Identifying Researchable Problem: Falls and Incontinence
Nursing practice has evolved a lot in the past century to meet the changing health care need s of the world’s population. One of the most significant changes has been the rise of Evidence Based Practice (EBP). EBP is the tendency to used evidence drawn from scientifically rigorous studies to make decisions on patient care. For instance, nursing practice code and hospital regulations require nurses to maintain hygiene in the hands to prevent the spread of hospital acquired infections and promote wellbeing in patients. Hygiene can be maintained through rubbing hands with alcohol wipes which are antiseptic or washing hands with soap and water. A review of evidence on the topic can be used to guide which of the two practices is most effective in different conditions.
Problem Identification in my Interest Area
My interest are in nursing practice is geriatric care. The improved living standards means that people are living longer and today there are more geriatric patients than in the past. Geriatric patients face a unique set of health challenges which must be tackled effectively to enhance well being and promote health. Two of the most common problems in geriatric patients are falls and urinary incontinence which affect up to 40% of all geriatric patients (Wenger, Roth, Hall et al., 2010). All though fall injuries in geriatric patients results in low trauma, the injuries can cause health complications, prolong hospital stay and are a major cause of hospital admission. In most hospitals and nursing homes, there are comprehensive guidelines for caring for fall victims and for patients suffering from urinary incontinence. These guidelines treat the two conditions as separate health risks. However, recent findings show that urinary incontinence is a risk factor for falls especially in geriatric patients with dementia (Lee et al., 2011). The problem I want to tackle in this EBP project is suitable combined interventions for both urinary incontinence and falls in geriatric patients. This problem is relevant to nursing practice since a combined solution will enhance care for over 40% of geriatric patients who suffer from urinary incontinence and experience fall events.
Falls and urinary incontinence have been treated as separate health condition in the care of geriatric patients. To evaluate evidence for the joint care of patients with urinary incontinence who have experienced fall events, the following questions have been generated;
- What is the relationship between falls and urinary incontinence in geriatric patients?
- How common is the comobidity of falls and urinary incontinence in geriatric patients?
- What are the joint interventions available for care of geriatric patients with urinary incontinence and falls?
- How effective are the joint interventions used to care for urinary incontinent patients who fall?
- Which risk factors cause the comobidity of urinary incontinence and falls in geriatric patients?
The questions are meant to provide guide lines for database searches in order to generate evidence for the joint care of urinary incontinence and falls. The question’s feasibility is based on being simple and unambiguous allowing for the generation of interventions which can be implemented in nursing practice.
Preliminary PICO analysis
PICO is a research model used to evaluate how suitable a research paper is for generating evidence applied in nursing practice. According to Wade, the acronym PICO stands for patients and problem characteristics, the intervention under consideration, comparison of the intervention with alternatives, and the anticipated measurable health outcome (2011). From the research questions identified above, the patient characteristics in this study is geriatrics suffering from a comobidity of falls and urinary incontinence. The interventions under consideration are joint care for urinary incontinence and falls in geriatric patients. The comparison will be done on the alternative interventions that will be identified to determine the most effective ones. The anticipated health outcomes will be to improve patient well being, control urinary incontinence and prevent falls. The table below summarizes a PICO analysis on the five research questions in this study
Keywords are short phrases used to search medical databases for research articles related to the topic of interest. In this study the key words selected are; incontinence, fall, geriatric patients, urinary incontinence risk factors, falls risk factors, incontinent patient care, fall prevention in the elderly, accidental falls predication, cognitive impairment, and safety and independence of geriatric patients. These keywords are selected based on relevance to the topic of falls and incontinence in geriatric patients and to generate more results during a database search.
Lee, C. Y., Chen, L. K., Lo, Y. K., Liang, C. K., Chou, M. Y., Lo, C. C., & Lin, Y. T. (2011).
Urinary incontinence: An under‐recognized risk factor for falls among elderly dementia patients. Neurourology and urodynamics, 30(7), 1286-1290.
Wade, C. (2011). Planning and writing an evidence-based critical reflection. Journal of
Paramedic Practice, 3(4), 190-195.
Wenger, N. S., Roth, C. P., Hall, W. J., Ganz, D. A., Snow, V., Byrkit, J., & Reuben, D. B.
(2010). Practice redesign to improve care for falls and urinary incontinence: primary care intervention for older patients. Archives of internal medicine, 170(19), 1765.