Ask Clinical Question in Evidence-Based Nursing

PICOT Question

The PICOT format is rather beneficial to identify a clinical problem and pinpoint all the necessary details. This tool allows formulating the problem in such a way that ensures attention to the selected intervention, expected outcome, and timeframe. By answering the PICOT question, it is possible to achieve a better understanding of the given topic and anticipate the intervention effectiveness. As discovered by Elias, Polancich, Jones, and Convoy (2015), the traditional format of the specified tool may be updated by adding one more dimension of D – digital data that clarifies data measures. The following PICOT question was formulated for this paper:

  • P (patient) – In patients at an NH,
  • I (intervention) – how does an educational program for nursing personnel
  • C (comparison) – compared to traditional care
  • O (outcome) – influence preventing falls
  • T (timeframe) – over 8 weeks
  • D (data) – when looking at incident reports and cause analysis?

PICOT: In patients at an NH, how does an educational program for nursing personnel compared to traditional care influence preventing falls over 8 weeks when looking at incident reports and cause analysis?

Relevant Nursing Theory

Nursing can be regarded as a profession and art, which integrally embraces a patient’s body and mind, supports spiritual, mental, and physical health through learning. It focuses on maintaining health and assisting patients in improving their health outcomes.

One of the most relevant theories about the given health problem is Orlando’s principles of caring about patients. Based on the interaction of a nurse with a patient, it describes the issues that characterize good and constructive relationships (Alligood, 2014). They had a great influence on the teaching of nursing, highlighting the interpersonal aspect of nursing, and defining care for the patient as a process allowing a nurse to purposefully identify his or her perceived needs and consider the treatment process in perspective and dynamics.

The interaction with a patient in need of help to improve his or her health, including patient confirmation and the adequacy of care, received, compose the main goal of nursing intervention, according to Orlando (Alligood, 2014). In this connection, a patient’s needs determine the actions of a nurse. Speaking of this theory in terms of nursing meta paradigms, it is possible to note that a person is perceived as those under medical supervision or undergoing treatment, while the human body is dynamic. Health is determined as the state of physical and mental comfort as well as a sense of adequacy and overall well-being (Smith & Parker, 2015). Besides, the environment is regarded as certain circumstances – time and place – in which there is a need for nursing care.

Orlando’s theory had a great influence on the teaching and training of nursing, as well as their practice. Relating this theory to the problem of patient falls in the hospital, it is important to specify the interpersonal aspect of caring for the sick as a process that allows a nurse to purposefully identify the perceived needs and address them. Since patients prone to falls are often chronically-ill, older adults, and those who have musculoskeletal problems, they need an individual approach (Dubois et al., 2013).

Based on Orlando’s theory, the patient-centered approach should be adopted to ensure that nurses provide sufficient attention to patients’ concerns. Orlando’s concept of a “person” is oriented towards practical activities and considers the task of improvement as one of the main prerequisites of high-quality care (Smith & Parker, 2015). Therefore, this is helpful since it may be applied to direct nurses’ activities and serve as a valuable framework for adjusting care processes to the ever-changing requirements of the society.

One more important aspect is the cooperation of a nurse with a patient and his or her family, which provides education and increased awareness of the patient. The positive relationship between a nurse and the patient largely determines the outcome of care (Smith & Parker, 2015). About preventing falls, a nurse’s tasks in establishing supportive relationships refer to creating an atmosphere of trust and facilitating personal growth and development of the patient in the process of collaborative problem-solving. At the same time, such an approach allows contributing to the preservation and development of the patient’s abilities as well as achieving physical and emotional well-being.

The paramount prerequisite for a patient’s trust in a nurse is his or her qualifications. However, it is only a tool, the effect of which depends on the personal qualities of the nurses and their attention to patients. To reduce fall rates, patients should have the impression that the nurse wants to help them. An unhappy voice, unfriendliness, and gloomy expression on the face may be perceived by patients as a negative attitude to their problems.

A nurse causes confidence if she or he is calm, confident, optimistic, conscientious, and tolerant, but not arrogant or rude. The emotional identification that is also known as empathy – the ability of an individual to perceive the inner world of another person with the preservation of emotional and semantic nuances – is important (Miake-Lye, Hempel, Ganz, & Shekelle, 2013). It does not imply mandatory active intervention to provide effective assistance to another, nor does it requires an assessment response. Therefore, Orlando’s theory should be used to design the educational program for nurses and guide their further improved practice.

