Three templates to be filled out with 2 sentence answers, three articles attached one for each template. instructions and all articles attached.  Instructions/guidelines in wk 4 assignment file. Deadline NOW.



The Clinical Issue and Research Questions Developed Using PICOT

Stephanie Ellis

West Coast University

NUR350 Research in Nursing

Dr. Sara Turpel

November 13, 2021

The Clinical Issue and Research Questions Developed Using PICOT

Background Information

Unintentional patient falls continue to be a concerning issue in nursing practice despite abundance of fall prevention strategies. A fall is an unplanned descent to the floor with or without injuries to the patient involve. Despite the exitance of fall prevention programs in most hospitals; the incidence of fall prevention is very high. Falls may result in devastating impact to the patient. Aside from the physical injuries that they cause to the patient, falls have psychological and social impact. Psychologically, the feeling of losing control over one’s own body increases the level of anxiety and depression to the individual. Moreover, the awareness of lost self-control has a negative impact to the individual’s self-confidence and by extension self-efficacy.

Importance of the Fall Prevention to Nursing

Nurses spends most of the time with patients. The importance of falls lies in its implication on healthcare outcomes. Increase of falls have a direct effect on the quality of care to the patient. In addition, fall related injuries have major economic impact on the healthcare institutions. Falls increase the cost of care, prolong hospital stays, and negatively affect other related measures of quality care. Conservative estimates place increment of cost as a result of care to between $1500 and $ 3500 for individuals with minor injuries and $9,000 to $ 24, 000 for individuals with moderate to severe injuries (Radecki, Reynolds, and Kara, 2018). Most of the healthcare providers recognize falls as a major impediment to providing quality and safe care. As a result, adoption and implementation of fall prevention strategies is common among different institution. In this clinical issue, hourly rounding is recommended for reduction of fall incidences in the hospital setting.


The target population will be elderly patients in the critical care unit of the hospital. These population have a higher incidence of falls than any other population within the hospital. Targeting this population expected to significantly reduce the incidence of falls in the unit.


The proposed intervention program involves the use of rounding hours to reduce the incidence of falls among the elderly in critical care units. The intervention will be carried out every hour form 6:00 am to 10:00 pm for each of the patients in the critical care unit.



A qualitative study of the determinants
of adherence to NICE falls guideline in
managing older fallers attending an
emergency department
Helen McEwan1* , Richard Baker2, Natalie Armstrong2 and Jay Banerjee3


Background: The National Institute for Health and Care Excellence (NICE) 2004 Falls guideline was developed to
improve the assessment and management of falls and prevention of future falls. However, adherence to the
guideline can be poor. As emergency departments (EDs) are usually consulted by older adults (aged 65 and over)
who experience a fall, they provide a setting in which assessments can be conducted or referrals made to more
appropriate settings.
The objective of this study was to investigate how falls are managed in EDs, reasons why guideline
recommendations are not always followed, and what happens instead.

Methods: The study involved two EDs. We undertook 27 episodes of observation of healthcare professional
interactions with patients aged 65 or over presenting with a fall, supported by review of the clinical records
of these interactions, and subsequently, 30 interviews with healthcare professionals. The qualitative analysis
used the framework approach.

Results: Various barriers and enablers (i.e. determinants of practice) influenced adherence at both EDs, including the
following: support from senior staff; education; cross-boundary care; definition of falls; communication; organisational
factors; and staffing.

Conclusions: A variety of factors influence adherence to the Falls guideline within an ED, and it may be difficult to
address all of them simultaneously. Simple interventions such as education and pro-formas are unlikely to
have substantial effects alone. However, taking advantage of the influence of senior staff on juniors could
enhance adherence. In addition, collaborative care with other NHS services offers a potential approach for
emergency practitioners to play a part in managing and preventing falls.

