NUR-550 Literature Review – Resubmission

TOPIC 1 DQ 1

Based on the PICOT you developed for NUR-550, summarize the intervention you are proposing. How does this support the population of focus, your setting, and role? Justify how the problem you selected to investigate is amenable to a research-based intervention using the PICOT format. Include your PICOT statement with your response.

Alzheimer’s patients were disproportionately affected by COVID-19 (Azarpazhooh, 2020; Wang, 2021). While there is a biologic/genetic component to the mortality rates (Wang et al., 2020), it is unknown whether the quarantine induced social isolation contributed to mortality rates. Since COVID-19 vaccines have high efficacy (CDC, 2021) and have increased the safety of the elderly in community settings, it has become more common for facilities to allow Alzheimer’s family member act as a caregiver and advocate.

The importance of family/friends to Alzheimer’s patients can not be denied. During the initial COVID-19 lock-downs of community settings and long-term care, dementia patients neuropsychiatric symptoms and confusion increased due to the dramatic change and loss of their loved ones (Boutoleau-Bretonnière,2020). Therefore, during the pandemic, caregivers were eventually allowed into the facilities for compassionate visitation. The question facing the community as it faces future pandemics and lock-downs, is how to keep the Alzheimer’s patients safe without the dramatic social isolation from their family caregivers. Therefore, like paid caregivers and medical staff, family caregivers should receive basic infection control training. The PICOT is defined by: NUR-550 Literature Review – Resubmission NUR 590 Topic 1 Assignment

Will educating Alzheimer’s’ caregivers in disease transmission control help reduce community acquired infections in Alzheimer’s patients living in community settings (i.e., long term care or assisted living) over a 3-month period?

Population: Alzheimer’s patients

Intervention: disease transmission education

Comparison: education complete versus not

Outcome: reduce community acquired infections (i.e. COVID-19, pneumonia, etc.)

Time period: 3 months

By educating family caregivers, it adds to the resources of the community settings. In the case of long-term care, the patient receives better care from their family member with staff support and reduces demands on staff time. This reduces staff stress and caseload while increasing the availability of staff to other patients.

Azarpazhooh, M. R., Amiri, A., Morovatdar, N., Steinwender, S., Rezaei Ardani, A., Yassi, N., Biller, J., Stranges, S., Tokazebani Belasi, M., Neya, S. K., Khorram, B., Sheikh Andalibi, M. S., Arsang-Jang, S., Mokhber, N., & Di Napoli, M. (2020). Correlations between COVID-19 and burden of dementia: An ecological study and review of literature. Journal of the Neurological Sciences, 416, 117013. https://doi.org/10.1016/j.jns.2020.117013

Boutoleau-Bretonnière, C., Pouclet-Courtemanche, H., Gillet, A., Bernard, A., Deruet, A., Gouraud, I., Mazoue, A., Lamy, E., Rocher, L., Kapogiannis, D., El Haj, M. (2020). The effects of confinement on neuropsychiatric symptoms in Alzheimer’s disease during the COVID-19 crisis. Journal of Alzheimer’s Disease. 76(1):41-47. doi: 10.3233/JAD-200604. PMID: 32568211.

Wang Q., Davis P., Gurney M., Xu, R. (2021) COVID‐19 and dementia: Analyses of risk, disparity, and outcomes from electronic health records in the US. Alzheimer’s Dementia, 2021, 1– 10. https://doi.org/10.1002/alz.12296

A Sample Answer 5 For the Assignment: NUR-550 Literature Review – Resubmission

Title: NUR-550 Literature Review – Resubmission 

TOPIC 1 DQ 2 

Explain the importance of a “spirit of inquiry” in an evidence-based culture and what you can do as an advanced registered nurse to encourage this within your practice or organization. In response to your peers, compare the role and implementation of EBP in your specialty area with another advanced registered nurse specialty.

Evidence-based practice for nursing is driven by the influence and motivation to seek more information that would support interventions and practice. The spirit of inquiry is the term given to this motivation as nurses continue to question current practices and knowledge for evidence-based practice. Without it, research would go stale and would not produce any change that could significantly increase positive outcomes in health care or practice. Evidence-based culture is dependent on those who nurses who seek to explore more possibility in practice, patient care and health knowledge so that health care not only constantly improving but also evolving to meet changes in health demands and technologies. Advanced registered nurses can encourage inquiry in their respective areas of practice where they feel that although there is good outcomes, better ones can be produced with a change in evidence-based practice. This would require extensive research which those advanced nurses must have the motivation to thoroughly examine through the evidence-based research process. Giving opportunity to make changes to how they practice and how it affects the patients will produce professional rewarding as well as personal ones too which is why nudging and leading other nurses to participate in change can greatly improve patient outcomes from interventions (Arzouman, 2015).