Practice Problem

Falls in inpatient settings are the second leading cause of death due to accidents and unintentional injuries in the world. According to the global statistics, there are 424,000 falls every year – annually, 37.3 million falls result in non-fatal cases with rather serious consequences, which requires rendering medical care (World Health Organization, 2018). In turn, according to the Joint Commission, falls with severe outcomes compose approximately five percent of all unforeseen situations in medical organizations. According to the World Health Organization (2018), one of the main risk factors for falls is the age of patients, especially after 60 years.

The highest risk of death or serious injuries as a result of the fall threatens the elderly, and this risk increases with age. For example, in the United States, 20-30 percent of survivors of older people suffer from moderate or severe injuries such as bruises, hip fractures, or head injuries resulted from falls. Moreover, the impact of external environmental vulnerabilities increases the likelihood of falling among the elderly.

To prevent the emergence of situations leading to disruption of life, a nurse should familiarize patients at risk with the daily routine, the process of the treatment, and monitor their compliance. To reduce the risk of complications as a result of procedures and manipulations, a patient should be aware of possible consequences of non-compliance with the rules of behavior in the given healthcare facility (Boyle, Cramer, Potter, & Staggs, 2015). Nursing interventions aimed at reducing the risk of falls, injuries, burns, food poisoning and electric shock during the procedures should be focused on identifying patients at high risk of accidents.

Even though it is not always possible to anticipate the emergence of certain situations that threaten the safety of the patient’s life, nurses should strive to minimize such cases (Ausserhofer et al., 2013). To prevent patient risk factors, the following prescriptions may be considered: a patient’s bed and bathroom should be equipped with calls for an emergency call, stairs and corridors should be well lit, and the floor should be wiped immediately so that a patient does not slip on the wet floor. Besides, to prevent falls on the premises of the health facility, there should be no high thresholds, wires, or other objects on the floor. The role of nurses is to control the mentioned issues and ensure patient safety.

The patient’s psychology who is prone to falls is characterized, on the one hand, by physical sensations (for example, pain, fever, et cetera) and, on the other hand, a certain attitude towards the disease (Boyle et al., 2015). An important task of a nurse is to penetrate the psychology of the patient and adjust care accordingly. Among the activities to reduce risk factors for patients is to provide a regime of emotional security through communication with a patient with the positive intonation and maintenance of a friendly atmosphere in the care facility (Ausserhofer et al., 2013).

The creation of a comfortable environment and the organization of leisure of patients, providing opportunities to engage in any accessible activities, such as reading, knitting, or watching TV may be useful. Thus, a nurse is expected to ensure safety by controlling the routine activities of patients at risk.

References

Alligood, M. R. (2014). Nursing theory: Utilization & application (5th ed.). St. Louis, MO: Elsevier Health Sciences.

Ausserhofer, D., Schubert, M., Desmedt, M., Blegen, M. A., De Geest, S., & Schwendimann, R. (2013). The association of patient safety climate and nurse-related organizational factors with selected patient outcomes: A cross-sectional survey. International Journal of Nursing Studies, 50(2), 240-252.

Boyle, D. K., Cramer, E., Potter, C., & Staggs, V. S. (2015). Longitudinal association of registered nurse national nursing specialty certification and patient falls in acute care hospitals. Nursing Research, 64(4), 291-299.

Dubois, C. A., D’amour, D., Tchouaket, E., Clarke, S., Rivard, M., & Blais, R. (2013). Associations of patient safety outcomes with models of nursing care organization at unit level in hospitals. International Journal for Quality in Health Care, 25(2), 110-117.

Elias, B. L., Polancich, S., Jones, C., & Convoy, S. (2015). Evolving the PICOT method for the digital age: The PICOT-D. Journal of Nursing Education, 54(10), 594-599.

Miake-Lye, I. M., Hempel, S., Ganz, D. A., & Shekelle, P. G. (2013). Inpatient fall prevention programs as a patient safety strategy: A systematic review. Annals of Internal Medicine, 158(5), 390-396.

Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice (4th ed.). Philadelphia, PA: FA Davis.

World Health Organization. (2018). Falls. Web.