Question:
| 1.1 In order to complete this assessment, you will need to identify a research question/hypothesis related to a specific topic, such as:
Infection control
You may choose a different topic, but your educator must agree with the topic you have chosen.
Your nursing research question or hypothesis may include:
½ Nursing interventions applicable to the topic ½ Client perceptions of the provision of this topic ½ Models of nursing care that utilise the topic ½ Political issues confronting nursing practice and health care provision in relation to the topic
An example of a question (the student can NOT use this example), would be: Does hand washing among healthcare workers reduce hospital acquired infections?
An example of a hypothesis (the student can NOT use this example), would be: It is the hypothesis of this experiment that bacteria will be best cleaned off when they are washed with chemicals like soap or hydrogen peroxide and the hands are then drying on a sanitary object like clean paper towels.
It is necessary to apply critical thinking skills to formulate a research question/hypothesis. In order to do this: ½ Have a sound understanding of what best practice is ½ Consider if best practice is being applied. If not, identify the specific areas where best practice standards are not being met ½ Drawing upon your knowledge, identify the impact of these gaps on healthcare outcomes for the client ½ Formulate a question/hypothesis based on your considered approach to minimise the impact on the client and improve knowledge/skills of the healthcare professionals.
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| 2. Definition of key terms | ||||||||||||||||||
| 2.1 THIS IS AN OPTIONAL STEP INTENTED TO HELP YOU RESEARCH YOUR ARTICLES. NO MARK ALLOCATED TO THIS TASK. Identify the key terms of your research topic. Give a synonym or variation of the term and provide a definition for each using the table below.
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| 3. Research question/hypothesis and its purpose | ||||||||||||||||||
| 3.1 Write a clear statement highlighting your research question or hypothesis, e.g. “is there a difference between hand washing protocols and actual practice”. | ||||||||||||||||||
| 3.2 Identify the role and the six (6) steps of the evidence based process. You may refer to http://guides.mclibrary.duke.edu/c.php?g=158201&p=1036021 | ||||||||||||||||||
| 3.3 Explain whether or not the future results of your study might contribute to evidence based practice. | ||||||||||||||||||
| 3.4 Briefly explain how your research will contribute to nursing practice and continuous improvement programs, e.g. better enforcement of hand washing protocols leading to decreased number of nosocomial infections. | ||||||||||||||||||
| 3.5 Identify ONE (1) member of the multidisciplinary healthcare team who would contribute to your research. Briefly explain his/her participation in the study. | ||||||||||||||||||
| 3.6 Contact your educator and discuss your Research Topic and verbally gain confirmation that you and your partner are on track. | ||||||||||||||||||
| 4. Literature review
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| 4.1 You are now to conduct a literature review.
½ The aim of your literature review is to ‘demonstrate in a rigorous way the background of the subject under discussion, and in many cases establish a justification for the need to research the particular topic.’ (Richardson-Tench et al. 2014, p. 46) ½ Include three (3) articles in your literature review. ½ Articles must be published in professional journals. Please find below the pyramid of evidence – this is a guide that may help you throughout your project. You may also refer to your learning activity (session 2, activity 5).
½ Hierarchy of nursing research evidence: 1. Systematic reviews and meta-analysis 2. Randomised controlled trials 3. Cohort studies 4. Case-control studies 5. Cross-sectional surveys 6. Case reports
½ To determine the quality of a research article: 1. Ensure authors/researchers are credible 2. The methodology or study design must be appropriate for the study 3. Clear data collection and data analysis processes 4. The findings should be effective and feasible 5. No breech of ethical guidelines 6. Limited/no financial or commercial bias
½ You may use the suggested articles found in your learning activities. ½ You may access the JBI and EBSCO databases from your Blackboard page. |
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| 4.2 Provide the reference for each article following Harvard System of Referencing. The reference list must be at the end of your project. Use Appendix C. | ||||||||||||||||||
| 4.3 For each article, highlight the main hypothesis or research question raised by the authors. | ||||||||||||||||||
| 4.4 For each article, write a brief analysis of how your study will build on these results or further contribute to literature surrounding your topic. | ||||||||||||||||||
| 4.5 Contact your educator and discuss your Research Topic and verbally gain confirmation that you and your partner are still on track.
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| 5. Methodology, data collection and analysis method | ||||||||||||||||||
| 5.1 Describe the data that will be collected, e.g. blood pressure, blood samples, etc. | ||||||||||||||||||
| 5.2 Identify the most appropriate research method you would use to address your research topic. Indicate whether you choose to undertake a mostly quantitative or qualitative study. Explain your response.
