NRS 445 Wk 1 Literature Evaluation Table GCU
NRS-445 Topic 1: Literature Evaluation Table
Student Name:
Faculty Name:
Background of Nursing Practice Problem
Patient safety is a global healthcare issue that care providers must prioritize in hospitals and community settings. Patient falls among older adults is a severe adverse event whose risk increases as age advances. Statistics show that the incidence of fall-related adverse events can reach as high as 40% in hospitals (Heikkilä et al., 2023). Patients can fall during hospitalization or at home. Besides age, health conditions increase the risk of falls since older adults with type 2 diabetes are 59% more likely to fall than non-diabetic older adults (Freire et al., 2024). Implementing evidence-based interventions to reduce the incidence of falls can prevent issues associated with falls among older adults, particularly fractures, fear of falling, low quality of life, and poor mental health. Other effects include increased mortality, extended hospital stay, and open wounds (Heikkilä et al., 2023). Reducing falls implies achieving a similar decline in fall-related issues and maximizing health and well-being in older adults.
Need a high-quality paper urgently?
We can deliver within hours.
PICO(T) Question: In older adults with type 2 diabetes (P), does an integrated (resistance, strength, and balance) weekly training (I) compared to no physical exercises (C) reduce the incidence of falls by 30% (O) within 10 weeks (T)?
| PICO(T) Question Template | ||
| P | Population | Older adults with type2 diabetes |
| I | Intervention | An integrated (resistance, strength, and balance) weekly training |
| C | Comparison | No physical exercises |
| O | Outcome | Reducing the incidence of falls by 30% |
| T | Timeline
| 10 weeks |
| Intervention | ||
| In older adults with type 2 diabetes (P), does an integrated (resistance, strength, and balance) weekly training (I) compared to no physical exercises (C) reduce the incidence of falls by 30% (O) within 10 weeks (T)? | ||
| Problem Statement | ||
| It is not known if the implementation of weekly integrated training would reduce the incidence of falls by 30% in older adults with type 2 diabetes. | ||
| Criteria | Article 1 | Article 2 | Article 3 | Article 4 |
| APA Reference Include the GCU permalink or working link used to access the article | Dierick, F., Bouché, A. F., Guérin, S., Steinmetz, J. P., Federspiel, C., Barvaux, V., & Buisseret, F. (2022). Quasi-experimental pilot study to improve mobility and balance in recurrently falling nursing home residents by voluntary non-targeted side-stepping exercise intervention. BMC Geriatrics, 22(1), 1006. https://doi.org/10.1186/s12877-022-03696-y | Rikkonen, T., Sund, R., Koivumaa-Honkanen, H., Sirola, J., Honkanen, R., & Kröger, H. (2023). Effectiveness of exercise on fall prevention in community-dwelling older adults: a 2-year randomized controlled study of 914 women. Age and Ageing, 52(4), afad059. https://doi.org/10.1093/ageing/afad059 | Halén, C., Gripenberg, S., Roaldsen, K. S., Dohrn, I. M., & Halvarsson, A. (2022). “A manageable and challenging fall prevention intervention with impact on society”-older women’s perspectives on participation in the stayBalanced training programme. Physiotherapy Theory and Practice, 38(13), 2806-2816. https://doi.org/10.1080/09593985.2021.1972498 | Cederbom, S., Bjerk, M., & Bergland, A. (2022). A qualitative study exploring physical therapists’ views on the Otago Exercise Programme for fall prevention: a stepping stone to “age in place” and to give faith in the future. Physiotherapy Theory and Practice, 38(1), 132-140. https://doi.org/10.1080/09593985.2020.1731895 |
| Purpose/Aim of Study | The purpose of the study was to examine the feasibility and possible mobility and balance benefits of side-stepping exercises in nursing home residents with recurrent falls. | The aim of the study was to examine whether participating in community exercise interventions would decrease the number of falls and fall-related injuries among older women. | The study aimed to describe the experiences of older women with osteoporosis participating in the StayBalanced Programme, a balance training program for community-dwelling older adults. Exercises included sitting, standing, walking, and cognitive tasks to challenge balancing. | The study explored physical therapists’ (PTs) experience with the applicability of the Otago Exercise Programme (OEP) in clinical practice for home-dwelling older adults on formal care and their beliefs about the program’s benefits on living longer at home. The OEP is a home-based exercise program for improving strength, balance, and walking. |
| Research question(s) | What is the feasibility and potential mobility and balance effects of voluntary side-stepping exercises among nursing home residents who fall recurrently? | Can participating in recreational sports facilities and supervised weekly sessions decrease the number of falls and related injuries in older women? | What are the experiences of older women with osteoporosis participating in the balance training program (StayBalanced)?
