Week 3 Discussion: Researching and Recommending Evidence-Based Research Resources
Step 1 Read the case scenario.
You are part of an interprofessional team working on an evidence-based project to look at falls in patients with dementia in the long-term care setting. The team was brought together in response to a noted increase in the incidence of falls in residents with dementia over the past three months. One of the recent changes before the increase in falls was a mandate to no longer use physical restraints on residents. Several staff members feel that the use of restraints is a must, and they do not have time to use the restraint alternatives that have been suggested. They also feel they do not have enough time to continuously check on residents. This has caused major issues of concern and has compromised the quality and safety of the residents.
When the team meets together, one of the first items discussed is the clinical question. The team uses the PICO question format to develop the following question:
In patients with a diagnosis of dementia in the long-term care setting (P), how does the use of a comprehensive falls assessment prevention plan that includes restraint alternatives (I) compare with the use of a fall prevention protocol that includes the use of restraints (C) affect the number of falls that occur (O)?
Step 2 Post to the discussion forum.
In your initial response, address the following questions:
a. Determine the best resources to use when conducting a search on the topic. Consider these questions: What databases would be most appropriate? Where would you locate clinical practice guidelines that could be used in the EBP process for this issue?
b. Conduct a search using the resources you identified in Step 2a. What key search terms did you use? What filters did you use?
c. From your search, identify at least three articles that you would consider using in an EBP project such as the one described in the case scenario. If possible, suggest resources that meet the highest level (Level I) of evidence. Why would these sources be most appropriate in determining best practices and supporting clinical decision-making for this issue?
Sample Paper
Discussion
Picot: In patients with a diagnosis of dementia in the long-term care setting (P), how does the use of a comprehensive falls assessment prevention plan that includes restraint alternatives (I) compare with the use of a fall prevention protocol that includes the use of restraints (C) affect the number of falls that occur (O)?
The literature review will entail a systematic review of existing studies on the research topic. The best article resources to use when conducting a study for this topic will be peer-reviewed and recent articles (not published more than five years ago) on the study topic. The articles will be obtained from two reliable online sources: PubMed and CINAHL. The rationale for selecting these online databases is they contain millions of international evidence-based and peer-reviewed articles and research studies related to medicine and nursing.
Besides offering variety and reliability, these databases have narrowed their articles to the topics associated with nursing and medicine, thus making it easier for the reader to find articles. In addition, they further make article search easier by indexing content that is directly relevant to nursing, inputting search limits by limiting articles by age or study type. Therefore, it is easier for the reader to filter content based on their preferences. They provide access to complete studies and are authoritative. They permit the reader to see who exactly conducted the research, who wrote the results, and even where the research was conducted (Lewis et al., 2018).
The appropriate source to locate clinical practice guidelines that could be used in the EBP process for this issue are the websites for organizations accredited by the government to provide reliable and up-to-date, evidence-based clinical data to consumers and providers of healthcare services. Such organizations include the CDC, WHO, and the American Geriatrics Society (Bartzak, 2021).
Research
The search of the articles from the identified online databases entailed using specific search terms from the search engine. The search terms used include a combination of two words using Boolean operators (Atkinson & Cipriani, 2018). These key search terms used included: Dementia and fall, fall prevention in the elderly, fall prevention protocols, Comprehensive falls assessment prevention plan, and Restraints for fall prevention. To further narrow down the search results, several filters were used. These are age and type of study. In addition, to improve the relevancy and reliability of the findings, the study was filtered to level 1 studies conducted within the past five years.
Search Results
The initial search results were 98 articles. After applying the filters, 17 articles remained. Among the 17 articles, below are the three articles I would consider using in an EBP project. These are among the sources that meet the highest level (Level I) of evidence. They would be most appropriate in determining best practices and supporting clinical decision-making for this issue because they provide evidence obtained from properly designed randomized controlled trials, thus free of biases and systematic errors.
- Toots, A., Wiklund, R., Littbrand, H., Nordin, E., Nordström, P., Lundin-Olsson, L., … & Rosendahl, E. (2019). The effects of exercise on falls in older people with dementia living in nursing homes: a randomized controlled trial. Journal of the American Medical Directors Association, 20(7), 835-842. https://doi.org/10.1016/j.jamda.2018.10.009
- Harwood, R. H., van der Wardt, V., Goldberg, S. E., Kearney, F., Logan, P., Hood-Moore, V., … & Orrell, M. (2018). A development study and randomised feasibility trial of a tailored intervention to improve activity and reduce falls in older adults with mild cognitive impairment and mild dementia. Pilot and feasibility studies, 4(1), 1-12. https://pilotfeasibilitystudies.biomedcentral.com/articles/10.1186/s40814-018-0239-y
- Chen, Y. L., & Pei, Y. C. (2018). Musical dual-task training in patients with mild-to-moderate dementia: a randomized controlled trial. Neuropsychiatric disease and treatment, 14, 1381. https://dx.doi.org/10.2147%2FNDT.S159174
References
Atkinson, L. Z., & Cipriani, A. (2018). How to carry out a literature search for a systematic review: a practical guide. BJPsych Advances, 24(2), 74-82. https://www.cambridge.org/core/journals/bjpsych-advances/article/how-to-carry-out-a-literature-search-for-a-systematic-review-a-practical-guide/629E710311A566E54F951E5E83621122
Bartzak, P. J. (2021). Creating a Nursing Procedure: When Evidence-Based Practice Doesn’t Fill in All the Blanks. Medsurg Nursing, 30(1), 59-60. https://www.proquest.com/openview/c4af02349b054e30effc277a85f8351b/1?pq-origsite=gscholar&cbl=30764
Lewis, S., Damarell, R. A., Tieman, J. J., & Trenerry, C. (2018). Finding the integrated care evidence base in PubMed and beyond: a bibliometric study of the challenges. International journal of integrated care, 18(3). https://dx.doi.org/10.5334%2Fijic.3975
