Discussion: Appraisal of Research Critic

Discussion: Appraisal of Research Critic

Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

Full APA formatted citation of selected article. Article #1 Article #2 Article #3 Article #4
Francis-Coad et al., (2018)


Lee & Yu (2020) Fariña-López et al., (2018) Cuttler, Barr-Walker & Cuttler (2017)
Evidence Level *

(I, II, or III)


Level II Level I Level III Level V
Conceptual Framework


Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**


The conceptual framework that was utilized in the research was not mentioned.



The conceptual framework that was utilized in this research was not stated. The conceptual framework that was utilized in this research was not stated. The conceptual framework for the research was not stated.


Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

This study was a systematic review. Articles for the research were obtained from databases that included MEDLINE and CINAHL. The studies were checked for methodological validity with data extracted using JBI SUMARI tool. The inclusion criteria included researches that used participants aged 65 years and above and living in long-term care settings that provided 24 hour supervision. It also included studies that focused on complex falls intervention programs delivered by teams such as residents, RAC organization, and RAC facilities. Quasi-experimental, experimental, randomized controlled, and controlled clinical trials that measured incidents of patient falls were included. Any study that did not meet these criteria was excluded. This research was a systematic review and meta-synthesis. The articles for the research were obtained from databases that included Cochrane Central Register of Controlled Trials, Ovid-Embase and Ovid-Medline. The articles were selected based on a developed inclusion and exclusion criteria. The inclusion criteria entailed randomized trials, studies on multifactorial fall prevention interventions, participants who were community-dwelling older adults and studies that reported outcomes such as fall rates and number of people who experienced falls. Studies were excluded if they were non-randomized, review articles, conference posters, abstracts, and not published in Korean or English. The study was a descriptive cross-sectional and multicenter study. It was conducted in acute hospitals in different regions in Spain. The participants were selected using non-probability sampling. The settings for the research were public teaching hospitals. The inclusion criteria for the registered nurses who took part in the research included being a registered nurse or nursing assistant and having a work experience of at least one month in the units of study. This study was performance improvement study with a historic control. It was conducted in four medical-surgical wards in a US public acute care hospital. It entailed the use of educational videos as well as fall prevention signaling icons to prevent and reduce the rates of patient falls. An inclusion and exclusion criteria that was used for selecting the units for use in the research was not stated.


The number and characteristics of

patients, attrition rate, etc.

The research used 12 studies with seven of them being considered eligible for a meta-analysis.





The study used 45 articles for the systematic review and meta-analysis. The setting of the research was public teaching hospitals in Spain. Six of the hospitals were tertiary level while two were primary level institutions. The study settings included resuscitation, general surgery, trauma, medicine, neurosurgery, neurology and medical surgical units. The study used 855 registered nurses and nurse assistants. The study was conducted ion four medical surgical units in a public acute care hospital in the US. Two of the selected units had surgical patients while the other two were acute care units for the elderly patients.
Major Variables Studied


List and define dependent and independent variables

The dependent variables in the study included fall incidents, number and rate of falls in every 1000 occupied bed days, number of injurious patient falls, and proportion of patients who experienced falls. The independent variables were the complex falls prevention interventions.


The dependent variables included number of people that fell and fall rates. The independent variables included multifactorial interventions to prevent patient falls such as education, exercise, environmental modification, and psychological management. The dependent variables included the professional variables and socio-demographic variables that influence the perception and use of physical restraints in the elderly patients. The independent variable included the use of physical restraints. The dependent variables included patient falls and injurious falls. The independent variables included the use of educational videos alarms and signals.


Identify primary statistics used to answer clinical questions (You need to list the actual tests done).

Articles that met the inclusion criteria were selected for the review. Independent reviewers determined the methodological quality of the studies using standardized tools. Data extraction was done using the JBI SUMARI protocol that focused on outcomes, interventions, and participants of the selected studies.

Data analysis was done using Revman V5.3.4. The analysis focused on fall rates, injurious falls, and number of fallers. Visual inspection of the Forest plot alongside I squared statistics and chi-square were used to assess heterogeneity of the data. Inverse variance DerSimonian and Laird methods were used to compute mean difference, standard error, and standard deviation of the data. Mantel-Haenszel’s random effects model was used to analyze the dichotomous outcomes of the research.

