Please respond to the Discussions and also response to the peer discussions

DQ1

Submit a summary of six of your articles on the discussion board. (see articles attached). Discuss one strength and one weakness to each of these six articles onwhy the article may or may not provide sufficient evidence for yourpractice change.

DQ2

Name two different methods for evaluating evidence. Compare andcontrast these two methods.

Peer DQ1

Although many evidence-based researches studies have evaluateddifferent approaches for fall prevention, fall rate continues to be inhigher range in acute care facilities that is, approximately 3.3 to11.5 per 1000 patients per day in United States during their admission(Bouldin et al., 2013). Unintentional falls increase the financialburden to the health care facility by adding additional treatment costand increase the length of hospital stay of the patient (Sahota etal., 2013). To prevent those fall related incidence and financialburden different types of fall detection devices are invented and usedin health care facilities. However, due to lack of time and resourcesevidence-based research has not been conducted.

1. In a qualitative study by Chaudhuri, Thompson & Demiris(2014), authors analyzed the effectiveness of wearable andnon-wearable devices on fall prevention of elderly patients in thereal-world situation. The authors compiled and systematically analyzeddata from previously published papers on fall detection. They foundthat only a fraction of the elderly patients was interested in usingsuch devices; many were reluctant to use such devicesciting the privacy issues.

Strength- This article reviewed and examined the extent to whichfall detection devices have been tested in the real world.

Weakness- This review was limited to articles written in English andindexed in PubMed, CINAHL, EMBASE or PsycINFO and as such may haveomitted other relevant published studies.

2. In the quantitative article by Shorr et al. (2012), the authorsconducted a paired cluster-randomized trial to investigate whether theuse of bed alarm decreases the number of falls and fall-relatedinjuries in a hospital setting. Their result showed that overall, theintervention increased the use of alarm mechanism among the patients;however, did not have any clinically or statistically significanteffects on fall or fall-related events.

Strength- An intervention increased the use of alarm mechanism amongthe patients.

Weakness- The study was conducted at a single site and was slightlyunderpowered compared with the initial design.

3. In the article by Sahota et al. (2013), authors conducted arandomized controlled trial of bed and bedside chair pressure sensorsusing radio-pagers and found that it did not reduce the rate ofin-patient bedside falls, time to first bedside fall and are not costeffective in elderly patients in acute, general medical wards in the UK.

Strength- They conducted a randomized controlled trial of bed andbedside chair pressure sensors using radio-pagers (intervention group)compared with standard care (control group) in elderly patientsadmitted to acute, general medical wards, in a large UK teaching hospital.

Weakness- There was several limitations in a study that need to berecognized. The study was powered to detect a 35% reduction in therate of bedside falls, based on the sample size estimates from ourpilot study. It is possible that the intervention may be associatedwith a smaller reduction in bedside falls, which may have been missed.

4. In the article by Bouldin et al. (2013), fall and injurious fallprevalence varied by nursing unit type in US hospitals. They used datafrom the National Database of Nursing Quality Indicators (NDNQI)collected between July 1, 2006 and September 30, 2008 to estimateprevalence and secular trends of falls occurring in adult medical,medical-surgical and surgical nursing units. Over the 27-month study,there was a small, but statistically significant, decrease in falls(p<0.0001) and injurious falls (p<0.0001).

Strength- The strengths of this study include the large number ofnursing units reporting data and the national sample of hospitals.

Weakness- They did not assess practices among nursing units nor seekto identify unit characteristics associated with fall rates or changesin fall rates over time.

5.In the study by Quigley (2016), the evidence supports theimportance of determining specific risk factors and initiatingmultifactorial fall risk factors tailored to the individual. Yet,little evidence exists for single interventions, universal fallprevention strategies, and population-specific fall preventionstrategies. A review of the literature confirms the effectiveness ofmany fall prevention practices and interventions remains insufficient.Of particular concern are rehabilitation units in hospitals that havehigher fall rates compared to other acute units.

Strength- The strength of this article is identification of the bestpractice interventions to prevent falls on rehabilitation units.

Weakness- The views expressed in this article are those of theauthor and do not represent the views of rehab nurses.

6. Evidence of this review indicates patient-centered interventionsin addition to tailored patient education may have the potential to beeffective in reducing falls and fall rates in acute care hospitals.There is limited high quality evidence demonstrating the effectivenessof patient-centered fall prevention interventions so novel solutionsare urgently needed and warrant more rigorous, larger scale randomizedtrials for more robust estimates of effect (Avanecean et al., 2017).

Strength- This study evaluated the effectiveness of patient-centeredinterventions on falls in the acute care setting.

