Johns Hopkins Nursing EBP Model: Sample Nursing Assignment

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Johns Hopkins Nursing EBP Model: Sample Nursing Assignment

Model of John Hopkin’s College of Nursing

TASK 1: Primary Quantitative

 

Article Goodwin, V. A., Paudyal, P., Perry, M. G., Day, N., Hawton, A., Gericke, C., & … Byng, R. (2016). Implementing a patient-initiated review system for people with rheumatoid arthritis: a prospective, comparative service evaluation. Journal Of Evaluation In Clinical Practice, 22(3), 439-445. doi:10.1111/jep.12505
Background Information The authors’ purpose statement involved the establishment of the differences in satisfaction levels between direct-access appointments versus the regular appointments in patients with rheumatoid arthritis. Similarly, the study sought to evaluate the execution processes that characterize the two. The objective of the study as stated by the authors was satisfactory to me. According to the Goodwin et al. (2016), there are different levels of satisfaction when an RA patient initiates review with their doctor in comparison to when they have to abide by a scheduled appointment. Thus, the authors seek to determine why the direct access method is more effective. Therefore, the description that they offered was comprehensive enough.
Review of Literature In their literature for this study, the authors covered the following topics: statistics of people with rheumatoid arthritis, traditional models of rheumatoid arthritis management, and alternative models of rheumatoid arthritis. In the first topic, the authors cited Cross et al. (2014), National “Rheumatoid Arthritis Society” (2014), and Pope et al. (2005). In stating the traditional models, they referred to Pope et al. (2005), Smolen etl at. (2010), and “National Institute for Health and Care” (2013). Finally, the authors used research by Hewlett e al. (2009), Whear (2013), and Paudyal, Perry, Child, and Gricke (2012).
Methodology The authors quantitatively carried out the research by prospectively evaluating the rheumatoid arthritis management service. This was done via the comparison of usual care and direct access care of patients at the PNHT in the period 2012-2013. The subtype of the present study was the randomized control trial. In the subtype, three rheumatologists came up with a list of individual patients they thought would meet the criterion of the study. 190 patients were randomly assigned to the direct access group of the RA management and a same subject assigned to the usual RA management. These subjects were followed up over a period of 12 months to determine their satisfaction levels by considering a decrease in consultations number. Since the primary objective of the study was to collect patient satisfaction, this was conducted using Short-Form-Patient-Satisfaction-Questionnaire (PSQ-18). Lickert scale was also used to demonstrate individual patient satisfaction I the study population.
Data Analysis The study used various tools to analyze the data that was collected from the study. A CONSORT flow chart was used to present the patients flow in the study. Afterward, descriptive statistics and Chi-square were used to determine certain aspects of the patients in the study.
Conclusion The researchers concluded that it was possible to execute the direct access intervention methodology in the management of RA patients since it showed benefits in actual healthcare setting. The conclusions make sense to me as a clinician. This is because we are looking at a method that the patients are absolutely comfortable with and the research illuminates it.

Johns Hopkins Nursing EBP Model: Sample Nursing Assignment

A2. & B2. Researcher’s Conclusion

In their conclusion, the researchers believe that it was viable to execute direct access service in our hospitals since the study was conducted in real-word hospitals. They argued that this is the case since patients illustrated benefit in an actual setting. The conclusion made by the researchers is fully supported by the first four sections of the research paper and as such, the researchers were within their right to make the conclusion. First, there are other studies that could explain their results. Also, their conclusions are supported by the fact that patients are the ones who understand their bodies much better and as such, they need to initiate the meeting with their doctors, which automatically improves their satisfaction. Therefore, the first four sections of the research paper support the conclusion as they address the above reasons.

A3. & B3. Protection and Considerations

Given the fact that the research used human subjects, there are certain ethical considerations that the researchers should have undertaken. First, the authors should have examined the principle of voluntary participation. From the information, it is the rheumatologists who identified the patients. As such, it could be argued that there was no chance for voluntary participation. Also, the principle of informed consent did not fully apply. Some of the prospective participants were eliminated because of their disabilities and perceived inability to initiate calls on the say so of their relatives. Further, the researchers did not enforce the anonymity requirement. Since the patients were identified by doctors and they actually saw those doctors, this meant that their anonymity was non-existent, which is contrary to ethical dictates of research studies.