Statistical analysis was performed using Review Manager Version 5.3, two-tailed test of significance, and generic inverse variance method for odds ratio and confidence intervals. The measurements that were used to answer the clinical question include professional and socio-demographic characteristics and their influence of the perception and use of physical restraints. Surveys were administered to obtain data on the socio-demographics data, experience, as well as training on the use of physical restraints in the elderly patients. The perception of restraint use questionnaire was also administered to determine the perception of the participants. The effect of the interventions were measured by calculating the rates of falls with or without injury, falls with any form of injury, and falls with serious injuries multiplied by 1000 by the number of the reported events divided by patient days. Student’s t-test was used to calculate bivariate statistics and X (square) for the categorical measures for the research. The proportion of patient falls was determined by dividing the number of patient falls with any injury due to all the falls. The whole statistics were computed using OpenEpi software.
Data Analysis Statistical or

Qualitative findings


(You need to enter the actual numbers determined by the statistical tests or qualitative data).

Complex falls interventions that were delivered at multiple levels in different residential aged populations did not produce any change in the patient falls (MD=-1.29; 95% CI{-3.01,0.43}) or proportion of falls among patients (OR=0.76; 95 CI {0.42, 1.38}). The use of additional resources in multiple sites lead to a significant positive change in the reduction of patient fall rates (MD= -2.26; 95 CI {-3.72, -0.80}). The use of multifactorial interventions led to a significant reduction in fall rates in the intervention group when compared to control group (0.68{0.58-0.81}, p<0.01, I-80%). Subgroup analysis showed a significant reduction in fall rates in high risk and health groups in control when compared to control groups (0.52-0.84}, p<0.01, I=78% and (0.72{0.58-0.89}, p<0.001, I=63%) respectively. Subgroup analysis based on intervention intensity revealed multifactorial interventions to be highly effective when compared to usual care (0.64 {0.51-0.80}, p<0.01, I=83%. However, no significant difference was noted between referral usual care and multifactorial interventions (0.77 {0.58-1.02}, p=0.07, I=73%). There was also a significant reduction in the number of people experiencing falls in the intervention groups when compared to usual care (0.83 {0.72-0.95}, p<0.01, I=69%). The comparison between nursing assistants and registered nurses was determined using chi-square tests. Pearson’s r was used to determine the association between other measures and PRUQ total score. Cohen’s d was used to determine the effect size of the mean comparisons. Nursing assistants had the highest PRIQ scores of 3.80 when compared to 3.25 for registered nurses. Both groups perceived the use of physical restraints to be ideal for removing medical devices and prevention of patient falls. A lack of association between socio-demographic factors and PRUQ total score was obtained. The was a decrease of patient falls by 20% from 4.78 to 3.80 in every 1000 patient days (IRR 0.80, 95% CI 0.66 to 0.96), decrease in falls with injury by 40% from 1.01 to 0.61 per 1000 patient days, and decrease in falls with serious injuries by 85% from the statistics of 0.159 to 0.023 per 1000 patient days.
Findings and Recommendations


General findings and recommendations of the research

The utilization of the above methods yielded 12 studies. Complex interventions that address patient falls did not show any significant effect on reducing patient falls and residents who fell in this study. However, the use of the interventions alongside additional resources results in significant positive effect in reducing the rate of patient falls. Therefore, adequate resources must be allocated for the effectiveness of complex falls prevention interventions to be effective. The findings revealed that active multifactorial interventions have positive effects on the number of people who experience falls and fall rates. It was recommended that all healthcare providers should play an active role in planning the delivery of fall intervention programs for optimum care to be provided to patients at risk. The findings of this research showed that nursing assistants and registered nurses perceived the use of physical restraints in the elderly patients to be essential in preventing falls among patients and removing devices. It is therefore recommended that physical restraints can be used to promote patient safety in the clinical settings. However, views of the users of the safety equipment should be taken into consideration. The use of educational videos, alarms and signals were effective in reducing falls, falls with serious injuries, and falls with injuries in medical-surgical patients. Therefore, the effect of these interventions should be evaluated further using multicenter randomized controlled trials.
Appraisal and Study Quality



Describe the general worth of this research to practice.


What are the strengths and limitations of study?


What are the risks associated with implementation of the suggested practices or processes detailed in the research?


What is the feasibility of use in your practice?

