Restatement of the PICO question and significance to nursing practice

Consider Parts 1 and 2 of your Course Project. How does the research address your PICO question?

With your PICO question in mind, identify at least one nursing practice that is supported by the evidence in two or more of the articles from your literature review. Consider what the evidence indicates about how this practice contributes to better outcomes.

Explore possible consequences of failing to adopt the evidence-based practice that you identified.

Consider how you would disseminate information about this evidence-based practice throughout your organization or practice setting. How would you communicate the importance of the practice?

To complete:

In a 3- to 4-page paper:

Restate your PICO question and its significance to nursing practice.

Summarize the findings from the articles you selected for your literature review. Describe at least one nursing practice that is supported by the evidence in the articles. Justify your response with specific references to at least 2 of the articles.

Explain how the evidence-based practice that you identified contributes to better outcomes. In addition, identify potential negative outcomes that could result from failing to use the evidence-based practice.

Outline the strategy for disseminating the evidence-based practice that you identified throughout your practice setting. Explain how you would communicate the importance of the practice to your colleagues. Describe how you would move from disseminating the information to implementing the evidence-based practice within your organization. How would you address concerns and opposition to the change in practice?

Translating Evidence into Practice

Restatement of the PICO question and significance to nursing practice

What measures can be taken to prevent falls among the elderly? Preventing and reducing falls among the elderly goes a long way in promoting the quality of life. The presence of multiple falls can result to mortality, injuries with long-term effects, or even non-life threatening injuries. If the risk factors associated with falls are reduced or eliminated, the elderly can manage leading more independent lives. In addition, they get the chance to live longer in their homes while leading quality lives. Reducing and preventing falls among the elderly reduces costs linked to hospitals, health care centers, and insurance companies. This is founded on the fact that falls are an enormous nursing concern. In addition to the high costs of managing them, they are linked to principal functional decline, morbidity, and escalated healthcare costs. Falls related injuries bring both suffering and pain to the elderly, in addition to the independent function loss. Following falls, the elderly develop the fear of ever falling again and this leads to a reduction in activities that might make them to fall. Consequently, there develops effects such as decreased socialization, loss of function, unnecessary dependency, and poor life quality. Considering that the babyboomers generation is gradually aging, it is important for the nursing professionals to consider it a priority using preventive measures for reducing fall injuries (Shubet, 2011).  They require systematic ways of identifying the elderly who are at the risk of falling and using preventive measures so as to ensure that the environments the elderly live in are safer.

                                                  Summary of the articles’ findings

            The elderly suffer a decline in mental and physical function, which increases the risks for falling and a declined life quality. Some of the multiple risk factors that lead to falls include muscle weakness, impaired balance, decreased endurance, poor sight, difficulty walking, medications, decreased sensation, and mental health disorders. When assessing falls, the post fall assessment tool is very reliable and leads to good results (Prevention, 2012).  The FEC (Falls Efficacy Scale) is the most suitable test for use among the geriatric population and it scores the social and physical aspects of various population settings. According to (AGS) American Geriatrics Society, it is recommended that adults aged sixty five years and above should undergo fall screens. Among the elderly, exercises are very essential in improving muscle tone and balance but it is only a component of the multifactorial intervention. Exercise programs should be progresses, structured, and use minimum doses as possible. Falls interventions that involve physical therapy are not very productive (Scheffer et al., 2008). It is more productive if exercise is combined with other interventions focusing on improving balance. For exercise programs to produce significant improvements, they should be conducted from 8 weeks to a year. Falls make a person have declined level of functioning. Falling is acknowledged as a multifactorial challenge that is linked to intrinsic as well as environmental risk factors. The combination of these risk factors results to falls and mobility impairment is the greatest risk factor. Understanding and having awareness about the risk factors helps in developing strategies aimed at reducing the falling fear, improving life quality, and an elderly experiencing an actual fall (Shubet, 2011). Women might suffer more falls than men due to the high use of depression medications that leads to declined functional status. Health services might be ineffective in addressing falls among the elderly.

Nursing practice that is supported by the articles’ evidence

The evidence from the articles indicates that exercise is a very effective nursing intervention for preventing and reducing falls among the elderly. Exercise improves muscle tone and balance, which are vital in improving the quality of life.