Keywords: Accidental falls, Emergency care systems, Emergency departments, Guidelines, Geriatrics, Qualitative

* Correspondence: [email protected]
1Department of Psychology, Faculty of Business, Law and Social Sciences,
Birmingham City University, C303 Curzon Building, 4 Cardigan Street,
Birmingham B4 7BD, England
Full list of author information is available at the end of the article

International Journal of
Emergency Medicine

© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (, which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the or


Examining the Relationship Between Environmental Factors and
Inpatient Hospital Falls: Protocol for a Mixed Methods Study

Ronald I Shorr1*, MD, MS; Sherry Ahrentzen2*, PhD; Stephen L Luther3*, PhD; Chad Radwan3*, PhD; Bridget Hahm3*,

MA, MPH; Mahshad Kazemzadeh2*, PhD; Slande Alliance4*, MPH, MCHES; Gail Powell-Cope4*, PhD; Gary M

Fischer5, MArch
1Geriatric Research Education and Clinical Centers, North Florida/South Georgia Veterans Health System, Gainesville, FL, United States
2Shimberg Center for Housing Studies, College of Design, Construction and Planning, University of Florida, Gainesville, FL, United States
3Research Service, James A Haley Veterans Hospital, Tampa, FL, United States
4Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, United States
5Office of Facilities Standards Service/Office of Facilities Planning, Office of Construction and Facilities Management, Department of Veterans Affairs,
Washington, DC, United States
*these authors contributed equally

Corresponding Author:
Mahshad Kazemzadeh, PhD
Shimberg Center for Housing Studies
College of Design, Construction and Planning
University of Florida
1480 Inner Road
Gainesville, FL
United States
Phone: 1 352 317 8172
Email: [email protected]


Background: Patient falls are the most common adverse events reported in hospitals. Although it is well understood that the
physical hospital environment contributes to nearly 40% of severe or fatal hospital falls, there are significant gaps in the knowledge
about the relationship between inpatient unit design and fall rates. The few studies that have examined unit design have been
conducted in a single hospital (non-Veterans Health Administration [VHA]) or a small number of inpatient units, limiting
generalizability. The goal of this study is to identify unit design factors contributing to inpatient falls in the VHA.

Objective: The first aim of the study is to investigate frontline and management perceptions of and experiences with veteran
falls as they pertain to inpatient environmental factors. An iterative rapid assessment process will be used to analyze the data.
Interview findings will directly inform the development of an environmental assessment survey to be conducted as part of aim
2 and to contribute to interpretation of aim 2. The second aim of this study is to quantify unit design factors and compare spatial
and environmental factors of units with higher- versus lower-than-expected fall rates.

Methods: We will first conduct walk-through interviews with facility personnel in 10 medical/surgical units at 3 VHA medical
centers to identify environmental fall risk factors. Data will be used to finalize an environmental assessment survey for nurse


Meteorological factors to fall: a systematic review

K. P. Chow1 & D. Y. T. Fong1 & M. P. Wang1 & J. Y. H. Wong1 & Pui Hing Chau1

Received: 3 July 2017 /Revised: 10 September 2018 /Accepted: 2 October 2018 /Published online: 27 October 2018
# ISB 2018

There existed systematic review on studies investigating the association between hip fractures and external risk
factors including meteorological factors. Albeit the fact that most serious common fall injury is a hip fracture, it
cannot account for all injuries forms of fall. There was a lack of systematic review covering all fall-related injury or
deaths to thoroughly summarise meteorological aspects of fall. This study aimed to systematically review epidemi-
ological studies of fall and fall-related circumstances without restriction to hip fracture. A systematic search in three
databases, namely PubMed, CINAHL Plus and EMBASE, was performed. Searches in two Chinese databases named
the Wanfang Med Online and the China Journal Net were done in addition. A total of 29 studies were identified.
The study site, fall cases identification, meteorological factors and findings of all the selected studies were being
extracted. The quality of the studies was critically appraised. We identified some of the environmental risk factors to
fall among those studies. Ranging from the lower ambient temperature, the presence of snow cover, seasonal factors,
and time of the day to location of fall, these factors have different levels of impact related to higher incidence or
mortality of fall. To conclude, a better understanding of injury mechanisms is a prerequisite for preventive

