### Step 2a: Determining Best Resources
To address the increase in falls among dementia patients in long-term care, several reliable databases and sources of clinical practice guidelines should be utilized:
**Databases:**
1. **PubMed:** This is a premier database for biomedical literature, including nursing and allied health topics.
2. **CINAHL (Cumulative Index to Nursing and Allied Health Literature):** Specifically tailored for nursing and allied health professionals, it includes peer-reviewed journals and evidence-based care sheets.
3. **Cochrane Library:** Known for its high-quality systematic reviews and meta-analyses, Cochrane is crucial for evidence-based practice.
**Clinical Practice Guidelines:**
1. **Agency for Healthcare Research and Quality (AHRQ):** Provides guidelines and evidence reports for improving healthcare quality and safety.
2. **National Institute for Health and Care Excellence (NICE):** Offers guidelines, advice, and standards for health and social care in the UK.
3. **American Geriatrics Society (AGS):** Provides guidelines specifically for geriatric care, including dementia care.
### Step 2b: Conducting a Search
**Search Terms:**
1. Dementia
2. Fall prevention
3. Restraint alternatives
4. Long-term care
5. Patient safety
**Filters Used:**
1. **Publication Date:** Articles published within the last five years to ensure the most current research.
2. **Peer-Reviewed Journals:** To ensure the reliability and validity of the sources.
3. **Study Type:** Systematic reviews, meta-analyses, randomized controlled trials, and clinical guidelines for high-level evidence.
### Step 2c: Identifying Articles
**Articles:**
1. **Abraham et al. (2019):** Implementation of a multicomponent intervention to prevent physical restraints in nursing homes (Level I evidence). This article explores the effectiveness of various interventions in reducing the use of physical restraints and their impact on fall rates.
2. **Gulka et al. (2020):** Efficacy and generalizability of falls prevention interventions in nursing homes: A systematic review and meta-analysis (Level I evidence). This study provides a comprehensive analysis of different fall prevention strategies and their effectiveness in nursing home settings.
3. **Hofmann & Hahn (2014):** Physical restraint reduction in nursing homes: A twenty-first-century approach. This article reviews strategies to reduce the use of physical restraints and the outcomes associated with these interventions, providing evidence-based recommendations for practice.
These sources are appropriate for determining best practices and supporting clinical decision-making because they provide high-level evidence on the effectiveness of interventions aimed at reducing falls and the use of physical restraints in long-term care settings.
### Step 3: Responding to Discussion Posts
**Response #1:**
I agree with your selection of databases and sources for conducting a literature search. MEDLINE, PubMed, and CINAHL are excellent choices for accessing high-quality peer-reviewed articles. Your search terms and filters are appropriate for this topic. The articles you selected are relevant and provide valuable insights into the impact of physical restraint reduction on fall rates in nursing homes. However, consider adding more recent articles to ensure the latest evidence is incorporated.
**Response #2:**
Your approach to using ProQuest, PubMed, CINAHL, and Cochrane Library is well-founded. These databases are excellent for finding high-quality, peer-reviewed evidence. The search terms you used are comprehensive and appropriate. The articles you identified provide a solid foundation for understanding the impact of restraint alternatives on fall prevention in dementia patients. Additionally, it might be beneficial to explore articles focusing on staff training and education as part of the intervention strategies.
### References
Abraham, J., Kupfer, R., Behncke, A., Berger-Höger, B., Icks, A., Haastert, B., Meyer, G., Köpke, S., & Möhler, R. (2019). Implementation of a multicomponent intervention to prevent physical restraints in nursing homes (imprint): A pragmatic cluster randomized controlled trial. *International Journal of Nursing Studies*, 96, 27-34. https://doi.org/10.1016/j.ijnurstu.2019.03.017
Gulka, H. J., Patel, V., Arora, T., McArthur, C., & Iaboni, A. (2020). Efficacy and generalizability of falls prevention interventions in nursing homes: A systematic review and meta-analysis. *Journal of the American Medical Directors Association*, 21(8), 1024-1035.e4. https://doi.org/10.1016/j.jamda.2019.11.012
Hakverdioğlu Yönt, G., Kisa, S., & Princeton, D. (2023). Physical restraint use in nursing homes—regional variances and ethical considerations: A scoping review of empirical studies. *Healthcare*, 11(15), 2204. https://doi.org/10.3390/healthcare11152204
Hofmann, H., & Hahn, S. (2014). Physical restraint reduction in nursing homes: A twenty-first-century approach. *Journal of Clinical Nursing*, 23(13-14), 2031-2045. https://doi.org/10.1111/jocn.12489
Minamizaki, M., Doi, M., & Kanoya, Y. (2024). Development of management indicators of nursing for minimizing physical restraints focused on older adult patients hospitalized in acute care settings: A Delphi consensus study. *PloS One*, 19(7), e0306920. https://doi.org/10.1371/journal.pone.0306920
Portegijs, S., van Beek, A. P. A., van Tuyl, L. H. D., & Wagner, C. (2022). “We usually choose safety over freedom”: Results from focus groups with professional caregivers in long-term dementia care. *BMC Health Services Research*, 22(1), 6. https://doi.org/10.1186/s12913-022-07952-0
Step 1 Read the case scenario. You are part of an interprofessional team working on an evidence-based project to look at falls in patients with dementia in the long-term care setting. The team was brought together in response to a noted increase in the incidence of falls in residents with dementia over the past three months. One of the recent changes before the increase in falls was a mandate to no longer use physical restraints on residents. Several staff members feel that the use of restraints is a must, and they do not have time to use the restraint alternatives that have been suggested. They also feel they do not have enough time to continuously check on residents. This has caused major issues of concern and has compromised the quality and safety of the residents.
