Capstone discussion 3

Question description

Please respond to the Discussions and also response to the peer discussions


Submit a summary of six of your articles on the discussion board. (see articles attached). Discuss one strength and one weakness to each of these six articles on why the article may or may not provide sufficient evidence for your practice change.


Name two different methods for evaluating evidence. Compare and contrast these two methods.

Peer DQ1

Although many evidence-based researches studies have evaluated different approaches for fall prevention, fall rate continues to be in higher range in acute care facilities that is, approximately 3.3 to 11.5 per 1000 patients per day in United States during their admission (Bouldin et al., 2013). Unintentional falls increase the financial burden to the health care facility by adding additional treatment cost and increase the length of hospital stay of the patient (Sahota et al., 2013). To prevent those fall related incidence and financial burden different types of fall detection devices are invented and used in health care facilities. However, due to lack of time and resources evidence-based research has not been conducted.

1. In a qualitative study by Chaudhuri, Thompson & Demiris (2014), authors analyzed the effectiveness of wearable and non-wearable devices on fall prevention of elderly patients in the real-world situation. The authors compiled and systematically analyzed data from previously published papers on fall detection. They found that only a fraction of the elderly patients was interested in using such devices; many were reluctant to use such devices citing the privacy issues.

Strength- This article reviewed and examined the extent to which fall detection devices have been tested in the real world.

Weakness- This review was limited to articles written in English and indexed in PubMed, CINAHL, EMBASE or PsycINFO and as such may have omitted other relevant published studies.

2. In the quantitative article by Shorr et al. (2012), the authors conducted a paired cluster-randomized trial to investigate whether the use of bed alarm decreases the number of falls and fall-related injuries in a hospital setting. Their result showed that overall, the intervention increased the use of alarm mechanism among the patients; however, did not have any clinically or statistically significant effects on fall or fall-related events.

Strength- An intervention increased the use of alarm mechanism among the patients.

Weakness- The study was conducted at a single site and was slightly underpowered compared with the initial design.

3. In the article by Sahota et al. (2013), authors conducted a randomized controlled trial of bed and bedside chair pressure sensors using radio-pagers and found that it did not reduce the rate of in-patient bedside falls, time to first bedside fall and are not cost effective in elderly patients in acute, general medical wards in the UK.

Strength- They conducted a randomized controlled trial of bed and bedside chair pressure sensors using radio-pagers (intervention group) compared with standard care (control group) in elderly patients admitted to acute, general medical wards, in a large UK teaching hospital.

Weakness- There was several limitations in a study that need to be recognized. The study was powered to detect a 35% reduction in the rate of bedside falls, based on the sample size estimates from our pilot study. It is possible that the intervention may be associated with a smaller reduction in bedside falls, which may have been missed.

4. In the article by Bouldin et al. (2013), fall and injurious fall prevalence varied by nursing unit type in US hospitals. They used data from the National Database of Nursing Quality Indicators (NDNQI) collected between July 1, 2006 and September 30, 2008 to estimate prevalence and secular trends of falls occurring in adult medical, medical-surgical and surgical nursing units. Over the 27-month study, there was a small, but statistically significant, decrease in falls (p<0.0001) and injurious falls (p<0.0001).

Strength- The strengths of this study include the large number of nursing units reporting data and the national sample of hospitals.

Weakness- They did not assess practices among nursing units nor seek to identify unit characteristics associated with fall rates or changes in fall rates over time.

5.In the study by Quigley (2016), the evidence supports the importance of determining specific risk factors and initiating multifactorial fall risk factors tailored to the individual. Yet, little evidence exists for single interventions, universal fall prevention strategies, and population-specific fall prevention strategies. A review of the literature confirms the effectiveness of many fall prevention practices and interventions remains insufficient. Of particular concern are rehabilitation units in hospitals that have higher fall rates compared to other acute units.

Strength- The strength of this article is identification of the best practice interventions to prevent falls on rehabilitation units.

Weakness- The views expressed in this article are those of the author and do not represent the views of rehab nurses.

6. Evidence of this review indicates patient-centered interventions in addition to tailored patient education may have the potential to be effective in reducing falls and fall rates in acute care hospitals. There is limited high quality evidence demonstrating the effectiveness of patient-centered fall prevention interventions so novel solutions are urgently needed and warrant more rigorous, larger scale randomized trials for more robust estimates of effect (Avanecean et al., 2017).