Keywords Fall . Meteorological factors . Temperature . Weather


Fall is Ban event during which a person takes a lying position
on a lower or the same level without the loss of
consciousness^ (National Insitute for Health and Care
Excellence 2004). Fall constitutes a crucial element of injury
or death particularly among the older ages (Nagurney et al.
1998; Sterling et al. 2001; Zautcke et al. 2002). Most of the
injuries among older people are caused by falls in northern
countries like Finland and Norway (Bulajic-Kopjar 2000;
National Center for Injury Prevention and Control 2004;
Saari et al. 2007). In northern countries like Canada and
England, there were 27% of community-dwelling persons
over age 65 years who fell each year and the figure rose to
50% for those over 80 years old (Carpenter 2009; Stalenhoef
et al. 1997). Among the community-dwelling older people in
United States, almost 30–40% of those aged over 65 years fall

at least once in a year (Mertz et al. 2010; Rubenstein and
Josephson 2002). Also, in an Asian city of Hong Kong which
has an ageing population, the prevalence having at least one
fall in the preceding 12 months among the elderly was be-
tween 18 and 19.


Appraisal Guide:

Findings of a Quantitative Study






What was the purpose of the study (research questions, purposes, and hypotheses)?

How was the sample obtained?

What inclusion or exclusion criteria were used?

Who from the sample actually participated or contributed data (demographic or clinical profile and dropout rate)?

What methods were used to collect data (e.g., sequence, timing, types of data, and measures)?

Was an intervention tested?  Yes   No

1. How was the sample size determined?

2. Were patients randomly assigned to treatment groups?

What are the main findings?


Is the study published in a source
that required peer review?  Yes   No   Not clear

*Did the data obtained and the
analysis conducted answer the
research question?  Yes   No   Not clear

Were the measuring instruments
reliable and valid?  Yes   No   Not clear

*Were important extraneous
variables and bias controlled?  Yes   No   Not clear

*If an intervention was tested,
answer the following five questions:  Yes   No   Not clear

1. Were participants randomly
assigned to groups and were
the two groups similar at the
start (before the intervention)?  Yes   No   Not clear

2. Were the interventions well
defined and consistently
delivered?  Yes   No   Not clear

3. Were the groups treated
equally other than the
difference in interventions?  Yes   No   Not clear

4. If no difference was found, was
the sample size large enough
to detect a difference if one existed?  Yes   No   Not clear

5. If a difference was found, are
you confident it was due to the
intervention?  Yes   No   Not clear

Are the findings consistent with
findings from other studies?  Yes   Some   No   Not clear

Are the findings credible?  Yes All   Yes Some   No

Clinical Significance

Note any difference in means, r2s, or measures of clinical effects (ABI, NNT, RR, OR)

*Is the target population clearly
described?  Yes   No   Not clear

*Is the frequency, association, or
treatment effect impressive enough
for you to be confident that the finding
would make a clinical difference if used
as the basis for care?  Yes   No   Not clear

Are the findings
clinically significant?  Yes All   Yes Some   No

* = Important criteria






Appraisal Guide:

Findings of a Qualitative Study






What experience, situation, or subculture does the researcher seek to understand?

Does the researcher want to produce a description of an experience, a social process, or an event, or is the goal to generate a theory?

How was data collected?

How did the researcher control his or her biases and preconceptions?

Are specific pieces of data (e.g., direct quotes) and more generalized statements (themes, theories) included in the report?

What are the main findings of the study?


Is the study published in a source
that required peer review?  Yes   No   Not clear

Were the methods used appropriate
to the study purpose?  Yes   No   Not clear

Was the sampling of observations or
interviews appropriate and varied
enough to serve the purpose of the study?  Yes   No   Not clear

*Were data collection methods
effective in obtaining in-depth data?  Yes   No   Not clear

Did the data collection methods
avoid the possibility of oversight,
underrepresentation, or
overrepresentation from certain
types of sources?  Yes   No   Not clear

Were data collection and analysis
intermingled in a dynamic way?  Yes   No   Not clear

*Is the data presented in ways that
provide a vivid portrayal of what was
experienced or happened and its
context?  Yes   No   Not clear

*Does the data provided justify
generalized statements, themes,
or theory?  Yes   No   Not clear

Are the findings credible?  Yes All   Yes Some   No

Clinical Significance

*Are the findings rich and informative?  Yes   No   Not clear

*Is the perspective provided
potentially useful in providing
insight, support, or guidance
for assessing patient status
or progress?  Yes   Some  No  Not clear

Are the findings
clinically significant?  Yes All   Yes Some   No

* = Important criteria




APP E-2 Brown

Brown APP E-1


Appraisal Guide:

Conclusions of a Systematic Review with Narrative Synthesis






What organization or persons produced the systematic review (SR)?