| What is the applicability of the OEP in clinical practice for home-dwelling older adults? What are the benefits of OEP for living longer at home? |
| Design Is the article qualitative, quantitative, or mixed methods? Explain how you determined the type of research design. | Quantitative design: the researchers conducted a quasi-experimental study. | Quantitative design: Rikkonen et al. (2023) conducted a randomized controlled trial (RCT) that quantified outcomes. | The study was qualitative: it was an exploration of experiences via interviews. | The study employed a qualitative inductive design. Using a phenomenological perspective, researchers explored participants’ experiences using semi-structured interviews. |
| Setting Where did the study take place? What type of setting: inpatient, outpatient, etc.? | The study was conducted in a nursing home in Bioul, Belgium. The inpatient facility had 45 nursing and care home residents. | The study was conducted in Eastern Finland. Participants living in Kuopio urban area were invited to conducted exercises in city’s recreational sports facilities (physical health settings). | The study was conducted in Karolinska University Hospital. Thus, it was in an inpatient setting. | The study was conducted in Eastern Norway. Outpatient setting: the intervention consisted of five home visits and seven telephone calls for twelve weeks. |
| Sample Number and characteristics of participants | After screening 35 participants for eligibility, researchers recruited 35 participants for the study. All participants were over 60 years old and recurrent fallers able to understand the intervention’s instructions. | A total of 914 women participated. Their mean age was 76.5 and experiencing falls and related injuries. | The study had 39 informants who had complected the balance training.
| Seventeen physical therapists (PTs) participated. They were trained in OEP and had clinical experience in fall prevention and caring for older adults. |
| Methods Interventions/Instruments | The pilot study design was a quasi-experimental controlled trial, hence no randomization. Eleven participants were assigned to the side-stepping exercises group (the intervention) and eleven to a control group under usual physiotherapy. Falls were systematically recorded in a paper-based falls diary. Clinical tests, such as the walking test, mini-motor test, and Time Up and Go, were also conducted by an experienced physiotherapist. | In this randomized controlled trial, 457 women were enrolled in the intervention (exercise) group and a similar number in the control group. Fall information was collected biweekly using short messages and fall diaries. | Each group had 4-9 participants who performed the balance training thrice weekly for 12 weeks. Researchers conducted individual face-to-face interviews with open-ended questions. Domains included physical activity and health, balance and falling fear, and overall program experience. | Data were collected via semi-structured interviews using an interview guide. An experienced researcher conducted the interviews on the applicability of OEP and its benefits with older adults. All interviews were audio recorded and transcribed verbatim by an independent person. |
| Analysis How were the collected data analyzed? | Researchers assessed the statistical differences between time points using Friedman repeated measures ANOVA on ranks or a one-way repeated measures ANOVA. | Data were analyzed using Chi-square test to compare proportions and Poisson regression analysis for incidence rate ratios. | The interviews were transcribed verbatim, followed by a thematic analysis to examine the underlying assumptions and ideas about perceptions and the program’s benefits. | Thematic analysis was applied to the transcriptions from the interviews, which helped to analyze the content of the interviews. |
| Outcomes/key findings of the study and implications for nursing practice Summary of study results | Primary outcomes were the intervention’s feasibility and potential mobility and balance effects. Researchers found the intervention beneficial to the STEP group at eight weeks, with the participants performing better on the clinical tests compared to baseline. The implication is that similar programs can be implemented in nursing practice to help older adults at risk of falls. The results demonstrate that the intervention is feasible as a fall prevention method associated with improved mobility and balance. | Researchers found that the intervention contributed to a 14.1% reduction in falls in the exercise group compared with the control group. The intervention group also recorded a 38% lower rate of fractures than the control group. The implication is that nursing practice should embrace similar programs for fall prevention since they are effective. These results highlight the benefits of physical training in reducing falls, fractures, and