Strength- This study evaluated the effectiveness of patient-centered interventions on falls in the acute care setting.

Weakness- Due to clinical and methodological heterogeneity among the included studies, a meta-analysis was not possible. The findings of this review have been presented in narrative form.


Avanecean, D., Calliste, D., Contreras, T., Lim, Y., & Fitzpatrick, A. (2017). Effectiveness of patient-centered interventions on falls in the acute care setting: A quantitative systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports, 15(1), 55-65. Retrieved from…

Bouldin, E. D., Andresen, E. M., Dunton, N. E., Simon, M., Waters, T. M., Liu, M., … Shorr, R. I. (2013). Falls among adult patients hospitalized in the United States: Prevalence and trends. Journal of Patient Safety, 9(1), 13. Retrieved from…

Chaudhuri, S., Thompson, H., & Demiris, G. (2014). Fall detection devices and their use with older adults: A systematic review. Journal of Geriatric Physical Therapy, 37(4), 178- 196. Retrieved from…

Sahota, O., Drummond, A., Kendrick, D., Grainge, M. J., Vass, C., Sach, T., … Avis, M. (2013). REFINE (Reducing Falls in In-patient Elderly) using bed and bedside chair pressure sensors linked to radio-pagers in acute hospital care: A randomised controlled trial. Age and Ageing, 43(2), 247-253. Retrieved from…

Shorr, R. I., Chandler, A. M., Mion, L. C., Waters, T. M., Liu, M., Daniels, M. J., … Miller, S. T. (2012). Effects of an intervention to increase bed alarm use to prevent falls in hospitalized patients: A cluster randomized trial. Annals of Internal Medicine, 157(10), 692-699. Retrieved from…

Quigley, P. A. (2016). Evidence levels: applied to select fall and fall injury prevention practices. Rehabilitation nursing, 41(1), 5-15. doi/abs/10.1002/rnj.253

Peer DQ2

The article by Buckner and Read (2016) discusses that the old-fashioned observation method for hand hygiene compliance has proved to be ineffective. Badge-based locating technology using a real-time locating system provides continuous monitoring of hand hygiene compliance, and offers valuable feedback that can be customized by staff group, individual, room, or time. This study evaluates the impact of implementing an automated badge-based monitoring system with individual feedback on hand hygiene compliance rates across numerous hospitals. The dramatic difference was noted between the compliance assessed through direct observation and baseline compliance recorded by an automated system further supports the inaccuracy of direct observation. This study had a limitation of a small sample size, but provides the necessary support for the hand hygiene monitoring system in the department.

In a different article by Chang, Reisinger, Jesson, Schweizer, Morgan, Forrest, and Perencevich (2016), the authors discussed the physical barriers to low hand hygiene compliance and different ways that it can be reduced. The gold standard was the direct observation for hand hygiene compliance upon entering and exiting patient rooms because of the availability of alcohol hand sanitizers. However, hand washing cannot be easily observed through direct observation and this supports the need for hand hygiene monitoring system that will also alert healthcare providers to wash their hands. This study is limited to the description of the use of hand sanitizers rather than hand washing with soap.

Chassin, Nether, Mayer, and Dickerson (2015) worked on the quality improvement project using a Lean, Six Sigma method to improve hand hygiene compliance in the organization. This articles provides valuable information on various causes of the hand hygiene noncompliance in various facilities and possible interventions at the causes. The article discusses a special tool that is used to initiate hand hygiene compliance project in clinical care settings. Healthcare organizations used the Targeted Solutions Tool to discover specific causes of hand hygiene noncompliance. This study is great because it discusses the Targeted Solutions Tool in depth and will allow me to use it in our healthcare facility.

In the study by McCalla, Reilly, Thomas, and McSpedon-Rai (2017), the authors described the relationship between hand hygiene compliance and healthcare associated infections. It is imperative for healthcare organizations to assess compliance by the hospital infection control staff. This article discusses the automated hand hygiene compliance system that was used as an alternative method to human observations. In this retrospection cohort design study, researchers concluded that personal observations of the hand hygiene compliance is not as effective as an electronic monitoring badge. The rates of healthcare associated infections can be significantly reduced with the electronic hand hygiene monitoring system.