Weakness- Due to clinical and methodological heterogeneity among theincluded studies, a meta-analysis was not possible. The findings ofthis review have been presented in narrative form.

References,

Avanecean, D., Calliste, D., Contreras, T., Lim, Y., &Fitzpatrick, A. (2017). Effectiveness of patient-centeredinterventions on falls in the acute care setting: A quantitativesystematic review protocol. JBI Database of Systematic Reviews andImplementation Reports, 15(1), 55-65. Retrieved from https://journals.lww.com/jbisrir/Fulltext/2017/010…

Bouldin, E. D., Andresen, E. M., Dunton, N. E., Simon, M., Waters,T. M., Liu, M., … Shorr, R. I. (2013). Falls among adult patientshospitalized in the United States: Prevalence and trends. Journal ofPatient Safety, 9(1), 13. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC35722…

Chaudhuri, S., Thompson, H., & Demiris, G. (2014). Falldetection devices and their use with older adults: A systematicreview. Journal of Geriatric Physical Therapy, 37(4), 178- 196.Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC40871…

Sahota, O., Drummond, A., Kendrick, D., Grainge, M. J., Vass, C.,Sach, T., … Avis, M. (2013). REFINE (Reducing Falls inIn-patient Elderly) using bed and bedside chair pressure sensorslinked to radio-pagers in acute hospital care: A randomised controlledtrial. Age and Ageing, 43(2), 247-253. Retrieved from https://academic.oup.com/ageing/article/43/2/247/1…

Shorr, R. I., Chandler, A. M., Mion, L. C., Waters, T. M., Liu, M.,Daniels, M. J., … Miller, S. T. (2012). Effects of an interventionto increase bed alarm use to prevent falls in hospitalized patients: Acluster randomized trial. Annals of Internal Medicine, 157(10),692-699. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC35492…

Quigley, P. A. (2016). Evidence levels: applied to select fall andfall injury prevention practices. Rehabilitation nursing, 41(1), 5-15. doi/abs/10.1002/rnj.253

Peer DQ2

The article by Buckner and Read (2016) discusses that theold-fashioned observation method for hand hygiene compliance hasproved to be ineffective. Badge-based locating technology usinga real-time locating system provides continuous monitoring of handhygiene compliance, and offers valuable feedback that can becustomized by staff group, individual, room, or time. This studyevaluates the impact of implementing an automated badge-basedmonitoring system with individual feedback on hand hygiene compliancerates across numerous hospitals. The dramatic difference was notedbetween the compliance assessed through direct observation andbaseline compliance recorded by an automated system further supportsthe inaccuracy of direct observation. This study had alimitation of a small sample size, but provides the necessary supportfor the hand hygiene monitoring system in the department.

In a different article by Chang, Reisinger, Jesson, Schweizer, Morgan,Forrest, and Perencevich (2016), the authors discussed the physicalbarriers to low hand hygiene compliance and different ways that it canbe reduced. The gold standard was the direct observation forhand hygiene compliance upon entering and exiting patient roomsbecause of the availability of alcohol hand sanitizers. However,hand washing cannot be easily observed through direct observation andthis supports the need for hand hygiene monitoring system that willalso alert healthcare providers to wash their hands. This studyis limited to the description of the use of hand sanitizers ratherthan hand washing with soap.

Chassin, Nether, Mayer, and Dickerson (2015) worked on the qualityimprovement project using a Lean, Six Sigma method to improve handhygiene compliance in the organization. This articles providesvaluable information on various causes of the hand hygienenoncompliance in various facilities and possible interventions at thecauses. The article discusses a special tool that is used to initiatehand hygiene compliance project in clinical care settings.Healthcare organizations used the Targeted Solutions Tool to discoverspecific causes of hand hygiene noncompliance. This study isgreat because it discusses the Targeted Solutions Tool in depth andwill allow me to use it in our healthcare facility.

In the study by McCalla, Reilly, Thomas, and McSpedon-Rai (2017), theauthors described the relationship between hand hygiene compliance andhealthcare associated infections. It is imperative for healthcareorganizations to assess compliance by the hospital infection controlstaff. This article discusses the automated hand hygienecompliance system that was used as an alternative method to humanobservations. In this retrospection cohort design study,researchers concluded that personal observations of the hand hygienecompliance is not as effective as an electronic monitoringbadge. The rates of healthcare associated infections can besignificantly reduced with the electronic hand hygiene monitoringsystem.

In another study, the researchers examined the perceptions andbarriers to nonsurgical scrubbed hand hygiene in the operating roomand endoscopy procedure room using Likert-scale surveys (Pedersen etal., 2017). The results of the study showed poor role modelingand inconvenience are the two major reasons for low hand hygienecompliance rate. There is a need to monitor hand hygienecompliance and feedback from the monitors can provide reminders andimprove self-awareness of hand hygiene practices.

