GCNRN4 Research in Nursing | Evidence Based Practice

Introduction

Evidence based practice (EBP) is the judicious use of research evidence to identify best practice interventions for the care of patient and effectively integrated it with clinical skills and knowledge to improve patient outcomes, provide high quality care and reduce health cost. It provides nurse the scope to professionally develop in practice and acquire evidence based skills to improve the quality of care (DiCenso, Guyatt & Ciliska, 2014). The main purpose of the paper is to analyse the issue of fall in neuro patients and then identify best evidence to prevent fall in neuro patients using the steps of the EBP process.

Rational for fall in neuro patient as a practice issue:

Neuro patients involve those people who suffer from specific neurological conditions such as stroke, dementia and other neurological conditions. Neurology inpatient units witness the highest rate of fall events because of the presence of multiple risk factors for falls such as gait problem, depression, cognitive deficits, muscles weakness, advancing age and use of psychotropic medications (Hunderfund et al., 2011). Fall in such patients lead to many psychological and physical morbidity for patients.  Hence, fall in neuro patient may contribute to serious injury and increased length of hospital stay. It also deteriorates health of patient and make them dependent on social support and health care services for their activities of daily living (Homann et al., 2013). It is also a practice issue for nurses or caregivers of neuro patients because fall related injuries increased burden of care. Therefore, fall prevention is necessary to ensure that neuro patients can lead an in independent life without the support from health or social services.

EBP process to identify best evidence to prevent fall in neuro patients

To prevent fall in neuro patients, identifying the best evidence that prevent fall in neuro patient is necessary. This can be done by identifying by following the six steps of the EBP process which are as follows: 

Developing a guiding research question:

To search for the best article that defines the most effective intervention to prevent fall in neuro-patient, developing a clinically guiding research question is important. The PICO question that can help in finding relevant best practice research evidence is as follows:

Which type of interventions can reduce the risk of fall in neuro patients?

Searching for evidence from appropriate source

Based on the research question, important keywords like fall prevention and neuro patients and interventions for fall prevention in neuro patients can used to search for articles in databases. Similar process was followed for identifying the best intervention to prevent fall in neuro patients too (Hall & Roussel 2016). Based on the use of search terms, research studies were found which reported about various types of fall prevention intervention in neurological care unit were analysed.

Critical appraisal of the selected evidence

The review revealed fall risk assessment as an important strategy to reduce fall events in neurology units. Two research evidences gave idea about the effectiveness of fall risk assessment process in preventing falls. All the three studies used fall risk assessment protocol in the fall prevention program. Goljar et al. (2016) used the Assessment Sheet for Fall Prediction in Stroke Inpatients (ASFPSI) to assess fall risk. The credibility of the tool was defines by giving evidence regarding the sensitivity and reliability of the scale. Identification of fall risk helped in taking additional measures for individuals at risk of fall. This helped in the reduction of fall risk in the rehabilitation ward. The research by Hunderfund et al. (2011) further proved the effectiveness of fall risk assessment process for neurology patient by adapting a multidisciplinary risk assessment process. Physician fall risk assessment process was address with nurse evaluation and Hendrich II Fall Risk Model score. The evidence revealed the effectiveness and feasibility of multi-disciplinary approach in correctly identifying patients at risk and preventing in-patient falls. Hence, coordinated efforts of nurse, physicians and other medical team are crucial for the success of fall prevention program.

Integration of the evidence with clinical expertise and patients values

Evaluation of the above two evidence confirmed fall risk assessment process 24 hours after hospital admission as an important strategy to prevent fall in neuro patients. To utilize the evidence, it will be necessary for nurse to coordinate with other team members to review fall risk assessment tools that is being used to assess fall risk. Developing knowledge to effectively used the tool and reporting the findings aand deciding fall prevention in collaboration with other team members can reduce risk of fall in neuro patients.

Evaluation of outcome

To evaluate the success of the intervention, comparison of fall rate should be done before and after the intervention. Number of reduced days in hospital and no reported fall events would indicate the success of the strategy.

Dissemination of the evidence

If the evidence is found to be effective, then the finding can be disseminated to other team members so that all can follow a common protocol to prevent fall in inpatient units.

Conclusion

To conclude, the paper aimed to address the issue of high incidence of fall in neuro units by identifying the best evidence using the EBP process. Based on the review of research evidence, the intervention related to multidisciplinary fall risk assessment along with the use of evidence based fall risk assessment tool was considered as an appropriate strategy to control fall events in neurology units. This strategy favoured implementing effective steps to control fall in high risk individuals.

References:

DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-Based Nursing-E-Book: A Guide to Clinical Practice. Elsevier Health Sciences.

Goljar, N., Globokar, D., Puzi?, N., Kopitar, N., Vrabi?, M., Ivanovski, M. and Vidmar, G., 2016. Effectiveness of a fall-risk reduction programme for inpatient rehabilitation after stroke. Disability and rehabilitation, 38(18), pp.1811-1819.

Hall, H. R., & Roussel, L. A. (2016). Evidence-based practice. Jones & Bartlett Publishers.

Homann, B., Plaschg, A., Grundner, M., Haubenhofer, A., Griedl, T., Ivanic, G., Hofer, E., Fazekas, F. and Homann, C.N., 2013. The impact of neurological disorders on the risk for falls in the community dwelling elderly: a case-controlled study. BMJ open, 3(11), p.e003367.