EVIDENCE BASED PROJECT PROPOSAL 2

 

• The purpose of the signature assignment is for students to apply the research and EBP concepts they have learned in this course and develop a framework for the initial steps of the student’s capstone project. The assignment allows the student to initiate the steps for planning, researching and developing an evidence-based practice intervention project proposal.  On or before Day 7, of week eight each student will submit his or her final proposal paper to the week eight assignment link in D2L. This formal paper will include and expand upon work completed thus far in prior assignments. Essential Components of the Final Project Proposal will include: This formal paper will include and expand upon work completed thus far in prior assignments. Be sure to use the headings as  listed below. Essential Components of the Final Project Proposal will include:     
• Introduction– Provide an introduction to your topic or project. The introduction gives the reader an accurate, concrete understanding what the project will cover and what can be gained from implementation of this project.
• Overview of the Problem – Discuss the problem,  why the problem is worth exploring and the potential contribution of the proposed project to the discipline of nursing.
• Project Purpose Statement – Provide a declarative sentence or two which summarizes the specific topic and goals of the project.
• Background and Significance – State the importance of the problem and emphasize what is innovative about your proposed project. Discuss the potential impact of your project on your anticipated results to the betterment of health and/or health outcomes.
• PICOt formatted Clinical Project Question(s)– Provide the Population, Intervention, Comparison, Expected Outcomes and Timeframe for the proposed project.
• Literature Review – Provide the search engines used and the key terms used to guide a search for evidence and discuss at least five (5) summaries (this can be the copy and paste lit reviews you did in the last paper) of relevant, credible, recent, evidence-based research studies to support the project proposal.
• Critical Appraisal of Literature – Discuss the strengths and weaknesses of the evidence, what is known from the evidence and what gaps in evidence were found from the appraisal of evidence-based research studies.

  Add this information at the conclusion of each of the articles you discussed above

• Develop an EBP Standard – Describe  two to three interventions (or a bundle of care) from the evidence and discuss how individual patient preferences or the preferences of others will be considered.
• Implications – Summarize the potential contributions of the proposed project for nursing research, education and practice.
• Expectations 
• Length: A minimum of 8 pages and a maximum of 10 pages (excluding the title and reference pages)
• Format: Formal scholarly paper in APA 7th ed format
• Reference Citations: A minimum of five, recent (past five years), peer-reviewed scholarly references cited in APA 7th ed format.
• File name: Save the file with Student First Name_Last Name_SigAssignment
• See USU NUR Research Paper Rubric for additional details and Proposal 
• Revised PICOT Question: On a medical-surgical hospital unit (P), how does implementing hourly nursing rounding (I), compare to no scheduled rounding (c), affect patient safety(o), within 6 months of implementation (T)?
• Attached sample paper with track changes and yellow highlights is to show you the strength /weakness discussion. one thing to remember is that even though an article is level I to III, the weakness may limit the validity of the study to be used in changing practice.
•   FYI please use the first attachment  below as sample paper and the guidelines them the other 3 papers need to be expanded and incorporated in.  On this last paper you are discussing the interventions you would do.

Running head: EVIDENCE-BASED PROJECT PROPOSAL 1

EVIDENCE-BASED PROJECT PROPOSAL 6

Evidence-Based Project Proposal

United States University, MSN563

Dr. Anita Hunter, Ph.D., MSN, RN

August 2, 2020

Abstract

Type 2 Diabetes Mellitus (T2DM) is an ever-growing problem in the developed world with a projection of increase to 625 million people in the next twenty-five years. Costs to manage this disease in the United States was 730 billion dollars in 2017. The objective of this project is to develop an intervention, based on the literature, to reduce the risk for Type2 DM. The review of literature in this proposed project resulted in evidence that supports a reduced calorie diet that is vegetarian/Mediterranean being combined with an exercise program that includes both aerobic activity and resistance training to best control HbA1c levels. Recommendations are to include a moderate calorie diet that is vegetarian or Mediterranean, combined with aerobic activity such as walking three days per week, 45 minutes per day and resistance training two days per week with follow up testing of HbA1c levels at 12 weeks to monitor effectiveness. Additionally, behavior control techniques that support understanding, follow through, buy in, and compliance from the patient will be included in the teaching self-management of this disease.

Keywords: Diet, calorie reduced diet, low carbohydrate diet, moderate carbohydrate diet, exercise, aerobics, moderate physical activity, Type 2 Diabetes, HbA1c, A1c, HbA1c, resistance training, vegetarian, vegan, Mediterranean.

Introduction: Evidence-Based Project Proposal

This proposed project seeks to discover if adults with Type 2 Diabetes Mellitus (T2DM) blood glucose levels are best controlled with a moderate exercise program alone, or if diet paired with exercise has the most significant impact on HbA1c levels. The focus will be on adults, ages 18 and over. T2DM is the most common type of diabetes. In 2017, it was estimated that 425 million adults in the United States had diabetes (Levy, 2019). The projected increase in those with T2DB over the next twenty-five years is a staggering 629 million. This number represents a forty-eight percent increase. The death toll of T2DM-related incidents across the world in 2017 was over four million adults, with a cost of nearly 730 billion dollars for managing the disease (Levy, 2019). There is a need to direct more funding to decrease health disparities to aid in managing chronic diseases such as T2DM (Meit & Knudson, 2017). Implementing research on best practices to manage T2DM, particularly in underserved communities, will result in better health outcomes and decreased disease management costs.

Overview of the Problem: Type 2 Diabetes Management

Diabetes results when insulin production is decreased, or receptor sites fail to function correctly. T2DM makes up ninety-five percent of individuals diagnosed with diabetes and is a disease related to poor diet and overweight or obesity (Levy, 2019). This disease can affect any age group. Just like Type1 diabetes, T2DM is a chronic disease. However, T2DM can be controlled with diet and behavior modification and does not always require pharmacotherapy (Levy, 2019).

HbA1c is a non-fasting blood glucose test that gives a snapshot of blood glucose of the past 90 to 120 days. The test is an accurate measure of control of HbA1c (Levy, 2019). The use of the HbA1c test is an appropriate measure for monitoring those diagnosed with T2DM. Managing chronic illnesses such as T2DM is supported by community healthcare workers and providers of community care. HbA1c levels may be better managed with community healthcare providers who help oversee the management of the disease process. Education and follow up are key to controlling the disease process (Levy, 2019).

