Discussion: NURS 3150 Choosing the Type of Research for a Research Problem Example
Part 1: Patient Safety Problem
The patient safety problem identified is the impact of prolonged bed rest on post-cardiac surgery patients, particularly in the context of the cardiovascular intensive care unit (CVICU). Prolonged immobility after cardiac surgery is associated with complications such as deep vein thrombosis (DVT), pleural effusions, nosocomial infections, pressure injuries, and ICU delirium (Jacobs et al., 2021). These complications can lead to extended ICU stays and hinder patients’ physical and mental recovery.
A specific change in practice to address this issue is the implementation of a group approach to turning patients. The establishment of turn teams, as seen in COVID ICUs, allows for efficient and timely patient turning, reducing the physical demand on individual nurses. This change aims to enhance early mobility and decrease the risk of post-surgical complications, contributing to improved patient outcomes (Jacobs et al., 2021).
Part 2: Research on Patient Safety Problem
Research Question:
Does utilizing a group approach to turning patients increase compliance with early mobility efforts in the CVICU?
The type of research that would be most suitable for this question is qualitative with a phenomenological design. Qualitative research allows for an in-depth exploration of individual experiences, attitudes, and perceptions (Gray & Grove, 2021). In this case, understanding the ICU nurse’s experience and identifying potential barriers to early mobility compliance is crucial. Phenomenological design specifically focuses on exploring the essence of lived experiences, providing valuable insights into the subjective aspects of the practice change (Gray & Grove, 2021).
Quantitative research, which focuses on numerical data and statistical analysis, may not be the best fit for this question. The effectiveness of the group approach depends on individual opinions, cultural factors within the unit, and personal preferences, making qualitative methods more appropriate for capturing these nuances (Gray & Grove, 2021).
By utilizing qualitative research, the study can delve into the perceptions of nurses regarding the group approach, uncovering factors that may contribute to or hinder compliance with early mobility efforts. This insight can inform future strategies and interventions to optimize the implementation of the practice change and ultimately improve patient outcomes.
References:
Jacobs, P., Gupta, P., Shiju, S., Omar, A. S., Ansari, S., Mathew, G., … Surendran, P. (2021). Multidisciplinary, early mobility approach to enhance functional independence in patients admitted to a cardiothoracic intensive care unit: a quality improvement program. BMJ Open Quality, 10(3). https://doi.org/10.1136/bmjoq-2020-001256
Gray, J., Grove, S. (2021). Burns and Grove’s The Practice of Nursing Research: Appraisal, Synthesis and Generation of Evidence. Elsevier Inc.
Response to Colleague 1:
Your identification of the patient safety problem related to falls in the emergency department is crucial, given its impact on patient outcomes and healthcare costs. The multifaceted approach you suggested, incorporating communication, protocols, and standardization of work, addresses the complexity of the issue. The emphasis on high-risk patient populations and the recognition of environmental factors contributing to falls demonstrate a comprehensive understanding.
The proposed change in practice involving communication through signage is practical and focuses on creating a visual reminder for both staff and patients. Your rationale for choosing this change, considering the dynamic and fast-paced nature of the emergency department, is well-founded. Additionally, your consideration of the brief duration of patient stays and the need for concise fall prevention measures aligns with the unique challenges of the emergency setting.
Your research question, exploring the effectiveness of fall-risk signage in reducing falls, is clear and focused. The use of quantitative research, particularly experimental research, is apt for assessing the impact of this specific practice change. The emphasis on incident rate metrics, Electronic Reporting System (ERS) reports, and staff surveys provides a well-rounded approach to data collection.
Overall, your thoughtful analysis and proposed solutions contribute significantly to addressing the patient safety problem of falls in the emergency department.
References:
Cook, N. S., Komansky, B. J., & Urton, M. S. (2020). Do no harm: A multifactorial approach to preventing emergency department falls—A quality improvement project. Journal of Emergency Nursing, 46(5), 666–674. https://doi.org/10.1016/j.jen.2020.03.007
Response to Colleague 2:
Your identification of unintentional falls as a patient safety problem, particularly among the elderly population, highlights a critical issue in healthcare. The comprehensive understanding of the causes, including medication-related factors, patient demographics, and communication challenges, provides a well-rounded view of the problem. The emphasis on the high nurse-to-patient ratio and poor communication contributing to increased falls underscores the importance of addressing systemic issues.