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| 5.3 Briefly describe the type and the size of your study population including inclusion and exclusion criteria, e.g. 200 women aged 60 or above (excluding men).
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| 5.4 Identify the most appropriate method(s) of data collection for your research, e.g. survey, questionnaire, interview, etc.
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| 5.5 In contribution to improving health promotion programs and best practice in nursing, your participation in this study is to identify THREE (3) questions you would include in the questionnaire or interview designed to gather the data required for your study. | ||||||||||||||||||
| 5.6 Identify the method you will use to analyse your data, e.g. statistical analysis. Briefly explain why. | ||||||||||||||||||
| 5.7 Identify TWO (2) potential uses of the data, e.g. updating hand washing guidelines in your workplace. | ||||||||||||||||||
| 5.8 Name ONE (1) document you would study to ensure you are following the statutory requirements for data collection and documentation.
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| 6. Validity of the research | ||||||||||||||||||
| 6.1 Identify and list the dependant and independent variables of your study. Include social, personal, socio-economic, physiological, emotional or physical variables. | ||||||||||||||||||
| 6.2 Identify TWO (2) obstacles to your study and provide ONE (1) solution for each.
Obstacle 1: Solution: Obstacle 2: Solution: |
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| 6.3 Identify ONE (1) strength of your research tools or methods in relation to validity, e.g. large sample size. | ||||||||||||||||||
| 6.4 Identify ONE (1) weakness of your research tools or methods in relation to validity, e.g. lack of accuracy of measuring tools. | ||||||||||||||||||
| 6.5 Identify and briefly outline ONE (1) strategy you could use to strengthen the validity of your study, e.g. applying for authorisation to access latest measuring tools.
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| 6.6 List TWO (2) questions that can be used to help evaluate the quality of the study. | ||||||||||||||||||
| 7. Ethical, cultural and religious considerations | ||||||||||||||||||
| 7.1 Identify ONE (1) physical and ONE (1) emotional effect the study may have on the life of the participants’ relatives and loved ones. Provide ONE (1) solution for each of their need.
· Physical need: · Solution:
· Emotional need: · Solution: |
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| 7.2 You are proposing to collect data from participants during the study. Discuss the potential cultural and/or religious considerations you need to anticipate to ensure you always follow ethical guidelines, e.g. special considerations for specific ethnicity. | ||||||||||||||||||
| 7.3 While researching and participating in the study, it is absolutely necessary that you apply the Professional Standards of Practice. They include:
□ ANMC Code of Conduct □ ANMC Code of Ethics □ NMBA Enrolled nurse standards for practice □ State/territory Nurse Regulatory Nurses Act □ State/territory Nursing and Midwifery Regulatory Authority Standards of Practice □ Scope of nursing practice decision making framework □ All of the above
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| 7.4 Identify (TWO) policies and/or procedures you need to be familiar with while applying for and conducting research according to: https://research.unsw.edu.au/policies-and-procedures . | ||||||||||||||||||
| 7.5 Obtaining ethic approval before you start your research is a compulsory step of the process. Identify the institution that would ensure your study has received ethical approval.
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| 7.6 Briefly discuss how you would ensure all research staff apply their duty of care throughout the study. | ||||||||||||||||||
| 7.7 Briefly discuss how you will maintain the confidentiality and privacy of the participants.
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| 8. Schedule, funding and dissemination of research | ||||||||||||||||||
| 8.1 Develop a summary of your study timeline. Use the table provided in Appendix A.
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| 8.2 Elaborate a simplified budget for your research. Use the table provided in Appendix B. Explain where you would apply for funding. | ||||||||||||||||||
| 8.3 As you are participating in research in order to work toward continuous improvement programs, you will need to share your findings within the workplace / industry. Briefly describe the method(s) of dissemination of your findings, e.g. articles, newsletters, conference, etc.
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| 9. Reflection | ||||||||||||||||||
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9.1 You are now at the end of your research proposal. You have been working on this project with another person as a team. Discuss how you planned and executed equitable team work and collaboration.
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Answer:
1.1
The proposed research is based on the topic of “Effectiveness of fall prevention strategy for elder patients in clinical settings”. The fall prevention strategy to the considered for the research would be targeted falls prevention program for addressing the needs of elderly patients in clinical settings. The study would have the main hypothesis as follows-
“Targeted fall prevention program reduces incidence of fall among elderly patient in healthcare settings.”
3.1
The proposed research would be undertaken in alignment with the research question of “Is targeted falls prevention program effective in preventing falls among elderly patients in healthcare settings?
