responses

3

Discussion 1:

Data Management in Research, Quality Improvement (QI) and Evidence-Based Practice (EBP)

Gap in Knowledge and Gap in Practice

For the research study conducted by Tzeng and Yin (2017), a knowledge gap is evident in the types of fall-prevention interventions considered the most effective in the various hospital settings. Despite the variety of approaches taken, there is a lack of clarity in the evidence base regarding the interventions that most effectively can lead to the reduction of adult inpatient falls across systems, as it restricts a generalizable conclusion. Conversely, the quality improvement (QI) research by Khoja and Moosa (2023) fulfills a gap in practice, specifically the inconsistent use of established fall-prevention strategies in the clinical environment. The issue does not lie in the lack of evidence but variation in compliance and reliability of the process, which results in avoidable patient harm. Dang et al. (2021) describe how research arises due to gaps in knowledge, whereas QI begins at performance gaps between existing and desirable outcomes.

Emergence of the Practice-Focused Question

The practice-based problem in the DNP evidence-based practice (EBP) project by Bangura (2024) was identified through the continuous high number of falls in a long-term care unit among veterans, despite the implementation of prevention strategies. Using the EBP process, the clinicians discovered a gap between anticipated and real results, overviewed the available evidence, and developed a narrow question addressing whether intentional rounding led by medical professionals would decrease the number of falls. This is an indication of the EBP stress on applying best evidence to practice to enhance local results.

Comparison across Research, QI, and EBP

An analysis of the three works exhibits a continuum of a nursing inquiry. The methodological gap in the research study covers the lack of theoretical knowledge and tries to find evidence that can be generalized. The QI study addresses a problem with local systems and aims to assess the potential improvement of results by means of the structured implementation (Khoja & Moosa, 2023). The DNP and EBP project combine the two perspectives by incorporating current evidence to a particular clinical situation and assessing practice change. Similarly, intervention effectiveness is investigated in the research question, process improvement is measured in the QI initiative, and a practice-based intervention is tested in the DNP project. Due to these efforts combined, the processes steps can be seen through research to create knowledge, through QI in order to improve processes, and EBP in order to implement evidence into quantifiable patient safety improvement.

 

 

References

Bangura, F. (2024). Development and evaluation of a nurse practitioner-directed intentional rounding strategy and its impact on decreasing falls in a veterans long-term care facility [Doctoral dissertation, Wilmington University]. https://www.proquest.com/dissertations-theses/development-evaluation-nurse-practitioner/docview/2932310765/se-2

Dang, D., Dearholt, S., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model & guidelines (4th ed.). Sigma Theta Tau International.

Khoja, A., & Moosa, L. (2023). Impact of tailored interventions for patient safety (TIPS) to reduce fall rates. Medsurg Nursing, 32(2), 89–93. https://www.proquest.com/openview/e52856a22a2f916fd1067124d6959420/1?pq-origsite=gscholar&cbl=30764

Tzeng, H.-M., & Yin, C.-Y. (2017). A multihospital survey on effective interventions to prevent hospital falls in adults. Nursing Economics, 35(6), 304–313. https://www.proquest.com/openview/760325318193f30ac9b63c9d154770b7/1?pq-origsite=gscholar&cbl=30765

Discussion 2:

Data Management in Research, Quality Improvement (QI) and Evidence-Based Practice

            The nursing and healthcare industry has undergone major transformations over the last century. Some of these changes have been the growth of research, which was first introduced by Florence Nightingale. Research has given way to the development of evidence-based practice and quality improvement, which are imperative to nursing. Grys (2022) noted that these help by enhancing the quality of care delivered, reducing costs, and promoting positive health outcomes. The goal of this discussion is to explore these three developments by analyzing resources addressing each.

Gaps in Knowledge and Practice

           It is important to explore the gap in knowledge and practice identified in the research article and quality improvement study, respectively, from the assigned resources in falls. A gap in knowledge explores a lack of insight or conflicting findings that would lead to a better understanding to improve the delivery of care. The research article selected to explore a gap in knowledge was “A Multihospital Survey on Effective Interventions to Prevent Hospital Falls in Adults.” The cross-sectional study was conducted with the aim of finding out the best and most effective fall prevention studies to use (Tzeng & Yin, 2017). The study found that the best strategies included environmental modification, vigilance from registered nurses, and addressing the patients’ environments (Tzeng & Yin, 2017). Despite this knowledge, the study made a good point clarifying that the effectiveness of these strategies was dependent on the patient, unit, or hospital, among other factors (Tzeng & Yin, 2017). Therefore, while one may be effective for the surgical unit, it may not have the same impact in the acute care unit (Tzeng & Yin, 2017). This knowledge helps nurses better explore fall prevention strategies to ensure they apply the most suitable based on the unit, patient, hospital, resources, and others.

