CHOOSING THE TYPE OF RESEARCH FOR A RESEARCH PROBLEM
Discussion: Choosing the Type of Research for a Research Problem
Part 1: Patient Safety Problem
The danger of unintentional falls, particularly for elderly and frail patients 65 years of age and above, has been recognized as the patient safety issue in this case (Guirguis-Blake et al., 2018). This is a major safety concern that affects the patient and the provider in a big way. According to Venema et al. (2019), the national threshold for patient falls in the US is 3.44 falls for every 1,000 patient days. One of its causes is that nurses do not have the necessary expertise to properly identify risks and know what to do when one is found. The other two factors are a lack of nurses and the elderly patient demography, which is the most vulnerable.
The outcomes for patients are significantly impacted by this fall issue. They might sustain fractures, bruising, a concussion, or an intracerebral hemorrhage. These are all potentially fatal and could result in an extended hospital stay or even death. Fehlberg et al. (2017) report that the Centers for Medicare and Medicaid treatments (CMS) implemented a policy of not reimbursing for treatments provided to individuals who have fallen within a facility. This began in October of 2008 and aims at shifting the responsibility for these preventable occurrences to the organizations responsible. In regulatory and nurse-sensitive indicator terms, falls are sentinel events.
Studies indicate that about one-third of falls are avoidable, and there are numerous fall prevention strategies available. Training nurses, implementing smart bed alarms, and having the nurses on a shift do meaningful hourly rounds are the practice changes that could assist improve patient outcomes (Guirguis-Blake et al., 2018). For these three modalities to be helpful in reducing falls, they must be used in combination. Since scientific nursing research has demonstrated their efficacy, they are all included in evidence-based practice, or EBP (Melnyk & Fineout-Overholt, 2023). Patients should get fall prevention education at the same time that nurses receive it.
Part 2: Research on Patient Safety Problem
Research question: Does a decrease in the frequency of unintentional patient falls correspond with the preventative bundle consisting of hourly rounding, bedside alarms, and nurse training?
I would employ quantitative research, particularly randomized controlled trials, or RCTs, to address the research topic above (Gray & Grove, 2021). Among the explanations for this are that RCTs, in particular, and quantitative studies are the most effective in proving causation or causality. They also confer the highest level of evidence on the pyramid of evidence at level I of evidence (best evidence possible). Because it is experimental in nature, an RCT will have a random sample of subjects divided into two groups. One will be the experimental group, and the other the control group.
The experimental group will then receive the intervention, while the control group will be given a placebo. In order to obtain even more valid and generalizable results, the investigators and/ or subjects can be single or double-blinded. This simply means that either the subjects or both the subjects and researchers will not be allowed to know which group is receiving the real treatment and which one the placebo. The purpose of this is to eliminate bias that may influence the results. In the above case in which the efficacy of falls prevention interventions is in question, an experimental style of research would be the most appropriate and definitive.
References
Fehlberg, E.A., Lucero, R.J., Weaver, M.T., McDaniel, A.M., Chandler, M., Richey, P.A., Mion, L.C., & Shorr, R. I. (2017). Impact of the CMS no-pay policy on hospital-acquired fall prevention related practice patterns. Innovation in Aging, 1(3), 1-7. http://dx.doi.org/10.1093/geroni/igx036Links to an external site.
Gray, J.R., & Grove, S.K. (2021). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence, 9th ed. Elsevier.
Guirguis-Blake, J., Michael, Y., Perdue, L., Coppola, E., & Beil, T. (2018). Interventions to prevent falls in older adults. JAMA, 319(16), 1705. https://doi.org/10.1001/jama.2017.21962Links to an external site.
Melnyk, B.M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice, 5th ed. Wolters Kluwer.
Venema, D.M., Skinner, A.M., Nailon, R., Conley, D., High, R., & Jones, K.J. (2019). Patient and system factors associated with unassisted and injurious falls in hospitals: An observational study. BMC Geriatrics, 19(348), 1-10. https://doi.org/10.1186/s12877-019-1368-8Links to an external site.
CHOOSING THE TYPE OF RESEARCH FOR A RESEARCH PROBLEM
How do you choose the type of research to conduct to address a research problem? What information should you keep in mind to ensure that your research process will adequately address your research problem?
Understanding the different types of research is a critical skill for the nurse researcher and nursing professional. As a current nursing professional, consider how understanding the different types of research may be conducive to achieving a particular mission in your health care setting, such as developing an intervention to address a quality or patient safety problem. This knowledge can also be a step toward assuming a nursing leadership position. As a critical component of your nursing toolkit, differentiating between the types of research is a fundamental step toward enacting change through the process of research.