The proposed change in practice involving standardized fall prevention measures, including communication through signage, is well-considered. The emphasis on continuous fall risk and mobility assessments, along with the implementation of assistive devices, aligns with evidence-based practices for fall prevention. The recognition of the brief duration of emergency department stays and the need for concise fall prevention protocols is insightful.
Your research question, exploring the effectiveness of a fall prevention bundle consisting of hourly rounding, bedside alarms, and nurse training, is clear and relevant. The choice of quantitative research, particularly randomized controlled trials (RCTs), aligns with the need to establish causation and gather robust evidence. The emphasis on blinding and randomization further strengthens the study design.
Overall, your analysis and proposed solutions provide a comprehensive and evidence-based approach to addressing the patient safety problem of falls in the emergency department.
References:
Fehlberg, E.A., Lucero, R.J., Weaver, M.T., McDaniel, A.M., Chandler, M., Richey, P.A., … Shorr, R. I. (2017). Impact of the CMS no-pay policy on hospital-acquired fall prevention related practice patterns. Innovation in Aging, 1(3), 1-7. http://dx.doi.org/10.1093/geroni/igx036
Gray, J.R., & Grove, S.K. (2021). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence, 9th ed. Elsevier.
Guirguis-Blake, J., Michael, Y., Perdue, L., Coppola, E., & Beil, T. (2018). Interventions to prevent falls in older adults. JAMA, 319(16), 1705. https://doi.org/10.1001/jama.2017.21962
Melnyk, B.M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice, 5th ed. Wolters Kluwer.
Venema, D.M., Skinner, A.M., Nailon, R., Conley, D., High, R., & Jones, K.J. (2019). Patient and system factors associated with unassisted and injurious falls in hospitals: An observational study. BMC Geriatrics, 19(348), 1-10. https://doi.org/10.1186/s12877-019-1368-8
Assignment Brief: NURS 3150 Choosing the Type of Research for a Research Problem Example
Overview:
In this assignment, you will explore the critical aspect of selecting the appropriate type of research to address a patient safety problem in a healthcare setting. The focus will be on identifying a clinical practice problem related to patient safety, proposing a change in practice, and developing a research question to investigate the effectiveness of the proposed change.
Understanding Assignment Objectives:
The primary objectives of this assignment are to:
- Identify a patient safety problem: Choose a clinical practice problem related to patient safety that you have encountered in your current or past job within a healthcare setting. Consider the causes of the problem and its impact on patient outcomes.
- Propose a change in practice: Based on the identified patient safety problem, suggest a specific change in clinical practice that could help improve patient outcomes. Consider the feasibility and relevance of the proposed change.
- Develop a research question: Formulate a research question that aims to assess the effectiveness of the proposed change in practice. Utilize principles from Chapter 5 of the textbook and the provided handout on developing research questions to create a clear and focused research inquiry.
- Choose the type of research: Explore the different types of research outlined in Chapter 5 of your textbook, considering their characteristics and applications. Select the type of research that aligns best with your research question and the nature of the proposed change in practice.
The Student’s Role:
As a nursing professional, your role is to draw upon your experiences in healthcare to identify a relevant patient safety problem. Reflect on the potential causes of the problem and envision a practical change in clinical practice that could positively impact patient outcomes. Formulate a research question that will serve as the foundation for your study.
Your critical thinking skills will be essential in selecting the most suitable type of research to answer your research question. Consider the characteristics of qualitative and quantitative research methods, and weigh the appropriateness of each in the context of your specific inquiry.
Ensure that your response is well-supported with evidence, incorporating relevant concepts from the textbook and additional sources if needed. Demonstrate clarity and coherence in your writing, adhering to the assignment guidelines for word count and citation style.
This assignment aims to enhance your ability to link real-world clinical problems with research methodologies, fostering a deeper understanding of how research can contribute to positive changes in healthcare practices.
Original Assignment Instructions: Assessment Description
NURS 3150 Choosing the Type of Research for a Research Problem
How do you choose the type of research to conduct to address a research problem? What information should you keep in mind to ensure that your research process will adequately address your research problem?
Understanding the different types of research is a critical skill for the nurse researcher and nursing professional. As a current nursing professional, consider how understanding the different types of research may be conducive to achieving a particular mission in your health care setting, such as developing an intervention to address a quality or patient safety problem. This knowledge can also be a step toward assuming a nursing leadership position. As a critical component of your nursing toolkit, differentiating between the types of research is a fundamental step toward enacting change through the process of research.