Community health nurses can play an active role in the management of T2DM via education and accountability (Crespo, Christiansen, Tieman & Wittberg, 2020). Diet and exercise play a significant role in the management of blood glucose levels. This paper will explore the best outcomes comparing exercise alone to a diet and exercise regime. In rural communities, there are increased smoking incidents, poor diet, obesity, and diabetes, making diabetes management even more critical. Addressing the needs of those in rural and urban communities and increasing access to medical care can be improved by using online healthcare as a community outreach (Goh, Gao & Agarwal, 2016). The use of online community outreach can reinforce teaching and behavior modification (Goh et al., 2016). Evaluating how exercise and exercise coupled with diet impacts HbA1c levels can improve health outcomes, increase the quality of life, and reduce costs related to unmanaged T2DM.

As the number of individuals living with T2DM increases, more studies are being conducted. T2DM sometimes requires management with medication. The ability to control some factors of T2DM makes it worth researching how this disease process can be best managed for individuals who may not have adequate access to medical care or fully understand the disease process and management.

Project Purpose: Controlling Type 2 Diabetes with Diet and Exercise

This project aims to proposed an intervention based on the review of literature regarding the management of Type 2 Diabetes (T2DM) using exercise alone and comparing that to the outcome of using a combination of training and a controlled diet. By searching evidence-based research and practice, better results for those living with T2DM can be achieved. This paper will seek to review the literature on the use of various types of diets and intensity and duration of exercise for best outcomes.

Background and Significance: Type 2 Diabetes Management

T2DM is considered a common disease, seen globally in the first world. It is a common disease that has both reversible and irreversible risk factors. Immutable factors that contribute to T2DM are age, genetics, race, and ethnicity. Reversible factors contributing to T2DM include smoking, diet, and physical activity level (Levi, 2019). Studies have revealed that diet and lifestyle are rapidly increasing the incidence in countries that are developing (Sami, Ansari, Butt & Hamid, 2017). It is reported that greater than fifty percent of those living with T2DM die of cardiovascular disease, evidencing the impact elevated blood sugar has on internal organs (Sami et al., 2019). A large number of studies have shown a correlation between inactivity and T2DM. Being active creates a sensitivity to insulin, helping to control blood sugar. Additionally, exercise reduces abdominal fat associated with T2DM (Sami et al., 2018).

As T2DM is slated to increase in overwhelming numbers, and most cases are related to lifestyle, this project comes at a significant time. It is more likely that there are a considerable number of people working from home, sheltering at home, and being inactive than has ever experienced before. The onset of COVID-19 has thrown society into an idle state without a conscious commitment to fight the lifestyle being lived. Physical inactivity and sedentary lifestyles have already been a pandemic of their own, wreaking havoc on health and increasing cases of T2DM. With the addition of a global pandemic and the effects of being sent inside, the sedentary lifestyle has worsened. It has been hypothesized that sheltering at home as a result of COVID-19, the impact of a physically sedentary lifestyle could further negatively impact health outcomes for several years to come (Hall, Laddu, Phillips, Lavie & Arena, 2020). As the effects of a sedentary lifestyle negatively impact those who are otherwise healthy, individuals with T2DM suffer a more significant impact when activity is reduced, making research surrounding combatting T2DM even more significant.

This innovative proposed research project seeks to discover how physical activity alone compares to physical activity combined with diet helps control T2DM. In this proposed project, a group of individuals with T2DM will be randomly selected into three intervention groups. Group one will enter: an exercise program of aerobic walking or other similar exercises for 45 minutes per day, three days per week with caloric restriction and no emphasis on the type of foods consumed. Group two will enter a program of aerobic walking or other similar exercises for 45 minutes per day, 3 days per week and will be placed on a carbohydrate-controlled diet with calorie restriction. Group three will enter a program of aerobic walking or other similar exercises for 45 minutes per day, three days per week and will be placed on a vegan/vegetarian with no animal products other than non-fat and low-fat dairy and calorie restriction. The result will be recorded over 16 weeks and the outcome data will compare the HbA1C levels between the three groups. The outcomes may be able to help direct providers in providing the best approach to managing T2DM.

The potential impact on individuals with T2DM is assumed to increase healthy outcomes and improve quality of life. The combination of diet and exercise is expected to result in the most exceptional outcomes. As exercise intensity increases, HbA1c levels drop more (Kirwan, Sacks & Nieuwoudt, 2017). The combination of a target heart rate during exercise may prove substantial for many individuals with T2DM and offer greater blood sugar control. The addition of different diet types could prove to be very beneficial at controlling HbA1c levels and finding what diet works best for each individual.

PICOT Formatted Clinical Project Question

The subject for Research from United States University Approved List is [Walking 3x/week or Other exercise activity] for 45-minutes Reduce Blood Sugar levels in [African- Americans or population] with Type 2 Diabetes.

The PICOT Question for Evidence-Based Project Proposal is: In adults with Type 2 Diabetes (P), how do moderate physical activity at least three times per week (I) compare to a modified diet and moderate physical activity at least three times per week (C) affect HbA1c levels (O) after 16 weeks (T)?

Literature Review and Summaries

Key terms used in this search were “diet”, “calories reduced diet”, “low carbohydrate diet”, “moderate carbohydrate diet”, “exercise”, “aerobics”, “moderate physical activity”, “Type 2 Diabetes”, “HbA1c”, “A1c”, “controlling HbA1c”, “lowering HbA1c”, “diet and HbA1c levels”, “exercise and HbA1c levels”, “social determinants of health”, and “access to healthcare”. The search engines used were PubMed, CINHAL Complete, ProQuest Nursing, and Allied Health Source, and Google Scholar. All search engines were accessed through the United States University Library. Boolean operators such as “and” and “or” were used to broaden or define research where needed.

The first systematic review is entitled “Clinical Outcomes and Glycaemic Responses to Different Aerobic Exercise Training Intensities in Type 2 Diabetes”, and includes 27 randomized control trials with a total of 1372 participants were evaluated for their results (Grace, Chan, Giallauria, Graham & Smart, 2017). The study was published in Cardiovascular Diabetology and included adults over the age of 18. RCTs included in this review were six weeks or longer in duration and all participants had elevated HbA1c levels. Studies of Type1 diabetes were excluded. HbA1c levels were used to determine impact of exercise as well as peak VO2 as HbA1c levels may not be impacted at the 6-week timeframe. Also recorded were baseline lean body mass, BMI, body composition, fasting glucose and insulin (Grace et al., 2017). Duration of exercise, frequency and intensity of exercise, and the length of the exercise program were also recorded. Resistance training studies were excluded as they do not impact peak VO2. All study groups were compared to a control group. More than 13 studies included were conducted poorly and nine out of 27 studies did not clearly report the method of randomization. Only four studies reported blinding. Exercise intensity was only reviewed in five studies. A systematic search was used to identify studies using MEDLINE from 1985 to September 2, 2016, CINHAL, SPORTDiscus, Cochrane Controlled Trial Registry from 1966 to September 2, 2016, and Science Citation Index. The strategy used was a mix of free text terms and MeSH for key concepts. The searches were limited to randomized controlled trials that included aerobic activity of individuals with T2DM who were 18 years of age and older and lasted for two weeks (Grace et al., 2017).

