NRS 433 Rough Draft Quantitative Research Critique and Ethical Considerations

Sample Answer

Practice problems are complex and continue to hamper patient outcomes significantly. Patient falls are common in inpatient and outpatient settings, and their prevention should be a priority for healthcare professionals and stakeholders. Records show that approximately 700,000 to 1,000,000 patients fall annually in U.S. hospitals (Ochoa, 2020). The impacts are far-reaching since trust in care providers depends on the quality of care that patients receive.

Other adverse outcomes associated with patient falls include prolonged hospitalizations, physical injuries, mental anguish, and persistent fear of falls (Chandrasekaran et al., 2021.). Older adults are at a high risk of falls due to decreased physicality, chronic diseases, and other factors. Quantitative research has explored evidence-based interventions for preventing patient falls to reduce their dangers in hospitals. As a result, the purpose of this paper is to critically appraise two quantitative studies exploring the practicality of exercise interventions for patient falls.

PICOT Question

Among hospitalized older adults (P), can exercise-based therapy (I) compared to usual care (C) reduce patient falls by 50% (O) in six months (T)?

Background of Studies

Patient falls affect patients’ health adversely and lower their quality of life. Rikkonen et al. (2023) stated that a higher proportion of older adults will be at risk of falls since the global population of people over sixty years will double by 2050. The problem is significant in nursing since the desired health outcomes are not achieved when patients fall. Also, healthcare facilities have a professional mandate to ensure the safety of all patients.

In response, Ehrari et al. (2020) evaluated the potential of engaging older adults in playful exercise to increase physical activity and balance. The objective was to evaluate the effectiveness of an exercise-based intervention among older adults for fall prevention. The research question guiding the study was how does playful exercise affect physical activity and balance among older adults?

In the other quantitative study, Chittrakul et al. (2020) demonstrated that patient falls among older adults are a significant threat to quality of life, requiring practical prevention measures. The study aimed to examine the effectiveness of a fall prevention physical exercise (multi-system physical exercise [MPE] program among pre-frail older adults. The objective was to study how MPE could prevent falls and improve the quality of life among the participants.

The research question guiding the study was what is the effect of MPE on falls and quality of life among pre-frail older adults? Generally, the two articles focus on the same problem affecting a unique population and requiring the support of healthcare professionals.

Articles Supporting the Nursing Practice Problem

As stated in the PICOT, the proposed evidence-based project examines whether exercise-based therapy can reduce patient falls among hospitalized older adults. The article by Ehrari et al. (2020) will be used to answer the PICOT question by demonstrating how participating in playful exercise improves balance and increases motivation to engage in physical activities. Exercises such as leg strength and balance training are eligible methods for reducing fall risk among at-risk populations (Thomas et al., 2019).

The article by Chittrakul et al. (2020) will be used to answer the PICOT question by showing the differences between patients engaging in a multi-system physical exercise intervention and those who do not. The article expands research on the importance of exercise intervention for fall prevention, aligning with the objectives of the proposed intervention as outlined in the PICOT.

Concerning interventions, the primary intervention in the articles and the PICOT question is moderate physical exercises of different types for various periods. Intervention groups have older adults engaging in exercise-based therapy, while comparison groups involve older adults who do not participate in exercises but continue with usual care.

Method of Studies

Research methods help researchers to implement a plan through data collection and analysis. Ehrari et al. (2020) conducted an experimental study (randomized controlled trial) among twenty-six independently living older adults. The intervention group comprised sixteen participants engaged in playful exercises on Moto tiles twice a week for ten weeks. The control group, consisting of ten participants, continued with normal daily activities.

Outcomes were compared pre- and post-intervention. Ehrari et al. (2020) measured outcomes using Berg’s Balance Score scale. In the other article, Chittrakul et al. (2020) experimented through a randomized controlled trial among seventy-two adults aged 65 and above. The intervention group received multi-system physical exercise training consisting of muscle strengthening, balance training, and proprioception for three days weekly for 12 weeks. The control group continued with routine care, and outcomes were assessed using the Physiological Profile Assessment.

Research methods have multiple benefits and limitations depending on accuracy levels, generalizability, and other factors. Experimentation through randomized controlled trials (RCTs) reduces bias through randomization since RCTs enable researchers to evaluate the causal relationships between the treatment and outcome (Zabor et al., 2020). Experimental research gives researchers a stronger hold over variables to manipulate them to get the desired results.

However, as Cook and Thigpen (2019) stated, RCTs’ findings may not effectively represent the broader population since only a small proportion of participants are enrolled. Researchers may improve generalizability by experimenting with large samples for more comprehensive results.

