Proposed evidence

Evidence-Based Practice Proposal - Section C: Literature Support

Evidence-Based Practice Proposal - Section C: Literature Support

With any evidenced-based practice(EBP) proposal it is imperative that there is literature support to strengthen the proposal. The World Health Organization(WHO), asserts "the global population of people aged 60 years and older will more than double, from 900 million in 2015 to about 2 billion in 2050" (WHO, 2017). One phenomena arising from these statistics is that of elderly abuse, according to WHO (2017), "rates of abuse may be higher for older people living in institutions than in the community." This paper is designed to address the following PICOT: In extended care facility patients, does staff education and proper staffing compare to lack of education and poor staffing decrease elderly abuse? This author will substantiate literature support for this PICOT by addressing, search method, summarizing research studies, and expound on the validity of internal and external research.

Search Method Description

To fully appreciate the information available on this topic, this author conducted research on the web as well as Grand Canyon University Library. Data bases included, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL, Ovid, Medline and pubmed. Publication date ranged from 2010 through 2017. Key words included: Elder abuse, Nurs* or staff*, Educat* or train*, and nursing homes. At first glance this search yielded 141 publications but was further streamlined to 75 articles. Inclusion criteria consisted of articles that were focused on extended care facilities, prevention, education and staffing ratios. Among the exclusion criteria were identifying and reporting abuse, articles that identified the problem but provided no data on education or staffing ratios. Through gleaning of abstracts and articles without abstracts, this author identified eight articles that were thought to be relevance to the topic at hand, but one was removed upon further review leaving seven articles.

Summary of Research Studies

In a study performed by Baker, et al .2016, the authors embarked on a journey to identify the effect of specific programs or strategies would have on the reduction of elderly abuse. Baker et al. compiled seven studies from 19 databases, with 1924 elderly participants and 740 individuals that were either caregivers, or nursing home staff who had rapport with the elderly participants. At the conclusion of the study the authors identified a risk of bias of about 40%; they also questioned "whether targeted educational interventions improved the knowledge and health of allied professionals and caregivers about elder abuse" (Baker, et al. 2016, pg. 1.) Limitations include studies that were done in countries with high income. There were no specific information on equity or disadvantages (Baker et al. 2016).

Daly and Coffey's study focused on the perception nurses and care givers held on elderly abuse, and whether they were educated on what constitutes elder abuse (Daley, & Coffey, 2010). This was a "quantitative descriptive co-relational design. Questionnaires were used for 66 nurses and 48 care assistants in long term care" (Daly, & Coffey, 2010, pg. 33). Daly & Coffey identified a "high level of uncertainty about what constitutes abuse" (2010, pg. 35) . Hence this study is supportive of education, as when staff are educated they will be able to identify abuse which should lead to a decrease in abuse. This study's limitations include, "a limited population and geographical area…and language of questionnaire could have been more culturally minded" (Daly & Coffey, 2010, pg. 34).

Another study conducted by Hawes, & Kimbell 2010, geared at detection, investigation and resolution of elder abuse for those living in residential care facilities (RCF). Study consisted of a national survey, telephone surveys, reviews of RCF licensing laws, along with focused group interviews (Hawes, & Kimbell, 2010). The findings supported the need for education was important in decreasing elder abuse. Education was recommended for RCF owners, operators and staff to prevent abuse and neglect. This study however had some limitations where only six states had site visits and the data collected from other states was limited. The states that were selected, were done so because variances were expected (Hawes, & Kimbell, 2010).

In 2014, Evanina, conducted a study to scrutinize the effect education had on staff and patients in long term care. This was of a quasi experimental design consisting of a control and an experimental group. Four long term care (LTC), from Pennsylvania was the target. Evanina concluded, that applying the strategy of education, is an effective strategy in preventing elderly abuse. Limitations include a small demographic are.

Natan, & Lowenstein, (2010), conducted a research on the different factors that leads to abuse of the elderly. This was a quantitative descriptive study that consisted of 600 questionnaires distributed to 24 out of 300 long term care facilities. The sample was a random one. The authors concluded, "the higher the staff-to patient ratio, the higher the risk of physical neglect and total number of maltreatment incidence per patient" (Natan, & Lowenstein, 2010, pg. 22). While 510 individuals responded to questionnaires the number of facilities surveyed was small.

Another study on elder abuse was conducted by Skirbekk, & James in 2011. Conducted in India, this study was concerned with what role education played in elderly abuse in India. This cross section analysis looked at the seven oldest states in India and interviewed 9852 elderly patients. The authors deemed education was important to decreasing elderly abuse. Limitations include the number of long term facilities that were study.

The final article was a conducted by Wangmo, Nordstrom, & Kressig in 2016. An exploratory qualitative interview that focused on why there is abuse and neglect of the elderly in geriatric institutions. This study had a cross section of nurses, healthcare providers and nursing assistants. The authors felt there may have been some response bias, along with a small sample size. The conclusion was that educational training and staff to patient ratio was important in decreasing elderly abuse and neglect. With only 23 participants, it is safe to say this study had some limitations. It could not be generalized and participants were recruited who knew each other. There was also the possibility that participants were bias in their response. With any research, validity is important.

Validity of Internal and External Research

Validity of research is "how well the results of a study measure what they are intended to measure" (Sauro, 2014).  For the most part the studies did a good job of matching the reality of elderly abuse. The findings can be see across many cross-sections. Most of the studies were interviews, or surveys which can be duplicated. The studies were consistent in identifying the problem of elderly abuse and the lack thereof identification and prevention.

Conclusion

The importance of appraising literature came full circle for this author. There were many literature that appeared to be what was needed but in depth appraisal proved otherwise. Understanding research is something this author needs to spend more time on. The take away from this paper is that proper appraisals and research will lead to a good end product. This author most certainly has work to do in order to answer her PICOT with supporting evidence.

References

Daly, J. & Coffey, A. (2010). Staff perceptions of elder abuse. Nursing Older People, (22)4, 33- 37

Evanina, K. (2014). The effect of education on elder abuse (Order No. 3617958). Available from ProQuest Central; ProQuest Dissertations & Theses Global. (1528538067). Retrieved from https://lopes.idm.oclc.org/login?url=https://search-proquest- com.lopes.idm.oclc.org/docview/1528538067?accountid=7374

Hawes, C., Kimbell, A. (2010). Detecting, Addressing and Preventing Elder Abuse In Residential Care Facilities. The School of Rural Public Health, TAMU 1266 Texas A & M Health Science Center. Retrieved from https:// www. ncjrs.gov/pdffiles1 /nij/grants/229299.pdf

Sauro, J. (2014). Assessing the Validity of your Research. Measuring U. Retrieved from https://measuringu.com/validity-research/

Skirbekk, V., & James, K.S. (2011). Abuse against elderly in India- the role of education, BMC

Public Health 14(1), 1. doi:10.1186/1471-2458-14-336

Wangmo, T., Nordstrom, K., &Kressig, R.W. (2016). Preventing elder abuse and neglect in geriatric institutions: Solutions from nursing care providers. Geriatric Nursing. doi:10.1016/j.gerinurse.2016. 12.016 Exploratory qualitative interviews (abstract)

World Health Organization (WHO), (n.d.). Abuse of the Elderly. Retrieved from http://www .who.int/violence_injury_prevention/violence/global_campaign/en/chap5.pdf