Szilagyi et al. (2013) researched the hand hygiene compliance usingthe World Health Organization five moments to assess hand hygienetechniques in various healthcare organizations. This articleprovides information on the hand hygiene education and assessmentprogram that was implemented in the hospital setting that includededucational stations to improve hand hygiene quality in healthcareproviders. This study supports the need for ongoing educationand training in improving hand hygiene compliance and technique ofclinical staff. The limitation of this study was the smallsample size and the educational program that was implemented in onlyone healthcare facility.

David

Buckner, J. B., & Read, M. (2016). Individual monitoringincreases hand hygiene compliance in multicenter registry utilizingbadge-based locating technology. AJIC: American Journal ofInfection Control, 44(Supplement), S94-S97. https://doi-org.chamberlainuniversity.idm.oclc.org…

Chang, N. N., Reisinger, H. S., Jesson, A. R., Schweizer, M. L.,Morgan, D. J., Forrest, G. N., & Perencevich, E. N. (2016).Feasibility of monitoring compliance to the My 5 Moments andEntry/Exit hand hygiene methods in US hospitals. American Journal ofInfection Control, pii: S0196-6553(16)00158-9. doi:10.1016/j.ajic.2016.02.007

Chassin, M. R., Nether, K., Mayer, C., & Dickerson, M. F.(2015). Beyond the collaborative: Spreading effective improvement inhand hygiene compliance. The Joint Commission Journal on Quality &Patient Safety, 41(1), 13-25.

McCalla, S., Reilly, M., Thomas, R., & McSpedon-Rai, D. (2017).Major Article: An automated hand hygiene compliance system isassociated with improved monitoring of hand hygiene. AJIC:American Journal of Infection Control, 45(1),492–497. https://doi-org.chamberlainuniversity.idm.oclc.org…

Pedersen, L., Elgin, K., Peace, B., Masroor, N., Doll, M., Sanogo,K., … Bearman, G. (2017). Barriers, perceptions, and adherence: Handhygiene in the operating room and endoscopy suite. American Journal OfInfection Control, 45(6), 695-697. doi:10.1016/j.ajic.2017.01.003

Szilagyi, L., Haidegger, T., Lehotsky, A., Nagy, M., Csonka, E.-A.,Sun, Z., … Fisher, D. (2013). A large-scale assessment of handhygiene quality and the effectiveness of the "WHO 6-steps".BMC Infectious Diseases, 13(1), 249. doi:10.1186/1471-2334-13-249

Peer DQ3

Handhygiene is recognized by infection prevention and controlexperts as the single most important intervention in decreasingthe spread of infection in both healthcare and communitysettings. Because the hands are vectors for transmission betweenpeople as well as inanimate objects such as environmentalsurfaces (i.e., blood pressure cuffs), it is critical topractice frequent hand hygiene using the traditional soap andwater or an alcohol-based hand rub as appropriate.

Summaryof six of your articles…..

1. Filho, M. A. O., Marra,A. R., Magnus, T. P., Rodrigues, R. D., Prado, M., de Souza Santini,T. R., … Edmond, M. B. (2014). Major article: Comparison ofhuman and electronic observation for the measurement of compliancewith hand hygiene. AJIC: American Journal of InfectionControl, 42, 1188–1192. https://doi-org.lopes.idm.oclc.org/10.1016/j.ajic….

Strength:Comparison of human and electronic observation for the measurementof compliance with hand hygiene for staff members.

Weakness:They only did a small sample size, there would be enoughevidence on the outcome.

2. Boyce, J. M. (2017). Stateof the Science Review: Electronic monitoring in combination withdirect observation as a means to significantly improve handhygiene compliance. AJIC: American Journal of InfectionControl, 45, 528–535. https://doi-org.lopes.idm.oclc.org/10.1016/j.ajic….

3. Vaidotas, M., Yokota, P. K.O., Marra, A. R., Sampaio Camargo, T. Z., Victor, E. da S., Gysi,D. M., … Edmond, M. B. (2015). Major article: Measuringhand hygiene compliance rates at hospital entrances. AJIC:American Journal of Infection Control, 43,694–696. https://doi-org.lopes.idm.oclc.org/10.1016/j.ajic….

Strength: Theycompared electronic handwash counters with the application ofradiofrequency identification (GOJOSMARTLINK) (electronic observer) that counts each activationof alcohol gel dispensers to direct observation (humanobserver) via remote review of video surveillance.