3.2
The six essential steps for implementing evidence based practice enhances the knowledge and skills of nursing professionals. The first setp involves frmaing a suitable research question based on a topic that is valuable in nursing profession. The second step involves suitable search method using relevant databases, keywords and Boolean operations. The third step is the critical appraisal of evidences with the help of critical appraisal tools. The next step is to integrate the evidences into practice for beter clinical decisions and patient outcomes. The fifth step involves evaluating and assessing the outcomes of the practice. Lastly, the findings from research and practical experience are to be disseminated among the professionals in the concerned organisation so that better care processes can be initiated (Parahoo 2014).
3.3
The future results of the proposed study would significantly contribute to evidence based practice. Based on the results, nurses can consider implementing the mentioned targeted fall prevention program in diverse settings with the aim of reducing falls among elderly population (El-Khoury et al. 2013).
3.4
The research holds much potential to bring changes in how fall risk among elderly population in geriatric wards are addressed by nursing professionals. Novice and effective method can emerge from research that when applied in practice might eliminate the challenge of reducing risk of falls among this population (Miake-Lye et al. 2013).
3.5
One member of the multidicipplinary healthcare team who would contribute to the proposed research is physiotherapist. A physiotherapist is responsible for including therapeutic principles of functional activities that reduce chances of fall in elderly patient population (Lam et al. 2015).
4.1
A literature review is to be undertaken for demonstrating the topic in a clear manner. The aim of the literature review is to establish a justification for the rationale of the research on the concerned topic (Houser 2016).
4.2
Article 1- Haines, T.P., Hill, A.M., Hill, K.D., Brauer, S.G., Hoffmann, T., Etherton-Beer, C. and McPhail, S.M., 2013. Cost effectiveness of patient education for the prevention of falls in hospital: economic evaluation from a randomized controlled trial. BMC medicine, 11(1), p.135.
Article 2- Uusi-Rasi, K., Patil, R., Karinkanta, S., Kannus, P., Tokola, K., Lamberg-Allardt, C. and Sievänen, H., 2015. Exercise and vitamin D in fall prevention among older women: a randomized clinical trial. JAMA internal medicine, 175(5), pp.703-711.
Article 3- Santesso, N., Carrasco‐Labra, A. and Brignardello‐Petersen, R., 2014. Hip protectors for preventing hip fractures in older people. The Cochrane Library.
4.3
Article 1- According to Haines et al. (2013) falls are to be considered as one of the most commonly occurring adverse events in healthcare settings that influences patient recovery. This is of more importance for elder patients in such settings who are at increased risk of falls. Patient education has been highlighted as a potential fall prevention strategy whose cost effectiveness had been not adequately adjudged in literature. The authors aimed at carrying out randomised controlled trial for assessing the cost effectiveness of patient education for the purpose of fall prevetion in hospitals.
Article 2- As mentioned by Uusi-Rasi et al. (2015) vitamin D supplementation and exercise are two key recomemdnations for preventing falls among older people. Research had previously indicated that the results of studies on use of these two factors were contradictory. The researchers therefore wanted to determine the actual effectiveness of targeted exercise training program and vitamin D supplementation in reduction of falls and adverse incidents among older women.
Article 3- Santesso et al. (2014) highlighted that older patient staying at care facilities are at high risk of falling and suffering hip fractures. Hip protectors are advocated as a tool to decrease the risk of hip fracture. Against this background the researchers thought it necessary to determine whether provision of external hip protectors reduce the risk of hip fracture in older patients.
4.4
Article 1- The mentioned study found that patient education programs are cost effective and helpful in reducing falls among the targeted population. The study inferred that the base of strong evidence revolving the cost effectiveness and efficacy of intensive patient education programs in the healthcare setting is expanding at large. Further work is required for examining the effectiveness of such an approach. Proper resource allocation is necessary to carry out flawless research (Haines et al. 2013). The present proposed research would contribute to this arena of research of add information on the effectiveness of patient education programs for fall prevention.
Article 2- The article determined that the rate of falls were not effected by exercise therapy. Exercise was effective in increasing physcial functioning of the patients. Future research was warrened for establishing exercise as the most feasible and effective strategy for prevention of falls (Uusi-Rasi et al. 2015). The proposed research would help in understanding the exact role of exercise therapy in preventing falls among older adults.
Article 3- The research concluded that hip protectors redcue the risk of hip fractures for older patients in care units without increasing the fall frequency. Future research is required to study wteher the use of such protectors increase the risk of other adverse effects (Santesso et al. 2014). The proposd study would scrutinise the mentioned concern appropriately.