This first systematic review of exercise revealed a 0.71% decrease in HbA1c levels with moderate exercise and a 1.03% decrease in HbA1c with intense exercise performed at peak levels (Grace et al., 2017). The study duration was two weeks. Included were 737 exercise groups and 636 control groups. This review evaluated exercise intensity on the control of HbA1c levels. The study discusses the benefits of lifestyle modification, namely diet and exercise, as beneficial to those with Type 2 Diabetes and HbA1c control. The focus, however, was on exercise intensity. It was discovered that various modalities of exercise result in different effects on HbA1c levels. Combining aerobic activity and resistance training is superior at controlling blood glucose levels for those with T2DM according to this article (Grace et al., 2017). For example, it was discovered that one 4-minute session of High-Intensity Interval Training (HIIT) was not as effective as four 4-minute sessions on HbA1c levels. However, according to this study, moderate exercise is still considered preferable as clinical improvements are seen at a moderate intensity and can be performed by most people (Grace et al., 2017). The primary outcome data in all RCTs were HbA1c levels. The instruments of measurement were HbA1c levels, fasting blood glucose, and weight loss validating the results (Grace et al., 2017).

This systematic review includes Level I evidence and is at the top of the evidence pyramid scale. The strengths of this article include a clear review of studies and benefits supporting a moderate exercise program. Additionally, the number of randomized control trials (RCTs) and participants provides for a detailed analysis. The study points out a weakness in findings related to exercise and red blood cells. Exercise increases red blood cells, and red blood cell lifespan is approximately four months in length. As this study points out, research on the impact of physical activity on HbA1c levels should last a minimum of four months to coincide with the red blood cell lifespan. HbA1C levels are a twelve-week look at plasma glucose concentration. Other parameters for testing should be included for a closer look at exercise related to blood glucose levels in the long run. The studies in this review lasted six weeks or longer, with the highest amount of time being twelve weeks or less (Grace et al., 2017). All findings were consistent and support exercise as a viable means for controlling blood glucose levels. Also, the longer the study continued, the more significant the impact on HbA1c levels. This supports testing subjects with elevated HbA1c levels in exercise programs for longer than twelve weeks (Grace et al., 2017). The more significant analysis could be obtained with a longer duration of studies related to exercise and HbA1c control. Additionally, this study has weaknesses in the RCTs and many should not have been included. Still, there is evidence that supports the common protocol of placing those with T2DM on an exercise regimen to help control blood sugar.

The second study in these summaries, another systematic review, is entitled “The Interpretation and Effect of a Low-Carbohydrate Diet in the Management of Type 2 Diabetes” and was published in The European Journal of Clinical Nutrition (Huntriss, Campbell & Bedwell, 2018). This systematic review approaching HbA1c control with diet was related to a low carbohydrate diet. The low carbohydrate diet resulted in a decrease in HbA1c levels of 0.28%, whether participants consumed 50 grams or 120 grams of carbohydrates per day (Huntriss et al., 2018). Eighteen studies were included in this review, with a total of 2204 participants that were 18 years of age and older. Seven of the studies analyzed HbA1c levels at three months, eight studies analyzed HbA1c levels at six months, and ten studies analyzed HbA1c levels at one year. At the trial’s end, HbA1c was analyzed, and data were available from seventeen studies. Not all studies included could effectively be blinded as participants could evaluate the diet they were to follow. A moderate carbohydrate diet resulted in twelve of the seventeen studies reporting a decrease in HbA1c levels, while four studies reported no change. One study reported the same effects as the control group and favored not reducing carbohydrate intake. The primary outcome data in the RCTs reviewed was HbA1c levels (Huntriss et al., 2018). Fifteen out of eighteen studies were considered to at high risk for bias in six of the criteria. RCTs were searched for using studies of individuals with T2DM who were over the age of 18. CINHAL, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ProQuest, ISRCNT, and opengrey.eu were used for the search. Studies containing data after one year on a low-carbohydrate diet were selected (Huntriss et al., 2018).

This study is a Level 1 evidence systematic review placing it at the top of the evidence pyramid scale. Shortcomings of the study were trials having different definitions of low carbohydrate. Some studies used a very low carb diet of fewer than 50 grams of carbohydrates per day. Other studies that considered their diet low or moderate in carbohydrates came in at 120 grams of carbohydrates per day. Adherence to diet was low, particularly in the groups that consumed 50 grams of carbohydrate per day. Several participants and RCTs reviewed add strength to this review, but the conclusion was less than helpful. While there is some evidence that a lower carbohydrate diet can positively impact HbA1c levels, it was considered inconclusive overall, with further studies needed (Huntriss et al., 2018). The unclear definition of low- and moderate-carbohydrate in this review weakens the overall strength of the study and carbohydrate control does not appear to be a major factor in controlling HbA1c levels. For this proposed project, this study should be eliminated.

The third study in these summaries is entitled “.” The study was published in The International Journal of Environmental Research and Public Health (Liu, Ye, Chen, Zhang, Kuo & Korivi, 2019). This second systematic review of activity revealed that low-moderate intensity resistance exercise resulted in a 0.23% decrease in HbA1c levels while the high-intensity group experienced a 0.61% decrease in HbA1c levels (Liu et al., 2019). The literature search for this review used SportDiscus, PubMed, Google Scholar, ScienceDirect/Scopus, EMBASE, and WanFang. All article available in English through September 2018 were searched using keywords such as “strength training” and “resistance training” along with “type 2 diabetes” (Liu et al., 2019). Titles and abstracts were screened for relevance related to the search criteria and further reviewed once appropriate articles were identified. Along with RCTs of individuals with T2DM written in English, resistance exercise programs of six weeks or greater were identified. There were twenty-four articles and 962 participants included in this review. Of the participants involved, 491 were in the exercise group, and 471 were in the control group. Groups were categorized as the low-moderate intensity in resistance training or high-intensity resistance training. There was also a control group that did not take part in resistance exercise. The report discusses the importance of comparing resistance training to aerobic activity in that aerobic activity can be difficult for overweight or obese individuals (Liu et al., 2019). All but one of the trials had a high risk of bias for blinding, though the authors of this study believe that did not compromise the validity of the study (Liu et al., 2019).