In another study, the researchers examined the perceptions and barriers to nonsurgical scrubbed hand hygiene in the operating room and endoscopy procedure room using Likert-scale surveys (Pedersen et al., 2017). The results of the study showed poor role modeling and inconvenience are the two major reasons for low hand hygiene compliance rate. There is a need to monitor hand hygiene compliance and feedback from the monitors can provide reminders and improve self-awareness of hand hygiene practices.

Szilagyi et al. (2013) researched the hand hygiene compliance using the World Health Organization five moments to assess hand hygiene techniques in various healthcare organizations. This article provides information on the hand hygiene education and assessment program that was implemented in the hospital setting that included educational stations to improve hand hygiene quality in healthcare providers. This study supports the need for ongoing education and training in improving hand hygiene compliance and technique of clinical staff. The limitation of this study was the small sample size and the educational program that was implemented in only one healthcare facility.


Buckner, J. B., & Read, M. (2016). Individual monitoring increases hand hygiene compliance in multicenter registry utilizing badge-based locating technology. AJIC: American Journal of Infection Control, 44(Supplement), S94-S97.…

Chang, N. N., Reisinger, H. S., Jesson, A. R., Schweizer, M. L., Morgan, D. J., Forrest, G. N., & Perencevich, E. N. (2016). Feasibility of monitoring compliance to the My 5 Moments and Entry/Exit hand hygiene methods in US hospitals. American Journal of Infection Control, pii: S0196-6553(16)00158-9. doi:10.1016/j.ajic.2016.02.007

Chassin, M. R., Nether, K., Mayer, C., & Dickerson, M. F. (2015). Beyond the collaborative: Spreading effective improvement in hand hygiene compliance. The Joint Commission Journal on Quality & Patient Safety, 41(1), 13-25.

McCalla, S., Reilly, M., Thomas, R., & McSpedon-Rai, D. (2017). Major Article: An automated hand hygiene compliance system is associated with improved monitoring of hand hygiene. AJIC: American Journal of Infection Control45(1), 492–497.…

Pedersen, L., Elgin, K., Peace, B., Masroor, N., Doll, M., Sanogo, K., … Bearman, G. (2017). Barriers, perceptions, and adherence: Hand hygiene in the operating room and endoscopy suite. American Journal Of Infection Control, 45(6), 695-697. doi:10.1016/j.ajic.2017.01.003

Szilagyi, L., Haidegger, T., Lehotsky, A., Nagy, M., Csonka, E.-A., Sun, Z., … Fisher, D. (2013). A large-scale assessment of hand hygiene quality and the effectiveness of the “WHO 6-steps”. BMC Infectious Diseases, 13(1), 249. doi:10.1186/1471-2334-13-249

Peer DQ3

Hand hygiene is recognized by infection prevention and control experts as the single most important intervention in decreasing the spread of infection in both healthcare and community settings. Because the hands are vectors for transmission between people as well as inanimate objects such as environmental surfaces (i.e., blood pressure cuffs), it is critical to practice frequent hand hygiene using the traditional soap and water or an alcohol-based hand rub as appropriate.

Summary of six of your articles…..

1. Filho, M. A. O., Marra, A. R., Magnus, T. P., Rodrigues, R. D., Prado, M., de Souza Santini, T. R., … Edmond, M. B. (2014). Major article: Comparison of human and electronic observation for the measurement of compliance with hand hygiene. AJIC: American Journal of Infection Control42, 1188–1192.….

Strength: Comparison of human and electronic observation for the measurement of compliance with hand hygiene for staff members.

Weakness: They only did a small sample size, there would be enough evidence on the outcome.

2. Boyce, J. M. (2017). State of the Science Review: Electronic monitoring in combination with direct observation as a means to significantly improve hand hygiene compliance. AJIC: American Journal of Infection Control45, 528–535.….

3. Vaidotas, M., Yokota, P. K. O., Marra, A. R., Sampaio Camargo, T. Z., Victor, E. da S., Gysi, D. M., … Edmond, M. B. (2015). Major article: Measuring hand hygiene compliance rates at hospital entrances. AJIC: American Journal of Infection Control43, 694–696.….