For this Discussion, please review the following:
Think about clinical practice problems you have seen in health care that compromise patient safety and health outcomes. For example, nursing-sensitive indicators reflect high-priority practice problems, which are described in the article by McIntyre, Cover, and Bonner (2019).
Choose one of the clinical practice problems you have seen in your current or past job in a health care setting. Consider the possible causes of this problem and how you think it is, or was, affecting patient outcomes.
Some patient safety problems are solved by making changes in clinical practice. For example, decreasing catheter-associated urinary tract infections in hospitalized patients often requires changes in clinical practice such as better adherence to preventive measures when catheters are inserted (e.g., use of disposable gloves, maintaining sterile fields, cleansing urethral meatus). For the problem you identified, what specific change in practice do you think is needed?
When a practice change is implemented, it is important to verify whether or not the change has improved patient outcomes. One way to determine this is by conducting research. One of the first steps in the research process involves developing a research question that will later serve as the foundation for your study. Using information from Chapter 5 in your textbook and the handout on developing research questions, think about a research question and about the effectiveness of the practice change you proposed in improving patient outcomes.
Another step in the research process involves identifying which type of research could be conducted to best answer your research question. In Chapter 5 of your textbook you will find a list of different types of research in the first column in Table 5.1 and Table 5.2. You can learn more about these different types of research in both Chapter 2 and the Glossary in your textbook. To locate even more information, you can also use an Internet search engine for more in-depth descriptions and examples. After learning more about the different types of research, think about which one you think is best for determining how well the clinical practice change you identified will improve patient outcomes.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
BY DAY 3
Post a description of how you would address the following:
Part 1: Patient Safety Problem
Describe the patient safety problem you identified, its causes, and the impact you think it has on patient outcomes. For this problem, describe a specific change in practice that could help improve patient outcomes.
Part 2: Research on Patient Safety Problem
Develop a research question that tests the effectiveness of your practice change in the improvement of one or more patient outcomes. What type of research would you use to answer this question? Describe the reasons why you think this is the best approach and why you would not use the other three types of research.
Note: Post a 3-paragraph (at least 350 words) response. Be sure to use evidenceLinks to an external site., in-text citationsLinks to an external site., and essay-levelLinks to an external site. writing skills, including the use of transitional materialLinks to an external site. and organizational framesLinks to an external site. Use the writing resources and the Discussion Rubric to develop your post.
Main Post
For post-cardiac surgery patients, early mobility is critical to avoiding complications of surgery and for the promotion of healing. The following complications are a few that are exacerbated by prolonged bed rest: development of deep vein thrombosis (DVT), pleural effusions, various nosocomial infections, pressure injury to the skin, and ICU delirium. These complications prolong ICU stay and affect the patients physically and mentally, slowing their progression of recovery (Jacobs et al., 2021). However, the opposite is true of early mobilization post-cardiac surgery. Early mobility has been shown to reduce the risk of post-surgical complications, reduce overall hospital stay/cost, and decrease ICU delirium (Jacobs et al., 2021)
Many strategies have been used to promote early mobility in the CVICU setting. The creation of turn teams is one example. Turns teams were utilized in COVID ICUs to reduce physical demand on the primary nurse and to efficiently facilitate placing patients in the prone position per ARDS protocol. After COVID, this concept was utilized in the ICUs to address pressure injury and early mobility. Six groups consisting of 2 staff nurses were assigned a time (800,1000,1200,1400,1600,1800) to turn all the patients in the unit at the assigned time. This process was also mirrored on the night shift. This allowed the primary RN to have their patients turned every two hours, and they did not have to facilitate that turn each time.
Because it is established that early mobility effectively improves outcomes, the question is: Does utilizing a group approach to turning patients increase compliance with early mobility efforts in the CVICU? The type of research that could be used for this question is qualitative with a phenomenological design because it explores the experience of the ICU nurse and barriers to early mobility compliance (Gray & Grove,2021. p. 118). It looks at the experience of individual nurses and examines if the group approach is more efficient in obtaining early mobility compliance. Because the results will depend on individual opinions, the culture of the studied unit, and personal preferences, other study methods relying on data and numerical results would not be best for this type of question (Gray & Grove 2012)
References
Jacob, P., Gupta, P., Shiju, S., Omar, A. S., Ansari, S., Mathew, G., Varghese, M., Pulimoottil, J., Varkey, S., Mahinay, M., Jesus, D., & Surendran, P. (2021). Multidisciplinary, early mobility approach to enhance functional independence in patients admitted to a cardiothoracic intensive care unit: a quality improvement program. BMJ Open Quality, 10(3). https://doi.org/10.1136/bmjoq-2020-001256Links to an external site.
