Problem Statement (PICOT)

Assessment 2 Instructions: Problem Statement (PICOT)INT

  • Develop a 5-9 page problem statement that presents information related to the problem-intervention-comparison-outcome-time (PICOT) approach to nursing research. 

You will also be required to submit your completed practicum hours using CORE ELMS. You must submit a minimum of 20 confirmed hours with each assessment deliverable to receive a grade for the entire assessment.

Introduction

Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.

For the first section of your final capstone project you will develop a proposal for an intervention plan to fulfill a need within a specific population. This assessment is meant to capture your initial thoughts about the need and impacting factors to help focus your in-depth analysis later on in the course.

First you will brainstorm and crystallize some of your ideas for this assessment, specifically ideas around needs, a target population, and some initial support from the literature and other sources of evidence. The problem statement is an important part of your capstone project as it will help illustrate the importance of your project, as well as help to clarify your project’s scope.

Preparations

    • Read Guiding Questions: Problem Statement (PICOT) [DOC]. This document is designed to give you questions to consider and additional guidance to help you successfully complete this assessment.
    • As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.
      • As you reflect on your work in the field, what population do you feel has the greatest need? Why? Is the need across the population, or within a specific setting?
      • What interventions already exist for the selected population? Are they effective? Why or why not?
      • How will site support from your practicum and your preceptor support your goals and objectives?

Instructions

Note: The assessments in this course are sequenced in such a way as to help you build specific skills that you will use throughout your program. Complete the assessments in the order in which they are presented.

Your problem statement will focus on presenting information related to the problem-intervention-comparison-outcome-time (PICOT) approach to nursing research. You will also present a brief literature review that supports the need you identified in your problem statement and the appropriateness of your broad intervention approach. Provide enough detail so that the faculty member assessing your problem statement will be able to provide substantive feedback that you will be able to incorporate into the other project components in this course, as well as into the final draft of your project.

At minimum, be sure to address the bullet points below, as they correspond to the grading criteria. You may also want to read the scoring guide and the Guiding Questions: Problem Statement (PICOT) document (linked above) to better understand how each criterion will be assessed.

Reminder: these instructions are an outline. Your heading for this this section should be titled Problem Statement and not Part 1: Problem Statement.

Your Problem Statement (PICOT) should be structured as follows:

PART 1: PROBLEM STATEMENT (2–3 PAGES)

Need Statement (1 paragraph).

    • Analyze a health promotion, quality improvement, prevention, education or management need.

Population and Setting (1–2 paragraphs).

    • Describe a target population and setting in which an identified need will be addressed.

Intervention Overview (1–2 paragraphs).

    • Explain an overview of one or more interventions that would help address an identified need within a target population and setting.

Comparison of Approaches (1–2 paragraphs).

    • Analyze potential interprofessional alternatives to an initial intervention with regard to their possibilities to meet the needs of the project, population, and setting.

Initial Outcome Draft (1 paragraph).

    • Define an outcome that identifies the purpose and intended accomplishments of an intervention for a health promotion, quality improvement, prevention, education, or management need.

Time Estimate (1 paragraph).

    • Propose a rough time frame for the development and implementation of an intervention to address and identified need.

PART 2: LITERATURE REVIEW (10–15 RESOURCES, 3–6 PAGES)

    • Analyze current evidence to validate an identified need and its appropriateness within the target population and setting.
    • Evaluate and synthesize resource from diverse sources illustrating existing health policy that could impact the approach taken to address an identified need.

ADDRESS GENERALLY THROUGHOUT

    • Communicate problem statement and literature review in way that helps the audience understand the importance and validity of a proposed project.

Practicum Hours Submission

You have been tracking your completed practicum hours each week using the CORE ELMS. By placing the hours into CORE ELMS, you will ensure you are accumulating all hours that are needed to meet the requirements for your specialization and degree. 

Submit your CORE ELMS practicum hours tracking log showing a minimum of 20 confirmed hours per assessmentReminder: Only confirmed hours will be considered for grading.

You will not receive a grade for this assessment without a practicum hours log showing a minimum of 20 confirmed hours for the time period of this assessment. Your faculty will review your hours to date and will contact you if he or she has any questions or concerns.