The outcomes of this research have a positive impact on nursing practice. The provide insights into the factors that should be considered when utilizing complex falls prevention interventions in the clinical settings. The study has strength of utilizing studies with high validity. The methods that were utilized demonstrate scientific rigor. However, the research has the weakness of not using human subjects to determine the effectiveness of the intervention. The risks associated with the implementation of the suggested complex practices are their failure to deliver the expected outcomes. Therefore, it is not feasible in my practice. This is due to its demand for significant resources for its success. This research has shown the need for active multifactorial interventions in the prevention of patient falls. It has also demonstrated the need for active inter-professional collaboration in the adoption of interventions to prevent patient falls. The study is associated with the strength of using studies that had high validity and reliability due to the methods used. However, it failed to address confounding factors that influenced the outcomes of the selected studies. The risks associated with the use of multifactorial interventions proposed in the research are the lack of active inter-professional collaboration. Despite this, the use of interventions is feasible in my practice due to the existence of culture of active stakeholder collaboration. This research has supported the need for the adoption of safety measures to prevent patient falls in clinical settings. It has shown the readiness of the nursing workforce to implement the use of physical restraints to prevent adverse events due to falls in the clinical setting. The study has the strength of using a large sample size that increased the generalizability of the study findings. It however has the weakness of using non-probability sampling that is associated with significant bias. The risk of implementing the processes detailed in the research includes the high vulnerability to bias and difficulties in the generation of cause-effect relationship between the variables. Despite this, the use of physical restraints is feasible in my practice due to the existence of the needed equipment. This study informs the need for the use of educational videos, signals, and alarms in clinical practice to prevent and reduce falls among patients. The study has the strength of being a multicenter research with a large sample size. It has the weakness of utilizing non-probability sampling methods, which increase the risk of bias in outcomes. The risks associated with the implementation of the suggested practices are the ineffective methods for determining the effectiveness of each intervention. However, the use of the interventions is feasible in my practice due to the existence of culture that supports innovation and change.


Key findings




There was no significance in-group difference of fall rates. There was significant heterogeneity in the selected studies. There was significant decline in fall rates in three studies that the interventions were delivered with additional resources. There was no significant between group differences in the fallers in studies pooled for meta-analysis. Multifactorial interventions led to a significant reduction in fall rates in high risk and healthy patients when compared to those in the control group. The use of active multifactorial interventions alongside exercise and environmental modification demonstrated a significant decline in fall rates when compared to usual care. The number of people who experienced falls in the multifactorial interventions was also lower when compared to those in the usual care. Registered nurses and nurse assistants perceived the need for use of physical restraints in removing medical devices and preventing patient falls. However, there is insufficient training on the use of physical restraints in the elderly patients. There was also insignificant association between other variables and PRUQ total score. The use of educational videos, alarms and signals are effective in preventing falls, falls with injuries, and falls with serious injuries in the clinical settings.






The use of complex prevention interventions on patient falls had no significant effect on rates and number of injurious falls. However, the use of additional resources enhanced the effectiveness of these interventions. Therefore, a focus should be placed on the allocation of adequate resources for the success of complex fall prevention interventions in the clinical settings. There was an overall significant decline in the rates of falls and proportion of people who experienced falls in the groups that were administered with the interventions when compared to those in the control groups. The use of physical restraints reduces the rates and risks of patient falls. Healthcare providers including the nurses should be trained on their use. There is an expected decline in the rate and prevalence of falls with the use of educational videos, signals, and alarms.
General Notes/Comments  

This research has highlighted the effectiveness of utilizing complex interventions in reducing patient falls. It has shown the need for effective allocation and use of the resources for their success. The study will therefore inform the decisions made if complex interventions are to be used in implementing organizational change.





This research is highly applicable for clinical use. It has revealed the effectiveness of multifactorial interventions in preventing patient falls and reducing rates of falls. It has also strengthened the need for active involvement of the healthcare providers in the assessment, planning and implementation of programs that aim at preventing patient falls. Therefore, the use of the proposed interventions is likely to create the desired culture of teamwork in health organizations. The findings of this study support the use of physical restraints in preventing patient falls. It is therefore important to ensure that all nurses are trained on its use among the elderly patients who are at a risk of falls. This will increase its efficiency in promoting patient safety. This study supports the need for environmental changes to improve patient safety. It increases the need for patient empowerment in the prevention of falls. The patient should understand the risks and ways of preventing inpatient falls. Therefore, the findings will be used to support the need for change in the interventions used to promote patient safety in the clinical settings.


