NU 390 INDIVIDUAL RESEARCH PAPER ASSIGNMENT In this assignment you will formulate a research problem/question, conduct a literature review, find research articles that help to explain and support your problem. This paper will be the beginnings of a research paper, but you will not carry out the research. You will basically be writing the introduction of a research paper. 1. This paper should be approximately four to five pages double spaced, excluding the title and reference page. 2. Limit your variables to two, one independent and one dependent variable. 3.Do not write an abstract. 4. Make sure you have a title. See text for writing a good title. 5. Use APA style. 6. Do not use any quotations in this paper. All your citations must be paraphrased not quoted. Points will be deducted for quoting. Introduce your research problem and state the importance of doing the study. In this section you introduce the reader to the problem, give data that supports the importance of exploring the problem and why this would be significant to nursing knowledge. This should be one to two paragraphs. Make sure that you support all of this with citations from the literature. 10 points Define the concepts or variables to be studied. Give definitions of the variables that you are exploring. These should come from nursing literature, not Webster’s dictionary. Make sure you cite the literature that helps you to define the concepts 15 points Write a review of the literature. Review several research articles that are relevant to your problem. (At least 3 articles must be used). Make sure you cite properly. 20 points Write a purpose statement for your research study Must be well- developed stating your problem. This should be in your own words and needs no citation. 20 Points Write a research question and an hypothesis In your own words, no citation. 5 points Identify your research design Include your research design and methods to be used. Provide sampling information for your study population 20 points APA format Paper must be of professional quality in terms of spelling, grammar, sentence structure 10 points
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THEMATIC EDITION:
GOOD PRACTICES: FUNDAMENTALS OF
CARE IN GERONTOLOGICAL NURSING
RESEARCH
Falls in long-term care institutions for elderly people:
protocol validation
Queda nas Instituições de Longa Permanência para Idosos: validação de protocolo
Caída en Residencias Geriátricas: validación de protocolo
Cristina Rosa Soares Lavareda BaixinhoI, Maria dos Anjos Coelho Rodrigues DixeII,
Maria Adriana Pereira HenriquesI
I
Escola Superior de Enfermagem de Lisboa, Nursing Research & Development Unit. Lisbon, Portugal.
II
Instituto Politécnico de Leiria, School of Health, Health Investigation Unit. Leiria, Portugal.
How to cite this paper:
Baixinho CRSL, Dixe MACR, Henriques MAP. Falls in long-term care institutions for elderly people: protocol validation.
Rev Bras Enferm [Internet]. 2017; 70(4):740-6. [Thematic Edition “Good Practices: Fundamentals of care
in Gerontological Nursing”] DOI: http://dx.doi.org/10.1590/0034-7167-2017-0109
Submission: 02-15-2017
Acceptance: 04-02-2017
ABSTRACT
Objectives: To validate the content of a fall management risk protocol in long-term institutions for elderly people. Methods:
Methodological, quanti-qualitative study using the Delphi technique. The tool, based on the literature, was sent electronically to obtain
consensus among the 14 experts that meet the defined inclusion criteria. Results: The 27 indicators of the protocol are organized in
three dimensions: prepare for the institutionalization (IRA=.88); manage the risk of falls throughout the institutionalization (IRA=.9);
and lead the communication and formation (IRA=1), with a CVI=.91. Two rounds were performed to get a consensus superior to
80% in every item. Conclusion: The values obtained in the reliability test (>0.8) show that the protocol can be used to meet the
intended goal. The next step is the clinic validation of the protocol with residents of long-term care institutions for elderly people.
Descriptors: Accidental Falls; Aged; Accident Prevention; Nursing; Institutionalization.
RESUMO
Objetivos: Validar o conteúdo de um protocolo para a gestão do risco de queda em Instituições de Longa Permanência para Idosos.
Método: Estudo metodológico, de abordagem quantiqualitativa, utilizando a técnica de Delphi. O instrumento, construído com base
na literatura, foi enviado por via electrónica, para obter consenso entre os 14 peritos que respeitam os critérios de inclusão definidos.
Resultados: Os 27 indicadores do protocolo estão organizados em três dimensões: Preparar a Institucionalização (IRA=,88); Gerir
o Risco de Queda ao longo da Institucionalização (IRA=,9) e Liderar a comunicação e formação (IRA=1), com um CVI=,91.
Foram efetuadas duas rodadas para se obter consenso superior a 80% em todos os itens. Conclusão: Os valores obtidos no teste de
fidedignidade (>0,8) atestam que o protocolo pode ser utilizado para atingir o fim que se pretende. A próxima etapa é a validação
clínica do protocolo com idosos residentes em Instituições de Longa Permanência para Idosos.
Descritores: Acidentes por Quedas; Idosos; Prevenção de Acidentes; Enfermagem; Institucionalização.