A4. & B4. Strengths and Limitations

The research study was limited by the lack of diversity in the number of patients. According to information thereof, the patients only came from three rheumatologists and as such, there could have been an element of bias. The sample size of 190 participants was small for a study of this magnitude. The authors also state that the study was limited by the absence of a diversity in the base line characteristics of the two study populations.

A5. & B5. Evidence Application

The study primarily involves the management of rheumatoid arthritis patients. The satisfaction of the patients as indicated by the study is important as it reduces the works of nurses. This will occur due to the fact that patients will determine when to go for check-ups, thus reducing admission rates for arthritis patients. Similarly, nurses will identify appropriate ways of handling such patients as a result of the study.

TAKS 1: Primary Qualitative

Article Schiøtz, M., Frølich, A., Krasnik, A., Taylor, W., & Hsu, J. (2012). Social organization of self-management support of persons with diabetes: A health systems comparison. Scandinavian Journal Of Primary Health Care, 30(3), 189-194. doi:10.3109/02813432.2012.704810
Background Information The authors’ purpose statement was the identification of crucial organizational elements in the provision of self-management support. The statement made a lot of sense to me as it compared the primary healthcare of angle of this issue between two countries. However, the description of the problem by the researchers was wanting.
Review of Literature In the review, the authors have used Corser and Xu (2009), Fenton et al. (2006), Philips et al. (2005), Rodger et al. (2005),Sobel et al. (2002), McDiarmid et al. (2001), and Piette (2002), and Wagner (2001)  to discuss the self-management of diabetes. Further, they have used  Feachem (2002), Ham et al. (2003), Frolich et al. (2008), Strandberg-Larsen et al. (2007) and Schioz, Frolich, and Kasnich (2008) to discuss the healhtcare systems in US and Canada.
Methodology Qualitative methodology was the major type of research used in the study. In this method, 36 healthcare professionals from the two nations were subjected to semi-structured (Schiotz et al., 2012), wherein they were required to give their opinions regarding factors that enhanced the provision of self-management to diabetes patients.
Data Analysis The study was a qualitative study. So, the data from the semi-structured interviews was coded for numerous themes. In addition, it was subjected to an analysis on the basis of the themes thereof.
Conclusion The researchers conclude that the implementation of the self-management support can be better of hospitals understood the aspects that support its provision. The conclusion makes lots of sense to a clinician such as me. As a consequence, of the research’s conclusion, the USA healthcare system can improve its support for the SMS foe diabetes patients.

 

A2. & B2. Researcher’s Conclusion

The researchers conclude by stating that the improvement of the comprehension of factors that lead to improved SMS amongst healthcare professional has a direct correlation to the level of SMS adopted by diabetics. Based on the purpose of the study, the researchers are permitted o make this conclusion. In addition, given the topics that the literature review covered, the researchers supported the conclusions of initial findings with their own conclusion. The conclusions are similarly supported by the themes found within the methodology of the study. They were designed to illuminate the impact of knowledge on SMS hence the results.  The analysis of the themes further supported the conclusion.

 

A3. & B3. Protection and Considerations

In conducting the semi-structured interview, the researchers did not give regard to anonymity. According to the paper, one of them physically interviewed the healthcare professionals. This could have biased some of their views or they could have misled the interviewer for fear of reprisal. Additionally, there was an issue with the right to service ethical considerations. The study did not offer the interview to people who are not part of the project. This contravenes the ethics of a good research. Lastly, the fact that there was a physical interviewer implies that the researchers did not regard the privacy of the interviewees.

A4. & B4. Strengths and Limitations

The study was conducted across two nations, which made its findings plausible. Also, the sampling strategy was poor as the healthcare professionals were elected for the study. However, the sample size was 36 and not uniform between the two nations, which is a limitation. The quality of the study was also good as the focus was on both meso- and macro-levels of the healthcare organizations.

A5. & B5. Evidence Application

The study essentially dealt with SMS improvements as far as management of diabetes wound is concerned. The specific part of the study that recommends for the continuous training of healthcare professionals is important for nursing practice. This is so since it improves the knowledge that nurses ill have regarding the same.

