introduction to nursing research
Summary of Clinical Issue:
Population: Falls in community-dwelling older adults.
Intervention: Adoption of Exercise Programs to prevent falls in older adults
Comparison: The Intervention seeks to determine whether the utilization of exercise programs will result in the lower occurrence of falls in non-frail elderly patients in comparison usual care.
Outcome: The intervention will result in health care practitioner using balance training (75%) in engaging patients in their individualized fall prevention plan through understanding of their overall risk factors and personalized inpatient fall prevention intervention (64%). A projected reduction in fall rates by almost 30% is expected after 30 days of adopting the intervention in comparison to the previous year’s fall rates of the same month.
Time: The intervention will be implemented over a 1-year period.
Conclusion: The clinical issue of interest is preventing falls in older people in hospitals and care facilities. Research has shown that falls in the older population is emerging as a crucial public health challenge and a top priority area for preventive healthcare in the United States and abroad (Severance et al., 2022; Cederbom et al., 2020; Worum et al., 2020). Bjerk et al. (2017) commented that a fall could contribute to detrimental consequences for the affected individual including morbidity, diminished quality of life, medical institutionalization, fear of falling, increased dependency on others, high medical costs and even pre-mature mortality. The adoption of evidence-based interventions such as home exercise programs, balance training, physiotherapy, and physical training in community-living elderly may contribute to reduced risk of falling, in both non-frail and frail older adults (Patti et al., 2021; El-Khoury et al., 2015).
PICOT Question: Are there evidence-based exercise programs that are effective in reducing the risk of falls in older adults when compared to usual care when implemented over one-year duration?
3 Qualitative Articles
|Criteria||Article 1||Article 2||Article 3|
|APA-Formatted Article Citation with Permalink||Worum, H., Lillekroken, D., Roaldsen, K. S., Ahlsen, B., & Bergland, A. (2020). Reflections of older people about their experience of fall prevention exercise in the community- a qualitative study exploring evidence-based practice. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-020-09630-4||Cederbom, S., Bjerk, M., & Bergland, A. (2020). A qualitative study exploring physical therapists’ views on the Otago exercise programme for fall prevention: A stepping stone to “age in place” and to give faith in the future. Physiotherapy Theory and Practice, 38(1), 132-140. https://doi.org/10.1080/09593985.2020.1731895||Bjerk, M., Brovold, T., Skelton, D. A., & Bergland, A. (2017). A falls prevention programme to improve quality of life, physical function and falls efficacy in older people receiving home help services: Study protocol for a randomised controlled trial. BMC Health Services Research, 17(1). https://doi.org/10.1186/s12913-017-2516-5|
|How Does the Article Relate to the PICOT Question?||The article explores the experiences of older people with regards to involvement in fall prevention exercise program in the community environment.||The article examined the effectiveness of physical exercise in reducing the risk of falls among home-dwelling older adults.||The article investigated the efficacy of exercise as fall prevention strategies for improving physical function, quality of life and reducing the risk of falls in older adults receiving home-help services.|
|Quantitative, Qualitative (How do you know?)||Qualitative study since it utilized semi-structured interviews.||Qualitative inductive design since it employed a phenomenological perspective and semi-structured interviews to explore the experiences of physical therapists with regards to the effectiveness of the Ontago Exercise program (OEP).||Qualitative study since it was conducted as a single-blinded, pragmatic RCT comparing one intervention group with a control group.|
|Purpose Statement||To explore the reflections of community-dwelling older people regarding their experiences of a fall-prevention exercise initiative.||To explore the sentiments of Physical Therapists (PT) with regards to the applicability of the OEP in clinical setting for older patients, and to determine their beliefs on the benefits of the fall prevention program in terms of improvements in physical function and quality of life.||To investigate the implications of a fall prevention exercise program and improvements in health-related quality of life.|
|Research Question||What are the expectations and views of older people about evidence-based practice (EBP) in physiotherapy in relation to fall prevention exercise?||How does PTs experience the applicability of the Ontago Exercise program in clinical practice for older adults and what are their beliefs on the practical benefits of exercise?||What are the implications of a fall prevention exercise program on physical function and quality of life and falls efficacy in elderly individuals receiving home-help services?|
|Outcome||Evidence-based practice in physiotherapy had positive implications on the efficacy on a falls prevention program for the elderly.||The utilization of OEP contributed to enhanced capacity of older patients to “age in place.”||The use of exercise as falls prevention may be associated with improvements in physical function, falls efficacy and quality of life in older persons.|
(Where did the study take place?)
