Evidenced Based Nursing Research

Explore two evidenced based nursing research articles on fall prevention and hand hygiene compliance. The articles provide insights on nursing practices, methodologies, and more.

Running head: EVIDENCED BASED NURSING RESEARCH
EVIDENCED BASED NURSING RESEARCH
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1EVIDENCED BASED NURSING RESEARCH
Qualitative article: Community service provider perceptions of implementing
older adult fall prevention in Ontario, Canada: a qualitative study
Background:
According to the evidence majority of the cases related to falls are predictable and the
injuries caused by the falls are preventable. There is a negative impact of the unintentional falls
and injuries among the person aged 65 years and more on the health care resources and the
quality of life of the old aged person of Canada. In Canada the rate of falls in the older adults per
year is 20-30%. Many studies have been indicated that adequate interventions are present that are
effective in order to reduce the risk factors of falls and injuries. However, the health care service
providers face some barriers in order to provide such fall prevention strategies. The purpose of
the study is to explore the barriers of the falls prevention strategy and introduce effective the
evidenced based fall prevention strategies to reduce the risk of falls. It would help to identify the
process that could help t reduce the rate of falls and injuries in the population (Dykeman et al.,
2018).
Review of the literature:
The increasing risk of falls and injuries has become the concern of the health care service
providers. Evidence has proved that most of the incidents of falls are predictable and the injuries
caused by the incidents are preventable. The people aged 65 years and more are susceptible to
falls. The rate of falls in the older adults in Canada is 20-30% that has a negative impact on the
health service and the standard of life of the older adults in Canada. According to some study

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with the implementation of the fall prevention activities in the population the risk of falls could
be reduced by 24%. However, it has been detected that the rate of falls in the older adults is
remained unchanged and it is high for the women aged from 65-70 years in the community.
Thus, the need of fall prevention process has become high in the recent days. In thus regards
evidence has shown that some factors are there that affect the implementation of the fall
prevention strategies and create barriers for the service providers, for example, lack of
communication and coordination between different health care organizations, insufficient
resources, lack of access or unequal access to the service and many others. Thus, the service
providers need to be focused on the factors and introduce effective interventions to resolve the
issue and reduce the risk of falls in the population ((Dykeman et al., 2018).
Discussion of Methodology:
The risk factor of falls varies according to the age, gender and population. Thus, the study
has chosen different areas such as North Bay Parry sound District Health Unit, Public health unit
in Ontario, Simoco Muskoka district Health Unit and York region Public Health Service as the
sample of the study. The researchers have worked with the staffs of the organizations in order to
understand the fall prevention activities. The staffs of the organization have contacted
participants from different levels such as managers, supervisors and frontlines. The people that
are interested in participation in the study have been informed about the study process. Common
interview has been conducted for the participants. Relevant questions related to types of fall
prevention activities in the organization, additional activities, factors that creates obstacle, new
interventions have been asked to the interviewee. The study has included broad sample size in
order to introduce broad discussion (Dykeman et al., 2018).

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Data analysis:
In order to analyze the data NVivo 10 software has been used to transcribe the individual
data collected by from the interview. In order to ensure the trustworthiness of the study Patton’s
suggestion has been taken, which assures that the researchers have adequate qualification to
complete the research in an effective manner. Triangulations have been used to complete the
findings and describe the realties across the community setting. After collecting the data
regarding the barriers and fall prevention process they are organized according to the major
categories. Documentation of the ideas and decision in the study has been done as part of audit
trail (Dykeman et al., 2018).
Researcher’s conclusion:
Implementation of effective fall prevention process is important but it is not sufficient in
order to reduce the risk of falls. The service providers need to focus on the improvement of the
effectiveness of the implementation. The service providers face numerous barriers while
providing community service. Some barriers limits the access of effective service thus, could
create inequalities in health service. Thus, it is important to provide focus to the factors affecting
the fall prevention activities in order to resolve them in an effective manner. It is important for
the health professionals to work together and convert their knowledge regarding fall prevention
into actions to reduce the rate of falls and injuries (Dykeman et al., 2018).
Criticism of researcher’s conclusion:
Throughout the article it has been found that effective fall prevention activities could
reduce the risk factor of falls. The article has provided relevant evidence for the fact that

