When working as a nurse, clinical questions come up regarding which is the best way to care for our patients. To help nurses make effective clinical decisions, they can use evidence-based research in their decision-making process. In order to search for the best evidence, it is important to develop research questions from the scenario and search for research evidence to answer the clinical questions. This knowledge of evidence-based nursing can help me make informed decisions and how to be prepared for future challenges as a nurse.
According to Registered Nurses’ Association of Ontario (2005), falls are the number one cause of injury in Canadian hospitals in adults over the age 65 and account for over half of hospital admissions. Falls can cause serious injuries like hip fractures or death, and financial strain on health care. It is important to take a look at this problem and find out how to reduce the risk of falls.
An example that I have encountered, while working in the hospital, is about a retired, independent woman named Eleanor. She is in reasonable good health, but the death of her husband and a few friends has taken a toll on her life. She remains active by volunteering and playing bingo at the local hall. She has three children that call regularly and live an hour drive away. Recently, Eleanor was diagnosed with arthritis, preventing her from doing some of her daily activities. One day she fell in the bathtub breaking her hip and has been admitted to the hospital after falling at home.
After undergoing hip surgery, Eleanor stayed in the hospital for one week and rehabilitation for three months in order to make a full recovery. She is now being discharged from hospital and is worried about falling again. Eleanor lives alone and one of her daughters has agreed to help with the transition of moving back home. The nurse on the floor is concerned about the number of elderly patients who have been readmitted to the hospital and wonder if implementing a fall prevention program prior to discharge will help decrease falls. In order to help Eleanor, the nurse decides to do a literature search on the issue and develops two types of questions.
Using the four elements of a question: Population, Intervention, Comparison, and Outcome (PICO), a question can be formed to help search for evidence easier (Cullum, Ciliska, Haynes, & Marks, 2008).
P- Elderly people who had a fall
I- Falls prevention program with usual care
C- Usual care
O- Decrease falls
In elderly people who had a fall, does implementing a falls prevention program with usual care decrease number of falls when compared to usual care?
I framed my qualitative question using the Patient and Situation (PS) model.
P- Elderly people
S- View on fall prevention
What is the view of elderly people on fall prevention?
After creating a quantitative and qualitative question, the next step is to choose a research design. The study design that I have chosen to fit for the quantitative question is the randomized controlled trial (RCT) because the question focuses on the prevention of recurrent falls in the elderly using the falls prevention program compared with usual care.