Part B


The reviewed literature has revealed that the issue of falls among hospitalized patients can be prevented and reduced with the use of interventions that aim at transforming healthcare environment. It can be seen from the research by Francis-Coad et al., (2018) that additional resources are needed for complex interventions to be effective. Some of these resources include training the staffs on the use of the interventions in preventing patient falls. The role of training or educating staffs can be seen in the research by Fariña-López et al., (2018) where the participants revealed that training is an effective intervention that can be utilized to increase the effectiveness of safety measures in the clinical setting. The analysis of the selected articles has also demonstrated the importance of active involvement of the other healthcare providers in the assessment, planning, and implementation of safety interventions to prevent and reduce patient falls. According to Lee and Yu (2020), healthcare providers, including the nurses have the collective responsibility of preventing and reducing the rates and risks of patient falls. One of the ways in which healthcare providers can achieve these outcomes is the use of multifactorial interventions. Some of these interventions include educational videos, alarms, exercise, and environmental modification. Environmental modification methods such as the use of alarms, educational videos, hourly rounds, and signals have been found to be effective in preventing and reducing the rates and risks of patient falls. Consequently, a focus should be placed on ensuring that the environment of care promotes patient safety. Healthcare providers should be aware of the ways of preventing patient falls. The patients should be educated on the risks factors and ways of preventing patient falls. Through these interventions, healthcare providers and patients are empowered to take actions that will ensure safety and improvement in the quality offered to those in need.

Re: Topic 3 DQ 2

Institutional Review Board (IRB) was formed under the Food and Drug Administration (FDA) to review and monitor translational research using human beings as subjects. IRB plays several roles not limited to approving or disapproving research proposals (Nurunnabi, 2014). For instance, for a study to be approved by IRB, some of the ethical requirements must be met, including informed consent, scientific validity, fair subject selection, respect for subjects, and many others. If the research lacks or fails to meet IRB requirements, the study can be disapproved or required to modify the design. Further, IRB has been assigned to offer training on how investigators can protect human subjects against harm during the research (Nurunnabi, 2014). Also, before investigators submit research proposals for funding, IRB must review the research proposals to determine whether ethical principles have been followed or not. Among the ethical research considerations specific to population health include fidelity, non-maleficence, and beneficence (DeCamp et al., 2018). Fidelity entails an individual’s respect, trust, and autonomy that the investigator should consider before starting the research. Non-maleficence means do no harm to human subjects, and beneficence implies that the study should act in the patients’ best interests (DeCamp et al., 2018).

Indeed, investigators should ensure respect for the persons, potential benefits, and burden of the research, and justice is kept balance during translation research. For example, selected individuals should be treated as autonomous subjects and are entitled to absolute protection from harm. Investigators should ensure the research is in the patients’ best interests; that is, the findings will improve population health. Again, the cost associated with research should be reasonable and affordable. After the research, participants should be distributed with benefits of research fairly and equitably. Once an investigator puts all these factors into consideration, the research has been kept balance from an ethical point of view.


Dong, Y. (2017). Translational Research: Ethical Considerations. Sound Decisions: An

Undergraduate Bioethics Journal3(1), 2.

Hostiuc, S., Moldoveanu, A., Dascălu, M. I., Unnthorsson, R., Jóhannesson, Ó. I., & Marcus, I.

(2016). Translational research—the need for a new bioethics approach. Journal of Translational Medicine14(1), 1-10.


use in your practice?
General Notes/Comments

Levels of Evidence Table

Use this document to complete the levels of evidence table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

Author and year of selected article
Article #1
Article #2
Article #3
Article #4
Study Design

Theoretical basis for the study

The number and

characteristics of

Evidence Level *

(I, II, or III)

General Notes/Comments

* Evidence Levels:

Level I
Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

Level II
Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis

Level III
Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis

Level IV
Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence

Level V
Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence

Outcomes Synthesis Table

Use this document to complete the outcomes synthesis table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

Author and year of selected article
Article #1
Article #2
Article #3
Article #4

The number and

characteristics of


Key Findings
Appraisal and Study Quality
General Notes/Comments
Part 4B: Critical Appraisal of Research

Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with at least 3 to 5 APA citations of the research.

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

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