Research Critique and PICOT Question Final Draft

Answer

1. Research Critique and PICOT Question Final Draft

   Patient falls are a regular occurrence within the critical care units across the world. Patient falls refers to a situation where a patient falls from a resting bed or falls as they try to walk within the unit. This condition is normally caused by factors such as polypharmacy and failure of the care giver to assess and diagnose the patient among others (). Nevertheless, there have been unrelenting efforts by nurses, hospital administrators, and researchers to come up with a lasting solutions to reduce patient falls. Hourly rounding has been a critical strategy to reduce patient falls. Most hospital have tried to increase the number of staffs in a bid to enhance the rate of rounding per day to ensure that there is sufficient surveillance in critical care units to minimize patient falls. However, lack of knowledge among nurses on hourly rounding especially on monitoring and occasional assessment of patient has made this strategy ineffective. A PICOT question has already been formulated to establish whether educating nurses to conduct hourly rounding within the hospitalized patients reduce falls. Therefore, this paper seeks to revise the PICOT statement, article critique and offers an evidence based change within the nursing practice. In particular, it seeks to establish the correlation between the PICOT question, nursing practice problem, as well as, research articles.

   Background Information

   Educating nurses to conduct hourly rounding within the hospitalized patient is likely to reduce falls. To validate this statement, Odias (2015) conducted a quantitative study to unravel the key barriers that both registered nurses and nursing assistants experience during their healthcare practice that hinder hourly rounding program. Evidently, findings of this study revealed that hourly rounding within the hospitalized patient is influenced by lack of knowledge of nurses, particularly their poor communication on monitoring and occasional assessment of patient. This, according to the study, bars nurses from constantly monitoring and assessing patients, as well as, delivering safe care resulting in poor patient satisfaction outcomes and overall quality. This study is significant to the nursing practice because it stresses on the need for registered nurses and nursing assistants to be educated to design an evidence-based practice behavior and foster staff communication during the hourly rounding process to prevent possible patient falls. Through education, the registered nurses and nursing assistants will acquire the necessary knowledge and proper communication skills to convey their rounding schedule with their partners, and effectively understand and communicate the safety and comfort needs of hospitalized patients seeking help about their positioning, pain management, personal needs, and fail prevention. Essentially, this study identified the barriers that registered nurse and nursing assistants experience that prevent them from conducting purposeful hourly rounding (Odias, 2015). By identifying these barriers, the study recommend the necessary training that nurses and other healthcare professionals involved in hourly rounding require so that they can improve the communication between themselves and their colleagues communication between registered nurses and nurse assistant during purposeful rounds. It also equips nurses with the knowledge on how to design appropriate checklists they require while conducting patient assessment and monitoring during hourly rounding. The research question for this study was: What are the core barriers inhibiting hourly rounding and safe, quality care provision to patients?

   Hourly patient rounding enhances high satisfaction scores and improves quality of care (Goldsack, Bergey, Mascioli and Cunningham, 2015).  Essentially, hourly rounding must be frequent, purposeful, and the nursing or therapy staff must be knowledgeable about the process (Allen, Rieck, & Salsbury, 2016). Various questions were raised during the study such as, “What is the relationship between hourly rounding and patient satisfaction?”. These questions relate to the study since they explain the major contributing factors that could cause the patient fall and this consequently would assist in preventing this issue by offering an examinable means to be followed to prevent falls in acute care units. Essentially, this is essential for nursing because it would minimize the quantity of resources and personnel required if falls are minimized not forgetting the duration it would take to document the instances of falls, as well as, the post fall debriefing that would occur. These consequently would yield a significant increase in job satisfaction and productivity of healthcare practitioners especially nurses tasked with hourly rounding.

   How the two Articles support the Nurse Practice Issue

               Odias (2015) supports the practice issue by arguing that registered nurses and nurse assistants require effective education so that they can gain necessary skills such as effective communication. Effective communication can assist these professionals to communicate the hourly rounding schedule with their partners and understand the safety and comfort needs of each patient thereby minimizing cases of patient falls within the hospitals. To achieve effective communication, the healthcare administrators should ensure that both registered nurses and nurse assistants receive thorough training and act as a unit champions in a bid to engage frontline workers (Odias, 2015). Essentially, this will reduce the problem of inadequate knowledge about monitoring and assessment of patients and provide additional support for the staff to sustain purposeful rounding.  The stated approach enables registered nurses and nurse assistants to communicate effectively with their colleagues and keep a close monitoring of their patients who have a greater risk of falling. This will reduce rates of falling, particularly in long term facilities or acute care settings. Principally, the intervention suggested in this study is expected to provide nurses with the necessary education they need for effective hourly rounding thereby reducing patient falls. Ultimately, this will yield the same result as PICOT research question that states that, “Will educating nurses to perform hourly rounding in hospitalized patients reduce falls?”

   Similarly, Goldsack, Bergey, Mascioli, and Cunningham (2015) will answer the PICOT question by contending that a personalized proactive hourly rounding approach where healthcare administrators in collaboration with unit managers aggressively engage in formulating education program for nurses can effectively equip these individuals with necessary knowledge for conducting hourly rounding. This implies that inadequate education coupled with lack of support from the hospital leadership is likely increase patient falls because most nurses are unlikely to conduct hourly rounding promptly and effectively. Therefore, with the effective training of nurses and proper support from the nurse leadership, the expected outcome is likely to answer the PICOT question and possibly yield better results such as better patient safety and reduced cases of patient falls.