Additional Requirements

    • Length of submission: 5–9 double-spaced pages.
    • Number of resources: 10–15 resources. (Your final project summation will require 12–18 unique sources across all sections.)
    • Written communication: Written communication is free of errors that detract from the overall message.
    • APA formatting: Resources and citations are formatted according to current APA style. Header formatting follows current APA levels.
    • Font and font size: Times New Roman, 12 point.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

    • Competency 1: Lead organizational change to improve the experience of care, population health, and professional work life while decreasing cost of care.
      • Explain an overview of one or more interventions that would help drive quality improvement related to an identified need within a target population and setting.
    • Competency 2: Evaluate the best available evidence for use in clinical and organizational decision making.
      • Analyze a health promotion, quality improvement, prevention, education, or management need.
      • Analyze current evidence to validate an identified need and its appropriateness within the target population and setting.
    • Competency 3: Apply quality improvement methods to impact patient, population, and systems outcomes.
      • Describe a quality improvement method that could impact a patient, population, or systems outcome.
    • Competency 4: Design patient- and population-centered care to improve health outcomes.
      • Propose a rough time frame for the development and implementation of an intervention to address an identified need.
    • Competency 5: Integrate interprofessional care to improve safety and quality and to decrease cost of care.
      • Analyze potential interprofessional alternatives to an initial intervention with regard to their possibilities to meet the needs of the project, population, and setting.
    • Competency 6: Evaluate the ability of existing and emerging information, communication, and health care technologies to improve safety and quality and to decrease cost.
      • Evaluate and synthesize resources from diverse sources illustrating existing health policy, health care technologies, or other communications that could impact the approach taken to address an identified need.
    • Competency 7: Defend health policy that improves the experience of care, population health, and professional work life while decreasing cost of care.
      • Define an outcome that identifies the purpose and intended accomplishments of an intervention for a health promotion, quality improvement, prevention, education, or management need.

Note: You will also be assessed on two additional criteria unaligned to a course competency:

    • Communicate problem statement and literature review in a way that helps the audience to understand the importance and validity of a proposed project.
    • Demonstrate completion of hours toward the practicum experience.

See the scoring guide for specific grading criteria related to these additional requirements.

 

Answer

 

Problem Statement (PICOT)

Healthcare institutions/organizations face various issues affecting the quality of care, patient and overall organizational outcomes. Therefore, the organization needs to be assessed to identify these issues and develop interventions or solutions to address them. However, sometimes there are interventions that are already in place to address the problem, but they fail to address the issue adequately. Therefore, it is essential to identify and propose other interventions as solutions to the problem. The problem of focus in this assessment is patient falls at RML specialty hospital- a long-term center. The proposed project aims to introduce an educational program to nurses and patients to prevent patient falls and fall-related injuries in the institution. This assessment will construct a problem statement and review the literature to support the problem and the need to address the problem.

Problem Statement

Need Statement

Patient falls, especially among older hospitalized patients, are a major patient safety and quality improvement issue that is common in healthcare settings since they are used as one of the measures of nursing care quality. Patient falls are defined as the unintended descent to the floor, which makes the patient sustain minor or major injuries. According to Vaishya and Vaish (2020), falls among elderly hospitalized patients are a major issue since they are mainly associated with an increased hospital stay, loss of independence for the elderly patient, reduced quality of life, and chronic pain. There is a need to prevent falls among the elderly hospitalized patient population in the institution, thus reducing falls-related injuries and other patient issues related to patient falls. The proposed project addresses the patient falls problem among elderly patients at RML specialty hospital-acute center. Addressing the need to prevent patient falls in this setting is vital since it will show improved nursing care quality and patient outcomes/quality of life.

Population and Setting

The target population in the proposed project is the elderly hospitalized patient population. Research shows that elderly hospitalized patients across different departments and units are the population most affected by patient falls (Pitchai et al., 2019). Additionally, geriatric patients lead to minor and major injuries, such as fractures, lacerations and internal bleeding. These injuries are associated with increased healthcare services utilization, healthcare costs, and poor patient/overall organizational outcomes. Therefore, it is vital to address the need to prevent patient falls among the elderly patient population.

The target healthcare setting is an RML specialty hospital long-term acute care center. Long-term care settings are known to report high numbers of patient fall cases (Shaw et al., 2019). Similarly, the target setting has been reporting increased patient falls, especially among elderly patients, despite the measures put in place to prevent falls among this population. Addressing the patient falls prevention needs in this setting will help improve the overall organizational outcomes/performance, nursing care quality, and quality of life for senior patients. The analysis of the need, patient population and setting is based on the assumption.

Intervention Overview

Various evidence-based interventions can be applied to address the identified need. One of the quality improvement interventions to achieve improved outcomes within the target population and setting is an educational program aimed at educating the nurses and the patients on how to effectively prevent patient falls. According to Heng et al. (2020), one of the ways to prevent and mitigate patient falls among geriatric patients is patient education aimed at awareness creation and increasing knowledge on fall prevention. The intervention is appropriate for addressing the target population’s needs and setting since some patients fall due to inappropriate prevention knowledge. Additionally, nurses require staff development and education to inform them of the new evidence-based and best-practice interventions to prevent patient falls. A disadvantage of educational programs is that they may not benefit patients with neurological conditions that limit them from learning. More so, educating the nurses and patients a lot of time.

