NRS 433 Research Critiques and PICOT Statement Final Draft

Sample Answer

Healthcare facilities should be safe environments for all patients seeking medical assistance for different health conditions. Unfortunately, patient falls occur in varying magnitudes and affect health outcomes significantly. Statistics show that approximately 700,000 to 1,000,000 patient falls are recorded annually in U.S. hospitals (Ochoa, 2020). The impacts are far-reaching, prompting the need for sustainable, evidence-based interventions.

Chandrasekaran et al. (2021) found that patient falls are a leading cause of physical injuries among patients, prolonged hospitalizations, mental anguish, and fear of falls. Risk factors include the patient’s age, conditions of the care environment, and conditions such as heart disease and foot problems affecting body balance. Preventing patient falls improves patient safety and care quality, improving health outcomes and high satisfaction.

Nursing research has extensively explored the effectiveness of exercise-based therapy as an intervention for patient falls. Therefore, the purpose of this paper is to critique quantitative and qualitative studies on the suitability of exercise-based therapy in reducing patient falls among older adults.

PICOT Question

Among hospitalized older adults (P), can exercise-based therapy (I) compared to usual care (C) reduce patient falls by 50% (O) in six months (T)?

Background of Studies

Patient falls are a severe practice problem affecting patients’ health adversely and lowering their quality of life. A higher proportion of older adults will be at risk of falls as time advances since the population of adults over sixty years will double by 2050 (Rikkonen et al., 2023). The problem is significant in nursing since patient falls inhibit achieving the desired health outcomes. Besides, they increase health management costs and the risk of readmissions (Cook et al., 2023).

In response, Ehrari et al. (2020) studied the potential of engaging older adults in playful exercise to increase physical balance. The study’s objective was to evaluate the feasibility of an exercise-based intervention in reducing patient falls among older adults. The research question guiding the study was how does playful exercise affect physical activity and balance among older adults?

In another quantitative study, Chittrakul et al. (2020) examined the effectiveness of a multi-system physical exercise (MPE) program among pre-frail older adults. The study’s primary objective was to determine how the program could prevent falls and improve the quality of life among the participants. The research question guiding the study was what is the effect of MPE on falls and quality of life among pre-frail older adults? Based on their purpose and study variables, the two articles focus on the same problem affecting a unique population and requiring the support of healthcare professionals.

Qualitative research (Cederbom et al., 2022; Arkkukangas et al., 2021) also demonstrates patient falls as a severe problem whose prevention should be prioritized in care facilities. The effects of patient falls, including functional deterioration, morbidity, and increased healthcare spending, underline its significance in nursing (Rikkonen et al., 2023; Cederbom et al., 2022). To drive evidence-based practice in nursing, Cederbom et al. (2022) evaluated physical therapists (PTs) experiences with applying the Otago Exercise Program (OEP) among home-dwelling older adults. Researchers aimed to answer the question what is the applicability of OEP among home-dwelling older adults depending on formal care?

In a different qualitative study, Arkkukangas et al. (2021) explored older adults’ experiences with a mobile application for fall prevention exercises. The objective of the two studies was to determine the outcomes associated with fall prevention programs and how they can be improved. Arkkukangas et al. (2021) aimed to answer the question what are older persons’ experiences with a mobile health application for fall prevention exercise? Both articles focus on the experiences of users and care providers as a major theme.

Articles Supporting the Nursing Practice Problem

As highlighted in the PICOT, exercise-based therapy could reduce patient falls among hospitalized older adults. Ehrari et al. (2020) answer the PICOT by demonstrating how playful exercise improves balance and increases motivation to engage in similar exercises. Chittrakul et al. (2020) answer the PICOT by showing the difference between participants of a multi-system physical exercise intervention and non-participants.

In the qualitative studies, Cederbom et al. (2022) answer the PICOT question by establishing the benefits of exercise-based therapy (Otago Exercise Program) among older adults at risk of falls. Arkkukangas et al. (2021) answer the PICOT question by exploring outcomes and positive experiences associated with fall prevention exercises. Interventions and comparison groups help researchers to determine relationships between variables.

In the intervention group, older adults participate in different moderate exercise programs for a period determined by researchers. The objective is to improve balance and strength, among other outcomes. The comparison groups involve older adults not engaging in exercise-based therapy but continuing with usual care. The intervention (moderate physical exercises) is similar to what is proposed in the PICOT question. The groups are also similar since participants are older adults at risk of patient falls.

