Evaluation Of A Primary Qualitative Research Peer-reviewed Journal Article On Older Adult Fall Prevention In Ontario

A. Evaluate a primary quantitative research peer-reviewed journal article that has healthcare implications by doing the following:

1. Identify how the researcher addresses the five following areas of the selected journal article.

2.Critique whether the evidence presented in each section of the journal article supports the researcher’s conclusion.

3. Explain the protection of human subjects and cultural considerations of the journal article.

4. Identify strengths and limitations of the study.

5. Describe how the evidence informs nursing practice.

B. Evaluate a primary qualitative research peer-reviewed journal article that has healthcare implications by doing the following:

1. Identify how the researcher addresses the five following areas of the selected journal article.

2. Critique whether the evidence presented in each section of the journal article supports the researcher’s conclusion.

3. Explain the protection of human subjects and cultural considerations of the journal article.

4. Identify strengths and limitations of the study.

5. Describe how the evidence informs nursing practice.

Overview of Evidence on Falls

According to the evidence majority of the cases related to falls are predictable and the injuries caused by the falls are preventable. There is a negative impact of the unintentional falls and injuries among the person aged 65 years and more on the health care resources and the quality of life of the old aged person of Canada. In Canada the rate of falls in the older adults per year is 20-30%. Many studies have been indicated that adequate interventions are present that are effective in order to reduce the risk factors of falls and injuries. However, the health care service providers face some barriers in order to provide such fall prevention strategies. The purpose of the study is to explore the barriers of the falls prevention strategy and introduce effective the evidenced based fall prevention strategies to reduce the risk of falls. It would help to identify the process that could help t reduce the rate of falls and injuries in the population (Dykeman et al., 2018).

The increasing risk of falls and injuries has become the concern of the health care service providers. Evidence has proved that most of the incidents of falls are predictable and the injuries caused by the incidents are preventable. The people aged 65 years and more are susceptible to falls. The rate of falls in the older adults in Canada is 20-30% that has a negative impact on the health service and the standard of life of the older adults in Canada. According to some study with the implementation of the fall prevention activities in the population the risk of falls could be reduced by 24%. However, it has been detected that the rate of falls in the older adults is remained unchanged and it is high for the women aged from 65-70 years in the community. Thus, the need of fall prevention process has become high in the recent days. In thus regards evidence has shown that some factors are there that affect the implementation of the fall prevention strategies and create barriers for the service providers, for example, lack of communication and coordination between different health care organizations, insufficient resources, lack of access or unequal access to the service and many others. Thus, the service providers need to be focused on the factors and introduce effective interventions to resolve the issue and reduce the risk of falls in the population ((Dykeman et al., 2018).

Review of the Literature

The risk factor of falls varies according to the age, gender and population. Thus, the study has chosen different areas such as North Bay Parry sound District Health Unit, Public health unit in Ontario, Simoco Muskoka district Health Unit and York region Public Health Service as the sample of the study. The researchers have worked with the staffs of the organizations in order to understand the fall prevention activities. The staffs of the organization have contacted participants from different levels such as managers, supervisors and frontlines. The people that are interested in participation in the study have been informed about the study process. Common interview has been conducted for the participants. Relevant questions related to types of fall prevention activities in the organization, additional activities, factors that creates obstacle, new interventions have been asked to the interviewee. The study has included broad sample size in order to introduce broad discussion (Dykeman et al., 2018).

In order to analyze the data NVivo 10 software has been used to transcribe the individual data collected by from the interview. In order to ensure the trustworthiness of the study Patton’s suggestion has been taken, which assures that the researchers have adequate qualification to complete the research in an effective manner.  Triangulations have been used to complete the findings and describe the realties across the community setting. After collecting the data regarding the barriers and fall prevention process they are organized according to the major categories. Documentation of the ideas and decision in the study has been done as part of audit trail (Dykeman et al., 2018).

Implementation of effective fall prevention process is important but it is not sufficient in order to reduce the risk of falls. The service providers need to focus on the improvement of the effectiveness of the implementation. The service providers face numerous barriers while providing community service. Some barriers limits the access of effective service thus, could create inequalities in health service. Thus, it is important to provide focus to the factors affecting the fall prevention activities in order to resolve them in an effective manner. It is important for the health professionals to work together and convert their knowledge regarding fall prevention into actions to reduce the rate of falls and injuries (Dykeman et al., 2018).

