NUR-550 adapting translational research methods

Read “About Us” page of the Centre for Evidence Based Medicine (CEBM) website.

Read the Evidence-Based Practice tutorial, located on the Duke University website.

Read Chapters 1-3 in Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice.

Explore the Resources page of the Centre for Evidence Based Medicine (CEBM) website.

TOPIC 1 DQ 2 

Explain the importance of a “spirit of inquiry” in an evidence-based culture and what you can do as an advanced registered nurse to encourage this within your practice or organization. In response to your peers, compare the role and implementation of EBP in your specialty area with another advanced registered nurse specialty.

Once a search is carried out to find relevant articles within a chosen topic, a literature review helps bring together what is already known about a topic, facilitating new learning opportunities (Watts, 2020). Gaps in current knowledge can be identified, or theories and academic opinions may raise new research areas during critical analyses. The initial question asked may evolve or change altogether when researching a posed question. Other themes or questions that may surface during the research journey, adding curiosity to what should be researched next. This “spirit of inquiry” is essential to our knowledge base and our peers well.

Nurse leaders have considerable influence on implementing evidence-based practice (EBP) in their departments, units, and organizations; however, resistance to change can stall innovations (Tucker & Mazurek Melnyk, 2019). Effective leadership requires an understanding of change theory, how change is facilitated and blocked, successful change steps, and strategies to promote each step. Implementation for promoting EPB falls into seven categories: leadership, coaching, communication, reinforcements, recognition, measurement, and reporting. Different strategies may be needed at each stage of change to promote and sustain the change. Nurse leaders can successfully implement EBP changes by being knowledgeable about a proposed change, partner with staff, engage the help of mentors or change agents, work with senior leaders, thank and celebrate all staff in the process, and disseminate findings.

References

Tucker, S., & Mazurek Melnyk, B. (2019). A leader’s guide to implementing evidence-based practice: Lead the way to healthcare quality and safety. American Nurse Today, 14(6).

Watts, K. (2020). How to conduct a literature review. Podiatry Review, 77(1), 14–15.

APA Writing Checklist

Use this document as a checklist for each paper you will write throughout your GCU graduate program. Follow specific instructions indicated in the assignment and use this checklist to help ensure correct grammar and APA formatting. Refer to the APA resources available in the GCU Library and Student Success Center.

☐ APA paper template (located in the Student Success Center/Writing Center) is utilized for the correct format of the paper. APA style is applied, and format is correct throughout.

☐  The title page is present. APA format is applied correctly. There are no errors.

☐ The introduction is present. APA format is applied correctly. There are no errors.

☐ Topic is well defined.

☐ Strong thesis statement is included in the introduction of the paper.

☐ The thesis statement is consistently threaded throughout the paper and included in the conclusion.

☐ Paragraph development: Each paragraph has an introductory statement, two or three sentences as the body of the paragraph, and a transition sentence to facilitate the flow of information. The sections of the main body are organized to reflect the main points of the author. APA format is applied correctly. There are no errors.

☐ All sources are cited. APA style and format are correctly applied and are free from error.

☐ Sources are completely and correctly documented on a References page, as appropriate to assignment and APA style, and format is free of error.

Scholarly Resources: Scholarly resources are written with a focus on a specific subject discipline and usually written by an expert in the same subject field. Scholarly resources are written for an academic audience.

Examples of Scholarly Resources include: Academic journals, books written by experts in a field, and formally published encyclopedias and dictionaries.

Peer-Reviewed Journals: Peer-reviewed journals are evaluated prior to publication by experts in the journal’s subject discipline. This process ensures that the articles published within the journal are academically rigorous and meet the required expectations of an article in that subject discipline.

Empirical Journal Article: This type of scholarly resource is a subset of scholarly articles that reports the original finding of an observational or experimental research study. Common aspects found within an empirical article include: literature review, methodology, results, and discussion.

Adapted from “Evaluating Resources: Defining Scholarly Resources,” located in Research Guides in the GCU Library.

☐ The writer is clearly in command of standard, written, academic English. Utilize writing resources such as Grammarly, LopesWrite report, and ThinkingStorm to check your writing.

Patient safety and improved quality of care requires providers and organization to use evidence-based practice (EBP) interventions to tackle issues that may cause adverse events like patient falls. Patients in medical-surgical units are susceptible to falls because of their delicate nature. The Centers for Medicare and Medicaid Services (CMS) considers falls as never events since they are preventable (Melnyk et al., 2022). Falls lead to increased stay in hospitals, poor patient outcome and serious fractures and head injuries that can lead to death. The use of bundled care approach through TIPS (tailoring interventions for patient safety) is considered one of the most effective ways to reduce and prevent falls in medical-surgical settings. The purpose of this literature review paper of the EBP project is to compare articles on the use of TIPS toolkit to reduce and prevent falls in medical-surgical settings.