Gray, J. Grove, S. (2021). Burns and Grove’s The Practice of Nursing Research: Appraisal, Synthesis and Generation of Evidence. Elsevier Inc.
BY DAY 7
Read two or more of your colleagues’ postings from the Discussion question.
Respond to two or more of your colleagues with a comment that asks for clarification, provides support for, or contributes additional information.
Post a Discussion entry on 3 different days of the week. See the Rubric for more information.
Main Post
Part 1: Patient Safety Problem
Patient falls are identified as an ongoing safety problem within the healthcare system. Falls lead to acute injuries, chronic health problems, increased admission expenses and medical costs, and lengthier hospital admissions. “In emergency departments, falls may be difficult to predict and prevent with the acute nature of patient visits and the brief, episodic encounters” (Cook, 2020, p. 668). Collaboration as a team can help reduce falls within the emergency department by implementing communication, protocols, and having a standard of work in place.
There are several reasons a patient can be considered a high fall risk. Certain medications can cause patients to be more at risk of falling. Dizziness, low blood pressure, vertigo, polypharmacy, the elderly population, post-operative patients, intoxication, patients with a history of strokes or acute neurological changes, and patients who use assistive devices at home are examples of the vulnerable population we need to pay close attention to. The multidisciplinary team can work to identify these high-risk patients with fall risk protocols in place. I also believe that the high nurse patient ratio and poor communication plays a significant role in the increase of patient falls. The constant running of staff from room to room with a high turnaround rate of emergency department visits along with call light and alarm fatigue plays a major role in the impact of increased falls.
Implementing a standard of work for fall risk patients is essential to their safety during their emergency department visit. The emergency department that I currently work in has several different safety measures in place that could help improve patient outcomes. The use of yellow fall risk bands immediately upon arrival at the emergency department to alert all staff members caring for this patient of their risk of falling. Placing fall risk grip socks on patients, activating bed alarms, placing call lights within reach, the use of color-coded fall risk signs outside patient rooms are all great safety measures implemented to help reduce the risk of falls. Continuous fall risk and mobility assessments would be beneficial to patient outcomes and progression of care. Communicating with staff and family members about promoting these protocols to keep them aware and to benefit the safety of patients is critical. Implementing assistive devices as needed depending on the patient’s ability would also be a critical component to the prevention of falls.
The change in practice that I think would be most beneficial in improving patient outcomes is communication through signage. Signage would include yellow color-coded fall risk bands, fall risk signage outside of the room, and fall risk information written on the white board in the patient’s room are all great examples of changes that can be implemented to reduce the risk of falls. By implementing these few changes to every patient who is a fall risk, we can help promote the reduction in fall related injuries within our vulnerable population. With the brief time each patient spends in the emergency department, it makes it harder to promote long term fall prevention. It also makes it difficult to implement extensive protocols because of the short duration of stay and high volume of a chaotic department. Patients arrive to the emergency department for treatment related to an injury or illness. When falls occur, it increases their length of stay and incurs additional treatment due to potential harm. Due to the lively, expeditious nature of the emergency department sometimes these falls are unpredictable and cannot be prevented. Implementing appropriate fall risk assessments, continuous staff communication, and other available resources, however, could help in the reduction in these events (Cook, 2020).
Part 2: Research on Patient Safety Problem
Research question:
Does implementing consistent communication through fall-risk signage within the emergency department aid in the reduction of falls?
Quantitative research can be used to determine if implementing these fall reduction protocols would help decrease the risk of falls. Specifically, experimental research would be best. The experimental research method allows coordination over the protocol to be put in place allowing observations and changes to be made along the way on the effectiveness of the reduction in falls. Using incident rate metrics to measure the effectiveness, data collection through the Electronic Reporting System (ERS) reports, and department staff surveys are all ways to collect and document pertinent data related to falls. In my opinion, this is the most effective way to use experimental research to achieve our goal.
References
Cook, N. S., Komansky, B. J., & Urton, M. S. (2020). Do no harm: A multifactorial approach to preventing emergency department falls—A quality improvement project. Journal of Emergency Nursing, 46(5), 666–674. https://doi.org/10.1016/j.jen.2020.03.007
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