RESUMEN
Objetivos: Validar el contenido de un protocolo para gestión de riesgo de caídas en Residencias Geriátricas. Método: Estudio
metodológico, de abordaje cualicuantitativo, utilizando técnica de Delphi. El instrumento elaborado con base en la literatura
fue enviado por vía electrónica para obtener consenso entre los 14 peritos que observan los criterios de inclusión definidos.
Resultados: Los 27 indicadores del protocolo están organizados en tres dimensiones: Preparar la Institucionalización (IRA=,88);
Gerenciar el Riesgo de Caída durante la institucionalización (IRA=,9); y Liderar la comunicación y formación (IRA=1), con
un CVI=,91. Fueron efectuadas dos rondas para obtener consenso superior al 80% en todos los ítems. Conclusión: Los valores
obtenidos en el test de fidelidad (>0,8) certifican que el protocolo puede utilizarse para alcanzar el fin pretendido. La siguiente
etapa será la validación clínica del protocolo con ancianos que moren en Residencias Geriátricas.
Descriptores: Accidentes por Caídas; Ancianos; Prevención de Accidentes; Enfermería; Institucionalización.
CORRESPONDING AUTHOR
http://dx.doi.org/10.1590/0034-7167-2017-0109
Cristina Lavareda Baixinho
Email: crbaixinho@esel.pt
Rev Bras Enferm [Internet]. 2017 jul-ago;70(4):740-6.
740
Baixinho CRSL, Dixe MACR, Henriques MAP.
INTRODUCTION
Falls are a recurrent problem for older people and a matter
of concern in long-term care (LTC) institutions for the elderly(1-3), where their incidence varies between 34% and 67%(4).
They are a common cause of institutionalization and affect the
independent residents of LTC facilities(5).
The incidence of fall-related injuries is higher in institutionalized elderly(6) than in older people that live at home, which
makes this type of accident an important cause of morbidity
and mortality in institutionalized elderly(3). It is estimated that
falls originate from 6,000 to 9,000 hospital admissions in this
population every year, with an average length of stay of 12 to
20 days(7).
Controlling this problem is difficult because the risk of fall is
complex and multifactorial. However, in a rapidly aging population, the need emerged for the transfer of knowledge as a proactive and systematic measure to prevent falls. This effort must
integrate policies, prevention, and practice(8), with a multiprofessional approach. The authors emphasize that prevention may
have several formats, but must involve different professionals(7).
Both in the level of healthcare policy definition and in direct care of the elderly, nurses are the most qualified and suitable professionals to identify and categorize risk and to plan,
implement, and evaluate prevention programs(4), playing a key
role in the assurance of quality of care in LTC units(4).
In the interface between the appointment and the analysis
of research results for this public healthcare issue, the need
arises to outline and validate an intervention protocol for fall
management risk in LTC institutions that allows nurses to use
tools and interventions in clinical practice based on investigation, and assess the results of nursing care. Research has been
useful to identify single and multiple sets of interventions that
effectively decrease the prevalence of falls and associated injuries, but there is no intervention protocol for nursing clinical
practice dedicated to LTC institutions that allows a systemic
approach to maintain the safety of the elderly.
Therefore, the goal of the present study is to evaluate the
content of a fall management risk protocol in LTC institutions.
METHODS
Ethical aspects
This study is part of an investigation into risk management
of falls in equipment for the elderly and has the approval of
the Ethics Committee of the Catholic University of Portugal.
Prior contact was necessary to obtain the authorization of
the professionals to join the team, and the referral to the instrument by the participants assumes the will to participate
in the research. For this reason, signature of the free and informed consent form was not required.
Type of study
Fall risk management in LTC facilities is a complex process
that implies keeping the elderly safe throughout the entire period of institutionalization. To validate a fall risk management
protocol for LTC units, a set of indicators was sent to a group of
Falls in long-term care institutions for elderly people: protocol validation
experts whose assignment was the evaluation of its pertinence
and contribution to solve this serious public healthcare issue.
This methodological, quanti-qualitative study was conducted
from February 2015 to July 2016 and the Delphi technique was
used to obtain consensus among the experts regarding the propositions submitted to analysis. The methodological choice was
state of the art and the goal of the study. This technique allowed
access to geographically distant people, the production of a profusion of high quality and high specificity ideas, the possibility
of individual thinking, and the integration and synergy of ideas
among experts, without the drawbacks of face-to-face meetings(9).
Sample
The intentional sample consisted of 14 experts that met the
predefined inclusion criteria: to have more than five years of
experience, with published research in the area of risk and/or
prevention of falls in the elderly. The researchers opted for a
heterogeneous sample, advocated by some authors to assure
the validity of the results, given that multidisciplinarity provides a more valid predictive consensus(10).
