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Intervention Strategy in Reducing Patient Falls

Introduction

This paper is an academic critique of the research report by Ang, Mordiffi, & Wong (2011) titled, ‘Evaluating the Use of a Targeted Multiple Intervention Strategy in Reducing Patient Falls in an Acute Care Hospital: A Randomized Control’. The study is a randomized controlled evaluation that focuses on assessing the effectiveness of a directed multiple intervention policy in minimizing the figure of patient falls. The rationale of this critique is to enable nursing practitioners to build up skills in analyzing and assessing research information based on its significance to present healthcare practices in addition to contributing to evidence-based nursing practices.

Identification of the PICO

In any quantitative nursing study, it is crucial to building up appropriately formulated questions regarding the patient population, interventions, comparison, and outcomes (PICO) (Coughlan, Cronin, & Ryan, 2007). The Foreground question aims at finding evidence to answer a particular need for clinical data related to a particular intervention and therapy. In the study, this is targeted multiple-intervention approach in minimizing incidences of patient falls. However, the researchers should have considered whether the assessment encompassed every form of multiple interventions in every patient fall and whether the question should be limited to a specific form of multiple intervention strategies for particular incidence of patient falls.

Applying PICO based on information retrieval progression needs a search engine that can identify and index PICO components in the collected works. There has to be the application of structural descriptors embedded in various nursing abstracts to automatically collect large testing data-sets for every PICO component. The BVSTEP software under PRIMER version 6.0 was used to assess the relationships between the variables and participants’ risk of fall along the ward gradient (Ang, Mordiffi, & Wong, 2011).

Population and Sample

A total of 1,822 participants took part in the study. 910 of them were included in the randomized assessment intervention group while the other 912 were randomized into the assessment control group. The study was based on a simple random sampling technique whereby all of the population descriptors have been defined and then given random numbers to select the population.

Critique of the Research Question/Hypothesis

In this study, the researchers failed to formulate appropriate questions that would have otherwise been regarded as a clear statement. The statement, ‘effectiveness of targeted multiple intervention strategies in reducing the number of patients falls in an acute care hospital’ does not concede the evidence offered (Ang, Mordiffi, & Wong, 2011). In the study, not all the data that was collected was reliable. Therefore, the above statement did not define why normal care is less safe than the targeted multiple interventions approaches in reducing falls inside acute care facilities.

Background and Purpose

Based on the guidelines of quantitative research by Coughian, Cronin, & Ryan (2007), the background of a research paper should offer a wide overview of the study to include the particular research aims, hypotheses, literature review, and the significance of the study. Polit & Beck (2008) asserted that the endeavor of any research should in any case point towards what the study concerns itself with through an established hypothesis that classifies the connection between the stated variables. In this research report, the researchers plainly defined their intention and hypothesis.

Furthermore, the background of the research problem for this study has been clearly stated. This background focuses on preventing patient falls as an issue that has evaded healthcare facilities. It also focused on the impacts of multiple-fall prevention approaches in solving such problems. The title of this report provides a direct intention of the study while defining the issue comprising the suggested rationale including the likely contributions and implications of the evaluation (Burns & Grove, 2010). Therefore, the background information, rationale, hypothesis, and report title have been stated properly. In addition, the researchers have applied a prospective, randomized, and controlled trial, a concept that is consistent with the quantitative research rule of having a control group with numeric and quantifiable data.

Sampling Design

This study followed a quasi-experimental design whereby the range of designs that comprise block randomization and computer program stratification guaranteed an even combination of the participants. In this study, the target population together with the criteria applied in including and leaving out participants has been stated. Thus, the stratification made certain that the number of participants used in the study is balanced from every ward of the care facility (Robson, 2002). According to Polit & Beck (2008), an adequate sample should comprise approximately ten individuals for every entry. A total of 1,822 participants took part in the study, with 910 of them being randomized into the assessment intervention and another 912 being randomized into the assessment control group. This was a far much greater number that validated the sampling process.

With the help of assessment forms, two outside nurses evaluated 10 participants followed by an evaluation of targeted multiple interventions. The use of Hendrich’s fall risk model enabled just the participants with a score of at least five to be enlisted. This was reasonable considering that the model had validated nearly 5,489 patients. Furthermore, participants who fulfilled the standards were randomized into the control group. The advantages of the sampling blueprint were based on the premise presented by Chan (2003) which stated that stratification involves having the number of participants obtaining each session of care is balanced from every quarter.

Instrumentation and Data Collection Method

Researchers do have the option of applying earlier designed instruments or developing a new one and this preference should be declared. This is a quasi-experimental design since a single variable has not been manipulated or controlled. The main data came from summaries and second hierarchical stage research mainly from the Ministry of Health in Singapore. The summary of the study comprised of the guidelines for handling patient-falls came only from the National University Hospital fall evaluation tool (Ang, Mordiffi, & Wong, 2011). However, the researchers were not successful in defending their decision not to apply higher-ranked evidence given that the study was conducted at a single location which resulted in warranting additional research within other facilities. Nevertheless, they argued that their use of Hendrich’s fall risk appraisal toolkit enabled them to offer the study nurses’ skills in designing individualized plans for patients who are at risk of falls.

