NRS 433 PICOT Question and Literature Search SOLUTION
NRS 433 PICOT Question and Literature Search SOLUTION
For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem.
Use the “Literature Evaluation Table” to complete this assignment. Prior to starting the “Literature Evaluation Table,” complete the following:
- Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population.
- Following the PICOT format, write a PICOT question in your selected area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
- Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. Note: This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem. A mixed methods article can qualify towards meeting a qualitative or quantitative methodology.
Articles must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.
The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments. The PICOT question will also provide a framework for your capstone project.
Clinical Problem-Shortage of nurses in the ICU
The increase in the number of patients in need of healthcare has caused crisis in healthcare systems in U.S and the world in general, especially the shortage of nurse workers in the ICU. This challenge is witnessed in many forms. For instance, most healthcare organizations requires that nurses to be assigned four patients to care for at once. However, high acuity may become a problem because it adds burden to the available nurses. The circumstance leads to the shortage of staff; therefore, the charge nurse could face a difficult task. If one nurse calls off from the ICU, the charge nurse is compelled to point someone to cover the shift during their day off. Therefore, she may be forced to give the nurse a total of more than four patients due to the absence of one nurse worker. When this happens, the available nurse becomes overburdened. The nurse workload increases due to the excessive patient care demands placed on the assigned nurse, whi
NRS 433 PICOT Question and Literature Search SOLUTION
ch compromises patient care. Nonetheless, the situation raises the occurrence of medical errors. The increasing volume of medical needs among the patients poses different challenges to the nurses including developing back injuries. In addition, due to severe workloads, nurses are frequently obliged to hold urination for extended periods of time, which can lead to urinary tract infections. Furthermore, the nurse workers experience significant stress and emotional damage. When faced with challenges caused by a heavy workload, having adequate nursing staff in the intensive care unit and other departments in a facility is the best solution. It significantly improves the well-being of nurses at work by increasing their job satisfaction and it prevents instances of poor health such as sickness and mortality rates.
PICOT Question
In the ICU departments, does sufficient nurse workers (I) prevent the occurrence of medical errors, infections and stress among patients and nurses themselves (O) within one year (T) compared to inadequate nurse workers (C)?
Population (P) – The target population is the patients in the ICU.
Intervention (I) – Sufficient nurse workers
Comparison (C) – Inadequate nurse workers.
Outcome (O) -Prevents infections, stress, and medical errors among the patients and nurses
Time (T) – The duration is one year.
Literature Evaluation Table
|
Criteria |
Article 1 |
Article 2 |
Article 3 |
| APA-Formatted Article Citation with Permalink | Fagerstrom, L., Kinnunen, M., & Saarela, J. (2018). Nursing workload, patient safety incidents, and mortality: An observational study from Finland. BMJ Open, 8(4), e016367 https://www.researchgate.net/publication/324739031_Nursing_workload_patient_safety_incidents_and_mortality_An_observational_study_from_Finland | Nogueira, T. D. A., Menegueti, M. G., Perdoná, G. D. S. C., Auxiliadora-Martins, M., Fugulin, F. M. T., & Laus, A. M. (2017). Effect of nursing care hours on the outcomes of Intensive Care assistance. PloS one, 12(11), e0188241. https://journals.plos.org/plosone/article/file?type=printable&id=10.1371/journal.pone.0188241 | Haegdorens, F., Van Bogaert, P., De Meester, K., & Monsieurs, K. G. (2019). The impact of nurse staffing levels and nurse’s education on patient mortality in medical and surgical wards: an observational multicentre study. BMC health services research, 19(1), 1-9. https://pubmed.ncbi.nlm.nih.gov/31752859/ |
| How Does the Article Relate to the PICOT Question? | The article identifies how nurses’ daily workloads relate to patients’ safety. It reveals that the nurses’ workload increases the health risks among patients. However, a reduced workload reduces the health risks. | It examines the ratio of nurse care hours delivered to patient needs. | It investigates the relationship between inpatient mortality and nursing staff ratios in the surgical and medical wards. |