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implementation of such process need more focus from the health care organizations. The study
has provided effective evidence regarding the presence of barriers that affect the implementation
of the fall prevention strategy and has provided relevant approaches such as education,
collaboration of the health professionals and improvement of policies. Such evidence provided in
the study has indicated that the conclusion provided by the researchers is relevant to the study
(Dykeman et al., 2018).
Protection of human subjects and cultural considerations of the article:
The study did not reveal the information of the participants. It has maintained the
confidentiality. The researchers did not force any interviewee in order to participate in the study.
Ethical factors such as patient safety and individual rights have been maintained by the
researchers. The study did not harm anyone during the research. Thus, it can be said that the
study has maintained human subject and considered the cultural factors in an effective manner.
However, the researchers have provided compensations such as gifts to the participant that is
unethical and need to be focused by the researchers (Hawley et al., 2014).
Strengths and limitation of the study:
The study has provided important knowledge regarding the implementation of the fall
prevention strategies and barriers that could affect the implementation process. The researchers
have gathered divergent opinions in order to provide broad prospective that could facilitate the
understanding. Beside such strengths of the study it contains some limitations as well. The
qualitative method used in the study could limit the generalization of the result of the study.
Another limitation is the study has not differentiated between the strategies that are actually

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implemented and the strategies that are untested. However, the study has used relevant evidence
for the prevention practice. Further research also needed to identify the barriers that affect the
fall prevention strategies (Dykeman et al., 2018).
Evidence of the article and nursing practice:
Strategies provided by the article in order to improve the fall prevention process is
helpful. The idea of educating the nursing staffs regarding fall prevention activities could help
the staffs in providing effective service. The article has proposed initiative regarding changing
policies and laws by the government to improve the standard of fall prevention. The
implementation of coordination of the health professionals could help the nursing practice to
improve its service in an effective manner. The information regarding the barriers would help the
nursing practice in introducing effective strategies to resolve the issue. Thus, it can be said that
the evidence provided by the article has informed the nursing practice efficiently (Stevens,
2013).

6EVIDENCED BASED NURSING RESEARCH
Quantitative article: Quantifying the Hawthorne effect in hand hygiene
compliance through comparing direct observation with automated hand
hygiene monitoring
Background:
Hand hygiene is considered as the one of the best methods for preventing infections and
transmission of infectious organism that causes morbidity and mortality within the patients in the
hospital. However, the rate of hand hygiene practice is remained low. It is important to observe
the hand hygiene process complied by the health workers in the health care centre while engaged
in the clinical practice. It has been seen that the incident of direct observation is prone to the
Hawthrone effect that explains the different behaviour of the people when they are under
observation. The introduction of electronic system for observing the hand hygiene of the health
workers has helped to reduce the influence of Hawthrone effect. The purpose of the study is to
understand the difference between the influence of Hawthrone effect on direct observation of
hand hygiene process and electronic monitoring process. It would help to introduce effective
process of monitoring the hand hygiene of the health workers and reduce the risk of infectious
disease and mortality rate due to such disease in the hospital (Hagel et al., 2015).
Review of the literature:
The process of hand hygiene has been acknowledged by most of the health care
organization as the effective strategy to prevent infections in the health care and reduce the rate f
infectious disease and death caused by the diseases in an effective manner. Thus, it is important

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to observe the hand hygiene adherence of the health workers in the hospital during the clinical
practice. In most of the cases the process is done by measuring the amount of disinfectant
consumed or counting the dispenser that are utilized. However, it has been found that the rate of
compliance with the effective hand hygiene process is low. According to the guideline of World
Health Organization’s “Five Moments for Hand Hygiene” the last observation regarding the
hand hygiene process in the hospital has indicated that the overall hand hygiene compliance of
hospital is 41%. Thus, direct observation process has been introduced in order to observe the
hand hygiene adherence of the health workers. However, presence of Hawthrone effect has been
found in the direct observation process. Thus, it is important to introduce effective strategy to
monitor the hand hygiene compliance in the hospital. In this regards, automated hand hygiene
monitoring process is also present. It is important to compare the both process in order to
identify the most effective process of monitoring hand hygiene compliance (Hagel et al., 2015).
Discussion of Methodology:
The study has chosen University hospital of Jena for the research purpose. 24 bed from
the intensive care unit of the anesthesiological surgery. The study was performed in the 1500 bed
of tertiary care from 1st October 2013 to 28th February 2014. The facilities institutional study
board has approved the study. Total 70 alcohol based handrub or AHR have been installed in the
ICU. When someone pushed the lever of the dispenser, a time-stamped hand hygiene event has
recorded and transmitted through WiFi to the centralized database. On the other hand direct
observation of hand hygiene of the by the infection control practitioners has been performed in
the regular basis. The process has been observed by the intern observer who has been trained for
the hand hygiene observation technique. Total 50 episodes of direct observation were performed.

