NR 505 Week 2: Refinement of a Nursing Concern into an Evidence-based Practice Proposal Using the Research Process

Research is typically conducted to explore and discover new knowledge or to validate existing information about a specific subject. Specifically, nursing research is form of scientific investigation meant to explore and explain a variety of clinical experiences, outcomes, and phenomena that is vital to the scientific and professional foundation of nursing (Baker, 2016). The goal of nursing research is to drive the practice to meet a high level of patient care outcomes (Baker, 2016). Nursing research also sets out to identify the links or gaps between published research and current clinical practice (Baker, 2016). Research is based on collected opinions, but it is also built upon a framework of scientific inquiry to avoid bias as much as possible (Baker, 2016).

In contrast, evidence-based practice (EBP) is founded on collected scientific and medical research, but it is also an expert opinion built on professional, clinical, and patient experiences. The goal of EBP is to translate or utilize current knowledge, research, and other pertinent medical data into everyday clinical practice to provide the best care possible for patients. FNPs and other nurses who utilize this approach should study recent healthcare research to determine the best course of patient care and treatment (Baker, 2016).

Evidence-based practice and research take different approaches to identifying quality nursing data and expert/clinical opinions. The difference between EBP and research is that FNPs can use evidence-based practice to make connections between conducted research and clinical experiences (Echevarria, Teegarden, & Kling, 2017). Evidence-based practice is not focused on research first but about employing traditional or alternative care and treatment methods then sharing that information in a published format (Echevarria et al., 2017). EBP urges nurses to consider the “why” and “how” behind existing nursing methods and applications in an effort to improve clinical outcomes (Echevarria et al., 2017). Lastly, EBP seeks to challenge and add to the traditional body of nursing knowledge.

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The contribution of EBP to professional nursing is vast. Since its professional inception, nursing has evolved the way nurses provide optimal patient care and the way in which they are educated. Over the past decade, EBP has been garnering more attention from nursing professionals and has slowly emerged as an excellent standard by which to provide clinical care (Mick, 2017). Evidence-based practice has transitioned to the classroom setting, influencing undergraduate and graduate nursing programs (Mick, 2017). EBP nursing coursework increases nursing students’ overall knowledge base as it teaches them the importance of professional accountability and fosters critical thinking skills (Stevens, 2013). EBP also makes an invaluable contribution to the field of nursing because it considers the nurses role in nurturing interpersonal relationships between patients and nurses (Stevens, 2013). EBP shows the relevance of respecting and seeking better understanding of how patients’ clinical, cultural, religious and socioeconomic backgrounds relate to scientific research and suggested treatments (Mick, 2017).

Incorporating EBP nursing concepts and findings throughout a nurse’s education and clinical experiences develops decision-making skills as nurses are better able to adapt to situations, utilize informatics, and work together in collaborative teams (Stevens, 2013). When EBP narratives are shared in the classroom, utilized to create health and nursing legislation, and accepted by nursing organizations and theorists, nurses gain a greater sense of confidence and pride in their work. Furthermore, EBP has led nurses to become more interested and invested in nursing research (Stevens, 2013). Additionally, when relevant EBP is used in a clinical setting, nurses have a working approach to managing complications associated with illness or disease. This patient centered approach helps lower costs of care as it eliminates unnecessary costs associated with testing and treatment plans (Stevens, 2013).

MSN Program Specialty Track and Practice Focus

My MSN specialty track is FNP, and my practice focus is reducing falls in long term care. I am interested in this topic to assess the current level of involvement of FNPs in activities related to preventing falls and managing fractures in long-term care (LTC) setting. EBP promotes change in an LTC setting because it has problem-solving approach (Echevarria, Teegarden, & Kling, 2017). Published evidence-based practice concepts becomes a viable literature resource for LTC nurses. This EBP knowledge is founded on best practices, information gathered from nursing and scientific studies, nurses’ expertise, and patients’ desires and beliefs—all of which improve patient outcomes; thus, nurses are more willing to implement EBP into care practices (Echevarria et al., 2017).

EBP also promotes change in an LTC setting because it empowers FNPs to practice autonomy and gives them the confidence to share and implement their, and other nurses, clinical expertise in their goal to improve patient outcomes (Specht, 2013). LTC nursing managers can refer to EBP to restructure their organizations’ care plans and LTC nursing roles (Specht, 2013). Implementing EBP practice in an LTC setting will embolden FNPs to find alternatives to traditional clinical treatment options. There are multiple barriers to promoting change in an LTC setting, yet there is clear evidence of the benefits that evidence-based practices have on LTC residents and to the health care system (Specht, 2013). The goal of patient centered change supports LTC based nursing research and the integration of best practices in LTC organizations (Specht, 2013).

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Identification of the Nursing Concern to be Improved

As an LTC nurse, I am familiar with the issues associated with residents/patients falling and fracturing bones, especially their hips. Falling is a painful and humiliating experience, especially for elderly patients. After suffering a fall in an LTC setting, patients may experience a decline in their quality of life. Kaasalainen, Papaioannou, Burgess, and Van der Horst (2015) state fractures can be a significant source of pain, anxiety, agitation, depression, disability, and decreased pulmonary function. Also, fracture rates are four to eight times higher in an LTC setting than in any other medical setting (Kaasalainen et al., 2015). In a mixed method study conducted on managing falls in an LTC setting, Kaasalainen et al. (2015), states NPs reported they overly familiar with caring for patients who received a fracture while in an LTC setting. NPs in this study also report, they have participated in multiple fall reduction initiatives (Kaasalainen et al., 2015). I believe NPs set the tone and expectations for nursing staff. NPs can assist nurses with applying learned fall prevention techniques, taking risk assessments, implementing balance and strengthening exercises, and ensuring all patients have taken an adequate amount of calcium and vitamin D.