PICOT Statement and Question

Nationwide, patient falls while in hospitals, particularly in medical-surgical units, are a leading cause of permanent disability and even death. Further, hospitalization increases one’s fall risk as close to three percent of patients fall while in hospitals. Nearly 30% of those who experience falls sustain injuries with a rise in the number of days in hospitals by close to 7 days. Again, under Medicare, the CMS does not reimburse falls and hospitals cannot get a Magnet designation when their fall rates are not below the national average (Khasnabish et al., 2020). The implication is that hospital managers and leaders must seek ways, through the use of evidence-based practice, to reduce the occurrence of falls. The use of TIPS toolkit is considered one of the most effective ways to reduce and mitigate falls and their occurrences as well as effects on patients in medical-surgical units.

PICOT Question

Among hospitalized adult patients in medical-surgical units (P) does the use of TIPS toolkit as a bundled care approach (I) compared to normal falls prevention approach (C) reduce the prevalence of falls (O) within 6 months (T)?

Search Methods

The evidence-based practice process implores researchers to seek evidence from previous research articles when doing their literature to obtain findings that support their proposed projects or interventions. The use terms, phrases and words associated with the topic under investigation and exploring databases to generate scholarly sources are some of the standard search strategies that one can deploy to attain relevant evidence. The study employed these strategies, starting with key terms and words in different databases. These included PubMed, Cochrane and Google Scholar as well as CINAHL. The strategy also entailed the use of CRAAP approach that involves searching for articles which are current, relevant, accurate, authoritative and purposeful to the area or topic under investigations (Melnyk et al., 2022). Using this criteria, the paper identified the reviewed articles and describes how they support the proposed EBP project to reduce and prevent the occurrence of falls in medical-surgical settings.

Research Synthesis

Article 1

The first article by Dykes et al. (2020) evaluates the use of a patient-centered fall prevention TIPS to lower falls and their associated injuries. Using non-randomized controlled trials with the study set in 14 medical units in Boston and New York, the researchers show a positive link between the intervention and a decline in number of falls. The researchers are categorical that nurse-led interventions can reduce injurious falls through providing information to families on fall management and prevention. The article demonstrates the efficacy of using TIPS as an intervention as depicted by the PICOT question.

Article 2

The second article by Tzeng et al. (2021) focuses on the impact of using TIPS program in reducing falls among older adults in nursing homes. Using a mixed method approach in a 15-bed nursing unit, the findings from the study shows that fall TIPS can reduce the rate of falls, especially injurious falls among older patients or adults. The TIPS program entails different approaches that include patient education and creating awareness about the harmful effects of falls. The article is critical to the EBP proposed project as it illustrates the increased role of TIPS initiative to reduce falls as depicted in the PICOT question. The article supports the EBP project since it shows that TIPS as an intervention is effective.

Article 3

In this article by Morris et al. (2022) the researchers conduct a systematic review of literature and meta-analysis on diverse interventions that can reduce falls. The researchers identify a host of interventions based on the data collected from the 43 studies that met their inclusion criteria. The findings show that tailoring or customization of interventions leads to reduced rates of falls for patients in such facilities. These interventions are effective when they consider the different components and factors impacting patient situations. As such, the article supports the EBP proposed project by demonstrating the effectiveness of diverse and tailored interventions for patients based on their level of acuity.

Article 4

The fourth article by Heng et al. (2020) is a scoping review of how hospitals can use patient education as a strategy to prevent falls. The researchers focused on 43 articles when analyzing the different approaches in patient education that confer benefits to patients to reduce their susceptibility to falls. The analysis shows that patient educational interventions can reduce falls that lead to injuries and bruises as well as lacerations and fractures. The study recommends the need to deploy TIPS as an effective approach to reducing and mitigating falls among patients. The article supports the EBP proposed project as it shows the need for diverse interventions like different approaches to educating patients on fall risks that they may be exposed to in their activities of daily living.

Article 5

In their article, LeLaurin et al. (201) aim at familiarizing different stakeholders about the benefits as well as the cons of various types of research studies on testing fall prevention interventions. The researchers opine that organizations and providers should focus on diverse interventions, one point at a time, to attain their efficacy and impact on patient fall management. The study’s findings are categorical that the effectiveness of each type of interventions depends on a host of factors. Therefore, customizing or tailoring these interventions is essential to attaining quality outcomes and helping patients avoid and reduce their susceptibility to falls. The article is important in the EBP project as it shows the need for tailoring each intervention to suit patient needs and situations.

Article 6

The article by Dykes et al. (2019) focuses on the effectiveness of tailoring interventions through a collaborative approach among providers. Using a qualitative approach or design, the article demonstrates that fall TIPS program is effective in reducing and preventing falls in diverse patient settings. The study is emphatic that TIPS model is important for providers to reduce and prevent falls. The article supports the EBP proposed project as it illustrates the importance of customizing interventions to meet patient needs and reduce susceptibility to falls.

Article 7

In this article by Cuttloer et al. (2018), the researchers aim at reducing inpatient falls in medical-surgical settings through technology-enabled TIPS initiative. The researchers use a four-minute video to provide patient education and collect their views on the implementation based on their situation. The findings are consistent that TIPS initiatives reduce and prevent falls. Therefore, the article supports the EBP project by showing that tailoring interventions is essential in addressing patient falls in medical-surgical settings.

