Critical Evaluation of Qualitative Research Study on Patient Perceptions and Experiences with Falls during Hospitalization and After Discharge

Evidence Based Nursing Research
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Introduction:
Nursing professionals need to understand and promote evidence-based nursing practice. It
can be achieved by identifying and evaluating research appropriate to their practice and
professional activity. Nurse need to critique evidence from the peer reviewed publications.
Qualitative research plays significant role in providing evidence for the human based
medicine and healthcare research (Taylor, 2013; Schmidt and Brown, 2015).
In this essay, critical evaluation of the qualitative research study will be undertaken. This
article will be reviewed by using Ryan, 2007 framework for critique analysis of qualitative
research. This essay will also draw earlier published research. This essay will evaluate
importance of this article for nursing knowledge and practice.
The selected article is Shuman et al (2016) published in the Applied Nursing Research. Its
title is concise “Patient perceptions and experiences with falls during hospitalization and after
discharge’’. It gives information to the reader about the focus of the study; however, it
doesn’t mention about subjects and nature of the study.
Authors of this article are well qualified and experienced in this filed. In abstract research
problem, methodology and findings are clearly mentioned; however, sample and
recommendations are not clearly mentioned.
Significance of the study:
In this study risk of fall for the older people was discussed. Fall is one of the significant
problems for the older people specifically hospitalised patients. Falls are one of the most
frequently accrued safety incidences in the hospitals and approximately 40 % of the adverse
effects in hospitalised patients occur due to fall. Approximately 50 % of the hospitalised
patients sustain injuries like fracture and trauma. It can lead to death in few of these patients.
Falls can affect physical, psychological, functional and social wellbeing of the older patient
in the form of patient anxiety, loss of confidence in mobility and activities, social isolation,
long-duration hospital stay, discharge to long-term care facilities and augmented healthcare
cost. Fall prevention strategies can be effectively implemented by understanding patients
perceptions about falls during hospitalisation, interventions to reduce falls during their
hospitalisation and instructions received at the time of discharge. By understanding
perception of the patient, information related to the needs and requirements of the patients
can be collected and specific intervention can be provided with respect to the needs and
requirements of the patients. Collecting information about the perceptions of falls and its
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intervention strategies of the hospitalised patients can be helpful in upgrading the knowledge
to prevent falls during and following hospitalisation. Data collected from this study could be
considered as the more valid data because it was collected from the patients (Parahoo, 2014).
Literature review:
Minimum research has been conducted on understanding perceptions of hospitalised patients
about the fall risk. Most of the research has been conducted to understand perceptions of
community based older people. Previous studies stated that perceptions of the patients in the
form of belief and awareness can be helpful in improving patient’s understanding about the
risk of fall and taking measures to prevent these risks. Outcome of previous studies stated that
these patients consider fall as the normal process of aging, they get embarrassed and feared
due to falls and they stop doing activities due to fear of fall. Results of these studies proved
useful in developing, guiding and implementing fall prevention programme. Less evidence is
available for the patients for the perception of falls of the hospitalised patients, even though
falls prevention education is given to these patients. Most of the hospitalised patients were
not aware of their risk of falling and those who were aware of it did not receive complete
information from the nurses (Calhoun et al., 2011; Høst et al., 2011; Karlsson et al., 2013).
From the previous studies it is also evident that hospitalised patients wanted to know about
their risk of fall, activities need to perform to reduce these risks and healthcare professional’s
role in reducing risk of fall of hospitalised patients. It indicates that hospitalised patients wish
to improve their understanding about the risk fall. Optimum education about the risk of fall
and its prevention strategies can be given to these patients by understanding their perception
of fall risk and prevention of fall risk. From the previous studies it is evident that risk of fall
is more in post-discharge patients as compared to the community people. However, hospital
discharge patients are not aware of fall prevention strategies (McInnes et al., 2011; Høst et
al., 2011). Even though less research has been done on this topic, researcher collected all the
required literature and took required message from the collected literature.
Overview of the research design:
The aim of this study was to describe hospitalised older adults’(60 years) perceptions about
(1) their fall risks while hospitalised; (2) fall prevention interventions received while
hospitalised; and (3) fall prevention discharge instructions. Aim of this study are clearly
mentioned in this research article.
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In this prospective exploratory study design was used. Prospective study design was used
because in this study design participants were enrolled prior to development of health issue.
In this study, participants prior to fall were enrolled to identify their perceptions of fall.
Exploratory study design was used because issue of perception of hospitalised patient’s fall
was not addressed clearly in the past. Through this study design priorities were established
and developed operational definitions to improve final research outcome. Participant’s
perceptions were inquired by using semi-structured interview guide by using open ended
questions and probes. It helped in meeting aim of the study because aim of this study was to
identify perceptions of hospitalised older people about fall risk, its intervention and
discharge. In semi-structured interview pre-decided open-ended questions were used and
these questions were useful to prompt the discussion. These types of interview process are
helpful in exploring the specific themes (Magnusson and Marecek, 2015; Stelter, 2010). In
this study both face-to-face and telephone-based interview was carried out. For carrying out
face-to face interview, participants were enrolled in the hospital were asked about their
perceptions about fall of risk and its intervention. In telephone-based interview, participants
were asked about the intervention provided in the hospital and education received during
discharge process.
In interview based qualitative study design, sampling is the central process. More focus need
to be given to the participants because they need to express themselves more and interviewer
need to understand them and interpret them. Content of the interview questions are the
important aspects of semi-structured interview process because it can influence outcome of
the study.
Questions incorporated in this study were designed in such a way that these questions could
answers related to participants perceptions about risk of fall, prevention of fall and discharge.
Answers of these questions can be helpful in meeting aim of the study because aim of this
study was to identify perception of risk of fall, its prevention and discharge.
Sampling:
In this study 18 participants were enrolled and 15 were available for the post-discharge
interview. Mean age of these participants was 72 years. 10 participants were male and 5
participants were female during discharge interview, however exact number of male and
female participants during the hospital interview were not mentioned in this research article.
Within 3 days of discharge, these participants were asked to give date and time for post-
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