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Post 1:

The nursing research article by Miura and Kanoya (2025) in the Healthcare journal implicitly reveals a serious nursing issue high fall rates in nursing homes though there are various fall prevention tools available. The underlying problem is that it is not clear which risk assessment tools and prevention measures are the most effective in the long-term care facilities. This issue characterizes a gap in knowledge since despite the extensive research that has been done on falls, a good portion of the evidence obtained is based on the acute care hospital setting and not nursing homes. Nurses in long-term care thus have no solid evidence that is context-specific to make decisions. The research problem will aim at explaining and integrating what is known and that which is not known as far as understanding the effectiveness of fall risk assessment in such settings.

Conversely, the Quality Improvement project, operated by Olatunbosun (2025) detects another form of nursing problem. There were already fall prevention policies in that community living center, but there was a lack of consistency in staff compliance to risk assessment procedures, and fall rates were also alarming. This is a practice gap and not a knowledge gap. Evidence-based tools were available to nurses; however, nurses were not always utilizing them. The problem was a workflow, education and accountability issue and not the lack of research evidence. The case problem statement focuses on enhancing compliance and staff competence in order to minimize falls.

The nursing problem of the DNP EBP project by Njong (2025) is based on the same issue of inconsistency in practices as well. Even though there were already fall prevention guidelines in the facility, there was a gap in staff knowledge and sometimes the structured fall risk assessment was not used, which led to a constant occurrence of falls. Similar to the QI initiative, it is a practice gap, however it takes a step further to transform the problem identified into a structured EBP intervention. This nursing problem consequently becomes a practice-based question that seeks to enhance improvement in a quantifiable manner.

These 3 works combined show that nursing problems characterize various categories of gaps. Research problems allow identifying needs in terms of inadequate or unclear evidence. QI and DNP issues focus on the inability to implement familiar evidence in a consistent manner. This differentiation is fundamental in the doctoral nursing practice since it determines the intervention and evaluation plan.

Comparison of the problem presentation and influence on positive practice change.

The manner in which the problems are articulated in each research affects the direction to take towards change. The problem in the research article is formulated in a broad and analytical manner. Literature synthesis is used by the authors to find the gaps in the current evidence of the assessment of the fall risks in the nursing homes. This method has an indirect effect on change by enlightening the future research and policy making. It lays the groundwork of the scientific foundation of long-term changes in improvement of the care standards.

The problem in the QI project is provided on a local and operational level. It is concentrating on quantifiable performance shortcomings in a single facility. Due to the practical and specific nature of the problem, the intervention can be taken immediately. Observable change can be achieved in a few months through education sessions and protocol reinforcement. The effect on practice is then direct and immediate.

As part of its DNP EBP project, the two views are merged. This issue is based on the local clinical observation but informed by the external evidence. The practice-oriented question converts the problem that was identified into an intervention that is structured and has measurable results. The synergistic nature of the approach has great potential of sustainable positive change since it relates the evidence obtained in research to actual nursing processes. As reiterated in the works of Gray and Grove (2024), proper problem statements inform methodological rigor and significant clinical effects.

Important Measures/Variables of the Study.

Both studies are based on quantifiable variables to assess the results. The fall incidence rate in nursing homes is one of the key variables in the research article by Miura and Kanoya (2025). The importance of this outcome variable is that it measures the number of falls, and it can be interventional and cross-setting. Other variables that have been discussed are the application of particular risk assessment instruments and the resident factors.

One of the variables in the QI project by Olatunbosun (2025) is the compliance of the staff with fall risk assessment. A quantifiable measure of practice change is the compliance rates. Outcome measures are also the fall rates, whereas compliance is the aspect of QI methodology that is focused on process improvement.

The individual variable in DNP EBP project by Njong (2025) is the knowledge scores of the staff prior to and following the educational intervention. A pre and post-intervention testing gives quantifiable evidence of the change. Fall incidence is once more an outcome variable, yet the immediate indicator that the intervention has been used to overcome the identified practice gap is knowledge improvement. These quantifiable variables reveal that the basis of EBP work is statistical thinking. Data are not just gathered haphazardly and they are chosen to directly respond to the posed clinical question.