| Quantitative or Qualitative (How do you know?) | The study is quantitative since the investigators employed an observational study as a research method to collect quantitative data. | This study is quantitative based on the nature of the research’s data. | The research is quantitative because it uses actual data from the selected hospital’s admission |
| Purpose Statement | The study seeks to determine if every nurse’s workload relates to patient safety issues and death. | To compare nursing care indicators with the typical number of nursing hours spent caring for patients in intensive care units (ICUs). | To ascertain how staffing numbers in surgical and medical wards affect patient mortality. |
| Research Question | Do patient safety incidents and mortality connect with individual nurses’ daily workload? | What is the relationship between patient care indicators and the amount of time spent on them during nursing care? | Is in-hospital mortality affected by the mean nursing hours per patient? |
| Outcome | A medical error and mortality likelihood was almost 25% lower if OPC/nurse was below the limit. Compared to the traditional patient-to-nurse measure, a workforce measure based on daily measurements of individual patient care needs and the required NWL (OPC/nurse) was marginally better at forecasting incidents and fatality rates. | Nursing care hours impact the health outcomes among patients. | The investigation determined that a higher nurse staffing level determines the low levels of patient mortality |
| Setting | The study included 36 units from four hospitals in Finland, one of which was a tertiary acute care hospital while the other three were secondary acute care hospitals. | An ICU in one of the private hospitals in Sao Paulo, Brazil | The study was conducted in seven Belgian Hospitals’ Medical and Surgical wards |
| Sample | 36 units | The selected hospital’s ICU patients between January 1, 2011, and December 31, 2013 | The research involved 34,267 patients admitted to both medical and surgical wards |
| Method | The researchers employed the studying of safety incidents through observation. Also, they are based on collecting information from the reporting system in healthcare institutions. | The researchers based on the daily schedule of the nursing staff and the electronic records system, which provided them with information on the number of nurses working in the surveyed ICU daily and monthly. The investigators then utilized the Generalized Linear Models to analyze it | The research included all admitted patients, excluding children under seven and pregnant women. The researchers employed a randomized controlled trial and conducted an observational study to collect data from the medical and surgical wards. |
| Key Findings of the Study | The increased workload of hospital nurses increases the danger of patient fatalities and safety problems. | According to the study, giving patients additional hours per day decreased the incidences of pneumonia and phlebitis, which are related to using a ventilator. | Understaffing among nurses results in higher patient mortality. The researchers reached this conclusion since there were negative outcomes concerning the nurses’ proportion of hours per patient and mortality rate. |
| Recommendations of the Researcher | Investigators, in this case, recommended that future researchers confirm the study’s findings. It showed a link between the daily workload for each nurse and patient safety issues and mortality. | Health care providers should focus on assessing the hazards which result from inadequate nurse staffing in the ICU because patient safety is impacted massively by the number of nursing care hours. They achieve this goal by including indicators to monitor healthcare services. In essence, there is a need to negotiate nurse staffing and promote patient safety using various indicators that monitor healthcare services. | According to the inquiry, creating a method for calculating the ideal nurse staffing level to provide care for each patient during the proper daily hours is crucial. |
|
Criteria |
Article 4 | Article 5 | Article 6 |
| APA-Formatted Article Citation with Permalink | Pazokian, M., & Borhani, F. (2017). Nurses’ perspectives on factors affecting patient safety: A qualitative study. Evidence Based Care, 7(3), 76-81. https://ebcj.mums.ac.ir/article_9382.html | Banda, Z., Simbota, M., & Mula, C. (2022). A qualitative study of nurses’ perceptions of the effects of high nursing workload on patient care in an intensive care unit of a referral hospital in Malawi. BMC nursing, 21(1), 1-7. https://pubmed.ncbi.nlm.nih.gov/35650646/
|
Bridges, J., Griffiths, P., Oliver, E., & Pickering, R. M. (2019). Hospital nurse staffing and staff–patient interactions: an observational study. BMJ quality & safety, 28(9), 706-713. https://pubmed.ncbi.nlm.nih.gov/30918050/ |
| How Does the Article Relate to the PICOT Question? | The article identifies how different elements, for instance, nurse staffing, affect patient safety. | The study investigates nurses’ perspectives on the issue of heavy workloads in the ICU.