Protocol
The indicators submitted for evaluation by the examining
board originated from a literature review and the results of research on this subject in LTC institutions. The analysis of interventions with emphasis on fall prevention, as well as good quality interventions that do not stress this aspect and the theoretical
framework of Meleis’s Theory of Transitions allowed categorization of the indicators, at first, into three aspects: prepare for
the institutionalization; manage the risk of falls throughout the
institutionalization; and lead the communication and formation.
A previous contact was established to explain the goal of
the study and avoid the abstention of the participants.
The questionnaire was designed and sent through Google
Drive®. The experts were asked to give their opinion about
the indicators; scores of −1, 0, and 1 point were given to
a non-pertinent indicator (“I do not have an opinion”) and a
pertinent indicator, respectively.
A pretest to evaluate the readability of the items was carried out with five experts that did not belong to the definitive
examining board(9).
Two rounds of evaluation(9-10) were conducted to get a consensus higher than 80% in all of the answers. After the referral of the instrument in the first round, the propositions were
analyzed with descriptive statistical tools and suggestions for
alterations/rewriting of the items were considered. The level
of consensus and the suggestions were integrated according
to the chosen theoretical framework.
The participants gave feedback on the answers, and the
indicators that obtained a consensus lower than 80% were
reformulated between rounds, following the reformulation
suggestions of the examining board. In the second round,
the items that reached the previously stipulated 80% consensus(9-10) were excluded. New questions were not introduced in
the questionnaire because the analysis of the answers to the
open-ended questions in the first round did not point to any
new queries.
Rev Bras Enferm [Internet]. 2017 jul-ago;70(4):740-6.
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Baixinho CRSL, Dixe MACR, Henriques MAP.
Falls in long-term care institutions for elderly people: protocol validation
Analysis of the results
For validation of the protocol content, the Content Validity Index was applied to each item (CVII) and to the whole
document (CVI). Also, the Interrater Agreement (IRA) was
used to evaluate the reliability or the inter-rater reliability.
To calculate the CVI for individual items and the entire protocol, the number of participants that gave a score of 3 or 4
in a Likert scale was divided by the number of participants
that judged the item or the instrument(11). IRA was obtained
by dividing the number of items with a consensus higher
than 80% among the experts by the total number of items in
each dimension(11).
SPSS version 21 software performed the statistical treatment of the data.
The suggestions given by the experts were analyzed within the
theoretical framework and introduced in the second round.
RESULTS
The sample, consisting of 14 female experts, was heterogeneous regarding the professional formation of the members,
although all of them had experience in researching and publishing about falls in the elderly. Regarding professional experience, there were eight nurses, one medical doctor, two
physical educators, one psychologist, and two physical therapists. Eight were Portuguese and six were Brazilian.
Chart 1 shows the dimensions and their indicators, submitted for evaluation by the examining board.
Chart 1 – Expert agreement (first round of the evaluation) regarding the items of a fall risk management protocol, Lisbon, Portugal, 2016
Dimensions of the fall risk management protocol for LTC institutions*
CVII** IRA*** CVI****
Preparing the institutionalization
1
Meets the elderly and their family before the admittance to a LTC unit*.
0.86
2
Applies an assessment scale for fall risk.
0.93
3
Applies a scale to evaluate the elderly’s practices and behaviors regarding the fall risk management.
0.86
4
Describes rules of good practice.
0.93
5
Tells the fall prevalence rate in the LTC institution*.
0.71
6
Contracts the commitment of the family in the elderly person’s safety.
0.86
7
Informs the elderly person of the need to report every fall episode.
0.93
8
Formalizes the care continuity with the family nurse.
0.79
9
Hands written information about the criteria for clothes/shoes to bring to the institution.
1.0
0.77
Managing the fall risk throughout the institutionalization
10 Evaluates the individual fall risk with a risk assessment tool.
1.0
11 Controls the environment and equipment.
1.0
12 Manages the daily activities of the elderly.
0.93
13 Manages the care given by different professionals.
0.93
14 Determines the task delegation mechanisms to other professionals.
0.79
15 Evaluates the practices and behaviors of the professionals regarding fall risk management.
1.0
16 Evaluates the practices and behaviors of the elderly regarding fall risk management.
0.86
17 Selects safe supporting products for the execution of daily activities.
0.86
18 Monitors the fall episodes.
0.93
19 Implements strategies to control fall consequences and prevent the decrease of functionality in the post-fall period.
0.91
0.9
1.0
Leading communication and formation
20 Decides as a team the preventive measures to be implemented.
1.0
21 Tells the family the individual fall risk factors of the elderly person.
1.0
22 Tells the family the implemented measures.
0.86
23 Evaluates the impact of the implemented preventive measures.
1.0
24 Communicates and reports the fall episodes.
0.93
25 Runs epidemiological studies.
0.93
26 Registers the fall episodes in a national platform.
0.86
27 Sets up the multidisciplinary team.
1.0
1.0
Notes: *Long-term care; **Content Validity Index, applied to the items of the protocol; ***Interrater Agreement, applied to the protocol dimensions; ****Content
Validity Index of the protocol
Rev Bras Enferm [Internet]. 2017 jul-ago;70(4):740-6.
