Running head: EVIDENCE BASED PRACTICE 1

Evidence-Based Practice and Applied Nursing Research

Task 1

your Name

3/13/2021

Western Governor University

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A. Impact of Problem on Patient and Organization

The selected clinical practice problem is Patient falls; this problem impacts the Patient

and the organization in various ways. It affects the Patient by threatening the Patient's safety as it

contributes to the increased fractures, soft tissue injuries, lacerations, and increased incidence of

preventable sentinel events.

It impacts the organization because it will be required to reimburse for the injuries

suffered from the Falls. This means that the organization may be financially burdened when a

fall takes place.

1 PICO Components
•   Patient/population/problem (P)

This clinical practice focuses on addressing. Patients'' falls in the acute inpatient hospital

setting. As already mentioned, the issue impacts both the Patient in terms of their safety, and the

hospital is affected negatively financially.

•   Intervention (I)

Providing education to the Patient and family is the critical intervention to improve the

rate of patient falls. Education about safety and fall prevention should be provided to the Patient

by the organization's staff, reducing the Patient's fall rate throughout the hospitalization process.

•   Comparison (C)

The comparison will be based on the difference in the rate of fall between the patients

without the fall risk and safety education and the patients with education on safety and fall

prevention during the treatment.

•   Outcome (O)
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The outcome for this problem would be an increased comprehension from the hospitalized

patients on fall precautions and safety via education provided. The increased comprehension

help reduce the Patient's fall rate hence increasing the safety of the Patient. The reduced falls

will help the organization prevent potential financial setbacks and the loss of reimbursement for

the preventable circumstances.

2.   Evidence-based practice (EBP) question

Will patient education on fall prevention reduce falls in hospitalized patients at risk for

falls compared to no patient education on fall precautions?

B.   Research-based article that answers the EBP question

"(Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A., & Morris, M. E. (2020). Hospital falls prevention

with patient education: A scoping review. BMC Geriatrics, 20(1)"".

https://doi.org/10.1186/s12877-020-01515-w)

1. Background/introduction

Patient falls during hospitalization have become a crucial problem across the globe.

Healthcare Organizations are making efforts to come up with ways that can help prevent

inpatient falls. This will, in turn, help in improving the clinical outcomes while at the same time

protecting the organization financially. This article discusses patient education as a strategy that

would increase patient comprehension and engagement in fall prevention plans. Reports have

indicated that more than 80% of the reported falls occur when the patients aren't observed. Some

patients usually indulge in risky decisions regarding mobility depending on their judgments,

without asking for assistance from the nurses among other health professionals (Heng et al.
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2020). This article examines the numerous reviews, clinical trials, and hospital interventions

utilized in showing changes based on patient education in fall situations or circumstances.

2.   Research methodology.

Arksey and O'Malley, the Joanna Briggs Institute, and the Preferred Reporting Items for the

Systematic Reviews. After introducing the broad research question, eight databases were

searched for the pertinent literature to examine the subject matter. Two reviewers did a thorough

screening of the data and the articles as well. The Narrative revies, clinical trials, as well as grey

literature, were systematically reviewed to get a summary of the highest level of evidence that is

available in the existing literature" (Heng et al., 2020).

3.   Level of evidence using the Johns Hopkins Nursing Evidence-Based Practice

(JHNEBP) model.
This article can be classified as a level III study based on the article's evidence and the

JHNEBP model. This article is further a nonexperimental study. The Study designs that include

the quantitative, qualitative, and mixed-method strategies have all been incorporated in the

article.

4.  Summary of how the researcher analyzed the data in the article.

The researcher used a thematic data analysis technique to analyze data in the article.

Thematic data analysis is a method that is mainly sued to analyze qualitative data. This

method was used because the data used in the article comes from a wide range of sources,

such as studies from different countries all of which were mainly qualitative data. Data

included various systemic reviews, randomized controlled trials, quantitative studies as well

as quasi-experimental trials. The studies considered are organized and presented as a

PRISMA flow chart within the article. The reviewers focused mainly on various

subcategories, including the Patient's information falls education programs, education

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delivery mode, educational design principles and models, education, and the fall outcomes.

The Fall-related results, quality of falls education programs, and systematic reviews (Heng et

al., 2020). The flow chart offers an excellent visual overview of the information collected.

5.  Summary of the ethical consideration(s) of the research-based article.

Ethical approval and ethical consent to participate have not been used/applied in the study.

The article is a cumulative study of the research; human experimentation and testing weren't

implemented to achieve the results in the study.

6.   Quality rating of the research-based article according to the JHNEBP model

Based on how the information has been presented in the article, it is clear that there is

transparency, diligence, verification, and insightful interpretation of data collected. Following

this and based on the JHNEBP model, the article is considered of High or Good quality

7.  Analysis of the results/ conclusions of the research-based paper and how the
article helps answer the EBP question.
The analysis and examination of the research show that there is emerging evidence that

hospital falls prevention interventions that incorporate patient education may help significantly

in reducing falls as well as related injuries such as bruising, lacerations, and fractures. This

evidence helps to answer the EBP question because the EBP questions seek to find out if patient

education on fall prevention reduces falls in hospitalized patients as compared to when there is

no education provided. This means that indeed, patient education helps to reduce patient falls as

indicated by the article.