           A gap in practice shows discrepancies between current routines and processes of care and the application of the highest standards of quality care guided by evidence. The article explored for a gap in practice was “Impact of Tailored Interventions for Patient Safety (TIPS) to Reduce Fall Rates.” The article noted that the gap in practice at the project sites was a lack of tailored fall prevention plans (Khoja & Moosa, 2023). While fall prevention strategies had been continuously implemented at the medical-surgical units, they remained a persistent challenge (Khoja & Moosa, 2023). This resulted in the developed of the TIPS toolkit that followed three main steps of fall prevention: risk assessment, developing a tailored plan, and implementing the tailored prevention plan (Khoja & Moosa, 2023). A test of the TIPS toolkit revealed positive results in fall reduction, which initiated its implementation in practice at the site to impart positive change (Khoja & Moosa, 2023). Therefore, the TIPS toolkit challenged current practices of fall prevention that had not resulted in fall reduction.

           The practice-focused question developed in the DNP EBP project emerged after the recognition of an existing gap in knowledge that could be potentially addressed by gathering new evidence to give way to evidence-based practice. The gap in knowledge emerged after it was identified that veterans are at increased risk of falls compared to the non-veteran population (Bangura et al., 2024). This led to the need to implement intentional roundings among nurses since this is recognized as one of the most effective strategies of fall prevention in facilities (Bangura et al., 2024). However, certain criticisms of intentional roundings exist, such as increased workloads for nurses, and it affects the nurses’ decision-making ability since the roundings are introduced as routines (Bangura et al., 2024). Therefore, these conflicting findings resulted in a knowledge gap that needed to be addressed using further research to determine the impact of intentional rounding (Bangura et al., 2024). This led to the development of the PICOT question “In veterans residing in a long-term care community living center (P), how does intentional rounding with the Morse Falls Tool (I), compared to the current practice of unstructured rounding(C) affect falls(O) in a six-week period (T)?” (Bangura et al., 2024).

Comparison

           It is important to compare and contrast the three articles by addressing the gap and questions used. The research study and DNP EBP project were addressing a gap in knowledge, with their intention being the development of new knowledge for fall prevention, while the quality improvement study had the intention of addressing a gap in practice by recognizing current failing systems and fixing them. The study recognized that easing fall prevention strategies in the medical-surgical units were not as impactful; thus, set to determine the impact of the TIPS toolkit and implement it in daily routines (Khoja & Moosa, 2023). Both the quality improvement and DNP EBP studies developed questions using the PICOT method. However, the question developed in the DNP EBP study was more of a research question whose intention was to generate new knowledge regarding the value of intentional rounding and fall prevention among veterans (Bangura et al., 2024). The question in the quality improvement study was a practice-focused question whose intention was to result in practice change by determining if the TIPS toolkit was superior in fall prevention compared to the current practices (Khoja & Moosa, 2023).

 

 

References

Bangura, F. (2024). Development and evaluation of a nurse practitioner–directed intentional rounding strategy, and its impact on decreasing falls in a veterans long-term care facility. (Publication No. 30991997) [Doctoral dissertation, Wilmington University]. ProQuest Dissertations and Theses Global.  https://www.proquest.com/dissertations-theses/development-evaluation-nurse-practitioner/docview/2932310765/se-2 Links to an external site.

Grys, C. A. (2022). Evidence-based practice, quality improvement, and research. Nursing, 52(11), 47-49.  https://doi.org/10.1097/01.nurse.0000889812.89287.45 Links to an external site.

Khoja, A., & Moosa, L. (2023). Impact of tailored interventions for patient safety (TIPS) to reduce fall rates. MEDSURG Nursing, 32(2), 89–93.

Tzeng, H.-M., & Yin, C.-Y. (2017). A multihospital survey on effective interventions to prevent hospital falls in adults. Nursing Economics, 35(6), 304–313.