Strength: They compared electronic handwash counters with the application of radiofrequency identification (GOJO SMARTLINK) (electronic observer) that counts each activation of alcohol gel dispensers to direct observation (human observer) via remote review of video surveillance.

Weakness: Even though the GOJO system was useful in capturing real life hand hygiene complaince at the resception area, this will not capture everyone who enters the hospital. There are other entrances into the hosptial such as emergency room.

4. Knighton, S. C., McDowell, C., Rai, H., Higgins, P., Burant, C., & Donskey, C. J. (2017). Major Article: Feasibility: An important but neglected issue in patient hand hygiene. AJIC: American Journal of Infection Control45, 626–629.….

Strength: Patient hand hygiene may be a useful strategy to prevent acquisition of pathogens and to reduce the risk for transmission by colonized patients. Several studies demonstrate that patients and long-term-care facility (LTCF) residents may have difficulty using hand hygiene products that are provided; however, none of them measure feasibility for patients to use different hand hygiene products.

Weakness: This study can’t expect eveyone to use the hand hygiene products. Soap and water works just fine if there are some alergic reactions to the products. This study wont be able to give good data, there will be outliers.

5. Ibrahim Aliyu, Teslim O Lawal, Wasiu Olawale, Kehinde Fasasi Monsudi, & Bashir Mariat Zubayr. (2018). Hand hygiene practices among doctors in health facility in a semi-urban setting. BLDE University Journal of Health Sciences, Vol 3, Iss 1, Pp 43-47 (2018), (1), 43.…

Strength: The study was among doctors on proper hand washing and the importance of good hand hygiene.

Weakness: The study didn’t focus on other staff members in the department, it only focued on the doctors.

6. Hosein Zakeri, Fatemeh Ahmadi, Ehsan Rafeemanesh, & Lahya Afshari Saleh. (2017). The knowledge of hand hygiene among the healthcare workers of two teaching hospitals in Mashhad. Electronic Physician, Vol 9, Iss 8, Pp 5159-5165 (2017), (8), 5159.

Strength: Training all health care professionals on hand hygiene.

Weakness: The did the observation by visual observation only. They found out that after the training, there were still alot of staff who was not doing proper hand hygiene. More education should have been provided to the particpants of the study.

Peer DQ4

Submit a summary of six of your articles on the discussion board. Discuss one strength and one weakness to each of these six articles on why the article may or may not provide sufficient evidence for your practice change.

1)Windle, P. E. (2008). Addressing the Nurse Staffing Shortage. Journal of PeriAnesthesia Nursing, (3), 209. Retrieved from…

·Strength:The article presents tremendous amounts of data regarding the nursing shortage as many new RN grad are not graduating enough ti be able to fill the numerous vacancies at many healthcare facilities.

·Weakness: The article does not address experience or lack of it. Many position require years of experience but new nurse fresh out of school may lack such experience. Unless they are hired but a new Grad RN program where they are taught such skill it becomes difficult to find quality work.

·This article does not provide the rounded information needed to complete the research I need. This is just one portion of the bigger whole needed to complete the writing.

2)Witzel, P. A., Smith, T. C., & Ingersoll, G. L. (2006). Staffing incentive programs to meet workforce shortage needs. Nurse Leader, 4, 46,55-48,55.…

·Strength: Presents ideas and incentives in order to recruit and retain the nursing workforce.

·Weakness: This is limited to facilities that actually promote incentives – not all facilities do this. This is not state wide nor country wide programs.

·This address only on portion of the problem. I will need other articles to complete the rest of the information needed. Though it does addressa mjor issue in the nursing field.


3)Alban, A., Coburn, M., & May, C. (1999). Addressing the emergency nursing staffing shortage: Implementing an internship using a nursing school instructor model. Journal of Emergency Nursing, (6), 509. Retrieved from…

·Strength: Aware of specialty positon nurses and is offering internships programs to prepare new nurses to fill vacant positions

·Weakness: Many different specialties were not covered that many students wanted to go over.

·This is a fantastic program to offer hospitals for the many different specialties.