 

Sources

Goodwin, V. A., Paudyal, P., Perry, M. G., Day, N., Hawton, A., Gericke, C., & … Byng, R. (2016). Implementing a patient-initiated review system for people with rheumatoid arthritis: a prospective, comparative service evaluation. Journal Of Evaluation In Clinical Practice, 22(3), 439-445. doi:10.1111/jep.12505

Schiøtz, M., Frølich, A., Krasnik, A., Taylor, W., & Hsu, J. (2012). Social organization of self-management support of persons with diabetes: A health systems comparison. Scandinavian Journal Of Primary Health Care, 30(3), 189-194. doi:10.3109/02813432.2012

PART 2

A1. Healthcare Problem

Inpatient falls are increasingly becoming highlighted in the literature. According to statistics, 2%-12% of patients undergo falls. Most importantly though, the inpatient falls result in harm in close to 40% of the cases. Therefore, there is need to examine the issue extensively.

A2. Significance of Problem

Focusing on inpatient falls is significant because of various reasons. Research reveals that inpatient falls lead to impacts such as increased mortality as well as morbidity. Further, the victims incur increased costs of care and do not benefit from payors’ reimbursement

A3. Current Practice

            In order to address the issue, hospitals are currently adopting the use of patient call lights. The practice allows patients to gain the attention of nurses through the usage of call lights. However, the practice has proven to be ineffective as it depends on a host of factors. One, studies state that nurses do not respond on time thus leading to increased incidences of patient falls. Further, patients have complained of a lack of follow-up on their call light requests thus exposing them to falls. Call light system also lacks uniformity in terms of nurses’ response further jeopardizing the lives of patients.

Furthermore, the usage of call light has also negatively impacted nurses thus leading to the ineffectiveness of the same. As a consequence, nursing has developed an element of confusion as it is not clear who is supposed to respond to call lights. In addition, nursing workflow has also been negatively impacted by call light systems. This is evident in the complaints of some nurses that call lights interfere with their workflow and general provision of healthcare services. For these reasons, the call light system has not been embraced by both patients and nurses, hence impeding the very purpose it was supposed to serve.

A4. Impact on Background

Almost all hospitals are committed to a culture of safety for the various types of patients, and inpatients in particular. To this end, hospitals strive to implement programs that will support prevention of falls. However, studies have revealed that falls are still persistent in hospitals despite the efforts. This negatively impacts the safety culture that hospitals have worked hard to institute. Consequently, the prevalence of falls leads to apprehension amongst patients as their safety will not be guaranteed.

  1. PICO TABLE
Problem/Patient Hospital inpatients
Intervention Post fall huddles form
Comparison Call lights use
Outcome Decreased rates of fall in the inpatient section patients
   

 

  1. PICO QUESTION

Among surgical unit inpatients, does post fall huddles form lower inpatient falls as compared to the use of call lights?

C1: Keywords: inpatient falls; patient falls, patient safety, nursing interventions, and falls prevention

C2: Number and Types of Articles

When I keyed the various keywords, almost 26 000 articles came up. I quickly whittled this number to 10 critical articles for this study. In the remaining articles, 2 of them were quantitative, 3 qualitative, and the rest RCT articles.

C2A: Research and non-research articles

Research Articles

Ireland, S., Kirkpatrick, H., Boblin, S., & Robertson, K. (2013). The Real World Journey of Implementing Fall Prevention Best Practices in Three Acute Care Hospitals: A Case Study. Worldviews on Evidence-Based Nursing, 10(2), 95. doi:10.1111/j.1741-6787.2012.00258.x

Two research articles were used for this study. In “The real world journey of implementing fall prevention best practices in three acute care hospitals: a case study”, Ireland etl. (2013) discovered that clinical staff played an important role in the prevention of falls in the impatient surgical unit. The article further revealed that the process of preventing patient falls needs to be continuous. Lastly, the authors argued that there is need to keep the execution of the process easy for everybody.

Reiter-Palmon, R., Kennel, V., Allen, J. A., Jones, K. J., & Skinner, A. M. (June 01, 2015). Naturalistic decision making in after-action review meetings: The implementation of and learning from post-fall huddles. Journal of Occupational and Organizational Psychology, 88, 2, 322-340.

