rounding compliance is an effective reduction strategy.
Recommendations	Current hospital care settings should engage interdisciplinary team and front line staff to reduce hospital fall rates.	The authors recommend that research is required to gain knowledge on how nurses should provide care to risk patients. There is also a need for patient centered and unit based interventions to prevent patient falls and preserve patient functions.	The study recommends that further research to be conducted on one the benefits of purposeful hourly rounding. Purposeful hourly rounding is a transformation in nursing culture. The study also provides opportunities for developing, implementing and evaluating hourly rounding programs in hospitals.	Health care settings should clinical decision making support such as the HDS. This can help them drive care that is paired with rounding compliance on high fall risking patients as an effective was to reduce falls.
Explanation of How the Article Supports EBP/Capstone Project	The article supports my capstone project on falls, because it relates well on how nurse’s hourly rounding’s can be decreased in hospital settings.	The article provides suggestions on how hospitals should lessen the pressure put on nurses to prevent patient falls and look for appropriate strategies to minimize patient falls.	The article supports capstone project in that it explains how implementation of purposeful hourly rounding can prevent patient falls.	The article argues that use of hourly rounding does can reduce the rate of hospital fall in health care settings.

 

 

 

Criteria	Article 5	Article 6	Article 7	Article 8
Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article	https://onlinelibrary.wiley.com/doi/pdf/10.1002/rnj.250	https://sigma.nursingrepository.org/bitstream/handle/10755/621219/AMoses.FinalManuscript2017.pdf?sequence=3&isAllowed=y	https://bmjopen.bmj.com/content/7/11/e017864	https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005465.pub4/full
Article Title and Year Published	2016	2017	2017	2018
Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study	The article examined how nurse leaders in an inpatient rehabilitation unit can reduce falls through implementing fall prevention strategies and sustaining their results by promoting a strong culture.	What are the effects of an alarm elimination programs compared to the practice of utilizing alarms on fall rates in a 2 month period.	To evaluate the effectiveness of fall prevention strategies on reducing falls in hospitalized adults.	To identify the effects of interventions designed to reduce incidence falls among older people in acute care facilities
Design (Type of Quantitative, or Type of Qualitative)	Qualitative A retrospective review of NDNQ for number of falls in 1000 patients from the fourth day of 2010 to the third quarter of 2012 was conducted. .	Quantitative	Qualitative	Qualitative
Setting/Sample	61-bed inpatient rehabilitation (IPR) 1070 bed tertiary teaching hospital from (National Data base of Nursing Quality Indicators (NDNQI)	Patients in a Rehab long term care facility in Missouri	Meta- analysis Study.	Thirty five trails that is 77,879 participants were included. The study sed 95 randomized control trial that involved 138,164 participants, Seventy one trials were in care facilities, and 24 in hospital settings.
Methods: Intervention/Instruments	A retrospective review of IPR fall rates was conducted. The quarterly fall rates were compared to implementation dates of fall prevention interventions such as hourly rounding, safety hurdles and signage,	The quality improvement project followed four steps that is Plan-Do-Check Act (PDCA).Data was collected from Incident Reporting Program (IDA).The outcomes were then measured through pre and prosy intervention deign. Pre intervention was collected from 2015 and post intervention collected in July to September 2016/	Criteria were followed in that studies that were eligible for inclusion for method and quality risk of bias and was based on the method quality. The author used Pedro scale and the Cochrane Risk of Bias based on 12 criteria that is binding, concealed allocation ,baseline comparability outcome assessment and incomplete data.	The study applied the use of randomized control measures to prevent falls among older people in residential and nursing care hospitals. The author screened abstracts where two review authors were successfully screened for inclusion.
Analysis	Total fall rates per 1000 patients were collected from the fourth quarter of 2010 to 2013 from NDNQI.	Fall rates decreased after post prevention but there was no statistical significance in the decrease in fall rates.	The eligibility criteria was based on the type of studies, types of interventions, compradors, outcome measures, study settings and t types of participants.	Majority of the results for the study were at risk of bias due to inadequate binding, Also risk of fracture and other adverse events were poorly reported the evidence was also of poor quality.
Key Findings	Decrease in fall rates was noted after revitalization efforts of IPR unit culture of safety together with hourly rounding.	The need for Alarm Elimination Fall Prevention program was a requirement in the chosen health care setting. The health care setting also required a vast amount of support from its management and administration to enable staff realize its importance and to view interventions for more work.	The studies suggested various strategies that were used to prevent patient falls in hospitals.	The authors found out that in hospitals ,there was an effect of additional physiotherapy on rate of falls as it reduces the risk of falling.
Recommendations	Physical injuries that occur due to falls reduce mobility and can increase morbidity. Through evidence based fall reduction strategies are crucial for nurses and leaders within the health care.	The authors suggest further studies should consider fall rates in relation to patient and staff ratios and follow up to be conducted during a much longer time frame to determine the importance that is noticed on higher compliance rates. Administrators through modifications and understanding of ideas and asking the right questions can create an opportunity and provide safe environment patients.	A proper understanding of hospital falls and effective strategies to prevent falls is an essential strategy to prevent individuals from falling.	The study suggests incorporatuo of apporahces on the cirumstancs o falls in addition to other factors such as regular assisted toileting and in facilities and hospitals. Health care settings should use educational focus and psychological strategies as patient centered directions.
Explanation of How the Article Supports EBP/Capstone	The paper explain how use of evidence based practices such as hourly rounding can prevent patient falls which are associated with increased morbidity.	The article relates on capstone project on falls since it describes of utilization of alarms can result to reduction in fall rates among patients.	The author supports the capstone project because the studies suggest various strategies that can be used to prevent patient falls.	The study relates to the capstone project since it analyzes risk prevention strategies in health care settings.