Comparison of Approaches

Other interventions/approaches can produce the desired outcomes in the target population and setting. One of them is using the patient falls risk assessment tools. Different fall-risk assessment tools are available to assist healthcare providers in assessing patients’ fall risk and therefore plan on preventing and managing falls on occurrence (LeLaurin & Shorr, 2019). Patient falls risk assessment tools encourage Interprofessional care approaches compared to educational programs since the risk assessment results are used by all the care providers in the team to prevent patient falls. Additionally, the intervention fits the target setting and population compared to patient education since most geriatric patients have low educational capacity, and thus a risk assessment can be more effective in preventing patient falls.

Initial Outcome Draft

The expected outcome of implementing the intervention in the proposed project is to reduce the number of reported patient fall cases in the institution. Reducing the number of patient falls reported in the institution will also improve the quality of care, patient safety, and care experience. The outcome can be evaluated by a comparison of the number of patient falls reported before and after the implementation of the proposed intervention.

Time Estimate

The development and implementation of the intervention to address the patient falls need in the institution is estimated to take approximately ten weeks. The potential challenges that may impact the time frame and affect the development and implementation of the intervention include inadequate collaboration from the Interprofessional team and lack of buy-in and support from the leaders and managers of the target institution.

Literature Review

According to Jia et al. (2019), patient falls among elder adults have been a major patient safety issue. Research shows that patient falls among older adults are a significant cause of death globally since the global burden of patient falls is substantial, with the highest incidence and prevalence rates reported among older adults (Vaishya & Vaish, 2020). Falls increase the disease burden, especially among hospitalized older adults and more so adults with chronic self-reported chronic illnesses such as diabetes, stroke and depression. Fall patients have lower health-related quality of life, increased mortality, and Quality Adjusted Life Years (QALY). Additionally, falls are known to lead to widespread disability and have other social consequences, such as loss of independence. Therefore, falls are a major problem among the elderly adult population, with more than 10% recording multiple falls annually. They will continue to increase the health burden as the populations age if the necessary precautions are not taken to prevent them (Jia et al., 2019).

The prevalence of patient falls among older adults currently ranges from 27.1%- 34.8% (Lan et al., 2020). Falls among adults in this population are mainly associated with frailty, which increases the risk of patient falls. The majority of patient fall incidences are in nursing homes and other long-term care facilities. However, even elderly adults in the community and those receiving homecare services report falls. Elderly adults at home, especially adults living alone, fall due to inadequate precaution and prevention measures (Cunha et al., 2019).

Furthermore, falls among hospitalized patients in long-term care facilities and acute settings increase the healthcare burden on individuals, families, and healthcare systems due to minor and major injuries. The most common injuries sustained by elderly patients after falls include hip, wrist, humerus and pelvis fractures. As mentioned earlier, sustained injuries lead to increased hospital length of stay, chronic pain and poor health-related quality of life, among other issues. Additionally, patient falls among older adults increase medical costs since internal and external injuries must be treated. Older adult patients require screenings and surgeries following falls.

The other significant effect of patient falls among elderly hospitalized patients is the cognitive and psychological effects of these patients sustaining head/brain injuries that impact their neurological functions. More so, the psychological impact of patient falls includes increased fear of subsequent falls, anxiety, and confidence in balance (Giovannini et al., 2022).

Research evidence supports the appropriateness of addressing the patient falls prevention need within the target population and setting due to the increased risk factors related to patient falls. Elderly hospitalized patients have increased risks of patient falls. According to Kiyoshi-Teo et al. (2019), the risk factors related to patient falls include age-related problems such as loss of muscle mass, difficulties in maintaining balance, and postural hypotension. Other risk factors are associated with falls among older patients in long-term care settings. Ha et al. (2021) note that the factors associated with inpatient and outpatient older adults include urinary incontinence, COPD, having more than three comorbidities, alcohol consumption, using psychotropic medications, and mobility impairment.

Furthermore, research shows that various preventive measures have been developed to address the issue of patient falls among hospitalized older adults. These measures are implemented in inpatient and outpatient settings such as homecare settings. The two major types of preventive measures used among older adult populations are exercise and multifactorial interventions. Other interventions, such as fall prevention and self-management education, also exist. The outcomes and applicability of these preventive measures differ due to health conditions and age issues. For instance, some patients may be unable t exercise due to frailty and other health condition limitations. Additionally, patients with neurocognitive deficiencies may not necessarily use the patient education measures due t the inability to learn (Wu et al., 2022)

The literature reviewed above is current, including sources published within the last five years. It is also relevant since it entails studies focusing on only older hospitalized adults. It is also trustworthy and sufficient since most of the studies used are randomized controlled trials and systematic reviews published in reputable journals. However, it is worth noting that locating literature to support the need and the appropriateness to address the need for patient fall prevention in long-term care facilities is challenging since patient fall cases in some care facilities are underreported. Therefore, there is limited information on the prevalence and incidence of patient falls in these population and healthcare settings, thus providing gaps in literature evidence. Therefore, patient falls among hospitalized elderly patients is a need that is heavily felt, based on the evidence presented in the literature, and thus should be addressed.

