Identifying Relevant Research Results
An important part of the project was identifying relevant research findings and applying them correctly to the proposed intervention. The PICOT question I had developed was as follows: In elderly patients at risk for fall (60 to 80 years old) (population), does using bed alarms and eliminating clutter in the room, such as carpets and furniture (intervention), compared with lack of supervision, clutter room, and walkways (comparison), produce a significant decrease or elimination of falls in elder patients at risk for falls (outcome) during hospital stay (time)?
A study relevant to my proposed intervention was conducted by Ward-Smith, Barrett, Rayson, and Govro (2014); the authors comprehensively reviewed various factors in fall events, including the application of bed alarms, and the result was that bed alarms were useful and could be helpful in addressing the problem, but only if they are used with additional interventions. Used alone, bed alarms can be either ineffective or even counterproductive.
Fit, Feasibility, and Appropriateness
According to the Johns Hopkins Practice Evidence Translation (PET) model, several steps need to be followed to successfully apply the evidence to a project (Dearholt & Dang, 2012). First, the results’ fit, feasibility, and appropriateness are to be assessed. The study is a good fit because it shows how bed alarms interventions can be used in combination with other fall prevention instruments; however, the authors stress that further research is needed to identify more correlations, and the proposed project will conduct such research by applying an appropriate intervention that Ward-Smith et al. (2014) did not consider: elimination of clutter. This is feasible, too, because the intervention will not require extensive external resources.
Second, the Plan-Do-Study-Act (PDSA) framework should be applied. Planning will involve reconsidering the physical environment in the rooms in which patients at risk for falls stay and determining how space can be cleared. Implementation will consist of installing bed alarm systems and clearing the space to eliminate clutter. The Study stage will occur during the implementation, as the fall rate will be constantly monitored.
The findings of the research by Ward-Smith et al. (2014) will be used so that multiple considerations are included in the assessment to make it “tailored to the specific health and demographic variables of the population” (p. 1). The Act stage, in case the number of fall events is decreased upon applying the intervention, will involve using the results to change the policy of health care facilities and recommend applying the combination of bed alarms and elimination of clutter.
Third, the necessary resources should be discussed. Two types of resources are identified for this project: external and internal. External resources will include the bed alarm systems; assistance may be needed for finding appropriate technological solutions, installing them, and training staff and patients to use the system properly. Internal resources will be nursing practitioners: operating the bed alarm systems and eliminating clutter will be their contributions to the project and their responsibility.
Fourth, evaluation criteria need to be designed. The successfulness of the proposed intervention will be measured by the fall event incidence rate: if there are fewer falls in the intervention group, and the results are statistically significant (i.e. it is confirmed that the correlation exists between the improvement and the intervention), the project will be considered successful.
Finally, it is needed to consider options for further research. To extend knowledge of the selected project results, it will be helpful to explore how bed alarm systems can be counterproductive, i.e. how the noise they produce can result in ignoring them by health care providers. It is possible that there are such unpredicted negative effects of de-cluttering, too, and they should be explored; for this purpose, future research should address not only the fall incidence rate and the patient perspective but also the perspective of health care providers.
Dearholt, S. L., & Dang, D. (2012). Johns Hopkins nursing evidence-based practice: Models and guidelines (2nd ed.). Indianapolis, IN: Sigma Theta Tau International.
Ward-Smith, P., Barrett, L., Rayson, K., & Govro, K. (2014). Effectiveness of a bed alarm system to predict falls in an acute care setting. Clinical Nursing Studies, 3(1), 1-4.