Question Development Tool Critique (Hicks, 2024).

The question development tool that Hicks (2024) brings focuses on the structured frameworks, including PICOT, to make sure the identified problem, EBP question, and the chosen measurements are clear. The organized method is especially helpful due to the lack of ambiguous statements on problems and the fact that variables can be quantified and fitted with results.

The tool would assist in making the research study understandable in terms of population intervention and outcomes and enhance the focus of the inquiry. The tool also makes sure that the intervention (staff education or protocol reinforcement) in the QI and DNP projects has a clear relationship with the measurable outcome (compliance rates, knowledge scores and fall incidence).

The fact that the Hicks framework compels one to align the clinical problem with the measurement of statistics is a strength of the framework. When a variable cannot be easily measured, then the question probably should be refined (Emsden et al., 2020). Nevertheless, the one weakness is that excessive strict compliance to pattern templates may occasionally simplify problems at systems levels. The issues of nursing practice usually include the multifactorial effect, and PICOT should be used thoughtfully but not in a mechanical way.

References

Emsden, C., Schäfer, U. B., Denhaerynck, K., Grossmann, F., Frei, I. A., & Kirsch, M. (2020). Validating a pain assessment tool in heterogeneous ICU patients: Is it possible?Links to an external site. Nursing in Critical Care, 25(1), 8–15.  https://onlinelibrary.wiley.com/doi/full/10.1111/nicc.12469 Links to an external site.

Gray, J. R., & Grove, S. K. (2020). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (9th ed.). Elsevier.

Miura, T., & Kanoya, Y. (2025). Fall risk assessment and prevention strategies in nursing homes: A narrative review. Healthcare, 13(4), 357.  https://doi.org/10.3390/healthcare13040357 Links to an external site.

Njong, G. F. (2025). Implementing Evidence-Based Strategies for Falls Prevention (Doctoral dissertation, Walden University).

Olatunbosun, M. (2025). Quality improvement project: Staff development for fall prevention in community living center

Post 2:

Alanazi et al. (2023) identified uncertainty of safety culture, missed nursing care, staffing levels, and quality indicators influencing patient fall rates. Khoja and Moosa (2023) addressed elevated fall rates despite the presence of established evidence-based prevention guidelines. Lastly, Bangura (2024) identified ongoing falls within a long-term care facility when standard precautions were still in place.

The problem in Alanazi et al. (2023) reflects a gap in knowledge because the purpose was to determine relationships between measurable variables by generating generalizable findings. Consequently, Khoja and Moosa (2023) address a gap in practice following inconsistent implementation best strategies. The project focused on improving adherence to the TIPS protocol within one organization. Bangura (2024) reflects a translation gap since available evidence required structured application.

The dependent variable in Alanazi et al. (2023) is the patient fall rate while independent predictors were staffing and missed care. Statistical modeling is used to determine strength and significance of associations. Khoja and Moosa (2023) had primary variable of fall rate per 1,000 patient days as measured before and after implementation of the TIPS initiative. The number of falls pre- and post-intervention was central variable in work by Bangura (2024).

The Hicks (2024) quality evaluation project asks whether retrospective evaluation of a CLABSI reduction program would demonstrate decreased infection rates. The tool is suitable because of explicit identification of outcome measures. Having defined timeframes and chi-square analysis strengthened internal comparison while supporting statistical evaluation. Nevertheless, the EBP question lacks full PICOT specificity. The comparison period and timeframe are not stated within the question minimizing clarity. Causal inference is also limited due to absence of control group.

References

Alanazi, F. K., Lapkin, S., Molloy, L., & Sim, J. (2023). The impact of safety culture, quality of care, missed care and nurse staffing on patient falls: A multisource association study. Journal of Clinical Nursing, 32(19–20), 7260–7272.  https://doi.org/10.1111/jocn.16792 Links to an external site.

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.

Hicks, T. D. (2024). Quality evaluation of a central line associated bloodstream infection reduction program [Doctor of Nursing Practice project, Walden University]. Walden University CAO Repository.

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