While the implementation plan prepares students to apply their research to the problem or issue they have identified for their capstone change proposal project

Literature Review

While the implementation plan prepares students to apply their research to the problem or issue they have identified for their capstone change proposal project, the literature review enables students to map out and move into the active planning and development stages of the project.

A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence. Students will use the information from the earlier PICOT Statement Paper and Literature Evaluation Table assignments to develop a 750-1,000 word review that includes the following sections:

  1. Title page
  2. Introduction section
  3. A comparison of research questions
  4. A comparison of sample populations
  5. A comparison of the limitations of the study
  6. A conclusion section, incorporating recommendations for further research

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Literature Evaluation Table

Student Name: Anna Uka

Change Topic: Hourly rounding is an effective fall prevention strategy

Criteria Article 1 Article 2 Article 3 Article 4
Author, Journal (Peer-Reviewed), and

Permalink or Working Link to Access Article

https://journals.lww.com/nursing/Fulltext/2015/02000/Hourly_rounding_and_patient_falls__What_factors.10.aspx https://academic.oup.com/gerontologist/article/58/2/331/2736326/ https://pdfs.semanticscholar.org/0bb0/1bd16c44a8a490e0712ca66fe1478e65fcfa.pdf https://epostersonline.com/ons2018/node/1002
Article Title and Year Published 2015 2016 2018 2018
Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study Does engaging in interdisciplinary team through leadership and unit champion’s result to reduction in fall rates?

The article seeks to find out those factors that boosts success and prevents patient falls due to nurse rounding’s.

To explore a nurses experience with fall prevention in hospital settings.

To determine the effects of those experience on how nurses provide care for the risk patients.

Does intense messaging from nursing administration to prevent patient falls, actions taken by nurses to address message and consequences to nurses and older patients

What are some of the effects of purposeful hourly rounding on the incidence of patient falls? The purpose of the article was to determine if implementation of strategic hourly rounding can reduce falls.
Design (Type of Quantitative, or Type of Qualitative) Quantitative Qualitative Quantitative Quantitative
Setting/Sample 30-day prospective pilot study was conducted in pre- and post-implementation units. 27 registered nurses and certified nurses

Two hospitals located in Wisconsin

241- bed acute care facility in south eastern United States Hourly rounding was conducted during 4-8 am time frame was implemented on all the patients.
Methods: Intervention/Instruments Lean Six Sigma process was used to determine improvement in the project In-depth interviews were conducted. Open, axial and selective coding was used in data analysis. Data was collected through retrospective data review to determine fall incidence in one year before and after implementation of hourly rounding program. An UAMS EBP model was utilized in the project. An hourly rounding during the 4- 8 am was implemented on all the patients and it continued throughout the day. The hourly rounding’s addressed the 4 p’s these are possessions. Position. Hygiene and personal.

Staffs were educated on rounding through the use of staff meetings, unit council meetings, daily audits and one- on one instruction.

Analysis On the units where staffs were engaged through leadership and unit champions there was a significant reduction in fall rates in Unit 1. In most hospital settings, nursing staff have been placed directly to prevent falls. As such, nurses feel an increasing pressure to meet hospital objective of zero falls. The study illustrates that total falls occurred before and after implementation of purposeful hourly rounding. In the study evidence-based standardized prevention resulted to decrease in falls though it was not statistically significant. Using analysis of variance in identification of the times when patients were more vulnerable to falling. Hour rounding for high risk patients who were vulnerable to falling decreased
Key Findings The authors found out that active involvement of front-line staff and leadership in program design and as unit champions during the period resulted to reduction in inpatient fall rates. The authors found out that nurses experience negative consequences as and when they are placed on intense pressure to prevent falls. As a result nurses adjust the care they deliver and restrict patient mobility and optimal patient progress. Purposeful hour settings can effectively prevent falls. The challenging factor is its implementations in health care settings. Hourly rounding’s decreases patient falls. Ensuring clinical support through HDS to drive care and rounding compliance is an effective reduction strategy.
Recommendations Current hospital care settings should engage interdisciplinary team and front line staff to reduce hospital fall rates. The authors recommend that research is required to gain knowledge on how nurses should provide care to risk patients.

There is also a need for patient centered and unit based interventions to prevent patient falls and preserve patient functions.

The study recommends that further research to be conducted on one the benefits of purposeful hourly rounding.

Purposeful hourly rounding is a transformation in nursing culture.

The study also provides opportunities for developing, implementing and evaluating hourly rounding programs in hospitals.

