This assignment is the first step in an ongoing project throughout the course. It is important to formulate your question carefully and specifically - you will be using this question to guide your evi

Identify a Clinical Problem and Formulate a PICO(T) Question

PICO Overview of Topic

When caring for patients, it is always important to assess for their fall risk, especially in elderly patients. For the patient, falls can result in very serious injuries and an increased hospital stay. For the healthcare facility, it can mean an additional healthcare cost that they have to pay. Centers for Medicaid & Medicare Services (CMS) refuses to reimburse for necessary care provided when patient’s experience an accidental fall (Schub & Woten, 2018).

Falls can occur due to a wide range of factors including: impaired mobility, cognition, balance and gait, over-reliance on routine living activities, and having a history of falls (Tzeng & Yin, 2015). Accidental falls, such as tripping, and anticipated physiological falls, such as an abnormal gait and balance, are generally preventable (Tzeng & Yin, 2015). However, unanticipated physiological falls, such as a seizure, and behavioral falls, such as when a patient acts out, are not avoidable (Tzeng & Yin, 2015). For this reason, this student believes that using a bed alarm will help reduce patient falls, rather than hourly rounding. In addition to fall prevention programs, having a bed alarm for patients who have a high fall risk will help address the issue of falls.

Population

The population that is most effected by falls are older patients, “approximately 23-42% of falls occur among older adults residing at home; this compared with 6-22% among older adults in nursing homes and 3-16% among older inpatients” (Jung, Shin & Kim, 2014). In 2010, 31.7% of patients over the age of 65, fell and experienced an injury (Tzeng & Yin, 2015).

Intervention

If utilized correctly, bed alarms will result in significant benefits. For instance, bed alarms alert healthcare staff whenever there is a change in the position of the patient. These alarms can be placed on beds, chairs, or wheelchairs. When the alarm goes off, it provides staff adequate time to get to the patient’s room to help them (Tzeng & Yin, 2015). It helps nurses to intercept the patient before any serious injury can occur. It can also help older patients, as a reminder that they cannot leave their bed, chair, wheelchair, without the assistance of a healthcare provider. Bed alarms should be used with other interventions such as floor mats and having the bed at the lowest position.

Comparison

Another strategy for preventing falls is hourly rounding. Even though hourly round can help, it may not be as effective as bed alarm. This is because a fall can still occur right after the nurse goes to round on a patient. With a bed alarm, the alarm will go off when there is a disturbance in weight change resulting in a healthcare provider to check on the patient right away. In a study done by Tucker, Bieber, Attlesey-Pried, Olson, and Dierkhising (2012), they examined the effect of a structed nursing rounds intervention on fall reduction. The intervention initially appeared to reduce falls, however, the reduction was not sustained 1 year later (Tzeng & Yin, 2015).

Outcome

When patients experience a fall, it can result in serious injuries such as fractures. Fractures are the most frequently reported injury resulting from falls among older adults, accounting for 60% of all fall-related injuries (Jung, Shin & Kim, 2014). Worst case scenario, a complication from certain types of fracture, such as hip joint, may even lead to death or immobility (Jung, Shin & Kim, 2014). If a fall results in immobility, that can lead to secondary health problems such as weakness, constipation, reduced fitness, social isolation and reduced quality of life (Jung, Shin & Kim, 2014).

Conclusion

Fall prevention is necessary for patients who are at high risk for falls. Interventions such as bed alarms will help with reducing falls because it aids nurses to monitor their patients. Bed alarms are more effective than hourly rounding because it helps constantly monitor patients.

PICO Question

In older patients (65 and older), can the use of alarms sensors or bed alarms help reduce accidental falls compared to hourly rounding?

Ethical Considerations

Ethical research exists because there are many factors in place to protect the rights of individuals (Schmidt & Brown, 2019). These factors are here to protect human rights. Human rights are “freedoms, to which all humans are entitles, often held to include the right to life and liberty, freedom of thought and expression, and equality before the law” (Schmidt & Brown, 2019, p. 54). When research and studies are conducted, individuals within this research have rights that need to be protected. It is their choice whether or not they want to participate. They should be given all the information of the study, so they can make an informed decision. It is the nurse’s job to help protect individuals and their rights.

Respect for Persons

The respect for persons principle states that “individuals should be treated as autonomous and that those diminished autonomy are entitles to protection” (Schmidt & Brown, 2019 p. 57). People should have the right to make decisions for themselves and when they are unable too, someone else should be there to look out for their best interest. The respect for persons comes down to respecting human dignity. Everyone is entitled to dignity. If patients did not want to be recorded for this study it would be their choice, however bed alarms are still implemented regularly to help prevent falls. If patients felt really uncomfortable using a bed alarm, other implementations would be used to help them from falling.

Assurance of Autonomy

Conducting an evidence-based practice with patients over the age of 65 years old, there is a chance some may have “diminished autonomy”. This term refers to a person in some respect controlled by others or incapable of deliberating or acting on the basis of his or her desired plans (Varelius, 2006, p. 377). Assuring their autonomy is utilized when conducting research is an important factor in respecting the patients’ rights. There will be someone that is there to decide for them that will most benefit the patient.

Beneficence

Beneficence is the principle of doing good (Schmidt & Brown, 2019). The main aspects of this principle are to do no harm and to maximize possible benefits and minimize possible harm (Schmidt & Brown, 2019, p. 58). This research will maximize benefits by collecting accurate data, utilizing a proper number of participants to yield precise results, and respecting everyone’s rights. In order to minimize harm to any patient, their confidentiality will be ensured, and informed consent will be gained. The benefits of changing practice would be to get different insight about the research, seeing if doing something different yields better results. The benefit of staying with the same practice would be familiarity and comfort.

With this particular research, the risk is minimal. Patients will still have other precautions to protect them from falls such as floor mats and having their bed on the lowest setting. This study is a very low risk study considering bed alarms and hourly rounding are already utilized. This study is just to see which particular implementation works better.

Justice

The principle of justice includes “equity or fairness in the distribution of burdens and benefits” (Schmidt & Brown, 2019, p. 58). Everyone should be treated equally. Everyone will be treated with fairness and respect. There will be a random selection of patients asked to participate so that results will not be skewed. They will be informed of the research and asked to sign an informed consent. Every participate will receive the standard of care (Schmidt & Brown, 2019). This researcher will ensure that all findings from this study are distributed to all clients as well as other units. However, patient confidentiality will still be maintained.

References

Jung, D., Shin, S., & Kim, H. (2014). A fall prevention guideline for older adults living in long-

term care facilities. International Nursing Review, 61(4), 525–533. https://doi- org.ezproxy.rasmussen.edu/10.1111/inr.12131

Schmidt, M. & Brown, N. (2019). Evidence-Based Practice for Nurses, 4th Edition. [Bookshelf Ambassadored]. Retrieved from https://ambassadored.vitalsource.com/#/books/undefined/

Schub, T. B., & Woten, M. R. B. (2018). Fall Prevention in Hospitalized Patients. CINAHL

Nursing Guide. Retrieved from http://ezproxy.rasmussen.edu/login?url=http://search.ebscohost.com/login.aspx?direct=tr ue&db=nup&AN=T700313&site=eds-live

Tzeng & Yin. (2015). Patient Engagement in Hospital Fall Prevention. Nursing

Economics, 33(6), 326–334. Retrieved from http://ezproxy.rasmussen.edu/login?url=http://search.ebscohost.com/login.aspx?direct=tr ue&db=keh&AN=111669237&site=eds-live

Varelius, J. (2006). The value of autonomy in medical ethics. Medicine, health care, and philosophy, 9(3), 377-88. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780686/