Research Critiques and PICOT Statement Paper

Below is a sample PICOT Statement Example to help craft your nursing PICOT paper.

If it’s your first time writing a nursing PICOT statement paper, you’ll find these guides useful

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  2. How to Create an Effective PICOT Question: A Step-by-Step Process
  3. Different ways to format a PICOT Question
  4. PICOT Question Paper Example for NPs

PICOT Statement Paper

Background

In the qualitative study, “Activity monitors as support for older persons’ physical activity in daily life: a qualitative study of the users’ experiences,” Ehn et al. (2018) claim that falls cause a significant threat to the independence and health of the elderly populations. Chronic conditions such as osteoporosis, diabetes, and hypertension are highly prevalent among older adults and increase the risk of falls.

The research shows that nurses care for old populations and are critical to fall prevention. For that reason, this research’s main objective was to determine how older adults experience the use of activity monitors to improve Physical Activity (PA) levels. Essentially, an increase in physical activity reduces the risk of falls. The research question addressed was to evaluate older persons’ experiences of balance function while using activity monitors.

Secondly, the qualitative study “Acceptability of a perturbation-based balance training program for falls prevention in older adults: a qualitative study” by Gerard et al. (2022) asserts that falls are common injuries and cause hospitalizations among the elderly. The conventional balance training interventions devised are not sufficient and task-specific for the mechanism of falls.

The study aimed to establish whether Perturbation-based Balance Training (PBT) (a task-specific intervention to improve balance reactive balance) was more effective than conventional balance training methods. The main objective was to determine the impact of three sessions of PBT protocol on balance control among the elderly. The research questions determined whether Perturbation-based Balance Training (PBT) was more effective than conventional balance training methods.

Quantitative study “Quantitative falls risk assessment in elderly people: results from a clinical study with distance-based up-and-go test recordings: physiological measurement, 41(11), 115006” (Ziegl et al., 2020) claims that a third of the people aged 65 years and above experience at least one fall yearly. Posture changes from sitting to standing cause about 40% of falls in nursing homes.

Significant risks of falls entail frailty, gait traits, balance problems, and using specific medications. The study evaluated the fall risk assessment capability of the Timed Up-and-Go test among the 46 participants. The test assesses individuals’ gait and balance. Notably, state-of-the-art-based questionnaires assessed the participants’ frailty and quality of life. The research question aimed to determine whether the TUG test effectively identified balance problems, gait characteristics, and reduced muscular strength among individuals aged 65.

In the other quantitative study, Santos et al. (2020) focus on non-communicable diseases such as diabetes, hypertension, and obesity, which are likely to increase the risk of falls among the elderly. The study claims that morphological and physiological changes brought by non-communicable diseases predispose older people to the risk of falls.

Nurses play an essential role in preventing health problems and promoting self-care. Therefore, the study’s main objective is to evaluate the Nursing Diagnosis risk of falls among the elderly in primary health care in the Federal District of Brazil. The research question addressed was whether Nursing Diagnosis was an effective means of assessment and interventional strategy for risks of falls among individuals aged 60 years and above.

How the Articles Support the Nursing Practice Issue.

The research “Activity monitors as support for older persons’ physical activity in daily life: a qualitative study of the users’ experiences” by Ehn et al. (2018) relates to my nursing practice issue by featuring fall risk assessments among the aged population. The study uses activity monitors to assess the participant’s physical activity level.

Physical activity increases bone mineral density preventing frailty that contributes to falls among the elderly. In this case, the physical activity levels are utilized as standards for evaluating the risks of falls among the elderly. Similarly, the study by Gerard et al. (2022) contributes to my research topic by determining the study participants’ balance control to assess the risk of falls. Notably, loss of balance significantly contributes to falls among the elderly. Gerards et al. (2022) compare Perturbation-based Balance Training (PBT) to conventional balance training methods as risk assessments and intervention strategies to mitigate falls among the elderly.

On the other hand, quantitative studies relate to my research topic. ” (Ziegl et al. 2020) feature the TUG tests and frailty evaluation as crucial fall risk assessment tools among the elderly. Nurses and other health care professionals use the TUG test to assess the patient’s balance and gait. Thus, the research is crucial for nurses and aids them in identifying the fallers from non-fallers among elderly patients. Secondly, Santos et al. (2020) highlight that nursing diagnosis is critical to preventing falls among the elderly. The study answers the research question since non-communicable diseases such as hypertension and diabetes are used as a major cause of frailty that leads to falls among the elderly.

 PICOT Question: In elderly patients (65 years or more) (Population), how will fall risks assessments (Intervention) compared to modification of the environment (Comparison) aid in reducing fall incidences (Outcome) in four weeks (Time).

In the study by Ehn et al. (2018), all eight study subjects represented the intervention groups identified in the PICOT question since the research did not have a control group. Thus, determining the eight participants’ physical activity levels as a fall risk assessment was an intervention strategy. In Santos et al. (2020) research, participants who reported falls from slips caused by environmental factors represent the control group in the PICOT question.

Methods of Study

Ehn et al. (2018) utilized a qualitative inductive study with a descriptive approach to understanding the experiences of older persons in measuring their daily activity levels using the number of steps taken per day. The data collected about participants’ experiences were obtained through activity diaries, interviews, and documentation of group discussions among the participants. Eight participants were recruited for the study, where the inclusion criteria included being 75 years old and living in ordinary homes in a community care setting. On the contrary, Gerards et al. (2022) utilized a qualitative study approach where semi-structured interviews were conducted on 16 older adults (14 men and two women) with a mean age of 73.6 +/-6 years in a university medical center in the Netherlands. The inductive study approach starts with theories followed by observations, allowing researchers to be flexible. Of importance, the interviews allowed researchers to have first-hand information. The limitations of both studies are that inductive study may not be used to prove anything, while conducting interviews is time-consuming.