Throughout the article it has been found that effective fall prevention activities could reduce the risk factor of falls. The article has provided relevant evidence for the fact that implementation of such process need more focus from the health care organizations. The study has provided effective evidence regarding the presence of barriers that affect the implementation of the fall prevention strategy and has provided relevant approaches such as education, collaboration of the health professionals and improvement of policies. Such evidence provided in the study has indicated that the conclusion provided by the researchers is relevant to the study (Dykeman et al., 2018).

Methodology

The study did not reveal the information of the participants. It has maintained the confidentiality. The researchers did not force any interviewee in order to participate in the study. Ethical factors such as patient safety and individual rights have been maintained by the researchers. The study did not harm anyone during the research. Thus, it can be said that the study has maintained human subject and considered the cultural factors in an effective manner. However, the researchers have provided compensations such as gifts to the participant that is unethical and need to be focused by the researchers (Hawley et al., 2014).

The study has provided important knowledge regarding the implementation of the fall prevention strategies and barriers that could affect the implementation process. The researchers have gathered divergent opinions in order to provide broad prospective that could facilitate the understanding. Beside such strengths of the study it contains some limitations as well. The qualitative method used in the study could limit the generalization of the result of the study. Another limitation is the study has not differentiated between the strategies that are actually implemented and the strategies that are untested. However, the study has used relevant evidence for the prevention practice. Further research also needed to identify the barriers that affect the fall prevention strategies (Dykeman et al., 2018).

Strategies provided by the article in order to improve the fall prevention process is helpful. The idea of educating the nursing staffs regarding fall prevention activities could help the staffs in providing effective service. The article has proposed initiative regarding changing policies and laws by the government to improve the standard of fall prevention. The implementation of coordination of the health professionals could help the nursing practice to improve its service in an effective manner. The information regarding the barriers would help the nursing practice in introducing effective strategies to resolve the issue. Thus, it can be said that the evidence provided by the article has informed the nursing practice efficiently (Stevens, 2013).

Hand hygiene is considered as the one of the best methods for preventing infections and transmission of infectious organism that causes morbidity and mortality within the patients in the hospital. However, the rate of hand hygiene practice is remained low. It is important to observe the hand hygiene process complied by the health workers in the health care centre while engaged in the clinical practice. It has been seen that the incident of direct observation is prone to the Hawthrone effect that explains the different behaviour of the people when they are under observation. The introduction of electronic system for observing the hand hygiene of the health workers has helped to reduce the influence of Hawthrone effect. The purpose of the study is to understand the difference between the influence of Hawthrone effect on direct observation of hand hygiene process and electronic monitoring process. It would help to introduce effective process of monitoring the hand hygiene of the health workers and reduce the risk of infectious disease and mortality rate due to such disease in the hospital (Hagel et al., 2015).

Data Analysis

The process of hand hygiene has been acknowledged by most of the health care organization as the effective strategy to prevent infections in the health care and reduce the rate f infectious disease and death caused by the diseases in an effective manner. Thus, it is important to observe the hand hygiene adherence of the health workers in the hospital during the clinical practice. In most of the cases the process is done by measuring the amount of disinfectant consumed or counting the dispenser that are utilized. However, it has been found that the rate of compliance with the effective hand hygiene process is low. According to the guideline of World Health Organization’s “Five Moments for Hand Hygiene” the last observation regarding the hand hygiene process in the hospital has indicated that the overall hand hygiene compliance of hospital is 41%. Thus, direct observation process has been introduced in order to observe the hand hygiene adherence of the health workers. However, presence of Hawthrone effect has been found in the direct observation process. Thus, it is important to introduce effective strategy to monitor the hand hygiene compliance in the hospital. In this regards, automated hand hygiene monitoring process is also present. It is important to compare the both process in order to identify the most effective process of monitoring hand hygiene compliance (Hagel et al., 2015).

The study has chosen University hospital of Jena for the research purpose. 24 bed from the intensive care unit of the anesthesiological surgery. The study was performed in the 1500 bed of tertiary care from 1^st October 2013 to 28^th February 2014. The facilities institutional study board has approved the study. Total 70 alcohol based handrub or AHR have been installed in the ICU. When someone pushed the lever of the dispenser, a time-stamped hand hygiene event has recorded and transmitted through WiFi to the centralized database. On the other hand direct observation of hand hygiene of the by the infection control practitioners has been performed in the regular basis. The process has been observed by the intern observer who has been trained for the hand hygiene observation technique. Total 50 episodes of direct observation were performed. In order to quantify the Hawthrone effect, comparison of the electronic monitoring process and direct observation process has been done by the researchers (Hagel et al., 2015).

