Evidence-Based Practice in Geriatric Nursing: Fall Risk Reduction

This nursing assignment explores evidence-based practices for reducing the risk of falls among elderly patients, a critical concern in geriatric care. The report investigates the effectiveness of physical activity interventions, using the PICO framework to formulate a research question: "Does the application of physical activity interventions help to reduce the risk of falls among the elderly population of Ireland?" The assignment details the literature search strategy, including keywords and database selection (PubMed), and critical appraisal of two peer-reviewed articles. The first article, by Lopez et al. (2018), examines the impact of resistance training, while the second, by Bray et al. (2015), focuses on Pilates exercises. Both studies demonstrate the positive effects of physical activity on balance, muscle strength, and overall functionality, leading to a reduced risk of falls. The report also acknowledges the limitations of the studies, such as potential adverse events and the need for detailed intensity and progression guidelines. The conclusion emphasizes the importance of physical activity interventions in geriatric nursing and highlights the significance of evidence-based practice in improving patient outcomes.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the student
Name of the university
Author note

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Introduction
Evidence based nursing practice helps the healthcare professionals associated in the care
process with effective interventions so that they could take quality decisions and make the care
process relevant (Bray et al. 2018). One such critical complication that majority of the geriatric
nursing professionals faces is implementing interventions that could prevent or reduce the falls
among elderly patients. As per Davies and O'mahony (2015), one in every three individual above
the age of 65 is suffering from the risk of fall as the total number of population that are above the
age of 65 is 11% of the total population.
Therefore the evidence based research question that this paper would use for conducting
evidence based literature search is:
Does the application of physical activity interventions could help to reduce the risk of
falls among the elderly population of Ireland?
The PICO structure of this question would be:
Population Intervention Comparison Outcome
Elderly patients at the
risk of falls
physical activities compared to other
interventions
reduces the risk of
falls
Literature search strategy
After developing the research question for evidence based nursing practice, literature
search would be conducted so that the interventions and their effectiveness could be developed.
Multiple keywords would be developed so that’s searching them over electronic databases could
provide numerous research papers. The keywords that would be used for this literature search

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would be such as “risk of fall”, “elderly patients”, “physical activities”, physical activities
reduces risk of falls”. After developing these keywords, these would be connected through
Boolean operators such as AND, OR, NOT so that through permutation and combination of these
search terms, effective and appropriate research articles could be collected from electronic
databases.
The electronic database that would be selected for this search strategy is Pub Med. As per
Lawrence (2016), Pub Med is the scientific database in which numerous nursing research articles
are present. Further, the multiple level of security would help to sieve through the research
articles that would help to identify the effectiveness of the evidences and would help to answer
the research question. In Pub Med, multiple filters would be used for identification of accurate
research articles, such as publication year within 2015 to 2019, peer reviewed journal article,
English language, and research articles would be collected. Further, the exclusion criteria would
be the languages other than English, abstract papers, descriptive articles with no data analysis
and research aspects, so that effectiveness of the evidences could be identified.
Critical appraisal of the articles
As per Department of Health and Children of Ireland ministry (2019) more than 468,000
people (11.1%) in Ireland are elderly and above the age of 65 and within 2025, more than 18% of
the population would reach to that level. as per LoBiondo-Wood and Haber (2017), fall is one of
the critical health complication and associated risk factor that the elderly people suffer from and
as per the data of hen and Schulz (2015) it was mentioned that every 80 deaths in 10,000 deaths
of elderly people occurs due to severe fall and fall associated health complication. As per hen
and Schulz (2015), there are multiple complications that the elderly population suffers from due

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to their falls and associated complications such as joint dislocation, brain injury and bruises,
open wound and fracture. There are multiple interventions and strategies that the healthcare
professionals implement in the healthcare process of the elderly patients that are affected with
critical risk of falls. These include therapeutic and non-therapeutic interventions. However, hen
and Schulz (2015) mentions about several critical complications that the elderly patients suffer
from and in this process of pharmaceutical interventions, and hence, in such condition, it is
important that the healthcare professionals implement interventions that would help the patients
to overcome their risk of falls gradually, and they would not suffer from critical side effects or
health complications.
There are multiple therapeutic interventions that are implemented upon the patient’s
health complications, such as music therapy, spiritual practices and others (LoBiondo-Wood and
Haber 2017). However to improve the elderly patient’s fall related risk factors, it is important to
improve their balance and hence, the research question has been formulated in such a manner so
that the effectiveness of physical activities could be identified and the way it could improve
patient condition could be understood. Further, as per Chatterji et al. (2015) identification of the
effectiveness of this intervention would help to reduce the risk of elderly patients in future.
Therefore, through this literature search, two peer reviewed articles with higher level of evidence
could be identified and could be used to establish the effectiveness of it.
After conduction of effective search in the Pub Med, one paper by Lopez et al. (2018)
met all the inclusion criteria as the primary aim of this research paper is to identify the effect of
resistance training process alone as well as combined on increased body balance, strength
increase, muscle hypertrophy and increased functionality of the elderly patients that are
associated with the physical frailty of elderly population involved in the care process. The

