Evidence Based Practice & Applied Nursing Research

In the abstract section, Kuhlenschmidt et al. (2016) clearly state the goal of their investigation. They discovered an increased incidence of falls among hospitalized cancer patients. The falls lead to increased financial costs, fatalities, sickness, and a lower quality of life. In the abstract, they conclude their background information by claiming that few evidence-based interventions have been specifically customized to the perception of the patients to the said risk for falls. It is on the basis of this background information that Kuhlenschmidt, et al. (2016) sought to establish the effect of a tailored intervention, delivered by the nurses on the perceived risk for falls in hospitalized cancer patients. The article successfully lays the background for the study and finishes by stating the purpose f the study based on the provided background.

Literature review

The authors did not provide a section called literature review, but did provide a number of studies in the introduction section that reviews the studies completed in similar topics. They have given the statistics of the national average of falls and the associated risks of the falls. The authors have narrowed the risks associated with cancer patients including nutritional and neurologic deficits associated to the treatment of cancer as well as fatigue. The authors acknowledge that while substantial studies have been done on the risk factors associated with the risk for falls among hospitalized patients, more needs to be done on the perception of the hospitalized patients regarding their risk for falls and sustenance of an injury (Kuhlenschmidt, et al., 2016). This situation exists despite the fact that prevention of falls involves the assessment of the awareness of the patient and the caregiver concerning the risk factors for falls and the falls that may lead to injury. The authors have also indicated the role of the nurses in educating the patients about prevention of falls. The authors cite 16 other articles in the introduction section that discuss the various aspects related to this topic.

Methodology

Kuhlenschmidt, et al. (2016) performed a prospective Randomized Controlled Trial (RCT) to establish the effect of a tailored and nurse-led intervention on the perception of the patients on the risk for falls. A convenience sample of 91 patients was randomly placed into two groups; the intervention and control groups. All patients completed a survey at baseline and after obtaining consent; the intervention was administered with the treatment group receiving individualized education on the risk category that was established by the evaluation of the patient’s perception of risk by the nurse while the control group patients were given the standardized education as prescribed by the hospital. The intervention included 15 education sheets addressing different topics like the use of sedating medication, toileting frequency and patient’s fall history and 4 videos that contained tailored messages about perception of falls. Data was collected at 24 hours and 72 hours after consent for both the control and intervention groups.

Data Analysis

Analysis of the demographic data between the treatment and control group was accomplished by the use of Chi-square, Wilcoxon and the Fisher’s exact tests. The differences in the proportions within the two groups were analyzed by a paired McNemar’s test. The authors used SAS, Version 9.4 or R, Version 3.1.1 to conduct all statistical analyses.

Conclusions

The authors conclude that using a patient-centred approach towards fall prevention should be encouraged. The determination of the risk for falls should include patients as they form part of the care team; this involvement raises the awareness of the patients regarding the risks while helping the nurse in tailoring patient education. The article does successfully make a claim of involving the patients in the development of fall prevention programs.

Researcher’s Conclusion

Prevention of patient falls is best approached through a patient-centered viewpoint where the patients are involved in every step of the way in determining the risk for falls and designing best education program. In arriving at this conclusion, the researchers provided a background to the study by explaining how the cancer patients are exposed to risks for falls and the resulting to adverse effects including higher rates of morbidity, mortality and poor quality of life. The literature review section provides detailed analysis of previous studies discussing similar aspects of the topic and identifying the gap that will be filled by undertaking the study but also in establishing the appropriate method of study. The researchers made substantive efforts to explain the methodology used in their study. To provide the highest levels of quality of evidence, the current research used a prospective randomized controlled trial by using a convenience sample placed into two groups; the intervention and control group and the survey completed at baseline and after the intervention. Data analysis is a significant aspect of conducting any research and in the study under review, the researchers have used appropriate statistical tools to analyse the various aspects demographic and differences in proportions in the intervention and control group.

The aspects discussed above are critical in any study that requires believability and stand any critique. The background information identifies the purpose of the study and informs the reader if the subject considered will be useful or not. The literature review section does not only identify the gaps in the study, but also helps define the research question in addition to determining the correct method of study (Coughlan, et al., 2007). The section refers to other studies done and what their findings were and how the current research will improve the practice. In the study Kuhlenschmidt, et al. (2016) clearly reviewed the literature concerning falls and have identified the limited research into the perception of the patients regarding the risk for falls. The research design to be employed should come out as clearly and Kuhlenschmidt, et al. (2016) clearly defined the research as a prospective randomized controlled design which provides the highest level of evidence. The study procedures have been extensively discussed and it is clear of the attention to details by the research in ensuring the selection, randomization and intervention is free of bias. Finally, the analysis section identifies how the data was manipulated using scientifically proven methods and tools which further strengthen the findings.

Protection and consideration

All research studies making use of human subjects should adhere to the four moral principles including autonomy, justice, non-maleficence and beneficence (Coughlan, et al., 2007). The subjects should have the right to freely participate or withdraw from a study. The researchers should not have any intentions to harm the participants physically or psychologically and that all subjects should be treated equally. The study findings should be of importance to the individual or society. It is, therefore, important that consent from the subjects is obtained before any research is conducted (Coughlan, et al., 2007). Besides, the research design should be reviewed by appropriate bodies to ensure that they have adhered to the ethical considerations guiding clinical studies. There is evidence that Kuhlenschmidt, et al. (2016) applied the ethical considerations by seeking consent. However, the researchers failed to mention how they ensured the privacy and confidentiality of the patient data.

Strengths and Limits

The strength of the study lies in the choice of the research design. The RCT provides the highest level of evidence because of the use of the intervention and control groups and the blinding of the researcher or the analysts (Coughlan, et al., 2007). The inclusion and exclusion criteria adopted further ensured that the participants in the study were competent to provide the necessary information to enhance the findings of the research (Coughlan, et al., 2007). The main limitation of the study was the use of a convenience sample which limits the generalizability of the study findings. Besides, the study used investigator-developed tools for measuring the perceived risk, readiness to ask for assistance and confidence which limited the extent of the evaluation. Exposing the patients to fall risks during the consent process increased their awareness which compromised the measurement of the effect of the interventions (Kuhlenschmidt, et al., 2016).

Evidence Applications

The findings of this study are critical to the nursing practice as they highlight the importance of identifying and addressing the differences between the patient’s perception of risk for fall and the nurse’s assessment of the risk. The results indicate the need to address these differences in addition to the nurses tailoring the educational interventions to individual patient’s perception of the risk. Finally, the results of the study imply that in performing the assessment of the risk factors for falls as perceived by the patients, there should be a structured method of evaluation.

References

Coughlan, M., Cronin, P., & Ryan, F. (2007). Step-by-step guide to critiquing research. Part 1: quantitative research. British journal of nursing, 16(11), 658-663.

Kuhlenschmidt, M. L., Reeber, C., Wallace, C., Yanwen, C., Barnholtz-Sloan, J., & Mazanec, S. R. (2016). Tailoring Education to Perceived Fall Risk in Hospitalized Patients With Cancer: A Randomized, Controlled Trial. Clinical Journal Of Oncology Nursing, 20(1), 84-89. doi:10.1188/16.CJON.84-89