The compliance of the hand hygiene was calculated considering the numbers of hand hygiene events observed and divided by the number of opportunities observed according to te guidelines provided by the WHO regarding the “Five Moments for Hand Hygiene”. The result was then expressed as percentage. The incident observed by the electronic monitor and the direct observation process has been analyzed by the Altman plot that helps to identify the mean of the values provided by the two different processes thus, helps to compare the two different processes.  The observed values then standardized to the intervals of two hours in order to allow the comparability. The e Spearman rank correlation coefficient has been used in order to explain the relationship between the two variables (Hagel et al., 2015).

Researcher's Conclusion

In many health care organizations, the infection control practitioners are recruited to observe the hand hygiene process. It is important to identify the true rate of hand hygiene adherence. The study has elaborate relation between the direct observation process and the electrical monitor. The study has revealed that the electrical monitoring process is more effective tool in order to observe the hand hygiene compliance as the Hawthrone effect is less in case of electrical monitor as compare to the direct observation process. The direct observation process could be used for getting feedback of individual performance and automated monitoring process need to be used for evaluate the hand hygiene adherence as it reduce both the observer bias and the Hawthrone effect (Hagel et al., 2015).

The study has provided effective evidence that supports the researcher’s conclusion. For example, the study has use reliable technique in order to interpret the result that indicates automated hand hygiene adherence monitoring process is more effective in observing the hand hygiene compliance of the health workers during clinical practice. The evidence provided by the article also proves that the influence of the Hawthrone effect is less in case of electronic monitoring process as compare to the direct observation. Thus, it can be said that the conclusion provided by the researchers is relevant to the study (Hagel et al., 2015).

  The information of the participants in the study has remained unclosed. Confidentiality regarding the information collected has maintained throughout the study. The study has included effective automated monitoring process and direct observation process that did not harm anyone, thus, maintained the safety factor. The researchers did not provide any compensation and did not force anyone in order to participate in the process. Thus, it can be said that the study has complied with the human subjects and considered the cultural or ethical factors effectively (Wendler, 2012).  

The study has provided effective information about the monitoring process of the hand hygiene adherence. The study has effectively informed about the influence of Hawthrone effect on the hand hygiene monitoring process. It has been revealed by the study that the automated hand hygiene adherence monitoring process is more effective as it reduces the Hawthrone effect and the risk of biasness. Apart from such strengths the study also bears some limitations such as the generalization of the result of the study is unknown as it is limited to the ICU of a single health care organization. The study could not evaluate the individual hand hygiene event. In addition the study did not include the health workers that works in night shifts. The study could not control the possibility workload during the observing period (Hagel et al., 2015).

The evidence provided by the study has helped to identify the effective hand hygiene adherence monitoring process. It is important to monitor the hand hygiene process of the health workers during nursing practice in order to ensure the quality of service. Such process helps to introduce effective interventions in order to reduce infectious disease and death caused by such diseases in the health care organization. The study has informed that the use of automated monitoring process could observe the hand hygiene adherence in an effective manner thus has helped the nursing practice to choose the appropriate process for monitoring the hand hygiene adherence of the staffs (Butts & Rich, 2013).

References:

Butts, J. B., & Rich, K. L. (2013). Philosophies and theories for advanced nursing practice. Jones & Bartlett Publishers.

Dykeman, C. S., Markle-Reid, M. F., Boratto, L. J., Bowes, C., Gagné, H., McGugan, J. L., & Orr-Shaw, S. (2018). Community service provider perceptions of implementing older adult fall prevention in Ontario, Canada: a qualitative study. BMC geriatrics, 18(1), 34.

Hagel, S., Reischke, J., Kesselmeier, M., Winning, J., Gastmeier, P., Brunkhorst, F. M., ... & Pletz, M. W. (2015). Quantifying the Hawthorne effect in hand hygiene compliance through comparing direct observation with automated hand hygiene monitoring. infection control & hospital epidemiology, 36(8), 957-962.

Hawley, N. C., Wieland, M. L., Weis, J. A., & Sia, I. G. (2014). Perceived impact of human subjects protection training on community partners in community based participatory research. Progress in community health partnerships: research, education, and action, 8(2), 241.

Stevens, K. (2013). The impact of evidence-based practice in nursing and the next big ideas. OJIN: The Online Journal of Issues in Nursing, 18(2), 4.

Wendler, R. (2012). Human Subjects Protection: A Source for Ethical Service-Learning Practice. Michigan Journal of Community Service Learning, 18(2), 29-39.