Benchmark – Capstone Project Change Proposal
In this assignment, students will pull together the change proposal project components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. At the conclusion of this project, the student will be able to apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.
Students will develop a 1,250-1,500 word paper that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:
- Background
- Problem statement
- Purpose of the change proposal
- PICOT
- Literature search strategy employed
- Evaluation of the literature
- Applicable change or nursing theory utilized
- Proposed implementation plan with outcome measures
- Identification of potential barriers to plan implementation, and a discussion of how these could be overcome
- Appendix section, if tables, graphs, surveys, educational materials, etc. are created
Review the feedback from your instructor on the Topic 3 assignment, PICOT Statement Paper, and Topic 6 assignment, Literature Review. Use the feedback to make appropriate revisions to the portfolio components before submitting.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
Running head:
Literature Review and PICOT Statement
1
NURSING
3
Literature Review and PICOT Statement
Ihuoma Agada
Grand Canyon University- NRS 490
December 22nd , 2019
An Analysis of Hourly Rounds and Prevalence of Pressure Ulcer in Hospital
The issue of fall-related injuries among elderly individuals is becoming a major concern in the effort of improving quality healthcare services to elderly individuals. There is an increase in trend towards aging demographic; therefore, it is the responsibility of the healthcare to ensure that there is creation or development of the effective strategies aimed at preventing falls among elderly individuals. One of the key strategies that have been recommended is the use of the hourly rounding proposal in the hospital. This strategy is supported by the literature as being a successful approach used for the purposes of preventing the falls and the improvement of patient safety (Dyck, Thiele, Kebicz, Klassen, & Erenberg, 2013). This paper is therefore aimed at comparing the research questions, a sample of the population, limitations of the studies, and making a conclusion and proposing the recommendation for further research.
Many healthcare facilities are facing clinical issues related to the acquired pressure ulcers. Acquired pressure ulcers still remains one of the persistent and relevant issue that requires agent response especially in the long-term care facilities. Hospitals are making attempts to implement the evidence based procedures even though there is still an increase in the incidence. Efforts are being made to integrate evidence-based strategies to help in curbing acquired pressure ulcers.
Comparing The Research Questions
While doing comparison of the research questions as used by the authors of the selected articles, the article by Mchem et al,. (2019) focuses on the teamwork as well as the good leadership as an effective approach towards reduction of the fall rates (MChem, Meredith, Mascioli, & Cunningham, 2019). The same leadership role is talked about in the article by the author Leone and Adams (2016). According to Leone and Adams (2016), nurse leaders, especially in the rehabilitation centers, have the crucial role in influencing the reduction of the fall rates through ensuring that there is successful execution of the fall prevention strategies and the sustenance of the outcome through promoting the stronger culture (Leone & Adams, 2016). In the article by King et al (2018), the concern is on how the communication process among the healthcare providers is helping in the reduction of the fall rates among the elderly individuals (King, Pecanac, Krupp, Liebzeit, & Mahoney, 2018). The research question used in the article by Brown (2016), the target of the question used is to establish the impact of adopting the hourly rounding on the rates of the patient falls. This is done on basis of looking at how successful the adoption of hourly rounding can be when it comes to the reduction of the incidences of the patients’ falls within the hospitals (Brown, 2016). The same idea is also shared by the author of the article by Rone (2018) that is targeted at determining whether the accomplishment of the strategic hourly rounding is helping in the reduction of the falls (Rone, 2018).
In a study by Angela (2017), the research question is different from other research questions since it tries to address the issue of falls through comparing the two practices i.e. elimination of the alarm program and the use of the alarm programs. Responding to this question will help determine the perfect strategy which can be used for example either to continue using an alarm program or to do away with it (Angela, 2017). On the other hand, the research question used by Slade et al (2017) is used to determine how various methods used in the prevention of the fall are effective towards a reduction of the fall rates (Slade, Carey, Hill, & Morris, 2017). This is similar to the study by Dyer et al (2018) who research question was also aimed at getting the answers regarding the impacts of the interventions that are used to help in the reduction of the falls among the elderly individuals within the acute care facilities (Dyer, Panagoda, Murray, Hill, Cumming, & Kerse, 2018).
In the article presented by Mervis and Philips (2019), the research question presented is aimed at some of the prevention and the processes of managing the pressure ulcers (Mervis & Philips, 2019). Concerning the study by Pittman et al (2015), the research question used was to guide the authors towards looking at the available present evidence and the clinical practice that is being recommended to help in the reduction of the hospital acquired pressure ulcers (Pittman, Beeson, Kitterman, Lancaster, & Shelly, 2015).
In the study by Engels et al (2016), the research question guided the authors to determine the factors that led to the development of the pressure ulcers among patients undergoing the surgical procedures (Engels, Austin, McNichols, Fencl, Gupta, & Kazi, 2016). In a study by Whitehead (2008), there is no mentioning of the research question, however, it is based on explanation on the understanding nursing research i.e. building an evidence-based practice (Whitehead, 2008).
Comparison of the sample populations
In the article by Engels (2016), there is no mentioning of the total number of participants used in the study. However, the sample used by the authors included adult patients who had acquired pressure ulcers that was absent at the time of their admission and developed it during the postoperative stay in the facility. On the other hand, the other three studies on the hospital acquired pressure ulcers do not have information about the sample used in the study.