Nurse Informaticists utilize evidence-based communication and technology integration techniques so that patient care and information systems are beneficial to all parties involved. Utilization of nursing experience in order to enhance communication or health records can streamline patient care so that efficiency can reach maximum potential. Leadership is also important to nursing informatics and communication when implementing evidence-based practice interventions. Having knowledge of communication barriers and having implementing creativity in overcoming them provides valuable resources to patient care and health (Farokhzadian, Jouparineiad, Fatehi & Falahati-Marvast, 2021).

NUR-550 Literature Review – Resubmission References:

Arzouman, J. (2015). Evidence-Based Practice: Share the Spirit of Inquiry. MEDSURG Nursing, 24(4), 209–211.

Farokhzadian, J., Jouparinejad, S., Fatehi, F., & Falahati-Marvast, F. (2021). Improving nurses’ readiness for evidence-based practice in critical care units: results of an information literacy training program. BMC Nursing, 20(1). https://doi-org.lopes.idm.oclc.org/10.1186/s12912-021-00599-y

A Sample Answer 6 For the Assignment: NUR-550 Literature Review – Resubmission

Title: NUR-550 Literature Review – Resubmission 

This is insightful Deanna, Maternal Morbidity and Mortality are on the rise in the United States compared to any other developed country. Maternal morbidity refers to the physical or mental illnesses or disability that directly relates to childbirth or pregnancy (Blosser et al., 2021). The above conditions may not be necessarily life-threatening but can lead to significant effects on the quality of life. Due to different health conditions, women often experience Postpartum hemorrhage which leads to high number of deaths (Evensen et al., 2017). Postpartum hemorrhage refers to a situation where women experience heavy bleeding after birth. The condition is always serious but rare; it is normally experiences within a day after childbirth. However, it can occur up to 12 weeks after birth. Almost one in five in 100 women suffer from postpartum hemorrhage in the United States (Newsome et al., 2017). The proposed intervention can successfully leads to the reduction in the number of deaths caused by postpartum hemorrhage in different healthcare settings.

NUR-550 Literature Review – Resubmission References

Blosser, C., Smith, A., & Poole, A. T. (2021). Quantification of blood loss improves detection of postpartum hemorrhage and accuracy of postpartum hemorrhage rates: A retrospective cohort study. Cureus. https://doi.org/10.7759/cureus.13591

Evensen, A., Anderson, J. M., & Fontaine, P. (2017). Postpartum hemorrhage: prevention and treatment. American family physician, 95(7), 442-449. https://www.aafp.org/afp/2017/0401/p442.html

A Sample Answer 7 For the Assignment: NUR-550 Literature Review – Resubmission

Title: NUR-550 Literature Review – Resubmission 

Patient safety and improved quality of care requires providers and organization to use evidence-based practice (EBP) interventions to tackle issues that may cause adverse events like patient falls. Patients in medical-surgical units are susceptible to falls because of their delicate nature. The Centers for Medicare and Medicaid Services (CMS) considers falls as never events since they are preventable (Melnyk et al., 2022). Falls lead to increased stay in hospitals, poor patient outcome and serious fractures and head injuries that can lead to death. The use of bundled care approach through TIPS (tailoring interventions for patient safety) is considered one of the most effective ways to reduce and prevent falls in medical-surgical settings. The purpose of this literature review paper of the EBP project is to compare articles on the use of TIPS toolkit to reduce and prevent falls in medical-surgical settings.

PICOT Statement and Question

Nationwide, patient falls while in hospitals, particularly in medical-surgical units, are a leading cause of permanent disability and even death. Further, hospitalization increases one’s fall risk as close to three percent of patients fall while in hospitals. Nearly 30% of those who experience falls sustain injuries with a rise in the number of days in hospitals by close to 7 days. Again, under Medicare, the CMS does not reimburse falls and hospitals cannot get a Magnet designation when their fall rates are not below the national average (Khasnabish et al., 2020). The implication is that hospital managers and leaders must seek ways, through the use of evidence-based practice, to reduce the occurrence of falls. The use of TIPS toolkit is considered one of the most effective ways to reduce and mitigate falls and their occurrences as well as effects on patients in medical-surgical units.

PICOT Question

Among hospitalized adult patients in medical-surgical units (P) does the use of TIPS toolkit as a bundled care approach (I) compared to normal falls prevention approach (C) reduce the prevalence of falls (O) within 6 months (T)?