 

 

 

 

© 2015. Grand Canyon University. All Rights Reserved.

© 2017. Grand Canyon University. All Rights Reserved.

PICOT STATEMENT 1

PICOT STATEMENT 2

 

PICOT Statement

Anna Uka

Grand Canyon University- NRS490

December 1st , 2019

 

P: Adults on an Acute Care floor

I: Required education on the Braden Scale

C: Standard Practice

O: Decrease in Hospital-Acquired Pressure Ulcers

PICOT QUESTION: Does the required education on the Braden scale increase nursing interventions for Adult patients on an acute care floor at risk of developing pressure ulcers during hospitalization?

Currently, most hospitals are faced with a clinical problem of acquired pressure ulcers. According to Pittman et al (2015), hospital-acquired pressure ulcers remain one of the persistent and relevant issues that need to be addressed in long-term hospital stay patients. Health care is attempting to implement evidence-based protocols, though patients continue to suffer from this prevalent and preventable injury. Health care institutions are facing a big challenge for the patients with this acquired condition because hospital bills continue to balloon and at the same time insurance companies stopped paying for this condition. Research shows that pressure ulcer is preventable; though, in spite of hospitals striving to integrate evidence-based approaches to curb the issue, it continues to remain a serious issue for long-term hospital stay patients. This PICOT statement this research paper is proposing to use is a Braden Scale which can be used by nurses in their practice to reduce hospital-acquired pressure injuries which will reduce the patient stay in the hospital as well as the bills burden in the hospital. Literature Review Nursing Assignment

 

Evidence-Based Solution

According to Engels et al (2016), “the importance of using evidence-based practice in long-term care hospitals to reduce prevalent pressure ulcers is to promote a safe cost-effective outcome for our patients, families, and the healthcare group. Research needs to be conducted and qualitative data collected when designing an evidence-based solution to hospital-acquired injuries”. Despite a lot of research being conducted from the past years concerning acquired pressure ulcers, many patients continue to get the disease. Evidence-based practice allows the nurse to get pooled in a team of experts where interdisciplinary collaboration becomes the ultimate objective for nurses to practice autonomy that enhances change in the nursing field based on data. “The nursing research utilizes qualitative and quantitative logical methods and an EBP approach aimed at around the study and change of patient consideration, understanding consideration frameworks, and patient results” (Mervis & Phillips, 2019). This PICOT question will effectively apply the Braden Scale to see how it can positively impact long-term hospital in reducing pressure ulcers injuries. Literature Review Nursing Assignment

Nursing Intervention

When starting a nursing research project, one has to consider a variety of factors. First, a nurse needs to look at the available intervention that would assist the patient in managing pressure ulcer injury on an adult acute care floor, particularly when using Braden Scale (Engels et al., 2016). For example, a nurse can initiate an intervention of training about the Braden Scale to make sure every day has the full knowledge of the tool and making sure that pressure injury prevention techniques are used when the Braden Scale is at a certain score.

Patient Care

According to Mervis, & Phillips (2019), “Nursing intervention techniques that are used to prevent pressure injuries in the hospital include placing silicone dressings on patient’s coccyx bones, avoiding moisture, RN skin checks to assess the skin every shift, turning repositioning the patient every two hours. These are only a few and with the education on the Braden Scale medical caretakers will have a more note worthy comprehension of how to better help their patients”.

 

Health Care Agency

Pittman et al (2015) argue that the health care agency’s primary role is to fund long-term care hospitals is providing safety, quality and effective communication between patients and nurses and improving overall healthcare services. An example of an agency responsible for ensuring patient’s health concerns are looked into is The National Institute of Nursing Research and Agency for Healthcare Research and Quality are a few (Berlowitz, VanDeusen Lukas & Parker, 2015). In the event, this research project receives great feedback it can perhaps get the financial support to attain the PICOT statement.

Nursing Practice

Whitehead (2008) stated that nursing practice is an important phenomenon that should be used by nurses in long-term hospitals when generating knowledge about their role and the overall practice of care to patients with acquiring pressure ulcers, as well as to add to nursing knowledge that every nurse should be adept with. A nurse should contemplate about the nursing standards and policies that healthcare utilizes when providing patient care. These policies were a result of research findings that affect nursing practice. Literature Review Nursing Assignment

 

References

Berlowitz, D., VanDeusen Lukas, C., & Parker, V. (2015). Preventing pressure ulcers in hospitals: a toolkit for improving quality of care. Agency for Healthcare Research and Quality.

Engels, D., Austin, M., McNichol, L., Fencl, J., Gupta, S., & Kazi, H. (2016). Pressure ulcers: factors contributing to their development in the OR. AORN Journal, 103(3), 271-281.

Mervis, J. S., & Phillips, T. J. (2019). Pressure ulcers: prevention and management. Journal of the American Academy of Dermatology.

Pittman, J., Beeson, T., Kitterman, J., Lancaster, S., & Shelly, A. (2015). Medical Device–Related Hospital-Acquired Pressure Ulcers. Journal of Wound, Ostomy and Continence Nursing, 42(2), 151-154.

Whitehead, D. (2008). Understanding Nursing Research: Building an Evidence‐Based Practice–4th Edition. Journal of Clinical Nursing, 17(4), 563-563.