Performing resistance exercises can be more comfortable for those with mobility issues and can be done in-home making it convenient. Results revealed that those participating in low-moderate intensity resistance training only experienced a moderate decrease in insulin levels. The groups that performed high-intensity resistance training had significant reductions in insulin levels. However, low-moderate and high-intensity resistance training substantially lowered HbA1c levels, with the most significant lowering seen in the high-intensity group. The primary measurement outcome of this study was HbA1c levels. The report concludes that high-intensity resistance training improves insulin resistance very effectively and lowers HbA1c levels and is more beneficial than aerobic exercise at managing T2DM (Liu et al., 2019).

This study is a Level 1 evidence systematic review placing it at the top of the evidence pyramid scale. The strengths of this study are the vast number of RCTs and participants reviewed. Additionally, it is one of few studies that compare the effects of resistance training on those with T2DM to aerobic activity with definitive results. This study’s weaknesses lie in the lack of timeframes of the RCTs included (Liu et al., 2019). Although the duration of exercise is not clear, this study provides information worth including in this proposed study as it is one of very few studies that evaluates the differences between resistance training and aerobic activity on HbA1c levels allowing for physical activity that may be more manageable for those who are overweight or obese (Liu et al., 2019).

The fourth study summarized is entitled “Exercise Training Modalities in Patients with Type 2 Diabetes Mellitus” and was published in The International Journal of Behavioral Nutrition and Physical Activity (Pan et al., 2018). This third systematic review of exercise control of HbA1c levels revealed that aerobic exercise compared to resistance exercise programs resulted in a 0.30% decrease in HbA1c levels, whether the plans were supervised or unsupervised. The study protocol for this review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (Pan et al., 2018). Searches were conducted in PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE in April 2017 for articles and systematic reviews. Keywords used were “type 2 diabetes”, “exercise”, “aerobic exercise”, “strength exercise”, and “combination exercise” (Pan et al., 2018). Inclusion for the review required participants be over the age of 18 with a T2DM diagnosis (Pan et al., 2018). The review included 37 studies and 2208 participants with T2DM. This study evaluated literature that compared aerobic activity to resistance exercise and a combination of both. The primary measurement of outcome in this study was HbA1c levels, with blood lipids and weight loss being second and third. The study further compared supervised exercise with unsupervised exercise. The articles reviewed for this study have an unclear risk of bias. The scales of measurement were HbA1c levels, fasting blood glucose, weight loss, and blood lipid profiles. There were no inconsistencies reported between studies (Pan et al., 2018).

The findings of this study were that supervised exercise, whether aerobic or resistance, had little improvement over unsupervised activity when it came to HbA1c levels. The study did reveal that the combination of resistance exercise and aerobic exercise yields the most considerable decrease in HbA1c levels. Other markers were measured with the different exercise groups due to the correlation between T2DM and cardiovascular disease. Increase insulin sensitivity as a result of aerobic activity improves lipid profiles, and aerobic activity appears to be more beneficial at lowering LDL cholesterol than resistance activity (Pan et al., 2018). Combined exercise resulted in a 0.47% decrease in HbA1c levels (Pan et al., 2018).

This study is a Level 1 evidence systematic review placing it at the top of the evidence pyramid scale. Some scales of measurements, such as quality of life, did not have the same baseline in the RCTs included in the study. Additionally, the duration of exercise sessions and the duration of the length of studies were not included weakening the study to some degree. This study’s strengths are the breakdown of aerobic exercise, strength training, and a combination of activity and their respective impact on HbA1c levels (Pan et al., 2018). Due to more evidence on type of exercise improving HbA1c levels, this proposed study should include this systematic review.

The fifth and final systematic review is entitled “Behaviour Change Techniques Targeting Both Diet and Physical Activity in Type 2 Diabetes” and was published in The International Journal of Behavioral Nutrition and Physical Activity (Cradock, ÓLaighin, Finucane, Gainforth, Quinlan, & Ginis, 2017). RCTs that included exercise and diet related to individuals with T2DM were searched for using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RCTs of any duration from January 1, 1975 through January 6, 2015 included as long as there was a dietary and exercise intervention. Participants had to be over the age of 18 with a current diagnosis of T2DM (Cradock et al., 2017). The review does not compare the effectiveness of diet to an exercise program to control HbA1c levels. Instead, it discusses the use of both diet and exercise together. Thirteen RCTs and evaluations made at three, six, nine, twelve, and twenty-four months. The primary measurement outcome in this study was HbA1c levels, with weight being secondary. All RCTs included evaluated both diet and exercise impact on HbA1c levels. Low or unclear risk of bias was reported.

Low carbohydrate or a Mediterranean diet was used in combination with exercise. The review discusses the difficultly in modifying more than one behavior at a time. However, the results are that combining training with diet is a superior approach to controlling HbA1c levels. Behavior change techniques (BCTs) were evaluated, and it was concluded that BCTs outside of diet and exercise do not have much impact on HbA1c levels. However, BCTs were said to create a feeling of control for the individual with T2DM and increased confidence in self-management of their condition. It was also found that HbA1c levels improved at the three- and six-month mark, but are not sustained after that time (Cradock et al., 2017). Though it was unclear who was following the low carbohydrate diet and who was following the Mediterranean diet, the first three months resulted in a decrease of 1.11% HbA1c. After six months, the reduction in HbA1c levels was 0.67%. At the end of the twenty-four-month analysis, the reduction in HbA1c levels was 0.53% (Cradock et al., 2017).

This study is a Level 1 evidence systematic review placing it at the top of the evidence pyramid scale. The strengths of this review are the RCTs used and the evaluation of both diet and exercise use to improve HbA1c levels. Additionally, the length of the study spanned twenty-four months. The weakness in this review is the difficulty in understanding how many participants were part of the RCTs used. It is also unclear how many participants followed a low carbohydrate diet or a Mediterranean diet. Diet and exercise combined have the most positive impact on controlling HbA1c levels (Cradock et al., 2017). As this review has quality evidence that diet and exercise combined can have a positive effect on HbA1c levels, and the use of BCTs increase confidence in managing T2DM, this proposed study should include this systematic review.

Interventions of Care

The proposed interventions include a vegetarian/vegan/Mediterranean diet, exercise a minimum of three days per week, and behavior control techniques (Cradock et al., 2017). These proposed interventions begin with identifying those with T2DM. The most significant decrease in HbA1c levels was with a combined diet and physical activity approach (Cradock et al., 2017). Once a diagnosis of T2DM is made, proactive teaching should occur. Weight reduction is directly linked to a decrease in T2DM (Cradock et al., 2017). A moderate calorie diet that is low in sugar and animal protein and fat, and moderate in dairy appears to be a beneficial approach to managing HbA1c levels. A decrease of 0.53% HbA1c levels was reported with the combination of diet and exercise making a manageable exercise program appropriate (Cradock et al., 2017).

