Evidenced based nurse practiced. Health, Medicine, Nursing Research Paper

Evidence-Based Clinical Question Search Assignment
Purpose:
The purpose of this Assignment is to give you a practical application to implement your PICOT idea, supported by the evidence-based research you have obtained in during your systematic review. You will apply evidence-based research findings discovered from your clinical question, and then integrate those to support your suggested change in nursing practice.
Directions:
1. Identify your refined PICOT question.
2. Using PubMed and the Cochrane collaboration database, do a systematic review of your clinical question.
3. Describe your systematic review and include an errors analysis.
4. Determine an evidence-based quantitative article from the search that contains an evidence-based randomized control trial.
5. Summarize the case study selected.
6. Describe the study approach, sample size, and population studied.
7. Apply the evidence from this review to your practice specifically in your overview.
8. Evaluate the outcomes, identifying the validity and reliability.
9. Discuss if the study contained any bias.
10. Determine the level of evidence identified in the review.
11. The length should be no less than 10 Pages in APA format.
Before finalizing your work, you should:
• be sure to read the Assignment description carefully (as displayed above)
• consult the Grading Rubric (under the Course Resources) to make sure you have included everything necessary;
• utilize spelling and grammar check to minimize errors; and
Your writing Assignment should:
• follow the conventions of Standard English (correct grammar, punctuation, etc.);
• be well ordered, logical, and unified, as well as original and insightful;
• display superior content, organization, style, and mechanics; and;
• use APA 6th edition format
Factors to Prevent Falls among Elderly in Nursing Homes
According to Johansson, Bachrach-Lindström, Struksnes, and Hedelin, falls account for complications that result in two out of three deaths among elderly people. Falls tend to occur more frequently in nursing homes than in other non-institutionalized areas (Johansson, Bachrach-Lindström, Struksnes, and Hedelin 62). Falls adversely affect the health of the elderly because they are expensive to treat and can drain the resources that are required in other areas.
Falls in the elderly are a major source of injury resulting in disability and hospitalization. Residents of nursing homes suffer from falls at nearly twice the rate of persons living in the community. The falls have a significant impact on individual basis loss of quality of live, nursing home admissions) and social basis. Even though falls in the elderly are common there are some well-studied risk factors (Pfortmueller & Exadaktylos2014).
Falls among adults age 65 and older are very costly. Each year about $50 billion is spent on non-fatal fall injuries and $754 million is spent on fatal falls in the united states
According to Ketut. S (2019), As the number of Americans, age 65 and older, grows we can expect the number of fall injuries and the cost to treat these injuries to soar.
Falls are frequent and often cause morbidity, mortality, and disability that require regular nursing. Most of these falls are associated with one or more identifiable risk factors, such as weakness, unsteady gait, confusion, and medication use. Usually, it occurs due to a combination of multiple risk factors, such as imbalance, degenerative diseases, porotic bone, and metabolic disturbances. Though in the orthopedic field, falls will most often result in injury such as femoral neck and proximal humerus fractures, all other parts of the body may also be affected due to
various mechanisms of injury. As a disabling phenomenon, fractures due to falls in elderly may then proceed to series of complications, from early to late complications, from local (such as nonunion, muscle atrophy, disuse osteoporosis, etc.) to systemic complications (such as pressure sores, pneumonia, ulcers, urinary tract infection, ileus, etc.). Therefore, prevention will play a critical role in this situation.
Reason for this project is to assess the effects of interventions designed to reduce the incidence of falls in older people in care facilities and hospitals as compare to older adult living in the community.
PICO questions allow for the development and further research within the healthcare field, encouraging providers to pursue expansion of ideas utilizing evidence-based research. It can be broken down and used within a multi-contextual template to include interventions, diagnosis, etiology, prevention, prognosis, quality of life, and therapy (Riva, Malik, Burnie, Endicott & Busse, 2012). Foreground information benefits on focus information to seek relationships between each category whereas background information is seeking information on general knowledge that is broader (Fineout-Overholt. & Johnston, 2005).
PICO search was done on factors to prevent falls among elderly in the nursing home.
P – older adult 65years and older
I- Falls factors
C-Non nursing home/facility elderly
O- falls prevention
search methods:
Search conducted on MEDLINE, CINAHL, PUD MED and Cochrane library.
Randomized search was done on factors or interventions for preventing falls in older people in residential or nursing care facilities, or hospitals relevant to this review up to August 2017.
