Evaluation Table
Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research
Full citation of selected article Article #1 Article #2 Article #3 Article #4
Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., … & Ganz, D. A. (2013). Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness. Journal of the American Geriatrics Society, 61(4), 483-494.
Kalisch, B. J., Tschannen, D., & Lee, K. H. (2012). Missed nursing care, staffing, and patient fall. Journal of nursing care quality, 27(1), 6-12. Twibell, R. S., Siela, D., Sproat, T., & Coers, G. (2015). Perceptions are related to falls and fall prevention among hospitalized adults. American. Journal of Critical Care, 24(5), e78-e85. Williams, T., Szekendi, M., & Thomas, S. (2014). An analysis of patient falls and fall prevention programs across academic medical centers. Journal of nursing care quality, 29(1), 19-29.
Conceptual Framework
Describe the theoretical basis for the study
The study applied a random effects model to carry out the research.
The missed nursing care model was used in the study. The study employed two approaches including protection motivation theory and social cognitive theory. The theoretical basis of the study was missed nursing care model.
Design/Method Describe the design
and how the study
was carried out
Systematic reviews were used to summarize results from various studies. The study applied a cross-sectional descriptive design. A correlational design was used in the study. It involved a survey of adult patients. The study used systematic review design to analyze the available literature.
Sample/Setting
The number and
characteristics of
patients,
the attrition rate, etc. 59 articles from 5 recognized electronic databases were involved in the research study.
The sample included 124 patients from 11 hospitals. A sample size of 90 patients was selected for the study. The study involved 19 reviews which were related to patient falls.
Major Variables Studied
List and define dependent and independent variables The independent variable includes implementation intensity, adherence levels, and intervention complexity while the dependent variable is hospital falls.
The independent variable includes missed nursing care and staffing levels while the dependent variable is patient falls. The independent variable is the perceptions while the dependent variable is patient falls. The independent variable is patient fall prevention programs while the dependent variable is patient safety.
Measurement
Identify primary statistics used to answer clinical questions The primary statistics include the 59 articles that met the inclusion criteria. The study involved 124 patients from 11 hospitals. The study involved 158 patients but a sample size of 90 was selected for the study. The study comprised of 4 reviews that were used to answer the research question.
Data Analysis
Statistical or
qualitative
findings Meta-regression was used in the data analysis of the variables. The study was a quantitative study. The study analyzed using regression analysis method. The data analysis involved mean scores, Cronbach’s correlation, and multi-regression analysis. The study employed a meta-analysis to carry out the research.
Findings and Recommendations
General findings and recommendations of the research The outcome of the study indicated there is no systematic relationship between Incident Rate Ratios and intervention complexity, implementation intensity and adherence levels. The study recommended that better reporting of outcomes and intervention components is necessary to find strategies for preventing hospital falls. The outcome of the study indicated that low level of staffing levels lead to increased patient falls. The findings of the study indicated that some patient falls were associated due to failure to ask for help or the perception that getting out of bed without help would not be risky. It is thus recommended for nurses to be available and for patients to change their perceptions. The study findings indicated that a single theme was not sufficient, but it was necessary to have multiple approaches. They identified themes such as leadership support and engagement of front-line staff.
Appraisal
Describe the general worth of this research to practice. What are the strengths and limitations of the study? What are the risks associated with the implementation of the suggested practices or processes detailed in the research? What is the feasibility of
use in your practice? The study involved a systematic review, which is essential in reducing bias since it provides a summary of the available research. The findings of the study can be used in practical nursing practice. Additionally, the recommendations can be relied on by scholars with minimal risk. The study pointed out that staffing levels had a significant impact on patient falls. The strengths of the study are that it utilized data from 11 hospitals thus making it comprehensive. However, it has limitations since only a few hospitals were utilized. The study is applicable to practical settings since it shows a direct link between staffing levels and patient falls. The research is worth since it presents results from the analysis indicating the need to change the perceptions among patients. The results indicate the risks associated with poor perceptions. It has no limitations but further studies are required in this field. The interventions necessary to prevent patient falls do not necessarily have to be cost intensive since they can include simple approaches such as training.
General Notes/Comments The study is an eye-opener to the various strategies that hospitals can utilize to prevent falls. Better reporting of outcomes is also necessary to establish evidence on how to prevent falls. The study indicates that missed nursing care was due to low levels of staffing and it ultimately led to patient falls. The study is effective since it presents the need to change the perceptions of the patients and to recommend to them the need to always seek help to reduce patient falls. The findings of the study indicate there are multiple limitations in the study but the results are still effective.
Levels of Evidence Table
Use this document to complete the levels of evidence table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research
Author and year of selected article Article #1 Article #2 Article #3 Article #4
Hempel et al. (2013)
Kalisch, Tschannen & Lee (2012) Twibell, Siela, Sproat & Coers (2015) Williams, Szekendi & Thomas, (2014).
Study Design
The theoretical basis for the study
The study adopted a systematic review approach.
The study applied a cross-sectional descriptive design. The study employed a correlational design. The study used systematic review design to analyze the available literature.
Sample/Setting
The number and
characteristics of
patients 59 studies met the inclusion criteria and were included in the systematic review. 124 patients in 11 hospitals were included in the study. The study involved 158 acutely ill male patients. The study involved 19 reviews which were related to patient falls.