NPs can also integrate new information and practices that will benefit existing fall prevention practices. Harrison (2017), states two primary reasons the NPs contribution to fall prevention strategies in an LTC setting are necessary: NPs have the clinical knowledge and skills to establish and lead fall prevention programs in community and LTC settings; FNPs are qualified to teach evidence-based education courses on fall risk factors. The stakeholders impacted most by my concern are patients and families, along with FNP nurses and nursing leaders who practice in LTC settings. Additional impacted stakeholders include nursing administrators, scientific and nursing researchers, physicians, nursing instructors, legislative bodies who create LTC laws, nursing professional associations, and nursing accrediting agencies.

Each of these stakeholders are responsible for promoting LTC patient care and ensuring that a high quality of care is provided to patients. The consequences of not utilizing or introducing LTC evidence-based data in an LTC setting is that it hinders or limits the treatment options provided to FNPs nurses. Another negative result is that it delays the advancement of the LTC and causes traditional LTC nursing treatment methods to become outdated instead of expanding upon them. My proposed solution is to advocate for evidence-based practice LTC methods to be implemented in LTC settings and within the classroom.

Purpose Statement

The purpose of this qualitative study is to determine FNPs clinical experiences in providing EBP centered care to patients who have fractured bones in an LTC setting. The goal is to take the information gathered and use it to create fall prevention programs and/or implement fall prevention strategies, which raises patient safety and satisfaction and lessens LTC malpractice and negligence suits.

PICOT/PICo question and Literature Search Process

My PICo question is: “What are NP’s experiences in providing care to patients who have fallen in an LTC and fractured bones in the United States?” The expected outcome of this query is that implementation of quality fall prevention programs and strategies will enrich the health and quality of life of LTC patients. Examining EBP fall prevention programs will circumvent patient falls and promote best patient outcomes. I hope to also prove that participation in fall intervention programs decrease LTC residents’ fears of falling, particularly for elderly patients.

A literature review is useful in that it examines and analyzes scholarly literature (books and articles) that are relevant to a health model or an area of research theory. When done correctly, literature reviews summarize research on a given subject and critically evaluate research publication sources. Within my practice focus and setting, literature reviews illustrate to long term care FNPs how EBP and research fit within a larger field of study (Maggio, Sewell & Artino, 2106). The systematic format of a literature review allows researchers to connect traditional explanations of dated research material with new interpretations of the same material (Maggio et al., 2016). The goal of a literature review is to summarize a body of valuable information and identify any disparities in research and to eliminate unrelated information (Maggio et al., 2016). A literature review will contribute to this EBP proposal because it assists with categorizing possible publication sources that I may need to use to construct the body of my final proposal. A literature review will also allow me to compare related research and connect my findings with traditional or EBP based practices, as well as investigate and apply my experiences with fall prevention programs in the LTC settings in which I have been employed.

I will use the following library databases: PubMed (Medline), CINAHL Plus, ERIC (EBSCOhost), JSTOR, and Google Scholar. Key search terms and phrases used are: LTC fall management programs, elderly falls in the LTC, falls and fall risks in LTC, EBP fall care, FNP narratives on fall care in LTC, evidence-based nursing fall interventions. Additional search terms used are minimizing fall risks in long term care facilities, strategies for reducing falls in long-term care, risk assessment and prevention in long term care. Specialty organizations relevant to this proposal are the American Nurses Association (ANA), American Healthcare Association (AHCA), The American Association of Directors of Nursing Services (AADNS), American Association of Retired People (AARP), National Association of Directors of Nursing Administration in Long Term Care, Americans for LTC Security, Long Term Care Partnership Program.

Theoretical Framework

Falls suffered in an LTC setting have lasting psychological and physical consequences. They lead to fractures and slow the healing process down. Furthermore, patients lose confidence in walking, which diminishes mobility and hastens health decline. Falls in the LTC lead to a decline in the services provided by an LTC facility and its nursing staff, raise healthcare and malpractice insurance costs of the facility, and decrease the quality of life for residents. The theoretical framework used for this EBP proposal is the Deliberative Nursing Process model developed by the theorist, Ida Jean Orlando. Her theory allows nurses to create effective, practical, and adaptable nursing care plans (Nursingtheory.org, 2016). These plans can be used to eliminate falls, prevent complications arising from patients not wanting to participate in fall prevention programs, and minimize barriers with FNPs and LTC administrators not wanting to integrate fall prevention strategies.

Orlando’s theory suggests that patients with acute illnesses or needing long term care must satisfy their physiological needs and eliminate fears if they want to heal (Nursingtheory.org, 2016). When these needs are not met, patients do not have a positive LTC or acute care experiences. Orlando’s theory is useful to create initial fall risk assessments and critical intervention plans. The theory promotes individualize care plans and interventions (Nursingtheory.org, 2016). In relation to eliminating falls in the LTC, Orlando’s theory posits all patient behavior is a cry for help (Nursingtheory.org, 2016). Thus, falling is the patient’s way of saying “pay attention to me.” The FNP must interpret this behavior and determine the needs of the patient (Nursingtheory.org, 2016). Orlando’s Deliberative Nursing Process includes five stages: assessment, diagnosis, planning, implementation, and evaluation (Nursingtheory.org, 2016).

References

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https://doi.org/10.1016/j.nurpra.2017.06.017

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