A combined approach to exercise that includes both aerobic activity and resistance training resulted in a 0.47% decrease in HbA1c levels (Pan et al., 2018). This is the greatest return on investment of physical activity. This proposed intervention includes two days a week of resistance training and a minimum of three days a week, 45 minutes per day of moderate aerobic activity such as walking. Combing exercise with diet will result in better glucose control of those with T2DM (Pan et al., 2018).

The third component of this intervention of care includes behavior control techniques (BCTs). Of the most useful BCTs, instructions on how to perform a behavior, practice and rehearsal of behaviors, and action planning, and demonstration were the most useful elements (Cradock et al., 2017). This supports that observational learning can empower individuals to make change (Cradock et al., 2017). This is an importance component of this proposed intervention of care that should be included.

Though further research needs to be completed, walking three days per week and resistance training two days per week for a minimum of 45 minutes per day will be the standard starting regimen. Although this area is unclear in research, the diet will lean toward vegetarian/vegan with the Mediterranean diet as an option where compliance may be low. More research is needed in this area as well. Weekly phone calls from a local clinic and support groups will be offered to support self-management of the disease process and reinforce the importance of monitoring blood glucose at home and having HbA1c screenings every 90 days. Adjustments to diet and exercise plans will be reviewed every 30 days to support compliance and evaluate the effectiveness of the bundle of care.

Implications of Using Interventions of Care

The potential contributions to T2DM care with this proposed project are greater self-management of HbA1c levels leading to a better quality of life. Research to this point has helped develop EBP to support the care of individuals with T2DM. By designing a plan of care that includes physical activity and diet combined, patient education, community support to help sustain lifestyle changes, and using this bundle of care in practice, more significant management of the T2DM disease process can occur. This bundle of care can be implemented in the practice of primary care providers and nurse practitioners, bringing attention and support for self-management into the communities. While there is still research to be done, many cases of T2DM can be managed without pharmacotherapy (Levy, 2019). Decrease medication management of T2DM reduces the cost of care and helps to put control of T2DM in the hands of the patient.

References

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Cradock, K. A., ÓLaighin, G., Finucane, F. M., Gainforth, H. L., Quinlan, L. R., & Ginis, K. A. (2017). Behaviour change techniques targeting both diet and physical activity in type 2 diabetes: A systematic review and meta-analysis. The International Journal of Behavioral Nutrition and Physical Activity, 14(1), 18.

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Crespo, R., Christiansen, M., Tieman, K., & Wittberg, R. (2020). An emerging model for community health worker-based chronic care management for patients with high health care costs in rural Appalachia. Preventing Chronic Disease, 17, E13.

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Grace, A., Chan, E., Giallauria, F., Graham, P., & Smart, N. (2017). Clinical outcomes and glycaemic responses to different aerobic exercise training intensities in type II diabetes: a systematic review and meta-analysis. Cardiovascular Diabetology, 16, 37. https://doi.org/10.1186/s12933-017-0518-6.

Huntriss, R., Campbell, M., & Bedwell, C. (2018). The interpretation and effect of a low-carbohydrate diet in the management of type 2 diabetes: A systematic review and meta-analysis of randomised controlled trials. European Journal of Clinical Nutrition, 72(3), 311-325. doi:http://dx.doi.org/10.1038/s41430-017-0019-4.

Kirwan, J. P., Sacks, J., & Nieuwoudt, S. (2017). The essential role of exercise in the management of type 2 diabetes. Cleveland Clinic Journal of Medicine, 84(7 Suppl 1), S15–S21.

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Levy, H. R. (2019). Using HbA1c testing for diabetes diagnosis and management. MLO: Medical Laboratory Observer, 51(7), 46–50. Retrieved from

https://www.mlo-online.com/disease/diabetes/article/21085351/using-hba1c-testing-for-diabetes-diagnosis-and-management

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Liu, Y., Ye, W., Chen, Q., Zhang, Y., Kuo, C., & Korivi, M. (2019). Resistance exercise intensity is correlated with attenuation of hba1c and insulin in patients with type 2 diabetes: a systematic review and meta-analysis. The International Journal of Environmental Research and Public Health.

https://doi.org/10.3390/ijerph16010140

Meit, M., & Knudson, A. (2017). Leveraging interest to decrease rural health disparities in the United States. American Journal of Public Health, 107(10), 1563–1564.

https://doi.org/10.2105/AJPH.2017.304025

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5607699/

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Pan, B., Ge, L., Xun, Y. Q., Chen, Y. J., Gao, C. Y., Han, X., Zuo, L. Q., Shan, H. Q., Yang, K. H., Ding, G. W., & Tian, J. H. (2018). Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis. The International Journal of Behavioral Nutrition and Physical Activity, 15(1), 72.

https://doi.org/10.1186/s12966-018-0703-3

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Sami, W., Ansari, T., Butt, N. S., & Hamid, M. (2017). Effect of diet on type 2 diabetes mellitus: A review. International Journal of Health Sciences, 11(2), 65–71. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426415/

.

INTRODUCTION AND PROBLEM STATEMENT

6

Introduction and

Problem Statement

Student’s Name

Department, Institutional Affiliation

Course Title

Tutor’s Name

Date

Falls, injuries, and nosocomial infections are some of the most common unsafe incidents that are common in the long-term care environment such as medical-surgical health departments. The nurses working in long-term care are such as the medical-surgical healthcare units are facing demanding tasks of ensuring that the patient population is kept safer from injuries caused by preventable falls on the daily basis. The majority of the patients in long-term care are older than 65 years and are usually exposed to lengthy hospital stays. These populations are exposed to several comorbidities, they take multiple medications, and are therefore having a decline in their functional ability (Brosely & March 2015). Elderly individuals are also exposed to nosocomial infections as a result of their weakened immune systems. Nursing home residents might be presenting a combination of the above-mentioned features and this implies that they are highly exposed to the risks of falls and are sustaining major injuries.

The prevention of falls and injuries to the patients requires multifactorial strategies and is important in dealing with the functional, physical, psychological, and educational components. It is also important for the Medical-surgical healthcare departments to ensure that the nurses are working as a team to ensure that there is an effective utilization of the collaborative interdisciplinary prevention measures that are helpful in the reduction of the risks of falls and injuries caused by the falls (Goldsack et al., 2015).