How exercise contributes to better outcomes

            Regardless of how minimal the exercise is, it has many positive benefits in preventing falls among elderly. For example, for an elderly person to be able to rise from a chair and walk around a room, there is need for proprioception, balance, and muscular power. There is a need to encourage the elderly to exercise and remain active as much as they can. This plays a great role in maintaining balance and joint position sense as well as strengthening muscles. The most recommendable exercises are those that improve gait and balance (Stevens et al., 2012). Another factor is that following a fall, the elderly might lose confidence and become inactive. Therefore, there is a need to encourage exercise as a strategy of encouraging being active. Exercise programs can be designed such that they match individual fitness and needs. This ensures that various personal factors are considered and this promotes quality of life. Through exercise interventions, it is possible to organize local networks comprising of exercise-related organizations and activities. This offers an opportunity for the elderly to interact with each other, which is essential in preventing boredom and sharing ideas as well as experiences (Stevens et al., 2012).

            The link between reduced falls and exercise among the elderly is well-established. Evidence shows that disability can be minimized through the use of well-designed exercise. Optimal strength training is very essential in promoting functional and cognitive benefits. However, high risk individuals should not be exposed to brisk walking. Exercise programs have also proved to be effective in reducing death risk.

Potential negative outcomes for failing to use the practice

If an elderly person remains inactive, there are a number of potential negative outcomes that can make his situation to deteriorate. For example, inactivity results to joint pain particularly in cases of osteoarthritis, which leads to muscle weakness, loss of balance, and losing the sense of joint position. If these accumulate, the elderly person is rendered impossible to move around, which minimizes his level of independence. Overall, this translates to poor quality life.
Strategy for disseminating the practice throughout the practice setting

A very effective strategy through which the practice can be disseminated in a healthcare setting is through the professional nurses’ association. These associations have proved to be extremely effective and active in promoting evidence-based nursing practices such as the use of exercise interventions among the elderly as a way of preventing and reducing falls. However, it is greatly emphasized that the associations should have a keen focus on transforming competencies and attitude by looking into intrinsic motivations. There can also be use of other modes including strategies that are based on involuntary involvement, behavior-oriented approaches, and approaches that use social, structural, and financial influence measures.
Communicating the importance of the practice

            The manner in which an evidence-based practice is presented to nurses determines its rejection or acceptance. There is a need to note that communication methods, social network influences of the users, and interpersonal communication channels determine the adoption of exercise interventions for preventing and reducing falls among the elderly. Consultation by experts, mass media, opinion leaders, education, and change champions have proved to be particularly effective when informing nursing colleagues regarding the use of falls interventions to manage falls among the elderly. It is worth noting that regardless of the fact that education is very important, it cannot transform a practice on its own. Rather, it needs to be used in combination with other approaches. More particularly, sole didactic continuing education results to very few outcomes.

Moving from disseminating the information to implementing the practice in an organization

            The dissemination process aims at making sure that the whole healthcare fraternity and colleagues are conversant with the benefits and significance of the preferred practice (Greenberg, 2012).  This ensures that the practice is embraced and embraced positively, which makes it productive in the institution. Therefore, proper creation of information or education is essential in ensuring that colleagues have the necessary knowledge and skills about the practice they are being presented. It is important if the top management embraces the practice first. Being the authority in the institution, they have a powerful impact regarding how other members embrace the practice. They can promote a faster and positive embrace of the practice.

Addressing opposition and concerns to the change in practice

            Concerns and opposition can be addressed by providing the colleagues with evidence and results from previous effective treatments. Moreover, presenting sufficient information about the practice goes a long way in ensuring that the colleagues are convinced, which is very vital in clearing any opposition

References

Greenberg, S. (2012). Analysis of Measurement Tools of Fear of Falling for High-Risk, Community Dwelling Older Adults. Clinical Nursing Research, 113-130.

Prevention, C. f. (2012). Falls among Older Adults. Retrieved from Centers for Disease Control and Prevention:

Scheffer, A., Schuurmas, M., Dijk, N., Hooft, T., & Ruuij, S. (2008). Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age and Ageing, 19-24.

Shubet, T. (2011). Evidence-Based Exercise Prescription for Balance and Falls Prevention: A Current Review of the Literature. The Journal of Geriatric Physical Therapy, 100-108.

Stevens, J., Ballesteros, M., Mack, K., Rudd, R., DeCaro, E., & Adler, G. (2012). Gender differences in seeking care for falls in the aged Medicare Population. American Journal of Preventive Medicine , 59-62.

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