5.1 The data required for the present study will be based on fall assessment among the elderly people. The fall history that measures the number of falls that participants have experienced during their hospital stay, injuries related to these falls and fall incidence rates.
5.2 Based on these parameters, the data will be collected where the study design will be a randomized control trial which is the most suitable for this present study for fall prevention among elderly population. The data will be collected based on incidence and frequency of falls during hospital stay in elderly population.
5.3 For the present study, 350 participants (patients) above the age of 65 years will be included who would be admitted to geriatric ward for three consecutive months in the hospital setting. The Peter James Centre falls risk assessment tool (PJC-FRAT) will be employed for the targeting of fall prevention and deployment of intervention or the elderly population. The inclusion criteria for the study comprises of elderly population of the age above 65 years being the intervention group and control group. The exclusion criteria comprise of the participants who would be previously enrolled in study and who would not provide any informed consent.
5.4 Using standardized procedures, medical histories of the patients admitted to geriatric population will be recorded by the hospital staff for three consecutive months. Baseline measures comprising of gender, age, incidence rates of fall, medical history, admission diagnostic category, cognitive impairment and functional dependency at the time of admission. Relevant data will be collected that provide patient information required for the study.
5.5 Questions are framed for knowing the incidence rates of fall and risk assessment in the nursing.
How often The Peter James Centre falls risk assessment tool (PJC-FRAT) is done for the patients?
How often do you perform fall-focused physical examination during the fall risk assessment for the patients?
What are the factors that you take into consideration during fall risk assessment?
5.6 The data analysis for the present study comprises of the statistical analysis of the primary outcomes for the treatment of basis. The data will be regarded as recurrent events comprising of survival data including all falls during study observation periods will be taken into account for the analysis. The cumulative incidence of falls will be compared graphically over time using Nelson-Aalen cumulative hazard estimator. The observation time of each participant would be started at zero regardless of the fact when they are admitted to the hospital in the three consecutive months. In the step function of Nelson-Alden hazard estimator, the height measures the number of falls within the considered group (intervention and control) in one day divided by participants who would have not been discharged. The equivalence of fall rates will be tested using log rank test between groups. This analysis also requires knowing about fall rates between the groups for maintaining a proportional relationship over time. The Peto extension of log rank test will also be considered for studying non-proportionality.
The comparison can be done between incident rates of falls between the intervention group and control group through log rank test. Participants who experienced more than one fall will be compared between the groups using 95% confidence intervals relative risk. The agreement between hospital prediction and participant group allocation will be analyzed through қ statistic. The analyses will be conducted through Stata 8.0 software.
5.7 The potential uses of the data is to understand the awareness among the nurses regarding fall assessment among geriatric population and aid in fall prevention program for reduction and prevention of falls and injuries in the geriatric population.
5.8 For data collection, The Data Collection Policy in Australia provide statutory guidelines for data collection and documentation.
6.1 The physical variables for the study comprises of fall history of the patient comprising of frequency and incidence rates of falls during hospital stays in the three consecutive months. Funding is the economic variable and communication between the participants and researcher is the social and cultural variable as the participants are elders above the age of 65 years.
6.2 Funding and language barrier are the two obstacles for the present study. For overcoming funding population, during the proposal planning, strategic budget planning should be undertaken. For overcoming lingual barrier, qualified medical interpreters can be helpful for proper language translation.
6.3 Randomized control trial (RCT) provides the strongest empirical evidence and has the ability to in making causal inferences in deciding a treatment’s efficacy (Östlund et al. 2011). In the present study, randomization of participants in test and control group would be helpful to study the effectiveness of fall prevention intervention program for the fall reduction and injuries among geriatric population.
6.4 There might be participant allocation being predictable and results in selection bias being a major disadvantage in RCT (Harwell 2011).
6.5 In the present study, consideration should be given to the study results with rigor for the research.
6.6 Rigor for the study can be done by enhancing the quality and in quantitative study design, validity and rigor can be done through validity measurement and reliability (Thomas and Magilvy 2011).
7.1 It is mandatory to conduct the research study ethically by adhering to norms or ethical standards distinguishing acceptable and unacceptable behavior. As the participants are above the age of 65 years, emotional and cultural needs of the participants (emotional risks) including family members and friends need consideration (Connelly 2014). It can be overcome through education making them understand the purpose of the study or else they may become anxious.
7.2 As the participants comprises of elderly people, cultural and religious considerations comprises of involving them in decision-making process through informed consents that is important to promote their independence and autonomy (Suri 2011).