One of the most important strategies that have been considered to be helpful in the improvement of the patients’ safety through the reduction of injuries and falls is the hourly nursing rounding. Hourly rounding is defined as a nurse-led proactive strategy utilized in the anticipation of the patients’ needs while using evidence-based interventions. This strategy requires nurses to ensure that patients are checked based on a specific set time frame. The nursing hourly rounding strategy also requires nurses to perform critical evaluations of the environment and taking necessary steps to ensure that there is the promotion of patient safety, improvement in the quality of healthcare, and improvement of team communication.

Problem Statement

Patient safety is a major area of focus among healthcare providers and healthcare organizations. The healthcare providers are playing a crucial role in ensuring that the patient population is protected from the fall episodes as a result of the longer lengths of stay, multiple comorbidities, polypharmacology, and reduction in their function ability, and advanced age. The issue of falls is common among aging individuals and their injuries are considered to be the causes of deaths caused by unintentional injuries. Due to the international impacts of falls in the aging population, there is a need to ensure that there is the existence of strategies or programs aimed at reducing falls and injuries that are associated with the falls (Hill & Fauerbauch, 2014).

Based on the consideration of the number of residents that are being cared for by the nurses, it is evident that the implementation of the effective measures are necessary to ensure that there is a reduction in the rates of falls and the needs of the individuals are cared for and the safety of the patients is promoted. The major area of focus on the safety of the patients especially the elderly patients is on the rate of falls. Falls is considered a major health concern for elderly patients. The World Health Organization (WHO) (2016) reports that about 20 to 30 percent of the aging population are experiencing moderate to major injuries from falls and greater risk of mortality caused by the fall-associated injuries (World Health Organization, 2016).

Neily et al (2015) report that approximately 3 to 20 percent of the inpatients are falling at a rate not less than once after being admitted to the healthcare facilities. This study further reveals that patients in the acute and the rehabilitation centers are experiencing about 30 to 51 percent of injurious falls. The falls and injuries are affecting the quality of life of the patients and this is causing an increase in healthcare costs. The healthcare cost associated with falls and fall-associated injuries is costly. Neily et al (2015) state that patient with two falls or more with no severe injury incurs approximated yearly healthcare cost of $ 16,000 while the individuals with severe injury is costing up to $ 27,000 (Neily et al., 2015).

The patients in the medical-surgical healthcare departments are also experiencing the risk of being exposed to the healthcare-acquired pressure ulcers and the low nurse patients’ ratios and this interferes with the level of their safety. The strategies or available solutions towards addressing these problems are not fully implemented. The failure in the implementation of the solutions such as hourly nursing rounding is associated with the numerous factors that can be considered as the barriers. Some of the barriers that interfere with the process of achieving full implementation of the hourly nurse rounding are the resistance from the nurses. The resistance is associated with the lower number of healthcare providers to offer services to a large number of the growing population of the patients (Brosely & March 2015).

The low nurse-patient ratio makes it hard for the healthcare facilities to ensure that there is an effective shifting process in the hourly rounding intervention. The implementation of hourly nursing rounding requires an adequate number of healthcare providers and this implies that the low number of these professionals makes it hard to ensure that the hourly nursing rounding procedure is implemented effectively to ensure that patients in the medical-surgical healthcare units are protected from unsafe incidences.

Therefore, these data are showing the need to ensure that efforts are made to help in the reduction of injuries, healthcare costs, and the promotion of a safer environment. It is therefore important for the healthcare facilities to ensure that there is an implementation of the evidence-based fall reduction approaches that are supported by the present literature (Hill & Fauerbauch, 2014).

Conclusions

Falls, injuries, and nosocomial infections are common healthcare issues that expose patients to severe infections and a longer stay in healthcare facilities. Purposeful hourly rounding has been confirmed to be a proactive method that can be adopted by the healthcare providers such as nurses to ensure that the needs of the healthcare providers are identified. It also helps in the demonstration of positive fall prevention outcomes. The utilization of the evidence-based hourly nurse rounding approach has been on the rise, nevertheless, its implementation is not fully achieved. It is, therefore, necessary for the nurse leaders to ensure that the rounding programs are evidence-based and clearly defined within the organization’s policies.

References

Brosely, L. A., & March, K. S. (2015). Effectiveness of structured hourly nurse rounding on patient satisfaction and clinical outcomes. Journal of Nursing Care Quality, 30(2), 153-159. doi:15505065.
Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly Rounding and Patient Falls: What Factors Boost Success? Nursing, 45(2), 25-30. doi:107770823
Hill, E., & Fauerbauch, L. A. (2014). Falls and fall prevention in older adults. Journal of. Falls and fall prevention in older adults. Journal of Legal Nurse Counseling, 25(2), 24-29.
Neily, J., Quigley, P. A., & Essen, K. (2015). Implementation Guide for Fall Injury Reduction: VA National Center for Patient Safety Reducing Preventable Falls and Fall-Related Injuries. 1-10.
World Health Organization. (2016). Fact sheet. http://www.who.int/mediacentre/factsheet/fs344/en/

6

Project Purpose Statement, Background, Significance and the PICOT Clinical Formatted Clinical Project Question

Student’s Name

Department, Institutional Affiliation

Course Title

Tutor’s Name

Date

Patient safety in healthcare facility that is affected by injuries, falls, and healthcare associated infections. These problems interfere with the quality of the healthcare services that are supposed to be received by the patients. Nurses employed in long-term care like the medical-surgical units are always under pressure to provide healthcare services and to improve the safety of the patients. The majority of the patients in medical-surgical units are elderly and most of them are older than 65 years. These populations are therefore exposed to the risk of falls and injuries (Daniels, 2016).

The purpose of the capstone project is to focus on the effects of the hourly rounding on the safety of the patients. The procedure of the hourly rounding considers positioning area, the proximity of the personal items, bathing, and pottying. Informing the patients about the role of the nurses is important in improving the comfortability that is needed by the patient. Making the patients aware of the work and the intention of the nurses is helping in reducing the level of stress especially when there is no nurse around. It also assists in reducing the patients’ need for ambulance thus reducing the risk of falls (Flynn et al., 2016).

Background

In healthcare facilities, elderly patients are exposed to a higher level of stress as a result of the rising healthcare conditions, treatment, nursing care they require. Nurses are also not free from these problems since they are socially and emotionally affected by the increased level of responsibilities. The elderly patients in the medical-surgical units experienced a decrease in their ability to perform the general ADLs. This, therefore, implies that in addition to the provision of nursing care to the patients, nurses help patients to meet their basic needs such as repositioning, eating, and elimination. The lack of information about the routines in the medical-surgical units increases assistance seeking by the patients thus increasing the nursing. This problem, therefore, requires evidence-based interventions to ensure that there is an improvement in the safety of the patients. One of the interventions that are considered effective in dealing with the above issues is hourly nursing rounding (Gormley, et al., 2019).