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In order to quantify the Hawthrone effect, comparison of the electronic monitoring process and
direct observation process has been done by the researchers (Hagel et al., 2015).
Data analysis:
The compliance of the hand hygiene was calculated considering the numbers of hand
hygiene events observed and divided by the number of opportunities observed according to te
guidelines provided by the WHO regarding the “Five Moments for Hand Hygiene”. The result
was then expressed as percentage. The incident observed by the electronic monitor and the direct
observation process has been analyzed by the Altman plot that helps to identify the mean of the
values provided by the two different processes thus, helps to compare the two different
processes. The observed values then standardized to the intervals of two hours in order to allow
the comparability. The e Spearman rank correlation coefficient has been used in order to explain
the relationship between the two variables (Hagel et al., 2015).
Researcher’s conclusion:
In many health care organizations, the infection control practitioners are recruited to
observe the hand hygiene process. It is important to identify the true rate of hand hygiene
adherence. The study has elaborate relation between the direct observation process and the
electrical monitor. The study has revealed that the electrical monitoring process is more effective
tool in order to observe the hand hygiene compliance as the Hawthrone effect is less in case of
electrical monitor as compare to the direct observation process. The direct observation process
could be used for getting feedback of individual performance and automated monitoring process

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need to be used for evaluate the hand hygiene adherence as it reduce both the observer bias and
the Hawthrone effect (Hagel et al., 2015).
Criticism of researcher’s conclusion:
The study has provided effective evidence that supports the researcher’s conclusion. For
example, the study has use reliable technique in order to interpret the result that indicates
automated hand hygiene adherence monitoring process is more effective in observing the hand
hygiene compliance of the health workers during clinical practice. The evidence provided by the
article also proves that the influence of the Hawthrone effect is less in case of electronic
monitoring process as compare to the direct observation. Thus, it can be said that the conclusion
provided by the researchers is relevant to the study (Hagel et al., 2015).
Protection of human subjects and cultural considerations of the article:
The information of the participants in the study has remained unclosed. Confidentiality
regarding the information collected has maintained throughout the study. The study has included
effective automated monitoring process and direct observation process that did not harm anyone,
thus, maintained the safety factor. The researchers did not provide any compensation and did not
force anyone in order to participate in the process. Thus, it can be said that the study has
complied with the human subjects and considered the cultural or ethical factors effectively
(Wendler, 2012).

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Strengths and limitation of the study:
The study has provided effective information about the monitoring process of the hand
hygiene adherence. The study has effectively informed about the influence of Hawthrone effect
on the hand hygiene monitoring process. It has been revealed by the study that the automated
hand hygiene adherence monitoring process is more effective as it reduces the Hawthrone effect
and the risk of biasness. Apart from such strengths the study also bears some limitations such as
the generalization of the result of the study is unknown as it is limited to the ICU of a single
health care organization. The study could not evaluate the individual hand hygiene event. In
addition the study did not include the health workers that works in night shifts. The study could
not control the possibility workload during the observing period (Hagel et al., 2015).
Evidence of the study and nursing practice:
The evidence provided by the study has helped to identify the effective hand hygiene
adherence monitoring process. It is important to monitor the hand hygiene process of the health
workers during nursing practice in order to ensure the quality of service. Such process helps to
introduce effective interventions in order to reduce infectious disease and death caused by such
diseases in the health care organization. The study has informed that the use of automated
monitoring process could observe the hand hygiene adherence in an effective manner thus has
helped the nursing practice to choose the appropriate process for monitoring the hand hygiene
adherence of the staffs (Butts & Rich, 2013).

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Reference:
Butts, J. B., & Rich, K. L. (2013). Philosophies and theories for advanced nursing practice.
Jones & Bartlett Publishers.
Dykeman, C. S., Markle-Reid, M. F., Boratto, L. J., Bowes, C., Gagné, H., McGugan, J. L., &
Orr-Shaw, S. (2018). Community service provider perceptions of implementing older
adult fall prevention in Ontario, Canada: a qualitative study. BMC geriatrics, 18(1), 34.
Hagel, S., Reischke, J., Kesselmeier, M., Winning, J., Gastmeier, P., Brunkhorst, F. M., ... &
Pletz, M. W. (2015). Quantifying the Hawthorne effect in hand hygiene compliance
through comparing direct observation with automated hand hygiene monitoring. infection
control & hospital epidemiology, 36(8), 957-962.
Hawley, N. C., Wieland, M. L., Weis, J. A., & Sia, I. G. (2014). Perceived impact of human
subjects protection training on community partners in community based participatory
research. Progress in community health partnerships: research, education, and
action, 8(2), 241.
Stevens, K. (2013). The impact of evidence-based practice in nursing and the next big
ideas. OJIN: The Online Journal of Issues in Nursing, 18(2), 4.
Wendler, R. (2012). Human Subjects Protection: A Source for Ethical Service-Learning
Practice. Michigan Journal of Community Service Learning, 18(2), 29-39.

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