Ziegler et al. (2020) utilized a quantitative study approach to collect the TUG measurements from February to July 2018. The data were collected six times (one TUG measurement per three weeks). Falls, demographic data, and medications prescribed for the participants were also recorded at baseline. The study recruited 46 participants aged 65 years and above from four nursing homes operated by the Geriatric Health Center in Graz. Santos et al. (2020) feature a descriptive, quantitative cross-sectional study in two primary healthcare settings in Ceilândia, Brazil, from February to July 2017. Notably, a random sampling technique was applied to elderly subjects diagnosed with hypertension and diabetes. Sixteen hundred individuals were sampled with a sampling error of 6% and a confidence interval of 95%, resulting in 196 individuals as study subjects. Quantitative studies do not give a detailed picture since the results lack deep insights and motivation, and data analysis is expensive and time-consuming. However, quantitative studies are objective and rely on fewer variables and concrete numbers.

Results of the Study

Ehn et al. (2018) revealed that all the participants improved their physical activity levels after adopting activity monitors. However, the level of motivation induced by the activity monitors varied between the participants. Participants who reached their activity goals were highly motivated to remain physically active.

Gerards et al. (2022) concluded that the PBT protocol is acceptable to the elderly population that is highly prone to risks of falls. Santos et al. (2020) reported that 71.2% of older adults had a history of falls. Females had a high prevalence of 83.5% compared to men. Older adults aged between 75-79 years had a 75% prevalence of falls, those aged 66 to 69 years had 73.5%, 70-74 years had 70.6%, 60 to 65 years had 66%, and persons aged 80 years above had 62 .5% prevalence.

Ziegler et al. (2020) revealed that 23 participants fell at least once during the measurement period, resulting in 75 fall times. Of all the parameters used to assess the risk of falls, Timed Up-and-Go tests recorded the best performance in classifying fallers.

The studies imply that falls are a significant cause of mortality and morbidity among individuals aged 65. Therefore, nurses should conduct a fall risk assessment to prevent falls among the target groups. For instance, Santos et al. (2020) assert that nursing diagnosis is vital in identifying chronic conditions among the elderly. Conditions like diabetes and hypertension cause frailty, increasing the risks of falls among the elderly. Nurses should adopt technology such as activity monitors and TUG devices that are vital in assessing the risk of falls.

Ethical Considerations

Researchers should observe ethical principles to conduct research without causing harm or deception. For instance, the researcher should seek informed consent from the participants and maintain confidentiality. In the research by Gerards et al. (2022), names and possible identification of the participants were removed from the transcript. Since the interview was conducted in Dutch, all the quotes were translated carefully to preserve their original meaning. In Ehn et al. (2018), the regional committee approved the first study of ethics in Uppsala, where all the participants were given written and verbal information about the research.

The study by Ziegler et al. (2020) sought ethical approval from the Medical University of Graz ethics committee. Secondly, all the participants were required to give written informed consent before inclusion in the study. Similarly, the research by Santos et al. 2020 received approval from the Ethics research committee of the Fundação de Ensino e Pesquisa em Ciências da Saúde (FEPECS). The research participants were informed about the study protocol, and those who agreed to participate must sign informed consent forms.

Outcomes Comparison

The PICOT’s expected outcome was to reduce fall incidences among individuals aged 65 years and above. Notably, the PICOT compared how fall risk assessments were crucial to reducing fall incidences to environmental modification. The research also expected that fall risk assessment was a better interventional strategy than environmental modification. Of importance are the PICOT outcomes related to those analyzed in the articles. For example, Ziegl et al. (2020) featured the TUG tests and frailty evaluation as crucial fall risk assessment tools among the elderly. The study assessed the participants’ balance and gait to differentiate between fallers and non-fallers. Secondly, activity monitors assessed physical activity levels, and PBT was crucial for fall prevention. Santo et al. (2020) state that nursing diagnosis of risk factors for falls is crucial in determining the high-risk individuals among the elderly. Therefore, the articles assessed fall risk factors through distinct methods, such as interventional strategies featured in the PICOT question, to reduce falls among the elderly. 

References

Ehn, M., Eriksson, L. C., Ă…kerberg, N., & Johansson, A. C. (2018). Activity monitors support older persons’ physical activity in daily life: a qualitative study of the users’ experiences. JMIR mHealth and uHealth6(2), e8345. Retrieved from https://mhealth.jmir.org/2018/2/e34/

Gerards, M. H., Sieben, J., Marcellis, R., de Bie, R. A., Meijer, K., & Lenssen, A. F. (2022). Acceptability of a perturbation-based balance training program for falls prevention in older adults: a qualitative study. BMJ Open12(2), e056623. Permalink: http://bmjopen.bmj.com/

Santos, P. H. F. D., Stival, M. M., Lima, L. R. D., Santos, W. S., Volpe, C. R. G., Rehem, T. C. M. S. B., & Funghetto, S. S. (2020). Nursing diagnosis Risk for Falls in the elderly in primary health care. Revista Brasileira de Enfermagem73. Permalink: https://www.scielo.br/j/reben/a/Jnxr5TkZsxDTp7PjpBrT8mQ/

Ziegl, A., Hayn, D., Kastner, P., Löffler, K., Weidinger, L., Brix, B., … & Schreier, G. (2020). Quantitative falls risk assessment in elderly people: results from a clinical study with distance-based up-and-go test recordings: physiological measurement41(11), 115006. Permalink: https://iopscience.iop.org/article/10.1088/1361-6579/abc352/pdf