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PICO PaperJennifer HeldFerris State UniversityThis paper addresses the clinical question: Do patients in a long term care facilities that have person centered care environment have less falls when compared to a non person centered care environment? Three different nursing research articles on this topic will be analyzed; their levels of evidence and findings identified. The results of the findings are then evaluated and decided if they can integrated into to current nursing practice in a .long-term care facility. Good start, should be more of a summary of what your paper contains verses what the elements of the paper areClinical Question PaperAccording to the syllabus for Nursing Research, this assignment’s purpose is to “interpret research finding and use evidence based research to support nursing decisions. The purpose of this assignment is to reflect how nursing knowledge is disseminated for use in personal and professional practice” (Ursuy, 2014, p. 11). This will be achieved by assessing nursing research findings and determining their plausibility to a select clinical practice environment. Nursing research is important to every nursing career because it helps nurses provide the best care possible for their patients. Nursing is always evolving as nurses research and identify which interventions work and which are no longer effective for patient care.Clinical QuestionThe clinical question that was researched was: Do patients in a long term care facilities that have person centered care environments have less falls when compared to a non person centered care environments? Person centered care is a current trend that has been on the rise in long term care facilities. It also maybe referred to as culture change, Eden alternative, green house model, wellspring model, or household model. While the names are all different, the goal is still the same: to get patients, out of the large institutionalized nursing home setting and into smaller home like areas to give patients greater quality of life. The person centered care has patients living in homes with about 10-20 other patients. They maintain the same consistent staff in the “household” so that the patients get to know the staff as part of their family. With person-centered care, there have been several documented benefits such as decreased anxiety, decrease need for antipsychotic medications, and weight stabilization. Meadowbrook brook facility has in the past year changed to the person centered care environment and continues to have falls. Falls are one of the quality indicators that the state of Michigan uses when assessing nursing homes. If a facility has several falls, it is a trigger for the state of Michigan that there is problem in a facility and that that facility cannot keep its patients safe. Meadowbrook has had several positive results from person-centered care but there has not been a reduction in falls. This promoted the question: Do patients in a long term care facility that have person centered care environment have less falls when compared to a non person centered care environment?The question was written in the PICO format. PICO is an acronym that identifies all the parts that are needed in a proper clinical question. According to Nieswiadomy (2012), PICO stands for "Patient or population, Intervention or interest area, Comparison intervention or current practice, and Outcome(s) desired" (p. 282). Methodology In order to find answers to this question, research was done using different data bases. These data bases include but were not limited to: Cumulative Index of Nursing and Allied Health Literature (CINAHL), PUBMED, Agency for Healthcare Research and Quality (AHRQ), and Cochrane Review. The CINAHL data base using the key words: person centered care, long term care, and falls, provided two articles. 100 % of the articles provided were appropriate. PUBMED database using the key words: person centered care, falls, and long term care provided 10 articles. 30% of the articles provided, were appropriate. Other data bases were used but were only minimally helpful or not helpful at all. All of the articles found were from nursing research. This is most likely because person centered care is a philosophy started by nurses and it takes place in a nursing home. Falls are also monitored by nurses. In the future, as more information is gathered about person centered care, there will most likely be more nursing research available. Information is difficult to find because person centered care is newer concept.Not all research is equal, just because research is at a certain level doesn’t mean that it is that it is appropriate for every research project. Melnyk & Fineout-Overholt (2011), list the different levels of evidence according to the following criteria:Level 1 - Systematic review & meta-analysis of randomized controlled trials; clinical guidelines based on systematic reviews or meta-analysesLevel 2 - One or more randomized controlled trialsLevel 3 - Controlled trial (no randomization)Level 4 - Case-control or cohort studyLevel 