other injuries in older women. | Participants experienced increased safety and self-awareness, which reduced exposure to falls, injuries, and fear of falling. Such a program could be implemented in nursing, although older adults require support with knowledge translation to maximize outcomes. The results support the uptake of balance training like the StayBalanced Programme for fall prevention in line with older adults’ values and preferences. | The primary outcomes were the applicability and benefits of the OEP program. PTs reported that the program is easy and safe to apply in clinical environments and homes. Benefits included improving older adults’ mastery of everyday life, reducing frailty, and enabling them to manage exercises on their own. Improving physical function reduces the chances of falling among older adults. Researchers concluded that the OEP is suitable for use in primary care settings and enables older adults to live longer at home. |
| Recommendations of the researcher | Researchers recommend future studies with larger samples and randomized controlled trials to validate the study’s findings. | Researchers recommend the broader implementation of light or moderate-intensity exercise group programs in nursing and for societal health promotion to reduce falls and fall injuries. | Researchers highlighted that the absence of men affected the generalizability of the study. Therefore, studies including men are vital to understanding their experiences and making studies more transferable to all individuals | Researchers recommend adopting such a program in healthcare settings to improve the physical and social function of frail adults who are at risk of falls. |
| Explain how this article supports your proposed PICO(T) question. | The article supports the proposed PICOT question by demonstrating balance and mobility training as an effective intervention for fall prevention by improving older adults’ physical health and strength. | The article supports the PICOT by demonstrating the link between physical training and fall reduction among older adults. | The study supports structured training to reduce falls among older adults, as the PICOT question proposes. It illustrates the benefits in-depth and positive perceptions from participants. | The article finds a positive correlation between balance and strength training through physical exercises and reducing falls among older adults. The improved physical function and strength to participate in social activities help older adults to avoid falls. |
Conclusion
Patient falls are a significant health issue with profound health outcomes. Older adults with type 2 diabetes are a high-risk population due to their advancing age and health condition. As the PICOT hypothesizes, integrated weekly training involving resistance, balance, and strength activities can reduce patient falls among older adults. The four studies summarized in the evaluation table provide literature supporting a similar intervention among older adults in other settings, with findings supporting its implementation.
References
Cederbom, S., Bjerk, M., & Bergland, A. (2022). A qualitative study exploring physical therapists’ views on the Otago Exercise Programme for fall prevention: a stepping stone to “age in place” and to give faith in the future. Physiotherapy Theory and Practice, 38(1), 132-140. https://doi.org/10.1080/09593985.2020.1731895
Dierick, F., Bouché, A. F., Guérin, S., Steinmetz, J. P., Federspiel, C., Barvaux, V., & Buisseret, F. (2022). Quasi-experimental pilot study to improve mobility and balance in recurrently falling nursing home residents by voluntary non-targeted side-stepping exercise intervention. BMC Geriatrics, 22(1), 1006. https://doi.org/10.1186/s12877-022-03696-y
Freire, L. B., Brasil-Neto, J. P., da Silva, M. L., Miranda, M. G. C., de Mattos Cruz, L., Martins, W. R., & da Silva Paz, L. P. (2024). Risk factors for falls in older adults with diabetes mellitus: systematic review and meta-analysis. BMC Geriatrics, 24(1), 201. https://doi.org/10.1186/s12877-024-04668-0
Halén, C., Gripenberg, S., Roaldsen, K. S., Dohrn, I. M., & Halvarsson, A. (2022). “A manageable and challenging fall prevention intervention with impact on society”-older women’s perspectives on participation in the stayBalanced training programme. Physiotherapy Theory and Practice, 38(13), 2806-2816. https://doi.org/10.1080/09593985.2021.1972498
Heikkilä, A., Lehtonen, L., & Junttila, K. (2023). Consequences of inpatient falls in acute care—a retrospective register study. Journal of Patient Safety, 10-1097. DOI: 10.1097/PTS.0000000000001230
Rikkonen, T., Sund, R., Koivumaa-Honkanen, H., Sirola, J., Honkanen, R., & Kröger, H. (2023). Effectiveness of exercise on fall prevention in community-dwelling older adults: a 2-year randomized controlled study of 914 women. Age and Ageing, 52(4), afad059. https://doi.org/10.1093/ageing/afad059