Health care settings should clinical decision making support such as the HDS. This can help them drive care that is paired with rounding compliance on high fall risking patients as an effective was to reduce falls.
Explanation of How the Article Supports EBP/Capstone Project The article supports my capstone project on falls, because it relates well on how nurse’s hourly rounding’s can be decreased in hospital settings. The article provides suggestions on how hospitals should lessen the pressure put on nurses to prevent patient falls and look for appropriate strategies to minimize patient falls. The article supports capstone project in that it explains how implementation of purposeful hourly rounding can prevent patient falls. The article argues that use of hourly rounding does can reduce the rate of hospital fall in health care settings.
Criteria Article 5 Article 6 Article 7 Article 8
Author, Journal (Peer-Reviewed), and

Permalink or Working Link to Access Article

https://onlinelibrary.wiley.com/doi/pdf/10.1002/rnj.250 https://sigma.nursingrepository.org/bitstream/handle/10755/621219/AMoses.FinalManuscript2017.pdf?sequence=3&isAllowed=y https://bmjopen.bmj.com/content/7/11/e017864 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005465.pub4/full
Article Title and Year Published 2016 2017 2017 2018
Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study The article examined how nurse leaders in an inpatient rehabilitation unit can reduce falls through implementing fall prevention strategies and sustaining their results by promoting a strong culture. What are the effects of an alarm elimination programs compared to the practice of utilizing alarms on fall rates in a 2 month period. To evaluate the effectiveness of fall prevention strategies on reducing falls in hospitalized adults. To identify the effects of interventions designed to reduce incidence falls among older people in acute care facilities

Design (Type of Quantitative, or Type of Qualitative) Qualitative A retrospective review of NDNQ for number of falls in 1000 patients from the fourth day of 2010 to the third quarter of 2012 was conducted.

.

Quantitative Qualitative Qualitative
Setting/Sample 61-bed inpatient rehabilitation (IPR) 1070 bed tertiary teaching hospital from (National Data base of Nursing Quality Indicators (NDNQI) Patients in a Rehab long term care facility in Missouri Meta- analysis Study. Thirty five trails that is 77,879 participants were included. The study sed 95 randomized control trial that involved 138,164 participants, Seventy one trials were in care facilities, and 24 in hospital settings.
Methods: Intervention/Instruments A retrospective review of IPR fall rates was conducted. The quarterly fall rates were compared to implementation dates of fall prevention interventions such as hourly rounding, safety hurdles and signage, The quality improvement project followed four steps that is Plan-Do-Check Act (PDCA).Data was collected from Incident Reporting Program (IDA).The outcomes were then measured through pre and prosy intervention deign. Pre intervention was collected from 2015 and post intervention collected in July to September 2016/ Criteria were followed in that studies that were eligible for inclusion for method and quality risk of bias and was based on the method quality. The author used Pedro scale and the Cochrane Risk of Bias based on 12 criteria that is binding, concealed allocation ,baseline comparability outcome assessment and incomplete data. The study applied the use of randomized control measures to prevent falls among older people in residential and nursing care hospitals. The author screened abstracts where two review authors were successfully screened for inclusion.
Analysis Total fall rates per 1000 patients were collected from the fourth quarter of 2010 to 2013 from NDNQI. Fall rates decreased after post prevention but there was no statistical significance in the decrease in fall rates. The eligibility criteria was based on the type of studies, types of interventions, compradors, outcome measures, study settings and t types of participants. Majority of the results for the study were at risk of bias due to inadequate binding, Also risk of fracture and other adverse events were poorly reported the evidence was also of poor quality.
Key Findings Decrease in fall rates was noted after revitalization efforts of IPR unit culture of safety together with hourly rounding. The need for Alarm Elimination Fall Prevention program was a requirement in the chosen health care setting. The health care setting also required a vast amount of support from its management and administration to enable staff realize its importance and to view interventions for more work. The studies suggested various strategies that were used to prevent patient falls in hospitals. The authors found out that in hospitals ,there was an effect of additional physiotherapy on rate of falls as it reduces the risk of falling.
Recommendations Physical injuries that occur due to falls reduce mobility and can increase morbidity. Through evidence based fall reduction strategies are crucial for nurses and leaders within the health care. The authors suggest further studies should consider fall rates in relation to patient and staff ratios and follow up to be conducted during a much longer time frame to determine the importance that is noticed on higher compliance rates. Administrators through modifications and understanding of ideas and asking the right questions can create an opportunity and provide safe environment patients. A proper understanding of hospital falls and effective strategies to prevent falls is an essential strategy to prevent individuals from falling. The study suggests incorporatuo of apporahces on the cirumstancs o falls in addition to other factors such as regular assisted toileting and in facilities and hospitals. Health care settings should use educational focus and psychological strategies as patient centered directions.
Explanation of How the Article Supports EBP/Capstone The paper explain how use of evidence based practices such as hourly rounding can prevent patient falls which are associated with increased morbidity. The article relates on capstone project on falls since it describes of utilization of alarms can result to reduction in fall rates among patients. The author supports the capstone project because the studies suggest various strategies that can be used to prevent patient falls. The study relates to the capstone project since it analyzes risk prevention strategies in health care settings.

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