|Four different regions in Oslo, Norway||Six municipalities in Eastern Norway||Participants’ Homes|
|Sample||16 older people (men=7; women=9)||17 physical therapists||150 participants|
|Method||Thematic analysis||Qualitative inductive design||Single-blinded control trial|
|Key Findings of the Study||EBP is integral to successful physiotherapy and transformation of knowledge into action can enhance the benefits of exercise program.||Based on the perceptions of the physical therapists, the OEP can contribute to improvements in quality of life including self-efficacy, mood, physical function and involvement in social activities in older persons||Exercise falls prevention program can contribute to improvements in health-related quality of life as well as secondary outcomes (such as balance, leg strength, walking habits, and speed, falls efficacy, nutritional status and routine activities.|
|Recommendations of the Researcher||Therapist-participant relationship is integral to ensuring the success of exercise programs.||OEP can be applied in primary care setting as falls prevention intervention.||Applying knowledge on the efficacy of exercise programs by nurses, clinicians and health managers can help to reduce fall rates among older adults receiving home-based help services.|
3 Quantitative Articles
|Criteria||Article 4||Article 5||Article 6|
|APA-Formatted Article Citation with Permalink||El-Khoury, F., Cassou, B., Charles, M., & Dargent-Molina, P. (2015). The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults:. British Journal of Sports Medicine, 49(20), 1348-1348. https://doi.org/10.1136/bmj.f6234
|Severance, J. J., Rivera, S., Cho, J., Hartos, J., Khan, A., & Knebl, J. (2022). A collaborative implementation strategy to increase falls prevention training using the age-friendly health systems approach. International Journal of Environmental Research and Public Health, 19(10), 5903. https://doi.org/10.3390/ijerph19105903||Patti, A., Zangla, D., Sahin, F. N., Cataldi, S., Lavanco, G., Palma, A., & Fischietti, F. (2021). Physical exercise and prevention of falls. Effects of a Pilates training method compared with a general physical activity program. Medicine, 100(13), e25289. https://doi.org/10.1097/md.0000000000025289|
|How Does the Article Relate to the PICOT Question?||The article explored the centrality of falls in older patients as a key issue with significant physical, psychological and financial costs and how exercise can be used to prevent this clinical issue.||The article identified exercise-related interventions as some of the evidence-based interventions and person-centered processes to tackle falls in older adults.||The article examined the role played by physical activity in the stimulation of postural control and prevention of falls.|
|Quantitative, Qualitative (How do you know?)||Quantitative due to application of statistical analysis||Quantitative study due to use of descriptive statistics||Quantitative since it was conducted as a randomized controlled trial (RCT)|
|Purpose Statement||To determine the effectiveness of exercise programs in preventing falls in aging community-dwellers.||To examine the outcomes of partnership among various stakeholders including government agency, education facility, emergency management services and community organizations in the implementation of falls prevention training program.||The purpose of the study was to determine the correlations between physical activity and secondary outcomes such as strength, balance, posture and reduced risk of falls.|
|Research Question||1. What are the effects of fall prevention exercise programmes on fall-induced injuries?
2. What are the effects of exercise on fall risk factors and overall quality of life of older adults in community-dwellings?
|Can collaboration between the various partners improve the delivery of falls prevention training to at-risk older adults?||What are the effects of physical activity on balance and on diminishing the potential risk of falling?|
|Outcome||If effectively adopted, falls prevention exercise programs can be a viable means of preventing injurious falls among older adults.||Enhanced partnership can boost improvements in community-based falls prevention education.||The Pilates matwork exercise Program contributed to improvements in bodily balance and stability.|
(Where did the study take place?)
|20 centers throughout France||Tarrant County, Texas.||The University of Palermo Sports Lab|
|Sample||Intervention group (352) and control group (354)||354 community-dwelling older adults||18 subjects (4 men and 14 women)|
|Method||Statistical analysis||Prospective study||Randomized Controlled trial; Statistical analysis|
|Key Findings of the Study||Falls prevention exercise programmes had positive in terms of preventing fall-induced injuries among the sampled population.||The mobilization of collaborative partnership can contribute to improved delivery of training on falls prevention and subsequent improvement in efficacy of falls prevention programs for community-dwelling older adults.||Physical activity can contribute to improvements in both bodily strength and balance, thus helping to reduce the risk of falls.|
|Recommendations of the Researcher||Exercise programs can be applied as evidence-based approaches for tackling the problem of falls in community-dwelling adults.||The completion of falls prevention training is integral to ensuring improvements in falls efficacy.||The Pilates Program can contribute to high fall efficacy when compared to a general physical activity initiative.|
Bjerk, M., Brovold, T., Skelton, D. A., & Bergland, A. (2017). A falls prevention programme to improve quality of life, physical function and falls efficacy in older people receiving home help services: Study protocol for a randomised controlled trial. BMC Health Services Research, 17(1). https://doi.org/10.1186/s12913-017-2516-5
Cederbom, S., Bjerk, M., & Bergland, A. (2020). A qualitative study exploring physical therapists’ views on the Otago exercise programme for fall prevention: A stepping stone to “age in place” and to give faith in the future. Physiotherapy Theory and Practice, 38(1), 132-140. https://doi.org/10.1080/09593985.2020.1731895
El-Khoury, F., Cassou, B., Charles, M., & Dargent-Molina, P. (2015). The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults:. British Journal of Sports Medicine, 49(20), 1348-1348. https://doi.org/10.1136/bmj.f6234
Patti, A., Zangla, D., Sahin, F. N., Cataldi, S., Lavanco, G., Palma, A., & Fischietti, F. (2021). Physical exercise and prevention of falls. Effects of a Pilates training method compared with a general physical activity program. Medicine, 100(13), e25289. https://doi.org/10.1097/md.0000000000025289
Severance, J. J., Rivera, S., Cho, J., Hartos, J., Khan, A., & Knebl, J. (2022). A collaborative implementation strategy to increase falls prevention training using the age-friendly health systems approach. International Journal of Environmental Research and Public Health, 19(10), 5903. https://doi.org/10.3390/ijerph19105903
Worum, H., Lillekroken, D., Roaldsen, K. S., Ahlsen, B., & Bergland, A. (2020). Reflections of older people about their experience of fall prevention exercise in the community- a qualitative study exploring evidence-based practice. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-020-09630-4
The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.
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.
Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic reviews, literature reviews, and metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles. Therefore, they should not be included in this assignment.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are not required to submit this assignment to LopesWrite.