In a study by Mchem et al. (2019), there is no specification about the number of study participants that were used. Nevertheless, the study targeted the patient at two units with the pre and post-implementation assessment to help in the determination of the patient-centered practical hourly rounding concerning the falls of the patients. This is similar to other studies except in the study by Dyer et al (2018) whereby the number of participants used in the study is specified to be 77, 879 participants from the 24 healthcare facilities were included in the study. In the studies by King et al (2018), Brown (2016), and Leone and Adams (2016), the explanation of the participants used in the study is based on the bed capacity i.e. 27 registered nurses and certified nurses in the two healthcare facilities in Wisconsin; 241-bed acute hospital within Southern United States; and 61 bed for inpatient in the rehabilitation and 1070 bed tertiary teaching healthcare facilities respectively.
Comparing the Limitations of the study
According to the study by Mchem et al. (2019), the primary limitation is based on the limited number of days that were used for this particular study (30 days). This, therefore, implies that more time was required to determine the impact of the hourly rounding could have been investigated further so that it can be proven that it is a sustainable intervention. In the article by King et al (2018), the limitation was based on the fact that the observation made was beyond the interviews could have analyzed to be stronger and that other rehabilitation centers could produce different results since the study was only concentrated on the two hospitals in Wisconsin.
The research by Brown (2016) includes localized data to a single unit and was not involved in the collection of patient information about the fall. The study by Rone (2018) did not have any limitations stated and this means that it is impossible to determine what factors hindered the success of the research work. Based on the research work by Leone and Adams (2016), the limitations are brought by the fact that the authors failed to perform the root cause analysis concerning the reason behind the two interventions that were not successful when used on their own to help in lowering the rate of falls. The limitations of the study by Angela (2017) were related to the calculation of the rough estimates for the adherence to the hourly rounding forms. The forms were never used as part of the electronic charting completed by the staff, therefore, it was hard to find accurate outcomes as a result of the missing forms and improper documentation methods. The study by Slade et al (2017) also had some limitations and this was related to the inclusion of the English language. Since there was no translation resource, it implies that the potential for the cultural and publication biases was higher. This is also the same case to the study by Dyer et al (2018) whereby the limitation of the study was based on the publication bias in addition to inconsistency of the effect, imprecision, and indirectness. However, the studies on the hospital acquired pressure ulcers have no information about the limitation of the study.
Conclusion
The issue of falls among elderly individuals continues to be on the rise, therefore, this calls for an instant adoption of strategies to help in the reduction of the reported cases of adult falls. Falls among elderly individuals are common due to physical impairment and the ability to maintain their body. This increases the rate of complications and deaths in hospitals. Therefore, future research should be aimed at looking at clinical decision making support is helping in driving the rounding compliance with the high fall risks patients. Healthcare providers need to ensure that there is an incorporation of the strategies aimed at assisting elderly individuals when going to the toilets. It is also important to evaluate the risks of falls among elderly individuals as well as to assess the psychological well-being of the patients during admission into the facilities. The prevention and the management of the pressure ulcers requires effective practices, therefore, it is important to engage in a study and the implementation processes on some of the procedures that are considered effective in the prevention of the pressure ulcers. Future research and the practical procedures needs to look into the factors that contribute to the increase in the development of the healthcare acquired pressure ulcers. The identification of the medical devices that are prone to hospital acquired pressure ulcers helps in the prevention of the spread of this infection.
References
Angela, M. (2017). The Utilization of an Alarm Elimination Fall Prevention Program.
Brown, C. H. (2016). The Effect of Purposeful Hourly Rounding on the Incidence of Patient Falls.
Dyck, D., Thiele, T., Kebicz, R., Klassen, M., & Erenberg, C. (2013). Hourly rounding for falls prevention: a change initiative. Creat Nurs, 19 (3), 153-158.
Dyer, S. M., Panagoda, C. E., Murray, G. R., Hill, K. D., Cumming, R. G., & Kerse, N. (2018). Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Library.
Engels, D., Austin, M., McNichols, L., Fencl, J., Gupta, S., & Kazi, H. (2016). Pressure ulcers: factors contributing to their development in the OR. AORN Journal, 103 (3), 271-281.
King, B., Pecanac, K., Krupp, A., Liebzeit, D., & Mahoney, J. (2018). Impact of Fall Prevention on Nurses and Care of Fall Risk Patients. The Gerontologist, 58 (2), 331-340.
Leone, M., & Adams, J. (2016). Safety Standards: Implementing Fall PreventionInterventions and Sustaining Lower Fall Rtaes by Promoting the Culture of Safety on an Inpatient Rehabilitation Unit. Rehabilitation Nursing, 41, 26-32.
MChem, G. J., Meredith, B., Mascioli, S., & Cunningham, J. (2019). Hourly rounding and patient falls. Nursing, 45 (2), 25-30.
Mervis, J. S., & Philips, T. J. (2019). Pressure ulcers: prevention and management. Journal of the American Academy of Dermatology.
Pittman, J., Beeson, T., Kitterman, J., Lancaster, S., & Shelly, A. (2015). Medical Device-Related Hospital-Acquired Prtessure Ulcers. Journal of Wound, Ostomy, and the Continence Nursing, 42 (2), 151-154.
Rone, C. (2018). It’s Peak Time: Prevent Falls with Hourly Rounding: Oncology Nursing Society’s Annual Conference 2018. Washington, DC: Washington Convention Centeer.
Slade, S. C., Carey, D. L., Hill, A.-M., & Morris, M. E. (2017). Effects of falls prevention interventions on falls outcomes for hospitalised adults: protocol for a systematic review with meta-analysis. BMC Open, 7 (11).
Whitehead, D. (2008). Understanding Nursing Research: Building an Evidence‐Based Practice. Journal of Clinical Nursing, 17 (4), 563.