4)Cracking the books – Training entry-level employees may help to ease staffing shortages for hospitals. (n.d.). HOSPITALS & HEALTH NETWORKS, 78(7), 28. Retrieved from…

·Strength: New program designed to help entry level employees gain the experience and education the facility needs.

·Weakness:Problems getting funding, learning space, initial costs.

·This is a great program set to have new employees grow confident in their skills and position and helps decrease turnover rates.

5)Martin, C. J. (2015). The Effects of Nurse Staffing on Quality of Care. MEDSURG Nursing, 24(2), 4–6. Retrieved from…

·Strength: Identifies the quality of serviceand patient outcomes is in direct correlation to staffing numbers

·Weakness:Does not discuss how to retain nurses nor how the turnover rate is regarding this program.

·A great article that provides quality information regarding patient care bases on staffing levels.

6)Tate, C. W. (2006). Saviours or scapegoats? It is time to stop blaming agency staff for the woes of the NHS and join forces to solve staffing shortages. Nursing Standard, (40), 34. Retrieved from…

·Strength: The article provides info on quality experienced nurses to fill much needed open shifts that facilities desperately need.

·Weakness: does not fully explain quality of agency staff or provide in-depth info on quality of care.

·Provides limited info on agency quality of care.

Peer DQ5

The two types of evaluation methods of the evidence in research studies is systematic reviews and meta-analysis. According to literature, systematic reviews provide explanations and answers to research questions through collecting and summarizing all the evidence that fits into a specific eligibility criteria (PubmedHealth, 2018). Systematic reviews identify, assess, and summarize the research findings of various scholarly studies that are relevant to the topic of interest to assist researchers and clinicians in decision-making processes. The negative side of the systematic review is that is needs enough data to make the necessary conclusion, in addition to the time it takes to analyze all the prior studies.

Meta-analysis on the other hand, uses statistical analysis to summarize results of prior studies (Haidich, 2010). When more than one study shows significant statistical results, then meta-analysis method would be the ideal method to evaluate the common theme among them. Meta-analysis is considered an effective method to evaluate evidence. The negative part of using meta-analysis is variations in the results of the studies that can mislead researcher to make improper conclusions on the prior research studies.


Pubmed Health. (2018). What is a Systematic Review? Retrieved from…

Haidich, A. B. (2010). Meta-analysis in medical research. Hippokratia, 14(Supp 1), 29-37.

Peer DQ6

Qualitative research is often used for exploring. It helps researchers gain an understanding of underlying reasons, opinions, and motivations. It provides insights into the problem or helps to develop ideas or hypotheses for potential quantitative research. Qualitative data collection methods vary using unstructured or semi-structured techniques. Common methods include focus groups, individual interviews, observation or immersion, and diary studies. The sample size is typically small, and respondents are selected to fulfill a given quota.

Quantitative research is used to quantify the problem by way of generating numerical data that can be transformed into useable statistics. It is used to quantify attitudes, opinions, behaviors, and other defined variables, and generalize results from a larger sample population. Quantitative research uses measurable data to formulate facts and uncover patterns in research. Quantitative data collection methods are much more structured; they include various forms of surveys – online surveys, paper surveys, mobile surveys and kiosk surveys, face-to-face interviews, telephone interviews, longitudinal studies, website interceptors, online polls, and systematic observations

Two methods of evaluating evidence are: Qualitative research method and Quantitative research method

Compare between qualitative and quantitative analysis:

  • Both are methods of research
  • Both are limited by variables
  • Both are applicable in the study of similar phenomenon
  • Both are dependent on the researcher who chooses the type of information to gather and how to interpret the data

Contrast between qualitative and quantitative analysis:

  • Qualitativeresearch relies primarily on inductive process in formulating hypotheses. On the contrary quantitative research depends on deductive process.
  • Qualitative research methods include focus groups, interviews, and reviews of analysis. Quantitative research include surveys, structured interviews, and observations.
  • Qualitative research is text-based whereas Quantitative research is number-based.
  • Qualitative research has unstructured or semi-structured response options while the former has fixed response options
  • Qualitative research lacks statistical tests whereas statistical tests are used for analysis
  • Qualitative research less generalizable while Quantitative research generalizable


Wienclaw, R. A. (2013). Quantitative and Qualitative Analysis. Research Starters: Sociology (Online Edition). Retrieved from…

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