NRS 433 PICOT Question and Literature Search

Falls among patients, especially older patients in nursing homes, are a critical healthcare concern because of their adverse effects on outcomes. Falls lead to increased cost of care due to lengthened stay in hospital, adverse events like head injuries and even death. Older patients, 65 years and above, are susceptible to falls due to different reasons that include loss of muscle mass, a condition known as sarcopenia, cognitive impairment or due to certain types of dementia and failing eye sight. Medications can also increase one’s susceptibility to due to their side effects like confusion and dizziness. According to the Centers of Disease Control and Prevention (CDC) (2023), fall pose a threat to the health of older adults and reduces their ability to remain independent. The CDC says that over 36,000 deaths occurred in 2020 associated with falls among the elderly with another 3 million emergency department visits due to falls. The Centers for Medicare and Medicaid Services (CMS) consider falls as a never event because they are preventable when hospitals implement evidence-based practice (EBP) interventions. Evidence-based practice interventions like tailoring interventions for patient safety (TIPS) can help providers reduce and prevent falls and their adverse effects in diverse healthcare settings. The purpose of this paper is to review articles on TIPS based on the formulated PICOT question. The paper reviews both qualitative and quantitative research articles on TIPS as an effective intervention to reduce falls among the elderly in nursing homes.

PICOT Question: Among older adults aged 65 years and above in nursing homes and residences (P), does the implementation of TIPS framework (I) compared to normal safety measures (C), reduce and prevent fall by 60% and associated effects (O) within six months (T)?

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Criteria	Article 1	Article 2	Article 3
APA-formatted article citation with permalink	Vincenzo, J. L., Patton, S. K., Lefler, L. L., McElfish, P. A., Wei, J., & Curran, G. M. (2022). A qualitative study of older adults’ facilitators, barriers, and cues to action to engage in falls prevention using health belief model constructs. Archives of gerontology and geriatrics, 99, 104610. https://doi.org/10.1016/j.archger.2021.104610	Carter, E. J., Khasnabish, S., Adelman, J., Bogaisky, M., Lindros, M. E., Alfieri, L., … & Dykes, P. (2020). Adoption of a patient-tailored fall prevention program in academic health systems: a qualitative study of barriers and facilitators. OBM Geriatrics, 4(2), 1-21. doi:10.21926/obm.geriatr.2002119	Rogers, C., Shamley, D., & Amosun, S. (2021). Older adults’ experience of an exergaming intervention to improve balance and prevent falls: a nested explanatory qualitative study. Applied Sciences, 11(24), 11678. https://doi.org/10.3390/app112411678
How does the article relate to the PICOT question?	The article supports the PICOT as it demonstrates the efficacy of using different interventions that focus on improving patient safety among patients	The article relates to the PICOT question as it demonstrates that fall TIPS can have significant impact on patients and staff when implemented in any setting.	The article relates to the PICOT as it shows that using better tailored interventions can reduce falls among patients in different settings.
Is the article qualitative, quantitative, or mixed methods? Justify your selection.	Qualitative The article is qualitative based on the method that the researchers apply informed grounded theory and focus groups based on semi-structured interviews	Qualitative The researchers use qualitative approaches like observation and interviews to gather perceptions and opinions about the implemented Fall TIPS aspects.	Qualitative The researchers uses focus groups and analyze the results using content analysis.
Purpose statement	The purpose of the study was to gather views and perceptions from older patients about ways to prevent falls	The purpose of the article was to identify the barriers and facilitators to Fall TIPS adoption.	The purpose of the article was to explore the efficacy of a large-scale randomized control trial that compared an exergaming intervention and gold-standard one as well as no intervention.
Research question(s)	Does engagement in fall prevention activities reduce and prevent falls?	What are the barriers and facilitators to Fall TIPS adoption in healthcare organizations?	What is the effects of using tailored interventions to improve patient safety through reduction and prevention of falls?
Outcome(s)	The outcomes demonstrate that using fall prevention activities focused on patient safety reduce falls among elderly patients in diverse settings	The researchers identified both facilitators and barriers to Fall TIPS implementation. The outcome also show that Fall TIPS enhanced collaboration between staff and patients since they were tailored to each patient needs and preferences	The outcomes show an improvement in different aspects related to fall prevention. The study also explored attitudes toward fall and fall prevention.
Setting (Where did the study take place?)	The setting was a community dwelling of older adults with average age of 78 years.	The setting entailed 11 hospitals representing three academic health systems.	The setting comprised of different areas based on the origin of participants.
Sample	The sample comprised of 27 older adults living in a community dwelling.	The sample comprised of 50 patients and focus groups with 71 staff	The sample comprised of 14 participants in the OEP framework and 16 on the WBB model
Method	Informed grounded theory and focus groups	The researchers used interviews and focus groups	The researchers used focus groups and interviews.
Key findings of the study and implications for nursing practice	The findings from the study show that individuals do not engage in fall prevention activities due to different reasons like severity and susceptibility. The findings also demonstrate diverse facilitators in engaging in fall prevention. The implications for nursing practice from this study is that providers should engage in tailored interventions based on the unique setting of the patients.	The use of Fall TIPS led to increased motivation among nurses, improved patients’ understanding of their roles and integration of the intervention into the workflow processes. The researchers also identified barriers like poor engagement practices, use of residual fall prevention strategies; especially one-size-fits-all approach. The implication of the study is that nurses should adopt Fall TIPS to improve safety in their settings.	The findings from the study show that those engaged through exergaming model enjoyed the applied intervention but did not comply with the provisions. The focus groups showed barriers and facilitators to implementation of TIPS in their areas or facilities.
Recommendations of the researcher	The researchers recommend the need for people to engage in fall prevention behaviors by addressing the barriers like limited knowledge and perceived self-severity and susceptibility to falls.	The researchers recommend the use of Fall TIPS adoption and enhancement of staff engagement of patients to develop trusting partnerships to improve safety among them.	The article recommends increased engagement of patients and implementation of strategies that are tailored to meet patient needs.