Results of Studies

Key Findings of Each Study

After comparing data pre- and post-intervention, Ehrari et al. (2020) found a significant difference between the intervention and control groups. The primary finding was an improvement of functional balance by an average of 5.02 points in the intervention group compared to the control group with 2.58 points. The exercise program also increased older adults’ motivation to engage in physical activities continually. Improvement in functional balance and motivation is crucial for fall prevention and sustained outcomes.

Chittrakul et al. (2020) also found exercise-based interventions crucial in fall prevention among older adults. After comparing outcomes between the groups, researchers found a statistically significant difference between the intervention and control groups in critical aspects like fall risk, muscle strength, and reaction time (p<0.001). The quality of life also increased significantly in the intervention group. These outcomes underscore the practicality of the intervention as a fall prevention method.

Implications in Nursing Practice

Health outcomes vary with nursing interventions and cultures in care facilities. The two studies found a positive link between exercise-based interventions and reduced fall risk. The implication is that exercised-based interventions can be implemented in healthcare facilities to prevent patient falls among older adults. Nursing professionals should be aware of length, intensity, and implementation time, among other factors affecting the programs’ effectiveness.

Ethical Implications

Nursing research should be ethical at all levels. A common ethical consideration is informed consent, which allows voluntary participation (Xu et al., 2020). Researchers should obtain informed consent from participants before commencing the study to ensure everyone is aware of the risks and benefits of research. The other ethical consideration is anonymity, which involves protecting the privacy of human subjects when collecting, analyzing, and reporting data (Hoft, 2021).

Researchers in both studies adhered to these principles. Chittrakul et al. (2020) ensured all participants provided written informed consent to participate and no identifiable information was collected or shared. In the other article, all participants signed an informed consent form (Ehrari et al., 2020). Identifiable data was coded to keep participants anonymous.

Conclusion

Patient falls are a significant health concern for healthcare providers, patients, and families. Due to their far-reaching effects, nursing professionals should implement evidence-based interventions to prevent falls. The two quantitative studies demonstrate the effectiveness of exercise-based interventions on fall prevention. As a result, they support the PICOT, which hypothesizes that patient falls can be reduced by 50% in hospitals through exercise-based therapy.

References

• Chandrasekaran, S., Hibino, H., Gorniak, S. L., Layne, C. S., & Johnston, C. A. (2021). Fear of Falling Significant barrier in fall prevention approaches. American Journal of Lifestyle Medicine, 15(6), 598–601. https //doi.org/10.1177/15598276211035360
• Chittrakul, J., Siviroj, P., Sungkarat, S., & Sapbamrer, R. (2020). Multi-system physical exercise intervention for fall prevention and quality of life in pre-frail older adults a randomized controlled trial. International Journal of Environmental Research and Public Health, 17(9), 3102. https //doi.org/10.3390/ijerph17093102
• Cook, C. E., & Thigpen, C. A. (2019). Five good reasons to be disappointed with randomized trials. Journal of Manual & Manipulative Therapy, 27(2), 63-65. https //doi.org/10.1080/10669817.2019.1589697
• Ehrari, H., Larsen, R. T., Langberg, H., & Andersen, H. B. (2020). Effects of playful exercise of older adults on balance and physical activity a randomized controlled trial. Journal of Population Ageing, 13, 207-222. https //doi.org/10.1007/s12062-020-09273-8
• Hoft, J. (2021). Anonymity and confidentiality. The Encyclopedia of Research Methods in Criminology and Criminal Justice, 1, 223-227. https //doi.org/10.1002/9781119111931.ch41
• Ochoa, D. (2020). Fall prevention in observation patients. St. Joseph Hospital. https //digitalcommons.psjhealth.org/cgi/viewcontent.cgi?article=1060&context=sjo-ebp
• Rikkonen, T., Sund, R., Koivumaa-Honkanen, H., Sirola, J., Honkanen, R., & Kröger, H. (2023). Effectiveness of exercise on fall prevention in community-dwelling older adults a 2-year randomized controlled study of 914 women. Age and Ageing, 52(4), afad059. https //doi.org/10.1093/ageing/afad059
• Thomas, E., Battaglia, G., Patti, A., Brusa, J., Leonardi, V., Palma, A., & Bellafiore, M. (2019). Physical activity programs for balance and fall prevention in elderly a systematic review. Medicine, 98(27), e16218. https //doi.org/10.1097/MD.0000000000016218
• Xu, A., Baysari, M. T., Stocker, S. L., Leow, L. J., Day, R. O., & Carland, J. E. (2020). Researchers’ views on, and experiences with, the requirement to obtain informed consent in research involving human participants a qualitative study. BMC Medical Ethics, 21(1), 1-11. https //doi.org/10.1186/s12910-020-00538-7
• Zabor, E. C., Kaizer, A. M., & Hobbs, B. P. (2020). Randomized controlled trials. Chest, 158(1S), S79–S87. https //doi.org/10.1016/j.chest.2020.03.013