Search Methods

The evidence-based practice process implores researchers to seek evidence from previous research articles when doing their literature to obtain findings that support their proposed projects or interventions. The use terms, phrases and words associated with the topic under investigation and exploring databases to generate scholarly sources are some of the standard search strategies that one can deploy to attain relevant evidence. The study employed these strategies, starting with key terms and words in different databases. These included PubMed, Cochrane and Google Scholar as well as CINAHL. The strategy also entailed the use of CRAAP approach that involves searching for articles which are current, relevant, accurate, authoritative and purposeful to the area or topic under investigations (Melnyk et al., 2022). Using this criteria, the paper identified the reviewed articles and describes how they support the proposed EBP project to reduce and prevent the occurrence of falls in medical-surgical settings.

Research Synthesis

Article 1

The first article by Dykes et al. (2020) evaluates the use of a patient-centered fall prevention TIPS to lower falls and their associated injuries. Using non-randomized controlled trials with the study set in 14 medical units in Boston and New York, the researchers show a positive link between the intervention and a decline in number of falls. The researchers are categorical that nurse-led interventions can reduce injurious falls through providing information to families on fall management and prevention. The article demonstrates the efficacy of using TIPS as an intervention as depicted by the PICOT question.

Article 2

The second article by Tzeng et al. (2021) focuses on the impact of using TIPS program in reducing falls among older adults in nursing homes. Using a mixed method approach in a 15-bed nursing unit, the findings from the study shows that fall TIPS can reduce the rate of falls, especially injurious falls among older patients or adults. The TIPS program entails different approaches that include patient education and creating awareness about the harmful effects of falls. The article is critical to the EBP proposed project as it illustrates the increased role of TIPS initiative to reduce falls as depicted in the PICOT question. The article supports the EBP project since it shows that TIPS as an intervention is effective.

Article 3

In this article by Morris et al. (2022) the researchers conduct a systematic review of literature and meta-analysis on diverse interventions that can reduce falls. The researchers identify a host of interventions based on the data collected from the 43 studies that met their inclusion criteria. The findings show that tailoring or customization of interventions leads to reduced rates of falls for patients in such facilities. These interventions are effective when they consider the different components and factors impacting patient situations. As such, the article supports the EBP proposed project by demonstrating the effectiveness of diverse and tailored interventions for patients based on their level of acuity.

Article 4

The fourth article by Heng et al. (2020) is a scoping review of how hospitals can use patient education as a strategy to prevent falls. The researchers focused on 43 articles when analyzing the different approaches in patient education that confer benefits to patients to reduce their susceptibility to falls. The analysis shows that patient educational interventions can reduce falls that lead to injuries and bruises as well as lacerations and fractures. The study recommends the need to deploy TIPS as an effective approach to reducing and mitigating falls among patients. The article supports the EBP proposed project as it shows the need for diverse interventions like different approaches to educating patients on fall risks that they may be exposed to in their activities of daily living.

Article 5

In their article, LeLaurin et al. (201) aim at familiarizing different stakeholders about the benefits as well as the cons of various types of research studies on testing fall prevention interventions. The researchers opine that organizations and providers should focus on diverse interventions, one point at a time, to attain their efficacy and impact on patient fall management. The study’s findings are categorical that the effectiveness of each type of interventions depends on a host of factors. Therefore, customizing or tailoring these interventions is essential to attaining quality outcomes and helping patients avoid and reduce their susceptibility to falls. The article is important in the EBP project as it shows the need for tailoring each intervention to suit patient needs and situations.

Article 6

The article by Dykes et al. (2019) focuses on the effectiveness of tailoring interventions through a collaborative approach among providers. Using a qualitative approach or design, the article demonstrates that fall TIPS program is effective in reducing and preventing falls in diverse patient settings. The study is emphatic that TIPS model is important for providers to reduce and prevent falls. The article supports the EBP proposed project as it illustrates the importance of customizing interventions to meet patient needs and reduce susceptibility to falls.

Article 7

In this article by Cuttloer et al. (2018), the researchers aim at reducing inpatient falls in medical-surgical settings through technology-enabled TIPS initiative. The researchers use a four-minute video to provide patient education and collect their views on the implementation based on their situation. The findings are consistent that TIPS initiatives reduce and prevent falls. Therefore, the article supports the EBP project by showing that tailoring interventions is essential in addressing patient falls in medical-surgical settings.

Article 8

In their study, Bargmann et al. (2020) evaluates the effects of implementing a multicomponent fall prevention program to improve patient safety because of risks associated with falls. Set in a 26-bed medical surgical telemetry unit, the study shows that these interventions are effective in reducing falls and risks associated with falling for fragile patients. The article supports the EBP project since it is categorical that TIPS model reduce and prevents the occurrence of falls.

