Evidence-Based Project, Part 3: Advanced Levels Of Clinical Inquiry And Systematic Reviews

• Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
• Develop a PICO(T) question to address the clinical issue of interest for the Assignment.
• Use the key words from the PICO(T) question you developed and  search at least four different databases in the Walden Library to  identify at least four relevant peer-reviewed articles at the  systematic-reviews level related to your research question.
• Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.

The Assignment (Evidence-Based Project)

Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Create a 6- to 7-slide PowerPoint presentation in which you do the following:

• Identify and briefly describe your chosen clinical issue of interest.
• Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
• Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
• Provide APA citations of the four peer-reviewed articles you selected.
• Describe the levels of evidence in each of the four  peer-reviewed articles you selected, including an explanation of the  strengths of using systematic reviews for clinical research. Be specific  and provide examples.

This is my picot question

In patients diagnosed with a mental illness,what effect does a fall risk  assessment specific for psychiatric patients have on a fall rates as  compared to universal fall assessments?

Matrix Worksheet Template

Use this document to complete Part 2 of the Module 2 Assessment, Evidence-Based Project, Part 1: An Introduction to Clinical Inquiry and Part 2: Research Methodologies

Full citation of selected article	Article #1	Article #2	Article #3	Article #4
	Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., & Ganz, D. A. (2013). Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness. Journal of the American Geriatrics Society, 61(4), 483-494.	DiBardino, D., Cohen, E. R., & Didwania, A. (2012). Meta‐analysis: multidisciplinary fall prevention strategies in the acute care inpatient population. Journal of hospital medicine, 7(6), 497-503.	Haines, T. P., Hill, K. D., Bennell, K. L., & Osborne, R. H. (2007). Additional exercise for older subacute hospital inpatients to prevent falls: benefits and barriers to implementation and evaluation. Clinical Rehabilitation, 21(8), 742-753.	Spiva, L., & Hart, P. (2014). Evidence-Based Interventions for Preventing Falls in Acute Care Hospitals.
Why you chose this article and/or how it relates to the clinical issue of interest (include a brief explanation of the ethics of research related to your clinical issue of interest)	Intercession elements intended for all patients were separated from care plans for person’s identified as being at great danger of falling. Data on approaches cultivating adherence to the implemented care procedures were documented, and information on the intercession fidelity was removed.	When inpatient falls, adverse effects such as injuries follows, which increases the time spent in the hospital and ballooning health care cost. General fall avoidance measures have been proposed and have been deemed as effective approaches. Along these lines, I picked this article to support the fact that compelling endeavors ought to be made to maintain and safeguard the wellbeing of all patients. The prevention ought to be the essential concentration and ought to be focused on decreasing fall rates. To reduce the number of inpatient falls, healthcare specialist must apply different multidisciplinary strategies and interventions. Before applying these changes, ethical issues should be considered to preserve their safety and their rights considered. In this case, the hospital opts to use a positioning belt and chair safety belt as examples of safety interventions strategies. Guidelines and procedures when connecting the belts should be followed, as explained by the fall prevention protocol and interventions policy. The belt is attached when a patient shows he/she can remove it or when he/she shows some indication that he/she needs some assistance. The belt helps to keep the patient remain in the position away from sliding or coming out of the chair. The belt attachment applies best for the patients with mental problems, but those with a sober mind, do not require the belt.	I selected this article because it is considered essential to do a systematic survey for individuals to get the knowledge behind the science on all avoidance in healthcare settings as falls contributes to many reported cases of increased morbidity and mortality. Outcomes will illuminate medical care experts, scientists, policymakers, caretakers, and clients. The ethical issue considered during exercise for older sub-acute medical clinic inpatients to counteract falls shows ambivalent perspectives on the target populace concerning fall risk and the need for fall avoidance. The ability to take up preventive measures relies upon a variety of personal factors, the nature of data, guidance, and decision-making, the prevention program itself, and social help.	The purpose behind picking this article is because falls are the most much of the time reported safety event among the United States hospitalized patients. Average hospital budget for reducing the morbidity and increased mortality risk is estimated to be $20 billion per year. Patient’s safety, whereby units prepared rooms for patient’s examination, was kept safe and secure. Patient safety was an ethical issue that was considered. Alongside a safe environment for a patient, a non-reusable fall prevention pack was applied for patients diagnosed with a high risk of a fall.
Brief description of the aims of the research of each peer-reviewed article	Hempel at al carried out this exploration where they used a prevention resource guide tool to assist the enhancement of clinic falls. The authors were determined to review the characteristics of different tools used in the hospital to prevent falls.	DiBardino, Cohen and Didwania conducted this research with the aim of promising safe and quality healthcare delivery to the patients by: minimizing injury fatalities for in-patients, litigations involved, health care cost, as well as reducing the time spent in the hospital. Authors used clinical evidence-based information to examine accessible information as well as assessing a multidisciplinary fall prevention program in acute impatient environment.	The research was conducted with the aim of evaluating the efficiency of implemented falls prevention exercise program purposed to minimize the number of elderly falls in the sub-acute unit environment.	Spiva and Hart carried this examination with the purpose of analyzing the development initiative in medical care facility. The viability of an action prevention program to minimize fall rates was also reviewed by authors where they used a fall prevention kit to minimize fall rates in the hospital.
