NRS 433 PICOT Question and Literature Search NRS 433 Solution
PICOT Question and Literature Search NRS 433 Solution
Summary of Clinical Issue: As part of their professional mandate, nurses should be identifying problems facing the populace and develop appropriate interventions. Like other professions, however, challenges are part of everyday practice. One of the widespread problems is a scenario where a proportion of the population is at risk of an illness. When a group is vulnerable, it implies that the entire public health is at risk, and such a group’s productivity declines. In such situations, nurses and other health care providers should be more committed to designing the most practical and safest interventions to ensure that the problem does not lead to severe outcomes such as death.
In this analysis, the clinical problem of interest is type 2 diabetes among older adults. According to Yakaryılmaz and Öztürk (2017), the
prevalence of type 2 diabetes is expected to increase proportionately as the population’s age and life expectancy prolong. This point implies that older people will be at risk of the illness and its secondary complications such as depression and cognitive impairment. It predicts a situation where health care providers will be burdened if the right approaches are not used to help decrease the rate of type 2 diabetes in older adults. The intervention of interest is avoiding pharmacological management of the disease and opting for lifestyle changes.
PICOT Question: In older adults with type 2 diabetes (P), can lifestyle changes (I) compared to medical interventions (C) help to reduce the rate of infection (O) in six months (T)?
| Criteria | Article 1 | Article 2 | Article 3 |
| APA-Formatted Article Citation with Permalink | Jackson, S. L., Long, Q., Rhee, M. K., Olson, D. E., Tomolo, A. M., Cunningham, S. A., Ramakrishnan, U., Narayan, K. M., & Phillips, L. S. (2015). Weight loss and incidence of diabetes with the Veterans Health Administration MOVE! lifestyle change programme: an observational study. The lancet. Diabetes & endocrinology, 3(3), 173–180. https://doi.org/10.1016/S2213-8587(14)70267-0
|
Reeve, E., Low, L. F., & Hilmer, S. N. (2016). Beliefs and attitudes of older adults and carers about deprescribing of medications: a qualitative focus group study. Br J Gen Pract, 66(649), e552-e560.doi: https://doi.org/10.3399/bjgp16X685669
|
Fowler, S. P., Williams, K., & Hazuda, H. P. (2015). Diet soda intake is associated with long‐term increases in waist circumference in a biethnic cohort of older adults: the San Antonio Longitudinal Study of Aging. Journal of the American Geriatrics Society, 63(4), 708-715. https://doi.org/10.1111/jgs.13376 |
| How Does the Article Relate to the PICOT Question? | It is centered on the premise that participating in lifestyle change programs can reduce the incidence of type 2 diabetes in clinical settings and communities. | It follows the premise that medication procedures are not as effective as lifestyle programs in managing type 2 diabetes. | Examines how unhealthy lifestyle patterns put older adults at risk [weight gain] of type 2 diabetes. |
| Quantitative, Qualitative (How do you know?) | Qualitative- it is an observational study. | Quantitative- it is a focus group study. | Quantitative- it is a longitudinal study. |
| Purpose Statement | The study investigates how participation in MOVE is associated with reduced incidence of diabetes. | The study explores the beliefs and attitudes of older adults and carers on deprescribing. | This study examines the relationship between diet soda intake and long-term waist circumference change. |
| Research Question | Does participation in lifestyle change programs reduce diabetes in older adults? | Does doing away with pharmacological interventions do more harm than good in diabetes management among older adults? | Does diet soda intake increase weight in older adults putting them at risk of type 2 diabetes? |
| Outcome | Diabetes can be managed by positive lifestyle changes. | Non-pharmacological approaches are more impacting depending on the interventions used. | Type 2 diabetes can be managed by healthy dietary patterns. |
| Setting
(Where did the study take place?) |
An outpatient care setting for veterans | New South Wales, Australia | San Antonio, Texas, neighborhoods |
| Sample | 238540 individuals participated | 14 older adults and 14 carers | 749 adults- 65 years and above |
| Method | Jackson et al. (2015) did a retrospective observational analysis of obese patients with weight-related disorder. | Four focus groups of 14 older adults and 14 carers were conducted with additional conventional content analysis. | Prospective cohort study |
| Key Findings of the Study | Participation in MOVE program was associated with weight loss and reduced incidence of diabetes. | Older adults would consider an alternative process since they dislike taking medications but fear since they are unaware of the outcomes. | Weight circumference increases with diet soda intake (DSI) with the most affected group being daily users. |
| Recommendations of the Researcher | Older adults should actively participate in lifestyle change programs to keep them safe from type 2 diabetes. | Older adults should be advised on the various non-medical interventions available for diabetes management to keep them away from the risks of too much medication. | DSI should be regulated as a way of avoiding escalating abdominal obesity that causes diabetes. |