Significance of the problem

The process of dealing with the problem presented in this case i.e. safety of the patients is important in revealing some of the pressing issues that patients and the nurses are facing concerning safety. In the healthcare facilities especially medical-surgical units, patients are at higher risks of falls, nosocomial infections, and pressure ulcers. The process of dealing with these issues requires effective strategies which must be implemented fully or the goal of achieving the patients’ safety is realized (Brosey & March 2015).

Addressing some of the issues that affect the safety of the patients is helping in revealing other forms of challenges that are faced in having effective strategies of addressing the issues such as falls, injuries, and nosocomial infections among others. It reveals some of the barriers that nurse managers are facing when it comes to the provision of the necessary resources and support required for the successful implementation of the intervention (Al Kuwait & Subbarayalu, 2017).

Usually, healthcare facilities are faced with the problems of a low nurse-to-patient ratio. This makes the implementation process of the intervention such as hourly nursing rounding to be unsuccessful in addressing the problem of the patients’ safety. When nurses are faced with an increased workload, it makes it hard to handle every need of the patients thus exposing patients to danger as a result of lack of emergency attendance. Therefore, this is significant in informing about the need to have an increase in the number of nurses to help in ensuring that the hourly rounding intervention is fully implemented to meet the needs of every patient (Daniels, 2016).

The possible impact of the project on the anticipated outcome of the betterment of health and or health outcomes

One of the most important effects of the successful implementation of the intervention is the overall reduction in the rates of falls. The reduced rate of falls implies that the safety of the patients is improving. It is also related to the drop in the healthcare cost since there need for the readmission for the fall-related injuries would not be there. It is also expected that the hospital reputation would be improved since the reported rising cases of hospital readmission, morbidity, and mortality associated with injuries, falls, and hospital-acquired infection would no longer be the case or concern. This is likely to benefit healthcare facilities due to the possibility of having an increase and continuous flow of reimbursement from the Centers for Medicaid and Medicare (CMS) (Brosey & March 2015).

The intervention is also addressing the patients’ anxiety since it creates a proactive and regular checking of the patients which ensures that nurses are always closer and present near the patients. Usually, patients are emotionally affected in the absence of the nurses and this interferes with the patients’ healing process. The implementation of the intervention, therefore, helps in the promotion of the coping skills that are helping in the successful healing process of the patients (Brosey & March 2015).

The implementation of the intervention is helping in ensuring that the needs of the patients are met. Some of the important patients’ needs such as bathing, pottying, positioning, control of the pain, and the proximity to the necessary items are addressed by the hourly nursing rounding. The intervention helps in creating a structured format that assists in ensuring that the needs of the patients are met (Gormley, et al., 2019).

PICOT Formatted Clinical Project Questions

Population: the targeted population is elderly individuals admitted to the medical-surgical units. The patients have a reduced ADLs, therefore, they rely mostly on the help of the patients for their bathing and pottying. These demands expose these patients to stressful situations due to the absence of the nurses in their units. The overdependence on the nurses implies that patients have to rely solely on nurses for their daily needs.

Intervention: the intervention to be implemented is focused on the hourly nursing rounding to ensure that the needs of the patients are addressed for their safety. The majority of the nurses in these units are exposed to the risk of falls and injuries when they attempt reaching out to their items, pottying, and bathing. Therefore, the intervention would be important in ensuring that the patients are assisted with these needs.

Comparison: the proposed intervention is compared to the non-scheduled rounding of the nurses.

Outcome: the anticipated outcome is the reduction in falls, injuries, and nosocomial infection thus assisting in the achievement of patients’ safety.

Time: the implementation of the program is expected to take at least six months for the implementation with the medical-surgical units.

References

Al Kuwait, A., & Subbarayalu, A. V. (2017). Reducing patients’ fall rate in an Academic Medical Center (AMC) using Six Sigma “DMAIC” approach. International journal of health care quality assurance. https://doi.org/10.1108/IJHCQA-03-2016-0030
Brosey, L. A., & March, K. S. (2015). Effectiveness of structured hourly nurse rounding on patient satisfaction and clinical outcomes. Journal of Nursing Care Quality, 30(2), 153-159. http://doi:doi:15505065.
Daniels, J. F. (2016). Purposeful and timely nursing rounds: a best practice implementation project. JBI Evidence Synthesis, 14(1), 248-267. http://doi:10.1097/NNA.0000000000000101
Flynn, F., Evanish, J. Q., Fernald, J., Hutchinson, D. E., & Lefaiver, C. (2016). Progressive care nurses improving patient safety by limiting interruptions during medication administration. Critical Care Nurse, 36(4), 19-35. https://doi.org/10.4037/ccn2016498
Gormley, D. K., Costanzo, A. J., Goetz, J., Israel, J., Hill-Clark, J., Pritchard, T., & Staubach, K. (2019). Impact of nurse-led interprofessional rounding on patient experience. Nursing Clinics, 54(1), 115-126. https://doi.org/10.1016/j.cnur.2018.10.007

Running head: LITERATURE REVIEW AND CRITICAL APPRAISAL 1

LITERATURE REVIEW AND CRITICAL APPRAISAL 2

Literature Review and Critical Appraisal

Student’s name

Instructor

Course

Date

This paper aims to review five different articles related to the PICOT question: “on a medical-surgical hospital unit (P), how does implementing hourly nursing rounding (I), compare to no scheduled rounding (c), affect patient safety(o), within 6 months of implementation (T)?” Some of the databases that examination or review was based on included the CINAHL, Cochran Library, and PubMed. The search strategy was also based on the inclusion criteria, i.e., using articles published from 2015-2020. During this search, patient safety was used as a dependent variable, while the hourly nurse rounds were used as an independent variable. The ten keywords used in researching the PICOT question were older, adults, fall, patient, hospital, effectiveness, hourly, rounding, injury, decrease, prevention, and safety. I used the Johns Hopkins Nursing EBP Rating Scale (JHNEBP) as a guide to critically analyze my peer-reviewed journals. It means my articles were based on the most evident measure level. The strength of evidence runs from the most significant article; for instance, I mostly used randomized controlled trials and experimental tests. Also, I avoided developing my literature review using weaker articles because they came from expert opinion websites.  