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C.  The non-research article from a peer-reviewed journal

“Ambutas, S. (2017). Continuous Quality Improvement. Fall Reduction and Injury

Prevention Toolkit: Implementation on Two Medical-Surgical Units. MedSurg Nursing, 26(3)”.

1.   Background/introduction

This article provides an examination of the patients at risk for falls on two medical-surgical

units at the medical center. The project's primary purpose was to improve the organization's

ability to comprehend, address, and identify solutions for the patients at risk for falls with injury

while hospitalized. Patient falls are common and usually lead to significant damage for the

patients while at the same time causing a financial loss for the organization involved because the

damages related to the inpatient falls are not reimbursable.

2.  Types of evidence

The article provides an overview of the quality improvement plan. Two medical-surgical

units having falls rate above the standard NDNQI rates were identified by two medical-surgical

units. The project offers an examination of the past falls analysis that happened in the facility to

establish trends. The project provides an assessment of the past practices, then unified new

techniques such as interprofessional fall team, low beds, floor mats, teach-back for at-risk

patients and their families, and documentation of the mobility on the communication board. The

significant objectives involved the implementation of the fall reduction tool kit, reducing falls to

less than 0.3 per 1,000 patient days on the units being studied, and reducing the fall with injury

to below 3.4 per 1,000 patient days on the participating facility (Ambutas, 2017).

3.  The level of evidence using the JHNEBP model.

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This is purely based on the JHNEBP model, which indicates that this article is of level V.

This is because the paper is typically based on the experimental non-research evidence while at

the same time incorporating the quality improvement project.

4.  The quality rating of the non-research-based article according to the JHNEBP

model.

This article can be considered high quality (rating A) based on the JHNEBP model. This

article has a clear focus and clear objectives about the fall reduction in numerous settings that

showcase or pose measurable scientific evidence.

5.   How the author's recommendation(s) in the article helps answer the EBP question.
The implementation of the quality improvement program helped to reduce falls with injury in

the setting considered. The performance of the new practices that involved increased staff

education and teach-back on the fall precautions to the patients and their families enhanced the

project's success. There were other strategies used in the fall’s toolkit in addition to the Patient

fall education; such methods included promotion-related techniques such as the utilization of

signs in inpatient rooms reading "Call Don't, Fall," among others. According to the author, the

project's success resulted from an accountability shift to the fall team members and the unit

leaders (Ambutas, 2017). The project's success supports the clinical practice problem by

showing positive results in reducing falls with the inclusion of fall education for the patients.
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D.  Recommended practice change that addresses the EBP question using both the research
and non-research articles selected.

Based on the review of the two articles and the positive evidence provided, I recommend a

practice change that incorporates an increased patient and family education regarding fall

precautions to decrease falls risk. The recommended practice change can contain the teach-back

and promotional materials that will serve as a reinforcement of the teaching; these may include

visible signs posted to remind the patients.

1.  How I would involve three key stakeholders in supporting the practice change
recommendation.

The three major stakeholders in the practice change are nursing supervisors and unit

managers, the nurses and support staff, and the nurse educators. The committee's formation,

including representatives from these three groups of stakeholders, is my starting point for

practice change. The Nursing supervisors and unit managers are critical stakeholders because

they have a better comprehension of the workflow and the operation of the unit; this means that

they can help the nurse educator provide staff education punctually to enhance the proposed

change.

Moreover, Nursing and support staff are vital stakeholders because they can offer essential

feedback recognizing practical implementation barriers. Lastly, the nursing educator is a crucial

stakeholder because they will need to have a good understanding of the data then present the

information in a form that enhances accountability among the staff. This is necessary for the

success of the change.

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2. Specific barriers when implementing the practice change recommendation.

Several barriers are likely to be encountered during the implementation of the practice

change. However, one main barrier is staff resistance. This is because the significant

stakeholders might fail to comprehend the positive impacts of the proposed practice change and

might consider it an extra burden that might disrupt the typical workflow.

3.   Strategy to overcome the barrier

One essential strategy that can help overcome the identified barrier is the provision of quality

education to the staff; this education should incorporate evidence-based research and clear

expectations regarding what the change will include in addition to the responsibilities and role

that each staff member will play. Staff members have to be valued and permitted to raise their

concerns. This way, resistance will be reduced.

4.  One outcome (the O component in PICO) from the EBP question to measure the
recommended practice change.

The outcome measure will be compared six months before the practice change and six

months after implementing the proposed practice change. Therefore, the EBP question's outcome

will involve showing over six months after implementing the proposed practice changes a

substantial decrease in the rate of inpatient falls as a result of the improved patient education on

the fall precautions.

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References

Ambutas, S. (2017). Continuous Quality Improvement. Fall Reduction and Injury Prevention

Toolkit: Implementation on Two Medical-Surgical Units. MedSurg Nursing, 26(3).

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A., & Morris, M. E. (2020). Hospital

falls prevention with patient education: A scoping review. BMC Geriatrics, 20(1).

https://doi.org/10.1186/s12877-020-01515-w