Method of Studies

Besides objectives and study populations, the articles differ in research methods. Ehrari et al. (2020) conducted an experimental study (randomized controlled trial) among twenty-six independently living older adults. The intervention group engaged in playful exercises for ten weeks (twice weekly) while the control group continued with regular daily activities. Chittrakul et al. (2020) also experimented through a randomized controlled trial among seventy-two adults aged 65 and above.

The intervention group received multi-system physical exercise training consisting of muscle strengthening, balance training, and proprioception for three days weekly for 12 weeks, as the control group continued with routine care. In the qualitative studies, Cederbom et al. (2022) conducted a phenomenological study to summarize individual experiences with a fall prevention intervention. In the other article, Arkkukangas et al. (2021) conducted a descriptive inductive qualitative study using focus group interviews.

Study methods have varying benefits and limitations. Experimentation through randomized controlled trials (RCTs) reduces bias through randomization since RCTs enable researchers to evaluate the causal relationships between the treatment and outcome (Zabor et al., 2020). However, the findings of RCTs may not effectively represent the broader population since only a small proportion participates in the study.

Phenomenological research allows researchers to explore how humans experience phenomena and make sense of experiences (Cederbom et al., 2022). Its main limitation is length since it is time-consuming. A qualitative inductive design gives a broad view of the studied phenomena since researchers are not limited to what they already know. However, such studies may lack analysis rigor if researchers are inexperienced.

Results of Studies

Key Findings

Ehrari et al. (2020) found a significant difference between the intervention and control groups since functional balance in the intervention group improved by 5.02 points compared to 2.58 points in the control group. The program also increased participants’ motivation to engage in physical exercises. Chittrakul et al. (2020) found a statistically significant difference between the intervention and control groups in critical aspects like fall risk, muscle strength, and reaction time (p<0.001).

The quality of life also increased significantly in the intervention group. In the qualitative articles, Cederbom et al. (2022) found the Otega Exercise Program effective in fall prevention since it improved patients’ physical function, self-efficacy, and mood. Arkkukangas et al. (2021) found the mobile health application a useful tool for helping older adults engage, get motivated, and adhere to fall prevention exercises.

Implications in Nursing Practice

Healthcare facilities should continually evaluate practice problems and address them through evidence-based interventions. From the summarized findings, it is evident that exercise-based therapy is an effective intervention for patient falls among older adults. As a result, similar programs should be embraced in nursing practice. Benefits include improved balance, better physical function among older adults, high self-efficacy, and more desire to engage in similar exercises independently.

Ethical Considerations

Nursing research can pose considerable risks to participants depending on data collection methods, information privacy, and other factors. Informed consent is among the primary ethical considerations in nursing research, which involves ensuring voluntary participation with complete information about the research (Xu et al., 2020). Critical information includes potential risks, benefits, and research objectives. Anonymity is another dominant ethical consideration in nursing research.

Hoft (2021) described anonymity as protecting participants’ identities when collecting, analyzing, and reporting data. Researchers in the four articles obtained written informed consent from the subjects to ensure they participated willingly. Besides, identifiable information was not collected or appropriately coded to keep participants anonymous.

Outcomes Comparison

Nurses implement evidence-based projects seeking to achieve positive outcomes. The anticipated outcome for the PICOT question is a significant fall reduction (by 50%) among hospitalized older adults. This reduction would be achieved by implementing an exercise-based therapy. Reducing patient falls improves patient safety, satisfaction, and confidence in care providers (LeLaurin & Shorr, 2019).

The outcomes in the four articles are similar to the anticipated outcomes in the PICOT since they underscore the effectiveness of exercise-based interventions in preventing patient falls among older adults in various facilities. The positive outcomes and experiences among patients and care providers show that similar programs can be implemented in other areas for improved patient experience.

Proposed Evidence-Based Practice Change

As stated in the PICOT question, exercise-based therapy could help to reduce patient falls among hospitalized older adults. The research articles confirm the effectiveness of exercise-based programs in preventing patient falls, implying that they can be used to address the nursing practice problem (patient falls) to improve the patient care experience. Based on this information, an exercise-based therapy involving moderate exercises should be implemented in the current setting to reduce patient falls by 50%, as projected in the PICOT question.