Literature Review

In order to locate a specific subject for your literature review, you need to invest in countless hours of studying. It is not an easy task because when you select your articles, they must be grounded on the reliability and strength of their same EBP. Therefore, one must understand the quality and quantity of evidence available and rank it according to the pyramid visual perspective chart. For instance, when making practice recommendations, researchers use filtered resources grouped in levels I-III because they explore the articles’ quality. But when a researcher is searching the primary literature of the article’s evidence, researchers use levels I-VII because resources are filtered.

Brosey & March (2015) conducted my first resource study, “Effectiveness of structured hourly nurse rounding on patient satisfaction and clinical outcomes,” that showcased how the study’s level of evidence influences nursing practices. The authors used three sample groups of hourly rounding scheduled from 1 hour, 2-hour rounding groups and no proper rounding. A systematic mixed method was used along with an integrative review to analyze how the three rounding groups would change clinical outcomes and patient satisfaction. Results revealed that the structured hourly rounding during the four-week study indicates a significant drop in fall rate from 24 falls to 12. The hierarchy of evidence for the examination based on the evidence presented was appraised as level III. The article’s strength was associated with how it has impacted the nursing practice by providing a more detailed comprehension of reducing fall rates within a healthcare facility. However, the source had its weakness because researchers used a short period of 3 months to evaluate the project’s success and sustainability after implementation, which would have produced unevidenced-based outcomes.

My second article was about the “Purposeful and timely nursing rounds: a best practice implementation project” by Daniels (2016), who conducted six-week quasi-experimental research. The study’s primary goal is to demonstrate how purposeful and timely nursing rounds would improve patient safety and satisfaction upon implementation. The author initially set fall rates and patient satisfaction. Other objectives that were considered are to show how evidence-based procedures related to rounding protocols and times would affect nurses’ compliance and knowledge and how those standards can be increased. Results showed that from zero, the compliance rate rose to 64%. Even though the study setting did not attain its set goals, there was a substantive rate increase in the three elements of patient satisfaction. It implies patient falls decreased by 50%, nurse’s response rate, especially toileting, increased by 40%, and the pain management scores and nurse communication increased by 10% and 5%, respectively. Therefore, the article displays a significant strength that nurses can use best fall management protocols to promote practice change and team collaboration. The article had a weakness in its result because the applied intervention did not compare the actual results with the control group, which could have biased nursing behaviors. The evidence presented in this research would be the hierarchy level I.

The third study was conducted by Goldsack et al. (2015) about “Hourly rounding and patient falls: what factors boost success?” to demonstrate how two units with pre-and postimplementation assessment procedures determined the impact of proactive hourly rounding on patient falls. This prospective pilot study showed how patient-centered care would improve nursing practice using the Lean Six Sigma process. Findings revealed that, when nurses worked as a team and were provided with quality support from facility administration and unit chief nurse, a significant fall rate reduction was recorded because the six-sigma process and patient-centered care changed the paradigm of the hourly rounding program. Therefore, the initial phases of the improvement project were positively impacted by hourly rounding, which served as the main strength of this article. However, the article falls short of nursing staff who felt unmotivated and did not persevere to the program’s end. The hierarchy of evidence evaluated would be presented as level II.

Wilson (2017) conducted the fourth peer-reviewed article concerning “Nursing Staff Responsiveness to Patients and Hourly Rounding.” Wilson evaluated two points of fall rates using an HCAHPS survey and the scatter plot report to compare the impacts of pre-and post-nursing hourly rounding interventions rolled out in education sessions. Data collection was done using a descriptive comparative study of the two measures with an appropriate sampling, including medical-surgical unit nurses taking care of patients aged 18 and above. This study’s objective was to see how nurses in a 24 hours surveillance of patient care would improve their responsiveness to patients requesting for call light and determine if their satisfaction and positive patient outcomes would be recorded. Results indicated a decrease in the number of falls for patient’s responded with call lights. The article primarily supports the claim that hourly rounding minimizes fall rates, and patient satisfaction was dependent on Press Ganey and HCAHPS surveys. One primary strength of this article was that it helped providers relate reimbursement with the level of patient satisfaction. Though it has a weakness in that it only involved nursing staff in the hourly rounding improvement program. The level of evidence supported by the findings is the level I hierarchy.

The final article was conducted by Young & Siegel (2016), about “The right person at the right time: Ensuring person-centered care.” The article focused on older adults, and this quasi-experimental study aimed to answer the question, who at the right time can provide high-value, person-centered and high-quality care to meet the demands of the nursing practice in a comprehensive outlook of what is required? The central focus is on how healthcare facilities’ systems are initially designed to create a rapport between the caregiver and the elder. The article’s findings revealed that patient safety, satisfaction, and fall related issues are dependent on how the hourly rounding program is implemented within the hospital units. The article’s significant strength was that person-centered care produces unbiased results because it was between the nurse and the patient. However, it had a weakness of using a small sample size. The level of evidence supported by findings was the level I hierarchy.

Summary of Review

The PICOT question was supported by findings from all the above-discussed articles that implementing hourly rounding programs within a healthcare facility results in reduced fall rates, patient satisfaction and safety. It has been proved that the number of falls in each unit significantly reduces when there are one or two hours scheduled to look after the patient’s progress. Despite these articles supporting a similar claim, some provided more improvement in reducing fall incidences and increasing patient satisfaction. Therefore, a different inference drawn from these sources is that the adverse effects of fall incidences would be reduced and quality of care improved when healthcare facilities introduced hourly rounding in their daily activities. Also, the cultural changes from diverse populations should be considered while linking evidence with hourly rounding. As a result, a facility will report a high response rate from both the patient and the staff if they invest in educating the staff and improving the resident’s environment. It automatically translates to quality care delivery, fall incidences reduced significantly, and other associated complications when staff starts paying attention to improving primary care needs through increased surveillance and attention (Wilson, 2017). Meeting patients’ needs while preventing them from getting unattended requires a reactive strategy rather than a proactive method. Therefore, it is essential to appraise the hourly rounding program based on its effectiveness in reducing fall incidences.

References

Brosey, L. A., & March, K. S. (2015). Effectiveness of structured hourly nurse rounding on patient satisfaction and clinical outcomes. Journal of Nursing Care Quality, 30(2), 153-159.

Daniels, J. F. (2016). Purposeful and timely nursing rounds: a best practice implementation project. JBI Evidence Synthesis, 14(1), 248-267.

Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly rounding and patient falls: what factors boost success? Nursing2019, 45(2), 25-30.

Wilson, L. W. (2017). Nursing Staff Responsiveness to Patients and Hourly Rounding.

Young, H. M., & Siegel, E. O. (2016). The right person at the right time: Ensuring person-centered care. Generations, 40(1), 47-55.