742
Baixinho CRSL, Dixe MACR, Henriques MAP.
Falls in long-term care institutions for elderly people: protocol validation
After the referral of the form to the experts and an analysis of the answers, it was noticed that items 5, 8, and 14
did not attain a consensus higher than 80%. Also, the reformulation suggestions given by the examining board were
considered, and the items changed and resent. Regarding
item 5, an expert (E) expressed her concern about the communication of fall prevalence to the elderly person and how
it would influence the fear of falls, especially in individuals
that had already had an episode, and whether this information would impact the fear of a new fall episode or its occurrence in the first days of institutionalization. The expert (E7)
therefore disagreed on its pertinence. Another participant,
who stated not to have an opinion, argued that the low literacy of the elderly and their families could hinder their
understanding of this information and create anxiety about
the chosen LTC unit (E11).
As for item 8, an expert stated not to have an opinion and
two considered that the item was not pertinent. A participant
that considered this item pertinent suggested its reformulation
because not all of the population have a family nurse (E14).
Analysis of item 14 revealed a suggestion to make it clear that
the nurse has to determine the task delegation mechanisms to
hands-on healthcare professionals, instead of those with higher
professional autonomy and a superior academic degree (E3).
After the rewrite, the changed items looked like this: (5)
tells the family the fall prevalence rate in the LTC institution;
(8) assures the care continuity, asking the primary care nurse
for information; and (14) determines the task delegation
mechanisms to hands-on professionals. At the end of the second round, these items obtained a consensus of 93%, 93%,
and 86%, respectively. Chart 2 exhibits the results after the
second round of evaluation by the examining board.
Chart 2 – Expert agreement (second round, final version) regarding the items of a fall risk management protocol, Lisbon, Portugal, 2016
Dimensions of the fall risk management protocol for LTC institutions*
CVII* IRA** CVI***
Preparing the institutionalization
1
Meets the elderly person and their family before the admittance to a LTC unit*.
0.86
2
Applies an assessment scale for fall risk.
0.93
3
Applies a scale to evaluate the elderly person’s practices and behaviors regarding the fall risk management.
0.86
4
Describes rules of good practice.
0.93
5
Tells the family the fall prevalence rate in the LTC institution*.
0.93
6
Contracts the commitment of the family in the elderly person’s safety.
0.86
7
Informs the elderly person of the need to report every fall episode.
0.93
8
Assures the care continuity, asking the primary care nurse for information.
0.93
9
Provides written information about the criteria for clothes/shoes to bring to the institution.
1
1
Managing the fall risk throughout the institutionalization
10 Evaluates the individual fall risk with a risk assessment tool.
1
11 Controls the environment and equipment.
1
12 Manages the daily activities of the elderly.
0.93
13 Manages the care given by different professionals.
0.93
14 Determines the task delegation mechanisms to hands-on professionals.
0.86
15 Evaluates the practices and behaviors of the professionals regarding fall risk management.
1
16 Evaluates the practices and behaviors of the elderly person regarding fall risk management.
0.86
17 Selects safe supporting products for the execution of daily activities.
0.86
18 Monitors the fall episodes.
0.93
19 Implements strategies to control fall consequences and prevent the decrease of functionality in the post-fall period.
0.93
1
1
Leading communication and formation
20 Decides as a team the preventive measures to be implemented.
1
21 Tells the family the individual fall risk factors of the elderly.
1
22 Tells the family the implemented measures.
23 Evaluates the impact of the implemented preventive measures.
0.86
1
24 Communicates and reports the fall episodes.
0.93
25 Runs epidemiological studies.
0.93
26 Registers the fall episodes in a national platform.
0.86
27 Sets up the multidisciplinary team.
1
1
Notes: *Long-term care; **Content Validity Index, applied to the items of the protocol; ***Interrater Agreement, applied to the protocol dimensions; ****Content
Validity Index of the protocol
Rev Bras Enferm [Internet]. 2017 jul-ago;70(4):740-6.
743
Baixinho CRSL, Dixe MACR, Henriques MAP.
DISCUSSION
One of the greatest, if not the greatest, challenge in nursing as a science and a profession is the integration of research
results and practice, aiming the development of the subject
and a more efficient professional intervention. This contributes to the improvement of health care to the population and
decreases the costs related to disease treatment/incapacity, rehabilitation, and complications associated with the processes
of health/disease, promoting different transitions(12).
Falls in the elderly are a typical example of the need to in …
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