Fall incidences and subsequent injuries are important nursing quality indicators. The Morse Fall Scale is one way of evaluating a patient’s probability of falling and can be used in nursing homes as well as hospitals. However, it is not always an accurate assessment of fall risk but a study conducted in Australia by McFarlane-Kolb in 2004 found out that the Morse Fall Scale used with other risk factors, more precisely predicted the fall risk among the elderly admitted to an acute surgical ward. The advantage with the Morse Fall Scale is that it can be modified to include additional risk factors(In Nickitas, 2016).It follows a number of questions to assess a patients likelihood of falling. These include, is the history of the patient include recent falls, does the patient have pre-existing medical conditions of admission, does the patient have walking aids, does the patient have an attached IV line or a saline lock, what is the gait condition of the patient and what is the mental condition of the patient(Treas, 2018). To demonstrate a typical Morse Fall Scale, I came up with scores that showed the risk of falling and application. An outcome of 0-24 shows no probability of falling, 25-50 shows low probability of falling and an outcome of above 50 indicates a high probability of falling. The example, Morse Fall Scale can be drawn as below.

From the above Morse Fall Scale that attained a score of 65 for a patient, it indicates that the patient is likely to fall and thus attention from the nurses should be focused on him/her. The assessment should also include questions on previous falls by individual patients once they join the nursing home before orientation to ensure they know their way around the nursing home as well as areas where falls may be frequent. As acclaimed by multiple community-based surveys done in America, 30% of patients aged above 65 year's encounters fall each year in circumstances where there are little inherent causes. It was also noted that 55% of patients who fell ended up having multiple fall incidences. Elderly women were more prone to fracturing their hips on falling and this resulted in the death of 12,000 elderly patients all over USA per year. Also noted was that more than half of patients with ambulatory assistive devices fall each year with an estimated 1600 falls yearly per 1000 beds. The high number of falls by institutionalized elderly compared to their counterparts who are community-based result of their greater frailty. Fifty to seventy percent of the elderly in nursing homes have urinary incontinence compared to their counterparts in communities who have fifteen to thirty percent chance of having urinary incontinence. This may result from using various drugs in the nursing homes. This will see that the elderly in nursing homes will make the travel to the toilet more often increasing their chances of falling.(Tallia, 2012).
For comparison, the elderly that stay within the community setting fall less often compared to the institutionalized ones due to various reasons as we have seen. Some being that the institutionalized patients are more likely to be fragile from diseases and have conditions that may lead them to fall more often such as imbalance issues. Some conditions will also have them moving around more such as the urinary incontinence that will have them visit the washrooms more often. Nursing homes may also not be the best environment as those in communities may have customization, such as handrails to assist them that may not be available in nursing homes.
For the outcome, patients that fall above 50 on the Morse Fall Scale, we could recommend physical conditioning or physical therapy that may include exercise to improve strength and endurance among the elderly. We also recommend that there are frequent environmental assessments and modifications within the home to improve the mobility of the elderly such as placing handrails and grab bars in showers where falling may be frequent. Recent research also shows that music may hugely reduce the risk of falls by elderly patients and could be administered in nursing homes. This is because the musical rhythm, working in parallel with physical activities or exercises can improve gait stability(Chabot, 2019).There should also be a review of medication administered to the elderly and the time administered to assess the benefits and risks they may pose in regards to the fall rate of the elderly. We would also recommend silent alarm systems to be installed that can go off when the elderly leave bed to allow the nurses to help where needed. Nurses can also be trained on how to manage falls such as breaking falls with their bodies and the treatment thereafter to prevent further injury.
For time taken for the intervention to reach outcome, we have to address the nursing home management of our findings so as to be given the go ahead to elect the implementation team to start on the implementation process and this will be an ongoing process as we monitor the progress and if the outcomes reflect what our intention of solving the problem of falling get actualized.
The CDC injury center has created a program known as the STEADI, or ‘Stopping Elderly Accidents, Deaths & Injuries’, which is designed for researchers, medical practitioners, and the public. The STEADI program can be used by practitioners from different settings to address the risks that exist in their communities for the elderly people living in nursing homes.
References:
Chabot, J. B. (2019). Decreased risk of falls in patients attending music sessions on an acute geriatric ward: results from a retrospective cohort study. BMC complementary and alternative medicine, 19(1), 76.
Colvin, C. R. (2014). Evidence based training methods - a guide for training professionals.
In Nickitas, D. M. (2016). Policy and politics for nurses and other health professionals: Advocacy and action.
Johansson & Inger et al (2017), “Balancing integrity vs. risk of falling – nurses’ experiences of caring for elderly people with dementia in nursing homes.” J Res Nurs. 14.1 (2017):61-73. Retrieved from http://www(dot)ncbi(dot)nlm(dot)nih(dot)gov/pmc/articles/PMC3142214/
Pfortmueller CA, Lindner G, Exadaktylos AK. Reducing fall risk in the elderly: risk factors and fall prevention, a systematic review. Minerva Med. 2014;105(4):275-281.
Schmidt, N. A. (2019). Evidence-based practice for nurses: Appraisal and application of research.
Tallia, A. F. (2012). Swanson's Family Medicine Review E-Book.
Treas, L. S. (2018). Basic nursing: Concepts, skills, & reasoning. . Philadelphia: PA: F.A. Davis Company.
Excellent job with researching your topic and presenting an organized discussion of your problem and PICO question, see comments about formatting your paper correctly, nice job overall