Capstone Assignment Discussion Paper

Please respond to the Discussions and also response to the peer discussions

DQ1

Submit a summary of six of your articles on the discussion board. (see articles attached). Discuss one strength and one weakness to each of these six articles on why the article may or may not provide sufficient evidence for your practice change.

DQ2

Name two different methods for evaluating evidence. Compare and contrast these two methods.

Peer DQ1

Although many evidence-based researches studies have evaluated different approaches for fall prevention, fall rate continues to be in higher range in acute care facilities that is, approximately 3.3 to 11.5 per 1000 patients per day in United States during their admission (Bouldin et al., 2013). Unintentional falls increase the financial burden to the health care facility by adding additional treatment cost and increase the length of hospital stay of the patient (Sahota et al., 2013)Capstone Assignment Discussion Paper. To prevent those fall related incidence and financial burden different types of fall detection devices are invented and used in health care facilities. However, due to lack of time and resources evidence-based research has not been conducted.

ORDER YOUR PAPER HERE

1. In a qualitative study by Chaudhuri, Thompson & Demiris (2014), authors analyzed the effectiveness of wearable and non-wearable devices on fall prevention of elderly patients in the real-world situation. The authors compiled and systematically analyzed data from previously published papers on fall detection. They found that only a fraction of the elderly patients was interested in using such devices; many were reluctant to use such devices citing the privacy issues.

Strength- This article reviewed and examined the extent to which fall detection devices have been tested in the real world.

Weakness- This review was limited to articles written in English and indexed in PubMed, CINAHL, EMBASE or PsycINFO and as such may have omitted other relevant published studies Capstone Assignment Discussion Paper.

2. In the quantitative article by Shorr et al. (2012), the authors conducted a paired cluster-randomized trial to investigate whether the use of bed alarm decreases the number of falls and fall-related injuries in a hospital setting. Their result showed that overall, the intervention increased the use of alarm mechanism among the patients; however, did not have any clinically or statistically significant effects on fall or fall-related events.

Strength- An intervention increased the use of alarm mechanism among the patients.

Weakness- The study was conducted at a single site and was slightly underpowered compared with the initial design.

3. In the article by Sahota et al. (2013), authors conducted a randomized controlled trial of bed and bedside chair pressure sensors using radio-pagers and found that it did not reduce the rate of in-patient bedside falls, time to first bedside fall and are not cost effective in elderly patients in acute, general medical wards in the UK.

Strength- They conducted a randomized controlled trial of bed and bedside chair pressure sensors using radio-pagers (intervention group) compared with standard care (control group) in elderly patients admitted to acute, general medical wards, in a large UK teaching hospital.

Weakness- There was several limitations in a study that need to be recognized. The study was powered to detect a 35% reduction in the rate of bedside falls, based on the sample size estimates from our pilot study. It is possible that the intervention may be associated with a smaller reduction in bedside falls, which may have been missed.

4. In the article by Bouldin et al. (2013), fall and injurious fall prevalence varied by nursing unit type in US hospitals. They used data from the National Database of Nursing Quality Indicators (NDNQI) collected between July 1, 2006 and September 30, 2008 to estimate prevalence and secular trends of falls occurring in adult medical, medical-surgical and surgical nursing units. Over the 27-month study, there was a small, but statistically significant, decrease in falls (p<0.0001) and injurious falls (p<0.0001)Capstone Assignment Discussion Paper.

Strength- The strengths of this study include the large number of nursing units reporting data and the national sample of hospitals.

Weakness- They did not assess practices among nursing units nor seek to identify unit characteristics associated with fall rates or changes in fall rates over time.

5.In the study by Quigley (2016), the evidence supports the importance of determining specific risk factors and initiating multifactorial fall risk factors tailored to the individual. Yet, little evidence exists for single interventions, universal fall prevention strategies, and population-specific fall prevention strategies. A review of the literature confirms the effectiveness of many fall prevention practices and interventions remains insufficient. Of particular concern are rehabilitation units in hospitals that have higher fall rates compared to other acute units.

Strength- The strength of this article is identification of the best practice interventions to prevent falls on rehabilitation units.

Weakness- The views expressed in this article are those of the author and do not represent the views of rehab nurses.

6. Evidence of this review indicates patient-centered interventions in addition to tailored patient education may have the potential to be effective in reducing falls and fall rates in acute care hospitals. There is limited high quality evidence demonstrating the effectiveness of patient-centered fall prevention interventions so novel solutions are urgently needed and warrant more rigorous, larger scale randomized trials for more robust estimates of effect (Avanecean et al., 2017)Capstone Assignment Discussion Paper.

Strength- This study evaluated the effectiveness of patient-centered interventions on falls in the acute care setting.

Weakness- Due to clinical and methodological heterogeneity among the included studies, a meta-analysis was not possible. The findings of this review have been presented in narrative form Capstone Assignment Discussion Paper