Developing the question
The choice of the question “For hospitalized elderly patients how does hourly rounding compared to two hour monitoring help in reducing the occurrence of falls and their subsequent injuries?” was based on the need to explore the importance of regular and frequent monitoring for these patients to manage the cases of falls. There is enough evidence that supports that monitoring of these patients is the key to management of their healthy issues. It is important to know that patients in the geriatric care have unmet needs and they rely on the nurse to help meet these needs. These would include turning and repositioning as well as bathing and toileting. There is no proven method that can facilitate prediction of when these needs may occur for each patient (Mant, Dunning & Hutchinson, 2012).
In that case therefore, the formulated PICOT question seeks to determine the viability of more frequent monitoring (hourly rounding) compares to less frequent monitoring (two hour monitoring). This is in the hypothetical belief that with increased frequency of monitoring the patients there could be a decline in the cases of falls as the nurses would actually have a chance to review the needs of the patient thus limiting their need to seek or meet those needs independently in the absence of the nurse (Deitrick, Baker, Paxton, Flores & Swavely, 2012).
The hourly rounding technique is specifically designed in such a manner that the nurse will visit the patient at least once every hour and review their health status, any changes that may occur and thus review the care plan and the interventions within that scope. It will also mean that the needs of the patient which are highly unpredictable will be monitored at least once every hour in which the nurse will facilitate the patient in meeting those needs by affording them actual assistance (Ford, 2010). On the other hand, the two hour monitoring technique is specifically designed to offer a comparative measure on which to determine how frequent the needs of the patient change within a duration of two hours and whether they impact on the risk of falls.
Importance to clinical practice
The question is important in my clinical practice since it offers a chance to explore the evidence-based techniques that can be applied in the management of falls within the group of hospitalized early patients. In geriatric care, patients do present with several health issues and in many cases, a patient will present with multiple problems that affect their functioning and morbidity. These patients may have some physical impairments, systematic disorders, cognitive issues or coordination problems which at any time would pace them at risk of falls and subsequent injuries. The primary role of the nurse in the geriatric care setting is to ensure that these patients are not predisposed to risk factors that may cause further injury, pain or suffering and that includes managing their mobility and association within the settings (Dyck, Thiele, Kebicz, Klassen & Erenberg, 2013).
Injuries that result from falls within the facility are all recorded as hospital acquired illnesses and with the CMS having reviewed its stance on the reimbursement of HAIs, nurses have to take full responsibility in the management of the patients (Ford, 2010). When nurses increase their frequency of interacting and monitoring the patients, there is likelihood that they can ultimately determine or predict the needs of each patient over some specific duration of time. The nurse will therefore avail themselves only at the right time and thus eliminate the possibility of the patient seeking to fulfill their needs independently which would predispose them to risk of falls. In answering the proposed question, it will be possible to determine the viability of each of the two frequencies for monitoring patients (hourly rounding and two-hour monitoring/rounds) and in that case determine the rate of change of the needs of hospitalized geriatric patients. This data can then be used to develop more responsive measures to work alongside the monitoring such as the use of bell alerts.
Credibility and reliability
For the researcher finding sources that they can utilize in their study is mainly not the major problem. There are any databases and libraries online that can facilitate the search process and provide articles that seemingly meet the needs of the research as described by the researcher. However, not all sources that the researcher may find are suitable for research especially in relation to evidence based practice (American Nurses Association, 2015). The credibility and reliability of the sources is a key component on the choice and search. Poor reliability and low credibility of sources implies weak arguments and a possibility of the entire study losing its credibility and applicability. There are five key issues that the one has to observe in determining the credibility and reliability of research. These include the authority, purpose, objectivity, depth and currency of the source (Dearholt & Dang, 2012).
Authority is the element that explains the credentials of the author. It is important to ascertain whether the author is qualified to write on matters if such or in the case of an organization the idea is to determine whether the organization is unbiased on the matter or there are any interested parties within the organization. If the credentials of the author are not available and cannot be accessed, then there is a possibility that the source is not suitable for the study since anonymous authorship could imply a case of hidden interests beyond providing true evidence (Dearholt & Dang, 2012). On the element of purpose, one has to determine the interests on which the article was written. It is important to check whether the article has been written to entertain, reverse or influence public opinion, teach or present the results of a study. It is also important to determine the intended audience since reliable sources are specific in nature and will have a target audience as well as focusing on a specific field.
The third element that determines the reliability and credibility of the research is the objectivity. Checking for objectivity means determining whether the information utilized in the study is biased and whether the bias affects the conclusions or recommendations. In the search for objectivity, the value and influence of the interested parties should be assessed to determine whether they provided any information that has been used in the research. If so, then the research cannot be termed as objective and cannot be applied to provide credible evidence. Further, checking for objectivity should also include a review of the citations used in the article and their relevance (Dearholt & Dang, 2012). Credibility and reliability of a source as well as the strength of evidence is significantly influenced by the time relevance of research. Sources that are not up to date and those that have been written beyond the last ten years may not be applicable for current research. Sources within the last five years are more reliable and offer evidence that is reflective of the contemporary healthcare setting or society (Dearholt & Dang, 2012).
The forth element that determines the credibility of a source is the depth of the information and how well it has been covered. Depth of information does not necessarily imply too much content but rather the quality of the content and how well it has been presented. The source should offer a comprehensive but easy to follow format and ensure that technical terms are explained in detail. The strength of evidence is based on the reliability and credibility of sources. When the evidence is strong, the applicability of research is easier since there are minimal contradictions (Dearholt & Dang, 2012).
Evidence-based medicine is based on the utilization of data and evidence to make judgments. The quality of evidence helps prevent errors, improve communication as well as facilitate and influence critical appraisal of judgment. Strong evidence helps define and describe the outcomes towards a critical decision, seeking a balance between the harms and benefits as well as assessing the strength of recommendations (Dearholt & Dang, 2012). These three are the tenets on which the researchers can implement the recommendations and therefore actualize evidence-based practice. The determination of risks and benefits is probably the most pertinent of the three tenets. For instance, in the event there is a risk for an adverse effect and where that risk is primary in the judgment, when such evidence is weaker than the evidence that is available for the benefits then it is not possible to ignore the risk of harm as it could be problematic upon implementation. In that case, the strategy is to use the lowest quality if the evidence across the critical outcomes to make a decision for rating the overall quality and strength of evidence (Dearholt & Dang, 2012).
References
American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author.
Dearholt, S. L., & Dang, D. (2012). Johns Hopkins nursing evidence-based practice: Model and guidelines (2nd-ed.). Indianapolis, IN: Sigma Theta Tau International.
Deitrick, L. M., Baker, K., Paxton, H., Flores, M., & Swavely, D. (2012). Hourly rounding: challenges with implementation of an evidence-based process. Journal of nursing care quality, 27(1), 13-19.
Dyck, D., Thiele, T., Kebicz, R., Klassen, M., & Erenberg, C. (2013). Hourly rounding for falls prevention: a change initiative. Creative nursing, 19(3), 153-158.
Ford, B. M. (2010). Hourly rounding: a strategy to improve patient satisfaction scores. Medsurg Nursing, 19(3), 188-192.
Mant, T., Dunning, T., & Hutchinson, A. (2012). The clinical effectiveness of hourly rounding on fall-related incidents involving adult patients in an acute care setting: a systematic review. The JBI Database of Systematic Reviews and Implementation Reports, 10(56 Suppl), 63-74.