Statistical Methods and Tests Used

The statistics applied in this research were explanatory and inferential, as the researchers appropriately applied descriptive and intention-to-treat SPSS analysis. This is evident by their 95% CIs after calculation using Wilson’s method followed by a Chi-square test that was used to contrast the results. The measures of central tendency and event curves were calculated using the Kaplan–Meier approach whereby the contrast between the two sets was made through the application of the log-rank test. Thus, the inferential statistics applied interrelated with the variables that affirmed whether their relationship was real instead of just arising from a possibility. Therefore, there was an overall scheme of sample composition as avowed by Burns & Grove (2010).

Conceptual Framework

Coughian, Cronin, & Ryan (2007) asserted that the theoretical structures of a quantitative research study should describe major constructs along with variables abstracts. When no prescribed model is applied, the experiences and their reasons for happening should be stated and supported. In this study, the researchers provided a clear connection between individualized falls and the interventions used in preventing such incidences especially with the mentioning of collective multiple interventions comprising patient assessment, education, and medication review that were supported by the literature review. This information was collected from existing facilities and falls-assessment tools.

Evidence-Based Nursing from the Research

DiCenso, Bayley, & Haynes (2007) insist that the strengths, limitations, generalization, sample size, replication, and the overall implications of any evidence-based nursing study need to be highlighted. Therefore, this study offers evidence necessary to guide researchers and policymakers in care settings to change from the widespread approach that the study considers inappropriate in preventing patient falls to the individualized crafted but targeted multiple-fall intervention approaches. This information was supported by the assessment of existing literature regarding patients’ falls. The literature review provided a suitable depth and extent of reading on the subject matter in question by making the hypothesis discernible and continuous.

Ethical Considerations

This study has also observed the basic ethical principles of research as identified by Polit & Beck (2008). These principles include self-sufficiency, non-malfeasance, and justice. The participants decided on their will whether to participate in the study without being coerced and with complete knowledge of what was being assessed. Furthermore, the ethical committees of the hospital review boards approved before the study were done.

Rate Evidence of Hierarchy of Evidence

Evidence-based nursing requires the incorporation of clinical judgment and recommendations from best accessible evidence and patient values. It is essential to put presented literature into a hierarchy as this permits clearer communication when examining the research and in conducting a systematic review to institute practice recommendations. In this study, both research design and quality are within the hierarchy using the grading system applied by Oxford evidence-based medicine classification (Chan, 2003).

Validity and Reliability of the Study

The most important aspect of any research instrument is that it measures the concept being evaluated resolutely and reliably (Robson, 2002). This study fulfills the validity criteria since the instrument, Hendrich II Falls Risk has measured patient falls and it can be deemed to be reliable as it has consistently and precisely measured the key concept. The study has been conceptually planned but in a mini-version of core evaluation.

Identified Limitations

The research is simply a single-center assessment and as such the findings cannot be generalized to other settings. Moreover, even the number of participants who did not succeed in both groups was undersized. Therefore, there was inadequate evidence to perform a detailed examination of fallers. No justification was provided as to why higher-ranked support was not used, as this is a theme subject that is extensively described in the provided literature. Therefore, further work needs to be done to ensure that this segment of the study is included to support its arguments.

Conclusion

This paper has provided an in-depth critique of the quantitative article by Ang, Mordiffi, & Wong (2011). The paper has shown both the strengths and weaknesses of the study. Furthermore, the critique concludes that the research is an excellent example of evidence-based nursing investigations. Based on the abstract of the research report, a reader can get a succinct general idea of the study as it comprises information concerning the aim of the research, the method used, the sample size as well as selection. Furthermore, the researchers have provided their key findings including the conclusions and succinct recommendations. The research report was also presented logically. It has clear connections between all the stages from the aim of the study, to the literature review, through theoretical structure, data analysis, and then the findings. Furthermore, the samples were representative of the residents stated since they reflected the population that they drew from.

References

Ang, E., Mordiffi, S. & Wong, H (2011). Evaluating the use of a Targeted Multiple Intervention Strategy in Reducing Patient falls in an Acute Care Hospital: A Randomized Controlled. Journal Of Advanced Nursing, 67(9), 1984–1992.

Burns, N., & Grove, S.(2010). Understanding Nursing Research: Building an Evidence-Based Practice. London: Elsevier Health Sciences.

Chan, Y. (2003). Biostatistics 101: Data Presentation. Singapore Medical Journal , 44(1), 280–285.

Coughian, M., Cronin, P., & Ryan, F. (2007). Step-by-step Guide to Critiquing Research: Quantitative Research. British Journal of Nursing, 16(11), 658-663.

DiCenso, A., Bayley, L., & Haynes, R. (2007). Accessing Pre-appraised Evidence: Fine-tuning the 5S Model into a 6S Model. Evidence Based Nursing, 12(4), 99-101.

Polit, D. F., & Beck, C.(2008). Nursing Research: Generating and Assesing Evidence for Nursing Practice. London: Lippincott Williams & Wilkins.

Robson, C. (2002). Reat World Research (2 ed.). New York: Blackwell Publishing.

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