Potential outcomes include improved balance, physical strength, and motivation for exercises (Ehrari et al., 2020). Older adults should engage in these exercises two times weekly for six weeks to realize the expected outcomes. Continuous monitoring, support, and guidance from healthcare professionals are vital to ensure older adults at risk of falls can engage in moderate physical exercises independently.

Conclusion

Healthcare facilities should be safe settings for all patients. Due to the high potential of patient falls to hamper health outcomes, nurses should implement appropriate interventions depending on the magnitude of the falls and the affected population. As discussed throughout this paper, exercise-based therapy is a reliable intervention for preventing falls among older adults. This critical goal is realized by guiding and encouraging older adults to exercise moderately to improve balance and physicality. Therefore, similar outcomes would be realized in the current setting and broader nursing practice through exercise-based programs targeting older adults at risk of falls.

References

• Arkkukangas, M., Cederbom, S., Tonkonogi, M., & Umb Carlsson, Õ. (2021). Older adults’ experiences with mHealth for fall prevention exercise Usability and promotion of behavior change strategies. Physiotherapy Theory and Practice, 37(12), 1346-1352. https //doi.org/10.1080/09593985.2020.1712753
• Cederbom, S., Bjerk, M., & Bergland, A. (2022). A qualitative study exploring physical therapists’ views on the Otago Exercise Programme for fall prevention a stepping stone to “age in place” and to give faith in the future. Physiotherapy Theory and Practice, 38(1), 132-140. https //doi.org/10.1080/09593985.2020.1731895
• Chandrasekaran, S., Hibino, H., Gorniak, S. L., Layne, C. S., & Johnston, C. A. (2021). Fear of Falling Significant barrier in fall prevention approaches. American Journal of Lifestyle Medicine, 15(6), 598–601. https //doi.org/10.1177/15598276211035360
• Chittrakul, J., Siviroj, P., Sungkarat, S., & Sapbamrer, R. (2020). Multi-system physical exercise intervention for fall prevention and quality of life in pre-frail older adults a randomized controlled trial. International Journal of Environmental Research and Public Health, 17(9), 3102. https //doi.org/10.3390/ijerph17093102
• Cook, A., Swindall, R., Spencer, K., Wadle, C., Cage, S. A., Mohiuddin, M., … & Norwood, S. (2023). Hospitalization and readmission after single-level fall a population-based sample. Injury Epidemiology, 10(1), 49. https //doi.org/10.1186/s40621-023-00463-4
• Ehrari, H., Larsen, R. T., Langberg, H., & Andersen, H. B. (2020). Effects of playful exercise of older adults on balance and physical activity a randomized controlled trial. Journal of Population Ageing, 13, 207-222. https //doi.org/10.1007/s12062-020-09273-8
• Hoft, J. (2021). Anonymity and confidentiality. The Encyclopedia of Research Methods in Criminology and Criminal Justice, 1, 223-227. https //doi.org/10.1002/9781119111931.ch41
• LeLaurin, J. H., & Shorr, R. I. (2019). Preventing Falls in hospitalized patients state of the science. Clinics in Geriatric Medicine, 35(2), 273–283. https //doi.org/10.1016/j.cger.2019.01.007
• Ochoa, D. (2020). Fall prevention in observation patients. St. Joseph Hospital. https //digitalcommons.psjhealth.org/cgi/viewcontent.cgi?article=1060&context=sjo-ebp
• Rikkonen, T., Sund, R., Koivumaa-Honkanen, H., Sirola, J., Honkanen, R., & Kröger, H. (2023). Effectiveness of exercise on fall prevention in community-dwelling older adults a 2-year randomized controlled study of 914 women. Age and Ageing, 52(4), afad059. https //doi.org/10.1093/ageing/afad059
• Xu, A., Baysari, M. T., Stocker, S. L., Leow, L. J., Day, R. O., & Carland, J. E. (2020). Researchers’ views on, and experiences with, the requirement to obtain informed consent in research involving human participants a qualitative study. BMC Medical Ethics, 21(1), 1-11. https //doi.org/10.1186/s12910-020-00538-7
• Zabor, E. C., Kaizer, A. M., & Hobbs, B. P. (2020). Randomized controlled trials. Chest, 158(1S), S79–S87. https //doi.org/10.1016/j.chest.2020.03.013