The authors of the above research conducted an experimental study in 17 hospitals with regard to the subject of post-fall huddles form and reduction of inpatient fall rates. According to the result of Reiter-Palmon et al. (2015), all the hospitals indicated a reduction in inpatient falls upon the usage of the post-fall huddles forms.

Non-research articles

Avin, K. G., Hanke, T. A., Kirk-Sanche, N., McDonough, C. M., Shubert, T. E., Hardage, J., & Hartley, G. (2015). Management of Falls in Community- Dwelling Older Adults: Clinical Guidance Statement From the Academy of Geriatric Physical Therapy of the American Physical Therapy Association. Physical Therapy, 95(6), 815-834.

In the above article, the authors give guidelines on what should be done in the event that there is fall within a community (Avin et al. 2015). However, the information therein can be applied even in the inpatient surgical wards as these patients are similar. The strategies on the identification and management of fall risks offered herein is similar to the ones offered by various surgical units hence it is applicable in those settings.

Hartung, B., & Lalonde, M. (2017). Feature Article: The use of non-slip socks to prevent falls among hospitalized older adults: A literature review. Geriatric Nursing, 38412-416. doi:10.1016/j.gerinurse.2017.02.002

Hartung and Lalonde (2017) discovered that non-slip socks could prevent the rates of fall among hospitalized adults. However, in the article, they review certain literatures that have ecplored the possibility of using the same in surgical units. These articles presented a positive outlook on that possibility.

  1. Evidence Matrix

Evidence Matrix

Authors Journal Name/ WGU Library Year of Publication Research Design Sample Size Outcome Variables Measured Level (I–III) Quality (A, B, C) Results/Author’s Suggested Conclusions
Reiter-Palmon, R., Kennel, V., Allen, J. A., Jones, K. J., & Skinner, A. M.

 

Journal of Occupational and Organizational Psychology 2015 Experimental 14 hospitals Inpatient falls I A Implementation of post-fall huddle forms reduces inpatient falls
Titler, M. G., Conlon, P., Reynolds, M. A., Ripley, R., Tsodikov, A., Wilson, D. S., & Montie, M. Applied Nursing Research 2016 A prospective pre–post implementation cohort design Thirteen adult medical-surgical units Reduction in falls I A Fall reduction when hospitals use post-fall huddles forms to implement prevention strategies
Cioffi, C., Plumadore, J., & Clark, K. (2013). ICSI 2013 Systematic Literature review 182 reports Reduction in falls II A Elimination of falls upon using post-fall huddles report
Urquhart Wilbert The Journal Of Chi Eta Phi Sorority 2013 Random control study 70 patients Reduction of falls due to nurses intervention I A Interventions such as post-fall huddle forms significantly reduced fall rates
Ireland, S., Kirkpatrick, H., Boblin, S., & Robertson, K. World Views Evidence Based Nursing 2013   Patients from Falls prevention II B Reduction in falls

 

  1. Recommended Practice Change

All of the articles call for the adoption of post-fall huddles forms in the hospital set-up so as to prevent inpatient falls. Ireland and his colleagues conducted a research in three acute care hospitals with regard to the effective fall prevention strategies. In their study, the usage of post-fall huddles form was one of the stratagems. Ireland et al.  (2013) concluded that hospital management need to explore the possibility of executing post-fall huddle forms strategy so as to address the issue of inpatient falls.

Further, Urquhart (2013) examined the impact of post-fall huddles forms on the prevention of falls in patients. Using retrospective medical records review, a wide range of hospitals were reviewed for falls before and after the implementation of the strategy. Urquhart (2013) posited that the implementation of post-fall huddles form was an effective method of reducing inpatient falls and reducing the seriousness of such falls.

In addition, Reiter-Palmon et al. (2015) asserted that from the evidence that they gathered, post-fall huddle forms reduced fall rates. The researchers arrived at this conclusion after reviewing falls in targeted hospitals after application of post-fall huddles forms.

Similarly, Cioffi, Plumadore, and Clark (2013) reviewed hospital falls in lieu of the implementation of post-fall huddle forms. By examining the medical records of numerous hospitals, they were able to come to a certain conclusion. Thus, in their retrospective analysis, Cioffi, Plumadore, and Clark (2013) discovered that fall preventative measures such as post-fall huddles reduced the number of falls by a whopping 50%.