Weakness:Even though the GOJO system was useful in capturing real lifehand hygiene complaince at the resception area, this will notcapture everyone who enters the hospital. Thereare other entrances into the hosptial such as emergencyroom.

4. Knighton, S. C., McDowell, C., Rai,H., Higgins, P., Burant, C., & Donskey, C. J. (2017).Major Article: Feasibility: An important but neglected issuein patient hand hygiene. AJIC: American Journal ofInfection Control, 45, 626–629. https://doi-org.lopes.idm.oclc.org/10.1016/j.ajic….

Strength:Patient hand hygiene may be a useful strategy to prevent acquisitionof pathogens and to reduce the risk for transmission by colonizedpatients. Several studies demonstrate that patients andlong-term-care facility (LTCF) residents may have difficulty usinghand hygiene products that are provided; however, none of themmeasure feasibility for patients to use different hand hygiene products.

Weakness:This study can't expect eveyone to use the hand hygieneproducts. Soap and water works just fine if there are somealergic reactions to the products. This study wont be able to givegood data, there will be outliers.

5. Ibrahim Aliyu, Teslim O Lawal, WasiuOlawale, Kehinde Fasasi Monsudi, & Bashir Mariat Zubayr.(2018). Hand hygiene practices among doctors in healthfacility in a semi-urban setting. BLDE University Journalof Health Sciences, Vol 3, Iss 1, Pp 43-47 (2018), (1),43. https://doi-org.lopes.idm.oclc.org/10.4103/bjhs.bj…

Strength:The study was among doctors on proper hand washing and theimportance of good hand hygiene.

Weakness:The study didn't focus on other staff members in thedepartment, it only focued on the doctors.

6. Hosein Zakeri, Fatemeh Ahmadi, EhsanRafeemanesh, & Lahya Afshari Saleh. (2017). The knowledge ofhand hygiene among the healthcare workers of two teachinghospitals in Mashhad. Electronic Physician, Vol 9, Iss 8, Pp5159-5165 (2017), (8), 5159. https://doi-org.lopes.idm.oclc.org/10.19082/5159

Strength:Training all health care professionals on hand hygiene.

Weakness:The did the observation by visual observation only. They found outthat after the training, there were still alot of staff who wasnot doing proper hand hygiene. More education shouldhave been provided to the particpants of the study.

Peer DQ4

Submit a summary of six of your articles on the discussionboard. Discuss one strength and one weakness to each of these six articles onwhy the article may or may not provide sufficient evidence for your practicechange.

1)Windle, P. E. (2008).Addressing the Nurse Staffing Shortage. Journal of PeriAnesthesia Nursing, (3),209. Retrieved from https://lopes.idm.oclc.org/login?url=http://search…

·Strength:The article presents tremendous amounts ofdata regarding the nursing shortage as many new RN grad are not graduatingenough ti be able to fill the numerous vacancies at many healthcare facilities.

·Weakness: The articledoes not address experience or lack of it. Many position require years ofexperience but new nurse fresh out of school may lack such experience. Unlessthey are hired but a new Grad RN program where they are taught such skill itbecomes difficult to find quality work.

·This article does notprovide the rounded information needed to complete the research I need. This isjust one portion of the bigger whole needed to complete the writing.

2)Witzel,P. A., Smith, T. C., & Ingersoll, G. L. (2006). Staffing incentive programsto meet workforce shortage needs. Nurse Leader, 4, 46,55-48,55. https://doi-org.lopes.idm.oclc.org/10.1016/j.mnl.2…

·Strength: Presents ideas and incentives in orderto recruit and retain the nursing workforce.

·Weakness: This is limited to facilities thatactually promote incentives – not all facilities do this. This is not statewide nor country wide programs.

·This address only on portion of the problem. Iwill need other articles to complete the rest of the information needed. Thoughit does addressa mjor issue in the nursingfield.

·

3)Alban,A., Coburn, M., & May, C. (1999). Addressing the emergency nursing staffingshortage: Implementing an internship using a nursing school instructor model.Journal of Emergency Nursing, (6), 509. Retrieved from https://lopes.idm.oclc.org/login?url=http://search…

·Strength: Aware of specialty positon nurses andis offering internships programs to prepare new nurses to fill vacant positions

·Weakness: Many different specialties were notcovered that many students wanted to go over.

·This is a fantastic program to offer hospitalsfor the many different specialties.

4)Crackingthe books – Training entry-level employees may help to ease staffing shortagesfor hospitals. (n.d.). HOSPITALS & HEALTH NETWORKS, 78(7), 28. Retrievedfrom https://lopes.idm.oclc.org/login?url=http://search…

·Strength: New program designed to help entrylevel employees gain the experience and education the facility needs.

