Journal Of Korean Academy Of Nursing

Journal Of Korean Academy Of Nursing

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Journal Of Korean Academy Of Nursing

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Journal Of Korean Academy Of Nursing

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In order to determine best practices, scientific evidences can be used to define evidence based practices (EBP). This practise refers to a practise that is different from the conventional protocols of nursing (Lang, 2014). It helps to provide safe care delivery to the patient which is based on the scientific evidences. Use of evidence based practices helps in critical analysis and the evaluation of the research findings. This process can also be referred to aspractice of health care where the practitioner finds results systematically and appraises it. It uses the most current findings which are more credible in terms of findings related to the basis for clinical decisions.
This paper aims to appraise the evidence of the clinical question. Additionally it illustrates the summary of the best practices. The paper also suggests strategies to implement the evidence based practices along with the barriers that are faced while implementation of the practises.
Appraising the evidence
The role of the patient sitters are effective in terms of reduction of the risk of fall of patients. Use of the patient sitters form an integral part of the evidence based fall guidelines that implemented for falls. Inspite of the usefulness of this programs, questions have been raised regarding the cost and effectiveness of the sitter program. Often called as patient safety assistants or companions, these sitters provide constant observation to the patients. They are staff members or volunteers who have been assigned with the job of providing direct observation to the patients who are at high risk.
The articles selected provides evidence that there is a significant correlation between the low rate of falls associated with harm and the sitter program use. Studies have been conducted in 75 hospitals that were part of the Healthsystem Association of Pennsylvania Hospital Engagement Network, where such data was found after the conduction of the study (Tzeng, Yin & Grunawalt, 2008). The study showed significant correlation between the low rates of fall and the three specific aspects of the sitter program which refers to definite criteria for qualification of sitters, provision ofsitter training program along with establishment of a pool of sitters.
Summary of best practice
For proper determination of the use of patient sitters would help in reducing the fall rate among the older adults as compared to the fall rate in absence of patient sitters, one of the surveys that can be implemented comprises of Hospital Engagement Network Falls Reduction and Prevention Collaboration Self-Assessment Tool (SAT) survey (Feil & Wallace, 2014). This produced results which showed the structure and content of the falls occurring in the hospitals recently. The SAT survey to measure intent of the fall was required in composing an action plan in order to target the elements of best practice. Another study provided results of a comprehensive review that was carried out using the databases namely CINAHL, MEDLINE, PsycINFO, and the Psychology and Behavioural Sciences Collection (Lang, 2014). Two of the articles reported that there was a significant correlation between thereductions in fall rates and higher utilization of sitters. Another article evaluated the impact of adoption of an assessment tool namely the Patient Attendant Assessment Tool (PAAT) on nurses’ requests for sitters (Tzeng, Yin & Grunawalt, 2008). It includes the use of restraints and rates of falls and fall injuries.  Use of this tool helped in the better assessment in in filling the request of rates for the sitters. The result of this study showed that there was a high number of sitter requests. Although the total restraints would be lesser, however the rate of total fall would be higher.
Strategies to promote the evidence-based practice in the setting
For implementation of the strategies for effective evidence based practise, the PARiHS(Promoting Action on Research Implementation)framework can be used. The framework contains the components of context, evidence and facilitation (Rycroft-Malone et al.,  2013). An approach of multidisciplinary and multidimensional nature can be undertaken to implement the falls prevention program (FPP). The FPP was driven by policy that is aligned with the Western Australian Department of Health [WADOH] Falls Prevention Policy (2003) (Doh, 2017). There was instigation for the development of the publication of this policy in the hospital’s falls-Risk Management Policy.
Implementation can also be made through education of the patients regarding the evidence based practices. In order to prevent falls, interventions like working with a physiotherapist and a home-care nurse can be implemented.
Some of the identified barriers for the implementation of these practices includes lack of knowledge of the nurses in providing the interventions like exercises hence there will be no reduction of fall rates (Yoo, Jeon & Kim, 2013). Problems like lack of support from the management can pose a limitation in the path of strategy implementation. The healthcare organizations might perceive the change strategies as risk hence might want to stick to the traditional methods.
From the above discussion it can be concluded that the paper promoted well-researched evidence that can be used to change clinical practise. The study showed that there was significant correlation. Possible barriers to promote EBP and strategies to overcome them have been suggested in the paper for the clinical evidence to be successfully implemented.
Tzeng, H. M., Yin, C. Y., & Grunawalt, J. (2008). Effective assessment of use of sitters by nurses in inpatient care settings. Journal of advanced nursing, 64(2), 176-183.
Lang, C. E. (2014). Do sitters prevent falls?: A review of the literature. Journal of gerontological nursing, 40(5), 24-33.
Feil, M., & Wallace, S. C. (2014). The use of patient sitters to reduce falls: Best practices. Pennsylvania Patient Safety Advisory, 11(1), 8-14.
Schmidt, N. A., & Brown, J. M. (2014). Evidence-based practice for nurses. Jones & Bartlett Publishers.
Rycroft-Malone, J., Seers, K., Chandler, J., Hawkes, C. A., Crichton, N., Allen, C., … & Strunin, L. (2013). The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework. Implementation Science, 8(1), 28.
Yoo, J. S., Jeon, M. Y., & Kim, C. G. (2013). Effects of a Fall Prevention Program on Falls in Frail Elders Living at Home in Rural Communities. Journal of Korean Academy of Nursing, 43(5).
Doh, D. (2017). Towards active ageing: A comparative study of experiences of older Ghanaians in Australia and Ghana.

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