|
The authors successfully carried out an observational study to comprehend how patients feel about their satisfaction with the care they receive, both when it is high and when it is low. |
| Quantitative or Qualitative (How do you know?) | It is a qualitative study because it used structured interviews during the data collection process | Since interviews are conducted as part of the data collection procedure, the research is qualitative. | The research is qualitative because analyzing the patients’ provided feedback is involved. |
| Purpose Statement | The research seeks to determine nurses’ perspectives on the elements that influence patient safety | To investigate and describe how Malawian nurses perceive the effects of a heavy nursing burden in the ICU. | The study aims to look into how patients engage with nursing and staffing in terms of both quality and quantity. |
| Research Question | What elements, according to nurses, affect patient safety? | What impact do heavy workloads have in ICU nursing? | Is there a link between patient outcomes and high nurse staff? |
| Outcome | Improving nurses’ skills, ensuring adequate staffing, and improving nursing equipment and facilities are key to better health care services. | Because of their heavy workloads, nurses provided patients with subpar treatment, endangering their safety. High workloads also jeopardized the safety of the nurses. | Negative relationships occasionally prevented satisfaction |
| Setting
(Where did the study take place?) |
Five educational healthcare facilities in Tehran | Queen Elizabeth Central Hospital, Blantyre, Malawi. | England, NHS Hospital
Trust |
| Sample | The study involved 32 nurses from different units: critical care, intensive care, emergency, gastroenterology, and nephrology. | 12 nurses | The research involved 270 patients and 13800 staff members |
| Method | The research involved a qualitative study design involving semi-structured interviews of between 30 and 45 minutes. Before the interviews, the researchers obtained consent from the nurses who participated in the research. | The researchers conducted a purposive sampling to choose research volunteers depending on how long they had previously worked at the hospital. After that, they gave their informed consent. To gather the research data, the researchers then conducted ten in-depth interviews. They used Braun & Clarke’s thematic analysis technique to assess the data after the data collection phase. | The investigators observed the patient outcomes based on varied staff ratios for one year. Then they used regression analysis to analyze the gathered data about the quality of care for patients. |
| Key Findings of the Study | The outcomes for patient safety are enhanced when nurses’ skills are increased, staffing levels are met, and facilities and equipment are upgraded. These actions encourage motivation and job satisfaction. | The excessive nurse workload impacts critically ill patients and ICU nurses. It compromises patient safety and prevents effective care. It also hurts the health of nurses. | From the study, the nurses with at least eight patients displayed poor interaction with them compared to those who handled a lower number. |
| Recommendations of the Researcher | Adequate staffing should be implemented in nursing to prevent stress among them and promote better patient outcomes | Nurse managers and policymakers should concentrate on increasing the number of ICU nurses and implementing various measures to solve the problem of high workloads and the impacts it causes on patient care. | The authors advise looking into why there is a poor relationship between nurses and patients when there is a low staffing ratio. |
References
Banda, Z., Simbota, M., & Mula, C. (2022). Nurses’ perceptions on the effects of high nursing workload on patient care in an intensive care unit of a referral hospital in Malawi: a qualitative study. BMC nursing, 21(1), 1-7. doi: 10.1186/s12912-022-00918-x.
Bridges, J., Griffiths, P., Oliver, E., & Pickering, R. M. (2019). Hospital nurse staffing and staff–patient interactions: an observational study. BMJ quality & safety, 28(9), 706-713. DOI: 10.1136/bmjqs-2018-008948
Fagerstrom, L., Kinnunen, M., & Saarela, J. (2018). Nursing workload, patient safety incidents, and mortality: An observational study from Finland. BMJ Open, 8(4), e016367 DOI: 10.1136/bmjopen-2017-016367
Haegdorens, F., Van Bogaert, P., De Meester, K., & Monsieurs, K. G. (2019). The impact of nurse staffing levels and nurse’s education on patient mortality in medical and surgical wards: an observational multicentre study. BMC health services research, 19(1), 1-9. DOI: 10.1186/s12913-019-4688-7
Nogueira, T. D. A., Menegueti, M. G., Perdoná, G. D. S. C., Auxiliadora-Martins, M., Fugulin, F. M. T., & Laus, A. M. (2017). Effect of nursing care hours on the outcomes of Intensive Care assistance. PloS one, 12(11), e0188241. doi.org/10.1371/journal.pone.0188241
Pazokian, M., & Borhani, F. (2017). Nurses’ perspectives on factors affecting patient safety: A qualitative study. Evidence Based Care, 7(3), 76-81. DOI:10.22038/EBCJ.2017.24174.1520
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)?
| 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