·Weakness:Problems getting funding, learning space, initial costs.

·This is a great program set to have newemployees grow confident in their skills and position and helps decreaseturnover rates.

5)Martin,C. J. (2015). The Effects of Nurse Staffing on Quality of Care. MEDSURGNursing, 24(2), 4–6. Retrieved from https://lopes.idm.oclc.org/login?url=http://search…

·Strength: Identifies the quality of serviceand patient outcomes is in direct correlationto staffing numbers

·Weakness:Does not discuss how to retain nurses nor how the turnover rate isregarding this program.

·A great article that provides qualityinformation regarding patient care bases on staffing levels.

6)Tate,C. W. (2006). Saviours or scapegoats? It is time to stop blaming agency stafffor the woes of the NHS and join forces to solve staffing shortages. NursingStandard, (40), 34. Retrieved from https://lopes.idm.oclc.org/login?url=http://search…

·Strength: The article provides info on qualityexperienced nurses to fill much needed open shifts that facilities desperatelyneed.

·Weakness: does not fully explain quality ofagency staff or provide in-depth info on quality of care.

·Provides limited info on agency quality of care.

Peer DQ5

The two types of evaluation methods of the evidence in researchstudies is systematic reviews and meta-analysis. According toliterature, systematic reviews provide explanations and answers toresearch questions through collecting and summarizing all the evidencethat fits into a specific eligibility criteria (PubmedHealth,2018). Systematic reviews identify, assess, and summarize theresearch findings of various scholarly studies that are relevant tothe topic of interest to assist researchers and clinicians indecision-making processes. The negative side of the systematicreview is that is needs enough data to make the necessary conclusion,in addition to the time it takes to analyze all the prior studies.

Meta-analysis on the other hand, uses statistical analysis tosummarize results of prior studies (Haidich, 2010). When morethan one study shows significant statistical results, thenmeta-analysis method would be the ideal method to evaluate the commontheme among them. Meta-analysis is considered an effectivemethod to evaluate evidence. The negative part of usingmeta-analysis is variations in the results of the studies that canmislead researcher to make improper conclusions on the prior research studies.

David

Pubmed Health. (2018). What is a Systematic Review?Retrieved from https://www.ncbi.nlm.nih.gov/pubmedhealth/what-is-…

Haidich, A. B. (2010). Meta-analysis in medical research.Hippokratia, 14(Supp 1), 29-37.

Peer DQ6

Qualitative research is often used for exploring.It helps researchers gain an understanding of underlying reasons,opinions, and motivations. It provides insights into the problem orhelps to develop ideas or hypotheses for potential quantitativeresearch. Qualitativedata collection methods vary using unstructured or semi-structuredtechniques. Common methods include focus groups, individualinterviews, observation or immersion, and diary studies. Thesample size is typically small, and respondents are selected tofulfill a given quota.

Quantitative research is used to quantify theproblem by way of generating numerical data that can be transformedinto useable statistics. It is used to quantify attitudes, opinions,behaviors, and other defined variables, and generalize results froma larger sample population. Quantitative research uses measurabledata to formulate facts and uncover patterns in research.Quantitative data collection methods are much more structured; theyinclude various forms of surveys – online surveys, papersurveys, mobile surveys and kiosk surveys, face-to-face interviews,telephone interviews, longitudinal studies, website interceptors,online polls, and systematic observations

Twomethods of evaluating evidence are: Qualitative researchmethod and Quantitative research method

Compare between qualitative andquantitative analysis:

• Bothare methods of research
• Bothare limited by variables
• Bothare applicable in the study of similarphenomenon
• Bothare dependent on the researcher who chooses the type ofinformation to gather and how to interpret thedata

Contrastbetween qualitative and quantitative analysis:

• Qualitativeresearchrelies primarily on inductive process in formulating hypotheses.On the contrary quantitative research depends on deductiveprocess.
• Qualitativeresearch methods include focus groups, interviews, and reviews ofanalysis. Quantitative research include surveys, structuredinterviews, and observations.
• Qualitativeresearch is text-based whereas Quantitative research isnumber-based.
• Qualitativeresearch has unstructured or semi-structured response optionswhile the former has fixed response options
• Qualitativeresearch lacks statistical tests whereasstatistical tests are used foranalysis
• Qualitativeresearch less generalizablewhile Quantitativeresearch generalizable

References:

Wienclaw,R.A.(2013).QuantitativeandQualitativeAnalysis.ResearchStarters:Sociology(OnlineEdition).Retrievedfrom https://lopes.idm.oclc.org/login?url=http://search…