7.3 NMBA Enrolled nurse standards for practice, ANMC Code of Ethics, NMBA Regulatory Authority Standards for Practice and Professional Standards of Practice include ANMC Code of Conduct need to be applied during researching and participating in this research study.
7.4 National Health and Medical Research Council (NHMRC) and Australian Code for the Responsible Conduct of Research need consideration while conducting research.
7.5 National Statement on Ethical Conduct in Human research in Australia provide ethical approval.
7.6 The researchers should act working in accordance with maintaining confidentiality of the participants and working for their best interests (beneficence), respecting autonomy and ensuring safety (non-maleficence) under their duty of care during the research (Bužgová and Ivanová 2011).
7.7 To maintain confidentiality and privacy of participants, the researchers should not disclose personal information of the patients like medical history, family background and other medical information.
- Ref to appendix
The present research proposal was outlined in collaboration with team mate. Collaboration and team work was essential for coming up with the suitable proposal since it demanded much efforts. Team work requires a suitable mix of communication, problem solving and intrpersonal skills so that two person can work for a common goal (Houser 2016). Planning and time management lay at the core of our effective team work. Tasks and responsibilities were divided among the two members that made the work easier and simpler. Clear communication was necessary to put forward ideas and viewpoints and exchange opinions. This also prevented miscommunication between team members. It was a good learning experience to take part in the research activity and key lessons learnt would bee applied in future for professional development.
References
Bužgová, R. and Ivanová, K., 2011. Violation of ethical principles in institutional care for older people. Nursing ethics, 18(1), pp.64-78.
Connelly, L.M., 2014. Ethical considerations in research studies. Medsurg Nursing, 23(1), p.54.
El-Khoury, F., Cassou, B., Charles, M.A. and Dargent-Molina, P., 2013. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMj, 347, p.f6234.
Haines, T.P., Hill, A.M., Hill, K.D., Brauer, S.G., Hoffmann, T., Etherton-Beer, C. and McPhail, S.M., 2013. Cost effectiveness of patient education for the prevention of falls in hospital: economic evaluation from a randomized controlled trial. BMC medicine, 11(1), p.135.
Harwell, M.R., 2011. ReseaRch Design in Qualitative/Quantitative. The Sage handbook for research in education: Pursuing ideas as the keystone of exemplary inquiry, p.147.
Houser, J., 2016. Nursing research: Reading, using and creating evidence. Jones & Bartlett Learning.
Lam, J., Liamputtong, P. and Hill, K., 2015. Falls, falls prevention and the role of physiotherapy and exercise: perceptions and interpretations of Italian-born and Australian-born older persons living in Australia. Journal of cross-cultural gerontology, 30(2), pp.233-249.
Miake-Lye, I.M., Hempel, S., Ganz, D.A. and Shekelle, P.G., 2013. Inpatient Fall Prevention Programs as a Patient Safety StrategyA Systematic Review. Annals of internal medicine, 158(5_Part_2), pp.390-396.
Östlund, U., Kidd, L., Wengström, Y. and Rowa-Dewar, N., 2011. Combining qualitative and quantitative research within mixed method research designs: a methodological review. International journal of nursing studies, 48(3), pp.369-383.
Parahoo, K., 2014. Nursing research: principles, process and issues. Palgrave Macmillan.
Santesso, N., Carrasco‐Labra, A. and Brignardello‐Petersen, R., 2014. Hip protectors for preventing hip fractures in older people. The Cochrane Library.
Suri, H., 2011. Purposeful sampling in qualitative research synthesis. Qualitative Research Journal, 11(2), pp.63-75.
Thomas, E. and Magilvy, J.K., 2011. Qualitative rigor or research validity in qualitative research. Journal for specialists in pediatric nursing, 16(2), pp.151-155.
Uusi-Rasi, K., Patil, R., Karinkanta, S., Kannus, P., Tokola, K., Lamberg-Allardt, C. and Sievänen, H., 2015. Exercise and vitamin D in fall prevention among older women: a randomized clinical trial. JAMA internal medicine, 175(5), pp.703-711.
- Appendix
| Work to be done | Month 1 | Month 2 | Month 3 | Month 4-6 | Month 7 | Month 8 |
| Ethical clearance |
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| Preparation of study data collection tool |
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| Participant enrolment |
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| Implementation of intervention |
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| Data collection and analysis |
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| Report preparation |
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8.2 Budget
| Resource | Budget (in $) |
| Materials | 8,000 |
| Researcher expenses | 6,000 |
| Transport and communication | 5,000 |
| Miscellaneous | 12,000 |
| Grand total | 31,000 |