Literature Synthesis on the Impact of Healthcare Policy and Technology in Addressing the Need to Prevent Patient Falls in the Target Population and Setting

Health policy significantly impacts the approach selected to address the patient falls need in the target population and setting. By 2030, the number of people older than 65 will be more than the number of people in other age populations, including those below five. Therefore, healthcare policies have been developed to meet the healthcare needs of aging populations with time. Better health and health care for adults is one of the healthcare policies (Fulmer et al., 2021) that aims at addressing the healthcare needs of aging populations (2019), including putting in place preventive measures to reduce health risks such as patient falls (Singh et al., 2020). Healthcare institutions have institutional policies on the prevention of patient falls, which guide the approach taken to address the issue.

According to Singh et a. (2020), fall prevention management and procedures in healthcare institutions can be categorized into three; Pre-fall policies and procedures, post-fall policies and procedures, and communication between and amongst staff, patients and family members. The approach selected to prevent patient falls in the target institution will therefore depend on the institutional policy on patient falls prevention and be implemented according to the clinical practice guidelines employed in the institution. Based on the pre-fall policies and procedures on patient falls, the selected approach to education to nurses and patients to help them take necessary precaution to prevent falls should include the definition of falls (Singh et al., 2020) and awareness creation on patient falls risks (Montero-Odasso et al., 2021). Additionally, educational programs on patient falls, especially those focusing on educating older patients, should consider the various patient education needs of the target patient population, including health literacy, language and the appropriate educational level for the patient population (Fulmer et al., 2021; Singh et al., 2020).

Healthcare policies on the use of technology in the prevention of patient falls also exist. Recently, technology-based applications have been introduced in healthcare to obtain superior patient care outcomes and experience via efficiency, access, and reliability. These applications are widely used among older hospitalized patients, especially in acute care settings and long-term care facilities (Oh-Park et al., 2021). Some technologies used to prevent patient falls in healthcare settings include wearable sensors, movement detectors, cross-fall prevention intervention systems, and Modern Technology against fall interventions, among others. The government and other healthcare organizations recommend that healthcare institutions put in place healthcare technology to prevent patient falls (Oh-Park et al., 2021) and ensure that the technology is safe for the patient to use (Singh et al., 2020), and does not cause more harm to the patient while preventing falls (Montero-Odasso et al., 2021).

Furthermore, communication between and among the Interprofessional team is essential to address patient falls prevention needs. The Interprofessional team that must work together to facilitate the educational program for nurses and patients includes healthcare leaders, doctors, nurses and various specialists. Communication will enable the team to work together to ensure the program works effectively. For instance, the institution leaders will provide the necessary materials and funds to facilitate the educational program, while the doctors will run the program by playing the educating role.

However, the evaluation and synthesis are based on the assumption that all healthcare institutions, especially long-term care and acute settings, have the necessary institutional policies developed based on the recommended government policies and practice guidelines. However, information on evaluating the application of the available policies and practice guidelines on patient fall prevention is missing, hence deficits in the evaluation.

Conclusion

Patient falls are significant care quality and safety issues across different health populations. Falls lead to undesirable patient outcomes, increased healthcare costs, and reduced health-related quality of life. Older adults have a high prevalence of patient falls, mainly due to the related risk factors emphasized by age. Therefore, the need to address the prevention of patient falls, especially among hospitalized older adults, is vital. The literature review and synthesis show that patient falls among older adults are a significant health issue. Approaches to address the need to prevent patient falls should consider the necessary policies and practice guidelines. They can also use available healthcare technology to address the need. The proposed project will entail introducing an educational program to teach nurses and patients to maintain the necessary precautions to prevent falls. Deficiencies in literature and missing information have also been identified in the literature review and synthesis above.

 

References

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Vaishya, R., & Vaish, A. (2020). Falls in Older Adults are Serious. Indian Journal of Orthopaedics54(1), 69–74. https://doi.org/10.1007/s43465-019-00037-x

Wu, Y., Gu, Y., Rao, X., Cheng, M., Chen, P., & He, L. (2022). Clinical effects of outpatient health education on fall prevention and self-health management of elderly patients with chronic diseases. Evidence-Based Complementary and Alternative Medicine, 2022, 1–9. https://doi.org/10.1155/2022/6265388

 

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