Problem Statement (PICOT) Assignment Paper

Problem Statement (PICOT) Assignment Paper

Guiding Questions

Problem Statement (PICOT)

This document is designed to give you questions to consider and additional guidance to help you successfully complete the Problem Statement (PICOT) assessment. You may find it useful to use this document as a pre-writing exercise, an outlining tool, or as a final check to ensure that you have sufficiently addressed all the grading criteria for this assessment. This document is a resource to help you complete the assessment. Do not turn in this document as your assessment submission.

Part 1: Problem Statement

Need Statement

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

• What type of need is your project trying to address?
• Why is addressing this need important?
• What are one or more key pieces of evidence that support the urgency of the need? Problem Statement (PICOT) Assignment Paper

Population and Setting

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

• What is the population you will be targeting with your project?
  • Why is it important to address your identified need within this population?
• What is the setting you will be targeting with your project?
  • Why is it important to address your identified need and target population within this setting?
    

    PLACE YOUR ORDER HERE NOW

Intervention Overview

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

• What interventions could be applied to your identified need?
  • How well do the interventions fit your target population?
  • How well do the interventions fit your target setting?
  • How well do the interventions address your identified need?

 

Comparison of Approaches

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

• Discuss one or more alternatives to the intervention(s) presented in your Intervention Overview.
  • How do the alternatives encourage interprofessional care approaches compared to the interventions in your overview?
  • How well do the alternatives fit your target population compared to the interventions in your overview?
  • How well do the alternatives fit your target setting compared to the interventions in your overview?
  • How well do the alternatives address your identified need compared to the interventions in your overview?

Initial Outcome Draft

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

• What is one outcome (or goal) that you want to achieve with your intervention and project?
  • How does this outcome illustrate the purpose of your intervention and project?
  • How does this outcome illustrate what you hope to accomplish with your intervention and project?
  • How does this outcome establish a framework that can be used to achieve an improvement in the quality, safety, or experience of care? Problem Statement (PICOT) Assignment Paper

Time Estimate

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

• What is a rough time frame for developing your intervention?
  • Is this time frame realistic?
  • What potential challenges may impact this time frame?
• What is a rough time frame for implementing your intervention?
  • Is this time frame realistic?
  • What potential challenges may impact this time frame?

Part 2: Literature Review

Analyze current evidence to validate an identified need and its appropriateness within the target population and setting.

• How does the evidence validate your identified need?
• How does the evidence support the appropriateness of attempting to address your identified need within your target population?
• How does the evidence support the appropriateness of attempting to address your identified need within your target setting?

Evaluate and synthesize resources from diverse sources illustrating existing health policy that could impact the approach taken to address an identified need.

• What health policy exists that is relevant to your identified need?
  • How will this health policy impact the way to try to address your identified need?
    • In other words, are there considerations that you need to be sure you include or approaches that will be unavailable to you based on policy, as you continue to develop your project?
  • Remember: In this literature review you are expected to have addressed 10–15 unique resources.

Address Generally Throughout

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

• Is your writing clear and professional?
• Does your writing effectively communicate your problem statement?
• Does your writing effectively communicate your literature review?
• Is your writing free from errors?
• Is your submission 5–9 pages?
• Does your submission conform to current APA style standards? Problem Statement (PICOT) Assignment Paper

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. Problem Statement (PICOT) Assignment Paper

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. Problem Statement (PICOT) Assignment Paper

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). Problem Statement (PICOT) Assignment Paper

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. Problem Statement (PICOT) Assignment Paper

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). Problem Statement (PICOT) Assignment Paper

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.  Problem Statement (PICOT) Assignment Paper

 

References

Cunha, L. F. C. D., Baixinho, C. L., & Henriques, M. A. (2019). Preventing falls in hospitalized elderly: design and validation of a team intervention. Journal of the School of Nursing, 53, e3479. https://doi.org/10.1590/S1980-220X2018031803479

Fulmer, T., Reuben, D. B., Auerbach, J., Fick, D. M., Galambos, C., & Johnson, K. S. (2021). Actualizing Better Health And Health Care For Older Adults: Commentary describes six vital directions to improve the care and quality of life for all older Americans. Health Affairs, 40(2), 219-225. https://doi.org/10.1377/hlthaff.2020.01470

Giovannini, S., Brau, F., Galluzzo, V., Santagada, D. A., Loreti, C., Biscotti, L., Laudisio, A., Zuccalà, G., & Bernabei, R. (2022). Falls among older adults: Screening, identification, rehabilitation, and management. Applied Sciences (Basel, Switzerland), 12(15), 7934. https://doi.org/10.3390/app12157934

Ha, V.-A. T., Nguyen, T. N., Nguyen, T. X., Nguyen, H. T. T., Nguyen, T. T. H., Nguyen, A. T., Pham, T., & Vu, H. T. T. (2021). Prevalence and factors associated with falls among older outpatients. International Journal of Environmental Research and Public Health, 18(8), 4041. https://doi.org/10.3390/ijerph18084041

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital falls prevention with patient education: a scoping review. BMC geriatrics, 20(1), 140. https://doi.org/10.1186/s12877-020-01515-w

Jia, H., Lubetkin, E. I., DeMichele, K., Stark, D. S., Zack, M. M., & Thompson, W. W. (2019). Prevalence, risk factors, and burden of disease for falls and balance or walking problems among older adults in the US. Preventive Medicine, 126, 105737. https://doi.org/10.1016/j.ypmed.2019.05.025

Kiyoshi-Teo, H., Northrup-Snyder, K., Cohen, D. J., Dieckmann, N., Stoyles, S., Winters-Stone, K., & Eckstrom, E. (2019). Older hospital inpatients’ fall risk factors, perceptions, and daily activities to prevent falling. Geriatric Nursing, 40(3), 290–295. https://doi.org/10.1016/j.gerinurse.2018.11.005

Lan, X., Li, H., Wang, Z., & Chen, Y. (2020). Frailty as a predictor of future falls in hospitalized patients: A systematic review and meta-analysis. Geriatric Nursing, 41(2), 69–74. https://doi.org/10.1016/j.gerinurse.2019.01.004

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: state of the science. Clinics in Geriatric Medicine, 35(2), 273–283. https://doi.org/10.1016/j.cger.2019.01.007

Montero-Odasso, M. M., Kamkar, N., Pieruccini-Faria, F., Osman, A., Sarquis-Adamson, Y., Close, J., Hogan, D. B., Hunter, S. W., Kenny, R. A., Lipsitz, L. A., Lord, S. R., Madden, K. M., Petrovic, M., Ryg, J., Speechley, M., Sultana, M., Tan, M. P., van der Velde, N., Verghese, J., Masud, T. and Task Force on Global Guidelines for Falls in Older Adults (2021). Evaluation of Clinical Practice Guidelines on Fall Prevention and Management for Older Adults: A Systematic Review. JAMA Network Open, 4(12), e2138911. https://doi.org/10.1001/jamanetworkopen.2021.38911 Problem Statement (PICOT) Assignment Paper