For this Discussion, please review the following:
Think about clinical practice problems you have seen in health care that compromise patient safety and health outcomes. For example, nursing-sensitive indicators reflect high-priority practice problems, which are described in the article by McIntyre, Cover, and Bonner (2019).
Choose one of the clinical practice problems you have seen in your current or past job in a health care setting. Consider the possible causes of this problem and how you think it is, or was, affecting patient outcomes.
Some patient safety problems are solved by making changes in clinical practice. For example, decreasing catheter-associated urinary tract infections in hospitalized patients often requires changes in clinical practice such as better adherence to preventive measures when catheters are inserted (e.g., use of disposable gloves, maintaining sterile fields, cleansing urethral meatus). For the problem you identified, what specific change in practice do you think is needed?
When a practice change is implemented, it is important to verify whether or not the change has improved patient outcomes. One way to determine this is by conducting research. One of the first steps in the research process involves developing a research question that will later serve as the foundation for your study. Using information from Chapter 5 in your textbook and the handout on developing research questions, think about a research question and about the effectiveness of the practice change you proposed in improving patient outcomes.
Another step in the research process involves identifying which type of research could be conducted to best answer your research question. In Chapter 5 of your textbook you will find a list of different types of research in the first column in Table 5.1 and Table 5.2. You can learn more about these different types of research in both Chapter 2 and the Glossary in your textbook. To locate even more information, you can also use an Internet search engine for more in-depth descriptions and examples. After learning more about the different types of research, think about which one you think is best for determining how well the clinical practice change you identified will improve patient outcomes.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
BY DAY 3
Post a description of how you would address the following:
Part 1: Patient Safety Problem
Describe the patient safety problem you identified, its causes, and the impact you think it has on patient outcomes. For this problem, describe a specific change in practice that could help improve patient outcomes.
Part 2: Research on Patient Safety Problem
Develop a research question that tests the effectiveness of your practice change in the improvement of one or more patient outcomes. What type of research would you use to answer this question? Describe the reasons why you think this is the best approach and why you would not use the other three types of research.
Note: Post a 3-paragraph (at least 350 words) response. Be sure to use evidenceLinks to an external site., in-text citationsLinks to an external site., and essay-levelLinks to an external site. writing skills, including the use of transitional materialLinks to an external site. and organizational framesLinks to an external site.. Use the writing resources and the Discussion Rubric to develop your post.
Main Post
For post-cardiac surgery patients, early mobility is critical to avoiding complications of surgery and for the promotion of healing. The following complications are a few that are exacerbated by prolonged bed rest: development of deep vein thrombosis (DVT), pleural effusions, various nosocomial infections, pressure injury to the skin, and ICU delirium. These complications prolong ICU stay and affect the patients physically and mentally, slowing their progression of recovery (Jacobs et al., 2021). However, the opposite is true of early mobilization post-cardiac surgery. Early mobility has been shown to reduce the risk of post-surgical complications, reduce overall hospital stay/cost, and decrease ICU delirium (Jacobs et al., 2021)
Many strategies have been used to promote early mobility in the CVICU setting. The creation of turn teams is one example. Turns teams were utilized in COVID ICUs to reduce physical demand on the primary nurse and to efficiently facilitate placing patients in the prone position per ARDS protocol. After COVID, this concept was utilized in the ICUs to address pressure injury and early mobility. Six groups consisting of 2 staff nurses were assigned a time (800,1000,1200,1400,1600,1800) to turn all the patients in the unit at the assigned time. This process was also mirrored on the night shift. This allowed the primary RN to have their patients turned every two hours, and they did not have to facilitate that turn each time.
Because it is established that early mobility effectively improves outcomes, the question is: Does utilizing a group approach to turning patients increase compliance with early mobility efforts in the CVICU? The type of research that could be used for this question is qualitative with a phenomenological design because it explores the experience of the ICU nurse and barriers to early mobility compliance (Gray & Grove,2021. p. 118). It looks at the experience of individual nurses and examines if the group approach is more efficient in obtaining early mobility compliance. Because the results will depend on individual opinions, the culture of the studied unit, and personal preferences, other study methods relying on data and numerical results would not be best for this type of question (Gray & Grove 2012)
References
Jacob, P., Gupta, P., Shiju, S., Omar, A. S., Ansari, S., Mathew, G., Varghese, M., Pulimoottil, J., Varkey, S., Mahinay, M., Jesus, D., & Surendran, P. (2021). Multidisciplinary, early mobility approach to enhance functional independence in patients admitted to a cardiothoracic intensive care unit: a quality improvement program. BMJ Open Quality, 10(3). https://doi.org/10.1136/bmjoq-2020-001256Links to an external site.