Criteria	Article 4	Article 5	Article 6
APA-formatted article citation with permalink	Guo, X., Wang, Y., Wang, L., Yang, X., Yang, W., Lu, Z., & He, M. (2023). Effect of a fall prevention strategy for the older patients: A quasi‐experimental study. Nursing open, 10(2), 1116-1124. https://doi.org/10.1002/nop2.1379	Duckworth, M., Adelman, J., Belategui, K., Feliciano, Z., Jackson, E., Khasnabish, S., … & Dykes, P. C. (2019). Assessing the effectiveness of engaging patients and their families in the three-step fall prevention process across modalities of an evidence-based fall prevention toolkit: an implementation science study. Journal of medical internet research, 21(1), e10008. DOI: 10.2196/10008	Dykes, P. C., Khasnabish, S., Burns, Z., Adkison, L. E., Alfieri, L., Bogaisky, M., … & Adelman, J. S. (2022). Development and validation of a fall prevention efficiency scale. Journal of patient safety, 18(2), 94. DOI: 10.1097/PTS.0000000000000811
How does the article relate to the PICOT question?	The article relates to the PICOT as it illustrates the effectiveness of using a fall prevention approach tailored to patient needs.	The article relates to the PICOT question as it shows that Fall TIPS framework is effective in reducing and preventing the occurrence of falls among diverse patients even in their homes.	Using a mixed method approach, the article related to the PICOT question as it shows that Fall TIPS model is effective in reducing falls
Is the article qualitative, quantitative, or mixed methods? Justify your selection.	Quantitative The article is quantitative since it employs a quasi-experimental design	Quantitative The article analyzes the outcomes through quantitative approaches like conducting risk assessments.	Mixed Methods The article incorporates both qualitative and quantitative approaches.
Purpose statement	The purpose of the article was to explore the impact of a fall prevention strategy among older patients founded on the patient engagement design.	The purpose of the article was to assess the effects of Fall TIPS modality on patient engagement in a three-step fall prevention process and gauge efficacy.	The purpose of the study was to learn the benefits and burdens associated with Fall TIPS program.
Research question(s)	Does engagement of patients reduce and prevent the occurrence of falls among elderly patients or individuals?	Does the Fall TIPS modality affect patient engagement using a 3-step fall prevention process and efficacy?	Does the implementation of Fall TIPS improve nurses’ ability to reduce and prevent falls?
Outcome(s)	The outcomes show that the intervention reduces falls among the targeted population.	The outcomes show that patient engagement is essential for implementing Fall TIPS interventions.	The outcomes show that learning about providers’ beliefs in the use of time related to Fall TIPS implementation is essential to enhance results that include a reduction in falls.
Setting (Where did the study take place?)	The study occurred in a hospital with two groups or cohorts to demonstrate the efficacy of the intervention.	The researchers conducted the study in healthcare settings in Boston and New York, Bronx and Manhattan	Three hospitals in Massachusetts and 3 in New York
Sample	The sample comprised of 116 subject with the intervention group having 58 and control with 58.	The sample comprised of nurses at the selected facilities.	The sample comprise of 72 nurses who participated in two phases of group interviews.
Method	The researchers used a longitudinal quasi-experimental quantitative design	Three modalities that included laminated Fall TIPS poster, electronic Fall TIPS poster and paperless patient safety displays at the bed side.	The methods included initial qualitative, second qualitative and psychometric evaluation.
Key findings of the study and implications for nursing practice	The key findings include effectiveness of the intervention, and need to engage patients when implementing the strategy. The implications of the study for nursing practice is that nurses should implement strategies that are patient-centered to improve their overall safety. The implication for nursing practice is each intervention works differently based on patient’s overall condition.	The findings show that these interventions are Fall TIPS that lead to improved safety and management of falls among patients. The implication of the article to nursing practice is that nurses should embrace these interventions to improve safety by preventing and reducing falls in their settings.	The key findings for the article include learning about the facilitators and burdens that nurses encounter when implementing falls in their settings, especially through Fall TIPS. The implications for nursing practice is that nurses should understand organizational barriers that can hinder the implementation of Fall TIPS.
Recommendations of the researcher	The researchers recommend more studies to understand the efficacy and effectiveness of engaging patients to develop a patient safety tool to reduce and prevent falls.	The researchers recommend implementation of the Fall TIPS to enhance patient safety and quality care for the affected patients.	Learning of these barriers allows organizations to improve areas of weakness and correct problems that waste time.