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researchers conducted a systematic review as the Joanna Briggs critical appraisal cycle mentions
this as the highest level of evidence because such papers involves randomized control trails. The
researchers collected paper from MEDLINE, Cochrane, CENTRAL, PEDro, SPORTDiscus
databases and then collected papers from 2005 to 2017 (Lopez et al. 2015). One of the primary
reasons of selecting this paper for critical appraisal is the involvement of research articles in
which researchers dealt with resistance training and associated physical activities and analyses
the way such activities increases the patient and their way living. As per Afzal et al. (2015),
resistance training was found to be effective in patients that are suffering from imbalance and
posture conditions and through this paper it was found that through the application of such
interventions, people that were suffering from posture problem were able to overcome their
critical conditions, by 85%. This was the primary reason that this resistance training associated
article was chosen or selected for identifying effectiveness of physical activity for the elderly
people that are at the risk of fall in their critical healthcare complications (Iatridou et al. 2018).
This research article that has been selected from the search strategy in Pub Med included
371 studies that have been conducted in the years 2005 to 2017 however, within these, only 16
research articles that used Randomized control trail and qualitative study so that the effectiveness
of the intervention and its qualitative approach could be identified in the process (LoBiondo-
Wood and Haber 2017). After the collection of the papers, the researchers identified that all the
articles mentioned towards the positive sides of the intervention. It is found that through the help
of physical training including resistance training process, the elderly patient’s increases their
37% of maximal strength, 7.5% of their muscle mass, 9% of their muscle power and 58%
improvement has been observed in the functionality of such patients (LoBiondo-Wood and
Haber, 2017). Further, it is also identified that 66% of the patients reduced their risk of fall and

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hence, this intervention and its effectiveness was identified in this research process. One of the
primary benefit of including this systematic analysis process in this process was the ability of the
research article to include all the randomized control trail in the paper so that all the articles
could be found to be effective in the identification of the effectiveness of the intervention.
Further Schwenk et al. (2016) also mentioned that application of RCTs helped to reduce the
combined bias from the research study, hence increased the effectiveness of it. Besides these,
there is several complication and loopholes that this research article failed to identify or mention.
As per Schwenk et al. (2016), while implementing this intervention, there is a chance of adverse
events as all the elderly patients may increase their risk of falls, and imbalanced postures which
was completely neglected or overlooked by the researchers that conducted this process among
the elderly patients. Hence, this should be analyzed in future research articles so that a holistic
research regarding such interventions could be provided for the evidence based nursing practice
(LoBiondo-Wood and Haber 2017).
Another research article that has been selected from the Pub Med database after
implementation of accurate inclusion and exclusion criteria is the research conducted by
Bray et al. (2015). These researchers also selected one of the most effective physical exercises
that have been widely popular around the world because of its ability to provide effective
solution to the people that are suffering from body imbalance and posture complications. As per
Lawrence (2016), Pilates are body stretching and contracting exercises that help people to
maintain effective blood flow throughout their bodies and then help them to understand the
effectiveness of it through movements, and posture corrections. Further, Gallo (2016) also
mentioned Pilates as one of the most effective structure physical activity that helps the people
that are performing them to increase their endurance and strength with postures that makes them

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stable and increase their body balance. As this exercise and training process is much newer than
any other training for physical activity, selecting one research paper with qualitative and
quantitative paper would not be able to identify the effectiveness of this intervention (Osar and
Bussard 2016). This was the reason; another research article with systematic review was selected
for the establishment of the effectiveness of the intervention. Further, this research article also
selected randomized control trails conducted upon Pilates and its effectiveness in preventing falls
among the patients that are elderly and are at the risk of critical falls (Bullo et al. 2015).
The primary aim of the researchers was to understand the way Pilates and associated
exercises help the patient to overcome their risk of falls, increases their quality of life by making
them independent (Bullo et al. 2015). Further they also analyzed the mental and spiritual aspects
of care that this intervention helps the patients to overcome so that these interventions could be
identified on the patients effectively (Bullo et al. 2015m 2918). The researchers conducted
effective evidence search in reputed science databases such as MEDLINE, Embase, Pub Med,
Scopus, PsycINFO and SPORTDiscus so that all the data related to these research articles could
be collected (Bullo et al., 2015). All these articles were randomized control trails so that all the
effective and personal bias included in all the research articles could be cumulatively eliminated.
Total 10 research articles were selected for this analysis and it was found that Pilates and
associated exercises helped the patients and elderly population that has been included in the
research process to overcome their balancing issues and increases their muscle strength (Bullo et
al. 2015). Further, it also effectively increases the patients and their mood and affects by
increases their activities of daily life and simultaneously their quality of life. Further it also
helped them to overcome metabolic distress and provide effective improvement in their
flexibility. Therefore, through the analysis of this research article it become evident that

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application of physical exercise helps the patients to overcome their critical risk of fall. However,
despite this, the article failed to provide a detail of intensity and progression of this activity that
the professionals should use for effective improvement (Bullo et al. 2015).
Conclusion
While summarizing the findings of this evidence based nursing process for the selected
research question, it was found that application of physical; activity and associated interventions
were effective for majority of the patients that were suffering from critical risk of falls and
associated health complications. Both the research articles were systematic reviews and hence
the effectiveness of the evidence increased because of their identification as the highest level if
evidence than qualitative and quantitative research articles. Therefore, in such conditions, the
research findings helped to establish the fact that application of these healthcare interventions
would help the elderly patients, to increase their muscle mass, their resistance power, their
endurance and other aspects that help them to increase their balance and prevent the risk of falls.
Further, through the analysis of another research, it was easier to analyze that all the research
articles were associated with critical risk factors and hence, it is important that the nursing
professionals or the healthcare professionals that are implementing such interventions, analyze
the critical nature of the intervention beforehand. Therefore, this aspect should be taken care of
effectively prior to implement this evidence in the care process of patients with risk of falls.

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