| Criteria | Article 4 | Article 5 | Article 6 |
| APA-Formatted Article Citation with Permalink | Carolan, M., Holman, J., & Ferrari, M. (2015). Experiences of diabetes self‐management: a focus group study among Australians with type 2 diabetes. Journal of clinical nursing, 24(7-8), 1011-1023. https://doi.org/10.1111/jocn.12724 | Harris, M. L., Oldmeadow, C., Hure, A., Luu, J., Loxton, D., & Attia, J. (2017). Stress increases the risk of type 2 diabetes onset in women: A 12-year longitudinal study using causal modelling. PloS one, 12(2), e0172126. https://doi.org/10.1371/journal.pone.0172126
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Xu, G., Liu, B., Sun, Y., Du, Y., Snetselaar, L. G., Hu, F. B., & Bao, W. (2018). Prevalence of diagnosed type 1 and type 2 diabetes among US adults in 2016 and 2017: population based study. Bmj, 362, k1497. https://doi.org/10.1136/bmj.k1497 |
| How Does the Article Relate to the PICOT Question? | It looks at the connection between the approaches used after diagnosis and outcomes in diabetes management. | Examines some of the factors that put older people at risk of type-2 diabetes and how it can be avoided through lifestyle approaches. | Examines the prevalence of diabetes in the US general population and effective management approaches. |
| Quantitative, Qualitative (How do you know?) | Qualitative- it is an exploratory qualitative design. | Quantitative- it is a longitudinal study | Qualitative- it is a cross-sectional survey. |
| Purpose Statement | The study examines the experiences of individuals with type 2 diabetes in a low-economic social setting. | The study examines the relationship between perceived stress and type 2 diabetes onset. | The study examines the proportion of each among US adult diagnosed with diabetes. |
| Research Question | Are older adults from low socio-economic backgrounds at risk of type 2 diabetes mismanagement? | Does stress increase the chances of getting type 2 diabetes in older adults? | Do lifestyles play any role in increasing diabetes prevalence? |
| Outcome | Many patients in low socio- economic backgrounds need support on self-management efforts. | Stress and type 2 diabetes have a direct relationship. | Lifestyles and the prevalence of diabetes are directly connected. |
| Setting
(Where did the study take place?) |
Local health settings in Australia | Australia- Women were randomly sampled through the Medicare Australia database. | National Health Interview survey [2016-2017] |
| Sample | 22 individuals with type 2 diabetes | 12,844 women completed the study’s surveys. | 58186 adults |
| Method | Focus groups were used to collect data. | A longitudinal study on women’s health. | Cross sectional survey |
| Key Findings of the Study | Patient experiences on diabetic management vary according to the socio-economic setting. | Avoiding stress is one way of improving lifestyle and plays a critical role in avoiding or reducing the rates of type 2 diabetes. | Factors that shape lifestyles such as education and race affect the prevalence of type 2 diabetes. |
| Recommendations of the Researcher | Self-management approaches improve the management of type 2 diabetes and lifestyle approaches should be encouraged. | Perceived stress is a strong risk factor for type 2 diabetes, and should be avoided as part of improving diabetes self-management. | People should be educated on diabetes self-management practices since the prevalence is likely to increase as time advances.. |
References
Carolan, M., Holman, J., & Ferrari, M. (2015). Experiences of diabetes self‐management: a focus group study among Australians with type 2 diabetes. Journal of clinical nursing, 24(7-8), 1011-1023. https://doi.org/10.1111/jocn.12724
Fowler, S. P., Williams, K., & Hazuda, H. P. (2015). Diet soda intake is associated with long‐term increases in waist circumference in a biethnic cohort of older adults: the San Antonio Longitudinal Study of Aging. Journal of the American Geriatrics Society, 63(4), 708-715. https://doi.org/10.1111/jgs.13376
Harris, M. L., Oldmeadow, C., Hure, A., Luu, J., Loxton, D., & Attia, J. (2017). Stress increases the risk of type 2 diabetes onset in women: A 12-year longitudinal study using causal modelling. PloS one, 12(2), e0172126. https://doi.org/10.1371/journal.pone.0172126
Jackson, S. L., Long, Q., Rhee, M. K., Olson, D. E., Tomolo, A. M., Cunningham, S. A., Ramakrishnan, U., Narayan, K. M., & Phillips, L. S. (2015). Weight loss and incidence of diabetes with the Veterans Health Administration MOVE! lifestyle change programme: an observational study. The lancet. Diabetes & endocrinology, 3(3), 173–180. https://doi.org/10.1016/S2213-8587(14)70267-0
Reeve, E., Low, L. F., & Hilmer, S. N. (2016). Beliefs and attitudes of older adults and carers about deprescribing of medications: a qualitative focus group study. Br J Gen Pract, 66(649), e552-e560.doi: https://doi.org/10.3399/bjgp16X685669
Xu, G., Liu, B., Sun, Y., Du, Y., Snetselaar, L. G., Hu, F. B., & Bao, W. (2018). Prevalence of diagnosed type 1 and type 2 diabetes among US adults in 2016 and 2017: population based study. Bmj, 362, k1497. https://doi.org/10.1136/bmj.k1497
Yakaryılmaz, F. D., & Öztürk, Z. A. (2017). Treatment of type 2 diabetes mellitus in the elderly. World journal of diabetes, 8(6), 278–285. https://doi.org/10.4239/wjd.v8.i6.278
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