Evidence Level *
(I, II, or III)
The systematic has level I of evidence level. The study had a level II evidence level. The evidence level of the study is II. The evidence level was I.
Outcomes
The outcome of the study indicated there is no systematic relationship between Incident Rate Ratios and intervention complexity, implementation intensity and adherence levels. The outcome of the study indicated that the level of staffing levels determined patient falls. The conclusions of the study indicated that some patient falls were associated due to failure to ask for help or the perception that getting out of bed without help would not be risky. The study findings indicated that a single theme was not sufficient, but it was necessary to have multiple approaches. They identified themes such as leadership support and engagement of front-line staff.
General Notes/Comments The study is an eye-opener to the various strategies that hospitals can utilize to prevent falls. Better reporting of outcomes is also necessary to establish evidence on how to prevent falls.
Nurse staffing levels predicted the rate of patient falls and thus high staffing levels were recommended. Nurses indicate that although they foresee danger among patients, the patients did not perceive the danger of falling, thus leading to increased accidents. There are various strategies that can be used to prevent patient falls such as leadership support.
* Evidence Levels:
• Level I
Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis
• Level II
Quasi-experimental studies, a systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis
• Level III
Nonexperimental, a systematic review of RCTs, quasi-experimental with/without meta-analysis, a qualitative, qualitative systematic review with/without meta-synthesis
• Level IV
Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence
• Level V
Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence
Outcomes Synthesis Table
Use this document to complete the outcomes synthesis table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research
Author and year of selected article Article #1 Article #2 Article #3 Article #4
Hempel et al. (2013)
Kalisch, Tschannen & Lee (2012) Twibell, Siela, Sproat & Coers (2015) Williams, Szekendi & Thomas, (2014).
Sample/Setting
The number and
characteristics of
patients 59 articles were used in the systematic review since they met the inclusion criteria. The study involved 124 patients in 11 hospitals. The study involved 158 acutely ill male patients. The study analyzed 2500 patient falls reports.
Outcomes
The outcome of the study indicated there is no systematic relationship between Incident Rate Ratios and intervention complexity, implementation intensity and adherence levels. The outcome of the study indicated that low level of staffing levels lead to increased patient falls. The outcome of the study indicated that some patient falls were associated due to failure to ask for help or the perception that getting out of bed without help would not be risky. The outcome of the study shows that multicomponent programs are effective in reducing patient falls.
Key Findings
The findings of the study indicated that there is no significant relationship between adherence levels, implementation intensity, intervention complexity, and Incident Rate Ratios. The study findings revealed that higher staffing levels reduced the patient falls while low staffing levels increased patient falls. The findings indicated that 75 percent of patients would ask for help while 48 percent were confident they would not fall. The study did not clearly indicate specific programs that were effective to prevent or reduce falls.
Appraisal and Study Quality
The study was carried out in a professional manner since the studies included were carefully searched from recognized databases and experts. The use of systematic reviews minimized the level of bias. It also provided a summary of all the available research. The study presents practical conclusions on missed nursing care and their effect on patient falls. The study was carried applied correlational design and presented the findings in percentages thus showing the perceptions of the patients. The study is also applicable in practical settings. The study was effective since it indicated that a single approach was not sufficient, but it was necessary to have multiple approaches.
General Notes/Comments The study established that there is no significant relationship between the variables. There is a need for further research, better reporting, intervention, and implementation to establish how hospital falls can be prevented.
The study indicates that missed nursing care was due to low levels of staffing and it ultimately led to patient falls. The study is effective since it presents the need to change the perceptions of the patients and to recommend to them the need to always seek help to reduce patient falls. The interventions necessary to prevent patient falls do not necessarily have to be cost intensive since they can include simple approaches such as training.
Critical Appraisal of Research
Critical appraisal involves a systematic analysis of a research study to establish its value and worthiness. It also assesses the value ofresearch in relation to the practical application of the findings. Critical appraisal of research is necessary since it helps healthcare providers to assess the feasibility of the study findings (Seers, 2015). It is also essential in making crucial decisions in the healthcare sector. It is also important since it provides a clear view of what is not relevant or what is misreported in the study (Seers, 2015). The process of critical appraisal is based on the strengths and weaknesses of a study to determine if it can be applied. It must be free from any systematic bias and also help improve the medical procedures.
The best practice identified in the critical appraisal process was systematic reviews. The reason is that they were used to present a summary of all the available research. Additionally, it was necessary to create a high level of confidence. The systematic reviews provide a one-stop summary of all the available evidence from various research studies (Seers, 2015). It is thus effective since it comprises of various perspectives thus eliminating the possibility of bias. They provide accurate conclusions since they are not based on generalizations or opinions from individuals. The summary provides current and the best solution possible in the healthcare sector. The studies carried out by Hempel et al. (2013) and Twibell, Siela, Sproat & Coers (2015) are clear examples of systematic reviews. The reviews are essential since they are used in making crucial decisions. In the current analysis, they are used to reduce patient falls and change patients’ perceptions.
References
Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., … & Ganz, D. A. (2013). Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness. Journal of the American Geriatrics Society, 61(4), 483-494.
Williams, T., Szekendi, M., & Thomas, S. (2014). An analysis of patient falls and fall prevention programs across academic medical centers. Journal of nursing care quality, 29(1), 19-29.
Seers, K. (2015). Qualitative systematic reviews: their importance for our understanding of research relevant to pain. British journal of pain, 9(1), 36-40.