5 - Systematic review of descriptive & qualitative studiesLevel 6 - Single descriptive or qualitative studyLevel 7 - Expert Discussion of LiteratureArticle OneThe first article is Effects of person-centered care on residents and staff in aged-care facilities: a systematic review by Brownie & Nancarrow. This article is a level one of evidence because it is a systematic review & meta-analysis of randomized controlled trials; clinical guidelines based on systematic reviews or meta-analyses. The article examines studies published between January 1995 and October 2012, which discussed person-centered care and the Eden Alternative and the effect that these types of facilities have on their residents.The Eden Alternative has the same philosophy as person center care. Brownie & Nancarrow (2013) stated the, “Eden Alternative facility had a higher rate of falls (31% compared with 17% within a 30-day period) compared with controls” (para. 20) The article went on to explain, “The few negative consequences of the introduction of person-centered care models suggest that the introduction of person-centered care is not always incorporated within a wider ‘hierarchy of needs’ structure, where safety and physiological need are met before moving onto higher level needs” (Brownie & Nancarrow, 2013). The focus with person-centered care is on the well being of the residents by having them feel more like they are at home. This is done by putting more focus on making resident’s feel good and less focus on keeping them safe as shown in this article. The hierarchy of needs states that first you need to provide safety before you can fulfill psychological needs. Based on this article, person centered care facilities are not providing safety for their patients. Article Two upper and lower case on headingsThe second article is Person-environment interactions contributing to nursing home resident falls written by E. Hill, T. Nguyen, M. Shaha, J. Wenzel, B. DeForge, & A. Spellbring. This article is a level 5 for evidence because it is a systemic review of descriptive & qualitative studies. This article was based on staff experiences and their thought on what happens during falls therefore, it is qualitative. It also is descriptive and describes all the different contributing factors that contribute to falls through study groups. Hill, Nguyen, Shaha, Wenzel, DeForge, & Spellbring (2009) stated, “One new insight related to nursing home staff was the importance of the role staff can play in reducing fall rates by better knowing the residents” (para, 51 ). With person-centered care, having all staff involved is critical. It allows direct care staff the ability to help make decisions about the resident’s plan of care. It also breaks down the hierarchy of management and allows everyone to focus on the patients. The direct care workers are often an underutilized resource and should be part of the team that plans for patient’s plan of care. In this article, the team, consisting of all staff, approach is shown to reduce falls. Article ThreeThe third article reviewed is The Effect on Nursing Home Resident Outcomes of Creating a Household Within a Traditional Structure by Yu-Ping Chang, Junxin Li, and Davina Porock. Chang, Li, & Porock (2013), state their goal was “To evaluate the effect of households on nursing home residents’ physical and psychological outcomes using the Minimum Data Set (MDS) comprehensive assessment data” (para ,7). This article is a level 3 for evidence because it contains a controlled trial and has no randomization. Minimum Data Set (MDS) is the standard that the government uses for all nursing homes. The MDS contains information such as falls, pain, ability to do activities of daily living (ADL), therapy, medications, restraints, and additional information that could affect resident’s quality of life. The MDS is then submitted to State and the Federal government to review. How often an MDS needs to completed and submitted is based on a written level of instructions provided by the government and varies for each patient but 90 days in the longest any patient can go without an MDS review submitted to the government.Chang, Li, & Porock (2013), state “Residents in the household unit had significantly better physical function (mobility, self-performed toilet use), more falls the past 30 days, less pain frequency, and less daytime sleepiness than those in the traditional unit” (para, 14 ). This article is comparative to the other articles in stating that person centered care is a positive change for majority patients but it doesn’t provide safety from falls. The article concludes that that person centered households have better resident outcomes than traditional nursing homes, except for when it comes to falls. Significance to NursingAccording to The essential Guide to Nursing Practice, apply the ANA’s scope and standards in Practice and Education, these standards hold “All registered nurses accountable to use evidence and research findings to guide their practice and to evaluate new evidence and research for practice changes” (White & O’Sullivan, 2012). White & O’Sullivan (2012), go on to explain “the Quality and Safety Education for Nurses (QSEN) program reaffirms that nurses must ‘function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care’” (p. 177). These requirements apply to all registered nurses to uphold the standard and function in an interprofessional team. An interprofessional teams work together to provide the best care possible for patients. The information discovered research findings should be shared with the interprofessional team and so there can be open communication between the team members about the best way to apply this information to current practices. According to current research, person centered care has many benefits but it may contribute to more falls. The question that the interprofessional teams need to decide is will the benefit of having a person centered care environment out weight the risk? The group will need to decide this for their patients on their individual levels and also as general practice. The benefit could be that the patients have the desire to do more things, then in a traditional institutionalized setting. For example, maybe patients are more willing to get out of their chairs to ambulate instead of giving up and lying in the bed all day; this puts that at higher risk for falls but is better for their health overall. The article by Hill, Nguyen, Shaha, Wenzel, DeForge, & Spellbring (2009) stated, having a team approach, which includes nursing assistants and direct care workers, was beneficial in preventing falls. This is a simply intervention that can implement without additional cost or resources. After every fall, nurse can call the staff together to have a small meeting to problem solve what contributed to this fall and how we can prevent the fall in the future. Focusing on prevention, nurses can have meetings with all their staff to discuss how to address possible causes of falls. Fall prevention can be achieved in a person centered care environment but that it will require more of an input from a team approach to help identify ways to prevent falls. References Brownie, S. & Nancarrow, S. (2013) Effects of person-centered care on residents and staff in aged-care facilities: a systematic review. Clinical Interventions of Aging.;8:1-10. doi: 10.2147/CIA.S38589. Epub 2013 Jan 3. Retrieved from: , Y., Li, J., & Porock, D. (2013) The Effect on Nursing Home Resident Outcomes of Creating a Household Within a Traditional Structure. School of Nursing and Institute for Person-Centered Care, The State University of New York, University at Buffalo, Buffalo, NY. Retrieved from: (13)00035-2/fulltextHill, E., Nguyen, T., Shaha, M., Wenzel, J., DeForge, B., & Spellbring, A. (2009) Person-environment interactions contributing to nursing home resident falls. Research in Gerontological Nursing, 2(4), 287-296 doi: 10.3928/19404921-20090527-02. Retrieved from: , K., & O’Sullivan, A., (2012). The Essential Guide to Nursing Practice. American Nurse’s Association: Silver Spring, MDMelnyk, B. & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia: Lippincott, Williams & Wilkins.Nieswiadomy, R. (2012). Foundations of nursing research (6th ed.). Boston: Pearson.Ursuy, P. (2014). Research in Nursing Syllabus. Ferris State University.Clinical Problem question grading rubricNeeds improvement (0=85%)COMMENTSCompetent (85-92%) Proficient (>95%)Expert (100%)Points Introduction> 3 sentencesClear purpose statement, may be direct quote from syllabus that is properly cited in APA?5/5Clinical Question~ 3 paragraphsGood introduction to the section. Includes explanation of the clinical problem. Accurate description and sourcing of the PICOT acronym. Addressed how an answer to the PICOT question will improve patient quality and safety ?25/25Methodology~ 3 paragraphsDescribes the methodology used to search for evidence to answer the PICOT question. Defended the exclusion criteria by describing why ONLY nursing research (your scope of practice i.e. NOT advanced practice nursing) was utilized. Included an explanation of the levels of evidence?20/20Discussion of Literature~2 paragraphs eachCritique of 3 articles included criteria outlined in the midterm article critique, including a sentence or two on the results. Appropriate level 2 headings were used in this section?25/25Significance to Nursing~3 paragraphsGood discussion on how the evidence findings can be integrated into practice to improve quality and safety of the identified population. This discussion includes sources and definitions from QSEN. Considered the impact that professional values, relevant healthcare policy, and availability of resources had on the decision to utilize the evidence. This discussion includes support from the ANA scope of practice?20/25Sub-total100Deductions APAWriting mechanics< 5 issuesSeveral APA and writing/grammatical errors in paper and on reference page (blog citations). See paper for corrections.<2 issuesRare -5/-30 many APA formatting errors relating to headings, reference page, abstract, and in text citationsTotal 95 ................
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