Brief description of the research methodology used Be sure to identify if the methodology used was qualitative , quantitative , or a mixed-methods approach. Be specific.	A qualitative method was used by authors where they analyzed and recorded the reported that was based on the interventions placed to reduce the number of elderly falls in the hospital. By incorporating online resources and information, an account was provided by authors that the introduced equipment and tools reduced nurse’s injuries and improved patient safety. The name of the equipment and devices used were additionally included on top of the reliability and validity information that was abstracted from the qualitative approach applied.	Authors used a qualitative method when they were conducting their research. They used different search engine and databases such as the library, EMBAE, Cinahl, and literature of medicine to get information. Control fall measures on patients, inpatients, incidental preventions, and coincidental falls were some of the medical subjects used by authors during the study. Primary research studies associated with inpatient falls were the one incorporated into the examination. The results were analyzed, and it was deduced that the fall rate in the specialist’s room was 1000 patients per day. The authors got assurance intervals from individual examinations.	A quantitative method was used by authors using a subgroup examination. Participants were selected from a modern sub-acute/aged rehabilitation facility and were enlisted for a falls prevention action program in the section of a bigger randomized controlled trial. Both the inpatient and control fall participants, totaling 11 intervention groups were approved for this program and were monitored during their stay in the hospital to determine whether the falls occurred or not. During their referrals and after being discharged from the hospital, participants were examined for their balance, quality, and mobility. Also, performance status for each participant was recorded.	The research was conducted using a qualitative study where authors led one-day training before implementing the program. The purpose of these training units was to allow each group to identify a person showing the highest commitment effort to fall prevention. The potential person identified had to fulfill some task like managing any upcoming imaginable change within the group, build and encourage the group as well as being the leader of the group. Each unit was responsible for monitoring and assessing the groups on a routine basis. Electronic fall hospital database was used by each unit to track fall incidences that included; fall characteristics, strategies that have used by nurses to prevent falls, chances of falling, as well as assessment scores. Eight nursing units were identified from the national database nursing quality indicators, which were analyzed and used to direct fall rates from four community medical clinics. The fall balancing activity system included fall avoidance pack used to rate the fall cases, facility planning, group designing the activity, and line staff guidance.
A brief description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.	Findings were done to recognize whether the instrument had been utilized before in an acute care medical facility or in the event that it had been a piece of validity and reliability assessment. Adherence methodologies are of specific significance for long haul changes. Initial achievement probably won’t be kept up on the grounds that adherence to introduced care procedures blurs in clinical practice, utilization of the introduced risk evaluation instrument may not be supported, and prescribed measures may never again be systematically connected.	A broad eligibility criterion was incorporated in the study and questions were clearly reviewed and addressed. Authors used different languages to search for information on the electronic database search box.	The strength of the randomized controlled trial used an additional exercise program provided notwithstanding standard care that aided in the prevention of falls in the sub-acute medical clinic setting. Attendants should exploit this examination and use exercise programs notwithstanding normal care to prevent falls. New and inventive approaches to utilize exercise as an intervention could likewise be utilized for the patient’s plan of care.	A narrative summary was the strength of the investigation since it was utilized to report the discoveries that revealed a reduction in cases identified with fall prevention action unit and executing training. Patients were represented to encounter an infrequent perplexity, limited transferability, and high-risk drug that elevated rates of falling for patients admitted in neurology unit.
General Notes/Comments	Fall prevention programs have demonstrated to be best when there are a few elements, and all individuals from the care team are engaged to act in delivering safe patient care. The achievement of the fall prevention program relies upon the program itself as well as on the practical application, commitment, and training of the staff involved. The nursing leadership can be the main impetus to actualize change on a significant systematic level by following, tracking, detailing, and examining components to prevent further patient mischief. The general effect of a patient fall bringing about an injury can catastrophically affect the patient, their wellbeing, knowledge, and a financial burden on the facility.	Fall prevention strategies had a small effect but a significant statistical impact on fall rates irrespective of the application of multifaceted, multidisciplinary interventions. What the study also applied is the randomized trials that were required to assess different potential benefits associated with multidisciplinary approaches used to prevent falls in the acute in-patient environment.	Medical care practitioners prescribe vitamin D supplements to reduce the fall rate. It is deemed viable for exercises used in the acute care clinic; though it remains uncertain for its appropriateness use in the hospital due to conflicting results associated with potential interventions conflict of reliance. In hospitals, multidisciplinary interventions have been seen to reduce the rate of falls, even though the risk associated with fallen remain unclear. It was uncertain also that multifactorial interventions in lessening the number of falls should be recommended as the best method.	In rundown, the aftereffects of our examination demonstrate that a HIT intercession focusing on underlying regions of threat can prevent patient falls in older patients in acute care medical clinics. Likewise, the clinic understood that making of a situation that cultivates a workplace where staff and leaders are made responsible would give great help to fall avoidance.

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