How many persons were involved in conducting the review?

What topic or question did the SR address?

How were potential research reports identified?

What determined if a study was included in the analysis?

How many studies were included in the review?

What research designs were used in the studies?

What were the consistent and important across-studies conclusions?


Was the topic clearly defined?  Yes   No   Not clear

Was the search for studies and other
evidence comprehensive and unbiased?  Yes   No   Not clear

Was the screening of citations for
inclusion based on explicit criteria?  Yes   No   Not clear

*Were the included studies assessed
for quality?  Yes   No   Not clear

Were the design characteristics and
findings of the included studies displayed
or discussed in sufficient detail?  Yes   No   Not clear

*Was there a true integration (i.e., synthesis) of the findings—not
merely reporting of findings from
each study individually?  Yes   No   Not clear

*Did the reviewers explore why differences
in findings might have occurred?  Yes   No   Not clear

Did the reviewers distinguish between
conclusions based on consistent findings
from several good studies and those
based on inferior evidence (number or quality)?  Yes   No   Not clear

Which conclusions were supported by
consistent findings from two or more
good or high-quality studies? List




Are the conclusions
credible?  Yes All   Yes Some   No

Clinical Significance

*Across studies, is the size of the
treatment or the strength of the
association found or the
meaningfulness of qualitative findings
strong enough to make a difference
in patient outcomes or experiences of care?  Yes   No   Not clear

Are the conclusions relevant to the
care the nurse gives?  Yes   No   Not clear

Are the conclusions
clinically significant?  Yes All   Yes Some   No


Does the SR address a problem,
situation, or decision we are addressing in our setting?  Yes   No   Not clear

Are the patients in the studies or a
subgroup of pat

3 Articles will be attached, along with my prior assignment including the PICOT questions the professor refers to below. Forms to complete with questions for each article will also be provided . Contact me with any questions, grading rubric is on this document

Instructions from professor:

This week you will search the literature in WCU databases for 3 articles within 5 years of today’s date, that are appropriate for your PICOT question. One article is a quantitative research study, one is qualitative, and the third article is a Systematic or Integrative Review.

Ensure that you are using the approved week 2 assignment topic list as all of these topics have guidelines associated with them and many WCU articles can be found.

· Read the first few sentences of methods section of your articles to assess what type of article you have

· Critique each article using the appropriate Appraisal Forms. The form takes you through a reflection on WHY was research done-HOW was research done and WHAT was found.

· Review rubric carefully to ensure all questions have been answered. Points are deducted for articles not loaded or if incorrect type of article submitted. 
The quantitative and qualitative articles will be used in week 6 Article Critique therefore if you are unsuccessful with article selection in week 4 you will need to find a new article by the end of week 5 with the help of the librarian or your faculty in selecting a new article to use in week 6.

· All answers to questions for week 4 are brief and only 1- 2 sentences. Example: What group produced the guideline? Answer: US Preventive Services Task Force develops recommendations about preventive services based on a review of high-quality scientific evidence and publishes its recommendations on its website and or in a peer reviewed journal

· Avoid any copying and pasting 7 or more words of content from the article or another source. Use your own words to create your answers. APA is not required for content of answers on template

· APA is only required for your citation on the template.

· You must submit the research study articles along with your assignment

Here are the links to assist with APA and searches:

· APA Guide and Template

· Quantitative vs. Qualitative Research Guide

· A to Z Database List (for this assignment, the CINAHL+, ProQuest Nursing & Allied Health, and Academic Search Complete are recommended.)

Sometimes students have a difficult time locating clinical practice guidelines. If you have googl