Lastly, Titler e al. (2016) avers that addressing the factors revealed by post-fall huddles form enabled hospitals to reduce their inpatient fall rates by a significant amount. By reviewing 13 surgical units, they discovered that a certain strategy that involved post-fall huddles forms led to the reduction of falls in that unit. Thus, Titler et al. (2016) recommend the implementation of a Targeted Risk Factor Fall Prevention Bundle, which has post-fall huddles forms to offer he evidence-based practice that it needs.

F1. Key Stakeholders

The key stakeholders herein involve the nursing educators, floor nurses and nurse administrators. Nurse educators could be included in the decision-making by teaching the floor nurses how the whole post-fall huddles form process should be conducted. The floor nurses will participate in the intervention by filling in the forms, either electronically or manually. Finally, nursing administrators will need to provide financial and policy support for the implementation for the post-fall huddle forms program.

F2. Barriers

However, continuously executing strategies that may lead to improved nursing interventions may be met with certain barriers. The adoption of the post-fall huddle forms could become hampered by the lack of sustainability of the intervention, particularly regarding making it sustainable. The lack of such sustainability could impact the morale of the staff in implementing the intervention.  In addition, studies reveal that nurses are taking their time to fill in the forms. In fact, nurse managers always have to remind the floor nurses to fill in the forms, further proving problematic for the execution of the strategy.

F3: Strategies for Barriers

            To overcome the firs barrier, the management may need to involve all the key stakeholders in the decision-making process regarding the program. Further, hospitals need to encourage their staff through various databases that address issues such as the reduction of falls. Also, the management should consider offering reminders to nurses regarding the need to fill in the forms through strategies such as posters. By doing these, among other strategies, the above barriers could be overcome.

F4: Indicator to Measure Outcome

            After instituting post-fall huddle forms, hospitals need to conduct further studied on the incidences of current fall-rates vis-à-vis initial fall rates. The differences amongst these two fall rates will indicate the effectiveness of the post-fall huddle forms.

  1. Sources

Avin, K. G., Hanke, T. A., Kirk-Sanche, N., McDonough, C. M., Shubert, T. E., Hardage, J., & Hartley, G. (2015). Management of Falls in Community- Dwelling Older Adults: Clinical Guidance Statement From the Academy of Geriatric Physical Therapy of the American Physical Therapy Association. Physical Therapy, 95(6), 815-834.

Cioffi, C., Plumadore, J., & Clark, K. (2013). Decreasing inpatient falls: A retrospective analysis with clinical nurse specialist-led interventions. Journal of Hospital Administration, 2(2), 3-9.

Hartung, B., & Lalonde, M. (2017). Feature Article: The use of non-slip socks to prevent falls among hospitalized older adults: A literature review. Geriatric Nursing, 38412-416. doi:10.1016/j.gerinurse.2017.02.002

Ireland, S., Kirkpatrick, H., Boblin, S., & Robertson, K. (2013). The Real World Journey of Implementing Fall Prevention Best Practices in Three Acute Care Hospitals: A Case Study. Worldviews On Evidence-Based Nursing, 10(2), 95. doi:10.1111/j.1741-6787.2012.00258.x

Reiter-Palmon, R., Kennel, V., Allen, J. A., Jones, K. J., & Skinner, A. M. (June 01, 2015). Naturalistic decision making in after-action review meetings: The implementation of and learning from post-fall huddles. Journal of Occupational and Organizational Psychology, 88, 2, 322-340.

Titler, M. G., Conlon, P., Reynolds, M. A., Ripley, R., Tsodikov, A., Wilson, D. S., & Montie, M. (January 01, 2016). The effect of a translating research into practice intervention to promote use of evidence-based fall prevention interventions in hospitalized adults: A prospective pre-post implementation study in the U.S. Applied Nursing Research : Anr, 31, 52-9.

Urquhart Wilbert, W. (2013). The Effectiveness of a Fall Prevention/Management Program In Reducing Patient Falls: A Retrospective Study. JOCEPS: The Journal Of Chi Eta Phi Sorority, 57(1), 24-27.

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