Comparison of the Articles

The reviewed articles share certain aspects in their research findings and also differ in other areas. for instance, all the articles agree that tailoring interventions on falls is an effective strategy that all providers and facilities should leverage in their settings. Again, the article agree that the TIPS model gives hospitals and providers increased leeway to implement interventions that are appropriate to their facilities based on their cost and other components. Thirdly, all the articles demonstrate that multiple interventions are complementary to the efforts and policies developed by organizations to reduce and prevent falls in their articles.

None of the article demonstrates controversies but all agree conclusively that more studies are required to provide significant outcomes. The articles also share limitations like timelines to conduct the studies, use of same settings and need for beet support from management and other stakeholders (Khasnabish et al., 2020). The articles do not have significant differences as they are emphatic that these diverse interventions are necessary in reducing falls, especially injurious falls among older patients.

Suggestions for Future Research

An analytical perspective of the eight articles and others demonstrate the need for more research to tackle some of the gaps. For instance, the articles do not offer a standard TIPS approach that can be used across all facilities, irrespective of their patient’s acuity and needs. As such, it is important to have more studies on the development of a standardized tool or approach to falls based on the nature of the respective setting, from medical-surgical units to outpatient facilities.

Conclusion

Falls are a major health issue that impact overall quality of care and life for patients, especially the elderly admitted to medical-surgical units. The use of TIPS toolkit; either patient-centered or nurse-driven, is critical to reducing these falls because of their adverse effects like injuries and long-term fractures and disabilities. The articles are emphatic that using TIPS allows providers to offer the most effective interventions to reduce and prevent their occurrence. The review illustrates that sufficient evidence exists to support the proposed interventions based on the TIPS framework to reduce falls.

NUR-550 Literature Review – Resubmission References

Bargmann, A. L., & Brundrett, S. M. (2020). Implementation of a multicomponent fall

prevention program: Contracting with patients for fall safety. Military medicine, 185(Supplement_2), 28-34. https://doi.org/10.1093/milmed/usz411

Cuttler, S. J., Barr-Walker, J., & Cuttler, L. (2018). Reducing medical-surgical inpatient falls and

injuries with videos, icons and alarms. BMJ open quality, 6(2), e000119.

DOI: 10.1136/bmjoq-2017-000119

Dykes, P. C., Adelman, J. S., Alfieri, L., Bogaisky, M., Carroll, D., Carter, E., … & Spivack, L.

370. (2019). The fall TIPS (tailoring interventions for patient safety) program: A collaboration to end the persistent problem of patient Falls. Nurse Leader, 17(4), 365-370. https://doi.org/10.1016/j.mnl.2018.11.006

Dykes, P. C., Burns, Z., Adelman, J., Benneyan, J., Bogaisky, M., Carter, E., Ergai, A., Lindros,

2025889. E., Lipsitz, S. R., Scanlan, M., Shaykevich, S., & Bates, D. (2020). Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries. JAMA Network Open, 3(11), e2025889. https://doi.org/10

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

falls prevention with patient education: a scoping review. BMC geriatrics, 20, 1-12. DOI: https://doi.org/10.1186/s12877-020-01515-w

Khasnabish, S., Burns, Z., Couch, M., Mullin, M., Newmark, R., & Dykes, P. C. (2020). Best

practices for data visualization: creating and evaluating a report for an evidence-based fall prevention program. Journal of the American Medical Informatics Association, 27(2), 308-314. DOI: 10.1093/jamia/ocz190.

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: state of the

science. Clinics in geriatric medicine, 35(2), 273-283. DOI: 10.1016/j.cger.2019.01.007

Melnyk, B. M., & Fineout-Overholt, E. (2022). Evidence-based practice in nursing &

            healthcare: A guide to best practice. Lippincott Williams & Wilkins.

Morris, M. E., Webster, K., Jones, C., Hill, A. M., Haines, T., McPhail, S., … & Cameron, I.

(2022). Interventions to reduce falls in hospitals: a systematic review and meta-analysis. Age and Ageing, 51(5), afac077. https://doi.org/10.1093/ageing/afac077

Tzeng, H.-M., Jansen, L. S., Okpalauwaekwe, U., Khasnabish, S., Andreas, B., & Dykes, P. C.

(2021). Adopting the Fall Tailoring Interventions for Patient Safety (TIPS) Program to Engage Older Adults in Fall Prevention in a Nursing Home. Journal of Nursing Care Quality, https://doi.org/10.1097/ncq.0000000000000547