PICOT/PICo question and Literature Search Process

PICOT/PICo question and Literature Search Process

My PICo question is: “What are NP’s experiences in providing care to patients who have fallen in an LTC and fractured bones in the United States?” The expected outcome of this query is that implementation of quality fall prevention programs and strategies will enrich the health and quality of life of LTC patients. Examining EBP fall prevention programs will circumvent patient falls and promote best patient outcomes. I hope to also prove that participation in fall intervention programs decrease LTC residents’ fears of falling, particularly for elderly patients.

A literature review is useful in that it examines and analyzes scholarly literature (books and articles) that are relevant to a health model or an area of research theory. When done correctly, literature reviews summarize research on a given subject and critically evaluate research publication sources. Within my practice focus and setting, literature reviews illustrate to long term care FNPs how EBP and research fit within a larger field of study (Maggio, Sewell & Artino, 2106). The systematic format of a literature review allows researchers to connect traditional explanations of dated research material with new interpretations of the same material (Maggio et al., 2016). The goal of a literature review is to summarize a body of valuable information and identify any disparities in research and to eliminate unrelated information (Maggio et al., 2016). A literature review will contribute to this EBP proposal because it assists with categorizing possible publication sources that I may need to use to construct the body of my final proposal. A literature review will also allow me to compare related research and connect my findings with traditional or EBP based practices, as well as investigate and apply my experiences with fall prevention programs in the LTC settings in which I have been employed.

I will use the following library databases: PubMed (Medline), CINAHL Plus, ERIC (EBSCOhost), JSTOR, and Google Scholar. Key search terms and phrases used are: LTC fall management programs, elderly falls in the LTC, falls and fall risks in LTC, EBP fall care, FNP narratives on fall care in LTC, evidence-based nursing fall interventions. Additional search terms used are minimizing fall risks in long term care facilities, strategies for reducing falls in long-term care, risk assessment and prevention in long term care. Specialty organizations relevant to this proposal are the American Nurses Association (ANA), American Healthcare Association (AHCA), The American Association of Directors of Nursing Services (AADNS), American Association of Retired People (AARP), National Association of Directors of Nursing Administration in Long Term Care, Americans for LTC Security, Long Term Care Partnership Program.

Theoretical Framework

Falls suffered in an LTC setting have lasting psychological and physical consequences. They lead to fractures and slow the healing process down. Furthermore, patients lose confidence in walking, which diminishes mobility and hastens health decline. Falls in the LTC lead to a decline in the services provided by an LTC facility and its nursing staff, raise healthcare and malpractice insurance costs of the facility, and decrease the quality of life for residents. The theoretical framework used for this EBP proposal is the Deliberative Nursing Process model developed by the theorist, Ida Jean Orlando. Her theory allows nurses to create effective, practical, and adaptable nursing care plans (Nursingtheory.org, 2016). These plans can be used to eliminate falls, prevent complications arising from patients not wanting to participate in fall prevention programs, and minimize barriers with FNPs and LTC administrators not wanting to integrate fall prevention strategies.

Orlando’s theory suggests that patients with acute illnesses or needing long term care must satisfy their physiological needs and eliminate fears if they want to heal (Nursingtheory.org, 2016).  When these needs are not met, patients do not have a positive LTC or acute care experiences. Orlando’s theory is useful to create initial fall risk assessments and critical intervention plans. The theory promotes individualize care plans and interventions (Nursingtheory.org, 2016).  In relation to eliminating falls in the LTC, Orlando’s theory posits all patient behavior is a cry for help (Nursingtheory.org, 2016). Thus, falling is the patient’s way of saying “pay attention to me.” The FNP must interpret this behavior and determine the needs of the patient (Nursingtheory.org, 2016). Orlando’s Deliberative Nursing Process includes five stages: assessment, diagnosis, planning, implementation, and evaluation (Nursingtheory.org, 2016).

References

Baker, J. D. (2016). N