Article 8

In their study, Bargmann et al. (2020) evaluates the effects of implementing a multicomponent fall prevention program to improve patient safety because of risks associated with falls. Set in a 26-bed medical surgical telemetry unit, the study shows that these interventions are effective in reducing falls and risks associated with falling for fragile patients. The article supports the EBP project since it is categorical that TIPS model reduce and prevents the occurrence of falls.

Comparison of the Articles

The reviewed articles share certain aspects in their research findings and also differ in other areas. for instance, all the articles agree that tailoring interventions on falls is an effective strategy that all providers and facilities should leverage in their settings. Again, the article agree that the TIPS model gives hospitals and providers increased leeway to implement interventions that are appropriate to their facilities based on their cost and other components. Thirdly, all the articles demonstrate that multiple interventions are complementary to the efforts and policies developed by organizations to reduce and prevent falls in their articles.

None of the article demonstrates controversies but all agree conclusively that more studies are required to provide significant outcomes. The articles also share limitations like timelines to conduct the studies, use of same settings and need for beet support from management and other stakeholders (Khasnabish et al., 2020). The articles do not have significant differences as they are emphatic that these diverse interventions are necessary in reducing falls, especially injurious falls among older patients.

Suggestions for Future Research

An analytical perspective of the eight articles and others demonstrate the need for more research to tackle some of the gaps. For instance, the articles do not offer a standard TIPS approach that can be used across all facilities, irrespective of their patient’s acuity and needs. As such, it is important to have more studies on the development of a standardized tool or approach to falls based on the nature of the respective setting, from medical-surgical units to outpatient facilities.

Conclusion

Falls are a major health issue that impact overall quality of care and life for patients, especially the elderly admitted to medical-surgical units. The use of TIPS toolkit; either patient-centered or nurse-driven, is critical to reducing these falls because of their adverse effects like injuries and long-term fractures and disabilities. The articles are emphatic that using TIPS allows providers to offer the most effective interventions to reduce and prevent their occurrence. The review illustrates that sufficient evidence exists to support the proposed interventions based on the TIPS framework to reduce falls.

References

Bargmann, A. L., & Brundrett, S. M. (2020). Implementation of a multicomponent fall

prevention program: Contracting with patients for fall safety. Military medicine, 185(Supplement_2), 28-34. https://doi.org/10.1093/milmed/usz411

Cuttler, S. J., Barr-Walker, J., & Cuttler, L. (2018). Reducing medical-surgical inpatient falls and

injuries with videos, icons and alarms. BMJ open quality, 6(2), e000119.

DOI: 10.1136/bmjoq-2017-000119

Dykes, P. C., Adelman, J. S., Alfieri, L., Bogaisky, M., Carroll, D., Carter, E., … & Spivack, L.

370. (2019). The fall TIPS (tailoring interventions for patient safety) program: A collaboration to end the persistent problem of patient Falls. Nurse Leader, 17(4), 365-370. https://doi.org/10.1016/j.mnl.2018.11.006

Dykes, P. C., Burns, Z., Adelman, J., Benneyan, J., Bogaisky, M., Carter, E., Ergai, A., Lindros,

2025889. E., Lipsitz, S. R., Scanlan, M., Shaykevich, S., & Bates, D. (2020). Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries. JAMA Network Open, 3(11), e2025889. https://doi.org/10

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital

falls prevention with patient education: a scoping review. BMC geriatrics, 20, 1-12. DOI: https://doi.org/10.1186/s12877-020-01515-w

Khasnabish, S., Burns, Z., Couch, M., Mullin, M., Newmark, R., & Dykes, P. C. (2020). Best

practices for data visualization: creating and evaluating a report for an evidence-based fall prevention program. Journal of the American Medical Informatics Association, 27(2), 308-314. DOI: 10.1093/jamia/ocz190.

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: state of the

science. Clinics in geriatric medicine, 35(2), 273-283. DOI: 10.1016/j.cger.2019.01.007

Melnyk, B. M., & Fineout-Overholt, E. (2022). Evidence-based practice in nursing &

            healthcare: A guide to best practice. Lippincott Williams & Wilkins.

Morris, M. E., Webster, K., Jones, C., Hill, A. M., Haines, T., McPhail, S., … & Cameron, I.

(2022). Interventions to reduce falls in hospitals: a systematic review and meta-analysis. Age and Ageing, 51(5), afac077. https://doi.org/10.1093/ageing/afac077

Tzeng, H.-M., Jansen, L. S., Okpalauwaekwe, U., Khasnabish, S., Andreas, B., & Dykes, P. C.

(2021). Adopting the Fall Tailoring Interventions for Patient Safety (TIPS) Program to Engage Older Adults in Fall Prevention in a Nursing Home. Journal of Nursing Care Quality, https://doi.org/10.1097/ncq.0000000000000547