   Study Methods

   The researcher adopted pre-post design that comprised of a pre-implementation needs assessment survey and a post-intervention survey (Odias, 2015). The pre-implementation needs assessment survey were distributed to 38 registered nurses, 9 nurse assistants, and 4-unit secretaries. After that, the researcher designed a purposeful rounding checklist by stressing on registered nurse and nurse assistant communication and presented it at in service on improved communication (Odias, 2015). The services were conducted early in the morning and late evening with 5 registered nurses, 3 nurse assistants and one nurse secretary attending each huddle. Similarly, the in-service was performed over one a week alternative morning and evening huddles to avoid cases of in-service workers repeating themselves. The researcher used an infographic poster to show the vision and mission of the unit, findings of the pre-intervention survey results, and importance of purposeful rounding to patient care. The researcher equally distributed the paper copies of the post intervention survey to 38 registered nurses, 9 nurse assistants and 4 nurse secretaries within a period of one week of in services. The survey comprised of 4 multiple choice questions about registered nurse- nurse assistant communication during purposeful rounding, as well as a single yes/no question regarding the resources for purposeful rounding. A major benefit of pre- and post- intervention survey is that it saves researchers the time by gathering pre- and post-interventions data in a single session as opposed to two (Odias, 2015)). Consequently, this prevents the challenge with attrition. However, both pre- and post-intervention survey are vulnerable to concerns linked to self-reporting measures.

    Goldsack, Bergey, Mascioli and Cunningham (2015) used a prospective pilot study with post-test and pre-test to determine the impact of individualized proactive hourly rounding on patient falls. The benefit of a prospective pilot study is that it enables the investigator to establish the validity of the research with reference to skilled knowledge of other researchers within the same field (Sng, Yip, & Han, 2016). This addresses the issues of acceptance of influenced information in the study. However, the key limitation of this technique is that it safeguards reputable concepts and make it challenging to come up with new ideas (Sng, Yip, & Han, 2016).

   Results of the Study

   Odias (2015) established that almost all respondents who completed the pre-intervention surveys believed that purposeful rounding has numerous benefits to patients. In particular, the investigator found that purposeful rounding prevents fails, improve pain management, and prevent hospital acquired pressure ulcers. These findings implied that nurse education equips them with communication skills that assists them conduct their hourly rounding effectively. Therefore, registered nurses and other healthcare professionals should receive proper training on how to prepare their checklist and communicate effectively between themselves and their colleagues. Proper education will also equip nurses with the necessary skills to understand and communicate the safety and comfort needs of their patients. The findings also implied that purposeful rounding when performed consistently can enhance patient satisfaction scores, minimize the cases of call lights, improve pain management, and minimize patient falls.

   Findings of a study by Goldsack, Bergey, Mascioli and Cunningham (2015) revealed that the average fall rate declined significantly from 3.9 per 1000 patient days to 2.5 falls per 1000 patient during the period the project was being conducted. The findings further revealed that the average fall rate during the pilot time decreased to 1.3 falls/ 1000 patient days that is significantly below baseline of fall rate (Goldsack, Bergey, Mascioli, & Cunningham, 2015). However, there was no substantial difference between project and pilot period fall rates. Essentially, the critical finding of this study is that patient focused proactive hourly rounding program considerably lower fall rates in acute care settings. In nursing practice, this study implies that frontline workers and nurse leaders should actively take part in designing the program to improve its implementation.

   Ethical Considerations

                In a study by Odias (2015), patients’ privacy was considered because the researcher never recorded names of the participants. The questionnaires were designed in such a way that the participants were not required to give out their identities. Various healthcare professionals including nurses, nurse assistants and others were included in the study and their contributions incorporated in the final results to formulate the interventions that were considered necessary for hourly rounding and preventing patient falls. In the two studies, all the participants gave their informed consent and were surveyed willingly. Moreover, no mention of participants’ names were included in the survey and questionnaires. Moreover, no mentioned was made regarding whether the research was approved by an Institutional Review Board. All the participants were treated equally as there were no bias or preferential treatment of some participants.

   Outcomes Comparison

                The expected outcome for the PICOT question is educating nurses to conduct hourly rounding within the hospitalized patients reduce falls. Intuitively, the findings of a study by Odias (2015) answered the PICOT question for the present study because they revealed that proper education equips nurses with proper communication skills thereby enabling them to communicate effectively with their colleagues and to design checklists for effectively monitoring and assessment of patients during hourly rounding. Similarly, findings of a study by Goldsack, Bergey, Mascioli and Cunningham (2015) though mention hourly rounding and patient satisfaction does not answer the PICOT question. Precisely, the findings have not given any credible information on how training nurses on how to conduct hourly rounding in hospitalized patients can reduce falls. It would have been appropriate for the researchers of this study to pay attention to nurses’ knowledge on hourly rounding and patient falls.