Gray, J. Grove, S. (2021). Burns and Grove’s The Practice of Nursing Research: Appraisal, Synthesis and Generation of Evidence. Elsevier Inc.
BY DAY 7
Read two or more of your colleagues’ postings from the Discussion question.
Respond to two or more of your colleagues with a comment that asks for clarification, provides support for, or contributes additional information.
Post a Discussion entry on 3 different days of the week. See the Rubric for more information.
Main Post
Part 1: Patient Safety Problem
Patient falls are identified as an ongoing safety problem within the healthcare system. Falls lead to acute injuries, chronic health problems, increased admission expenses and medical costs, and lengthier hospital admissions. “In emergency departments, falls may be difficult to predict and prevent with the acute nature of patient visits and the brief, episodic encounters” (Cook, 2020, p. 668). Collaboration as a team can help reduce falls within the emergency department by implementing communication, protocols, and having a standard of work in place.
There are several reasons a patient can be considered a high fall risk. Certain medications can cause patients to be more at risk of falling. Dizziness, low blood pressure, vertigo, polypharmacy, the elderly population, post-operative patients, intoxication, patients with a history of strokes or acute neurological changes, and patients who use assistive devices at home are examples of the vulnerable population we need to pay close attention to. The multidisciplinary team can work to identify these high-risk patients with fall risk protocols in place. I also believe that the high nurse patient ratio and poor communication plays a significant role in the increase of patient falls. The constant running of staff from room to room with a high turnaround rate of emergency department visits along with call light and alarm fatigue plays a major role in the impact of increased falls.
Implementing a standard of work for fall risk patients is essential to their safety during their emergency department visit. The emergency department that I currently work in has several different safety measures in place that could help improve patient outcomes. The use of yellow fall risk bands immediately upon arrival at the emergency department to alert all staff members caring for this patient of their risk of falling. Placing fall risk grip socks on patients, activating bed alarms, placing call lights within reach, the use of color-coded fall risk signs outside patient rooms are all great safety measures implemented to help reduce the risk of falls. Continuous fall risk and mobility assessments would be beneficial to patient outcomes and progression of care. Communicating with staff and family members about promoting these protocols to keep them aware and to benefit the safety of patients is critical. Implementing assistive devices as needed depending on the patient’s ability would also be a critical component to the prevention of falls.
The change in practice that I think would be most beneficial in improving patient outcomes is communication through signage. Signage would include yellow color-coded fall risk bands, fall risk signage outside of the room, and fall risk information written on the white board in the patient’s room are all great examples of changes that can be implemented to reduce the risk of falls. By implementing these few changes to every patient who is a fall risk, we can help promote the reduction in fall related injuries within our vulnerable population. With the brief time each patient spends in the emergency department, it makes it harder to promote long term fall prevention. It also makes it difficult to implement extensive protocols because of the short duration of stay and high volume of a chaotic department. Patients arrive to the emergency department for treatment related to an injury or illness. When falls occur, it increases their length of stay and incurs additional treatment due to potential harm. Due to the lively, expeditious nature of the emergency department sometimes these falls are unpredictable and cannot be prevented. Implementing appropriate fall risk assessments, continuous staff communication, and other available resources, however, could help in the reduction in these events (Cook, 2020).
Part 2: Research on Patient Safety Problem
Research question:
Does implementing consistent communication through fall-risk signage within the emergency department aid in the reduction of falls?
Quantitative research can be used to determine if implementing these fall reduction protocols would help decrease the risk of falls. Specifically, experimental research would be best. The experimental research method allows coordination over the protocol to be put in place allowing observations and changes to be made along the way on the effectiveness of the reduction in falls. Using incident rate metrics to measure the effectiveness, data collection through the Electronic Reporting System (ERS) reports, and department staff surveys are all ways to collect and document pertinent data related to falls. In my opinion, this is the most effective way to use experimental research to achieve our goal.
References
Cook, N. S., Komansky, B. J., & Urton, M. S. (2020). Do no harm: A multifactorial approach to preventing emergency department falls—A quality improvement project. Journal of Emergency Nursing, 46(5), 666–674. https://doi.org/10.1016/j.jen.2020.03.007