Conclusion

Falls are a concern for nurses and other providers in diverse settings. Falls lead to adverse events and a rise in the cost of care. The use of evidence-based practice approaches is essential in preventing and reducing these events. As such, nurses, patients and other providers should develop Fall TIPS to reduce their occurrence and improve overall safety. The evaluation table shows that researchers can use diverse methodologies to demonstrate the effects of implementing Fall TIPS in their facilities for better management of these events.

References

Albasha, N., Ahern, L., O’Mahony, L., McCullagh, R., Cornally, N., McHugh, S., & Timmons, S. (2023). Implementation strategies

to support fall prevention interventions in long-term care facilities for older persons: a systematic review. BMC geriatrics, 23(1), 47. DOI: https://doi.org/10.1186/s12877-023-03738-z

Centers for Disease Control and Prevention (CDC) (2023). Older Adult Fall Prevention. https://www.cdc.gov/falls/index.html

Ziegl, A., Hayn, D., Kastner, P., Löffler, K., Weidinger, L., Brix, B., … & Schreier, G. (2020). Quantitative falls risk assessment in

elderly people: results from a clinical study with distance based timed up-and-go test recordings. Physiological measurement, 41(11), 115006. DOI 10.1088/1361-6579/abc352

NRS 433 PICOT Question and Literature Search