When the team meets together, one of the first items discussed is the clinical question. The team uses the PICO question format to develop the following question:
In patients with a diagnosis of dementia in the long-term care setting (P), how does the use of a comprehensive falls assessment prevention plan that includes restraint alternatives (I) compare with the use of a fall prevention protocol that includes the use of restraints (C) affect the number of falls that occur (O)?
Step 2 Post to the discussion forum. In your initial response, address the following questions:
a. Determine the best resources to use when conducting a search on the topic. Consider these questions: What databases would be most appropriate? Where would you locate clinical practice guidelines that could be used in the EBP process for this issue?
b. Conduct a search using the resources you identified in Step 2a. What key search terms did you use? What filters did you use?
c. From your search, identify at least three articles that you would consider using in an EBP project such as the one described in the case scenario. If possible, suggest resources that meet the highest level (Level I) of evidence. Why would these sources be most appropriate in determining best practices and supporting clinical decision-making for this issue?
Step 3: Reply to the 2 discussion responses below. Provide meaningful responses rather than good job. Provide APA citations.
Response #1
Determining the best resources to use when conducting research is of the utmost importance. I would choose MEDLINE, PubMed, and, Cumulative Index to Nursing and Allied Health Literature, to research information on the use of restraints in dementia patients in a long-term care facility (Vana et al., 2023). I would use the Agency for Healthcare Research and Quality (AHRQ) or the Registered Nurses’ Association of Ontario (RNAO), to find Evidence Based Practice (EBP) guidelines (Vana et al., 2023). Clinical guidelines are also in professional organization websites or published scholarly peer-reviewed journal articles (Vana et al., 2023).
Searching Using the Above Resources
When conducting the search for this case study, I used the National Library of Medicines (NLM) Medline. The key search terms used were dementia, fall interventions, and residents. The filter I used involved articles from five years old or less. I searched through NLM for Level I articles, since articles that are over five years old may be out of date and less reliable (Vana et al., 2023).
The Three Articles Found for the Case Scenario
The first article that I chose was published on August 11, 2023, and titled, “Physical Restraints Use in Nursing Homes-Regional Variances and Ethical Considerations : A Scoping Review of Empirical Studies” (Hakverdioglu et al., 2023), was published in April 2019, and titled, “Implementation of a Multicomponent Intervention to Prevent Physial Restraints in Nursing Homes” (Abraham et al., 2019), and the third article I chose, was published in 2020 and titled, “Efficacy and Generalizability of Falls Prevention Intervetions in Nursing Homes: A Systemic Review and Meta-Analysis” (Gulka et al., 2020). Choosing a Level I resource ensures that it is the resource is the most reliable evidence available (Vana et al., 2023).
References
Abraham, J., Kupfer, R., Behncke, A., Berger-Höger, B., Icks, A., Haastert, B., Meyer, G., Köpke, S., & Möhler, R. (2019). Implementation of a multicomponent intervention to prevent physical restraints in nursing homes (imprint): A pragmatic cluster randomized controlled trial. International Journal of Nursing Studies, 96, 27–34. https://doi.org/10.1016/j.ijnurstu.2019.03.017Links to an external site.
Gulka, H. J., Patel, V., Arora, T., McArthur, C., & Iaboni, A. (2020). Efficacy and generalizability of falls prevention interventions in nursing homes: A systematic review and meta-analysis. Journal of the American Medical Directors Association, 21(8), 1024–1035.e4. https://doi.org/10.1016/j.jamda.2019.11.012Links to an external site.
Hakverdioğlu Yönt, G., Kisa, S., & Princeton, D. (2023). Physical restraint use in nursing homes—regional variances and ethical considerations: A scoping review of empirical studies. Healthcare, 11(15), 2204. https://doi.org/10.3390/healthcare11152204Links to an external site.
Vana, P. K., MSN, RN. (2023). Quality and safety education for nurses (G. Altmiller EdD, APRN, ACNS-BC, ANEF, FAAN., Trans.). In B. A. Voter PhD, RN, CNE. (Ed.), Encyclopedia of nursing research (Third ed., pp. 288–307). Springer Publishing Company. https://doi.org/10.1891/9780826150332.0189Links to an external site.
Response #2
Week 3 Discussion: Researching and Recommending Evidence-Based Research Resources
Research (Minamizaki et al., 2024) shows physical restraint causes serious physical and emotional problems and negative outcomes, such as poor quality of life, increased fall risk, mortality, and longer hospital stays. As nurses, we understand that restraint alternative interventions often consist of physical, policy, or structural elements rather than healthcare or education-based components. These interventions play a crucial role in improving the communication skills and attitudes of care workers. However, the effectiveness of restraint and non-restraint-based interventions in preventing falls and impacting patient outcomes in long-term care settings is a key area that requires our attention. Many studies focus on the fall-preventive effect of alternatives to restraints in a nursing home setting, including providing more personal freedom, cameras, sensor mats, bed rails, and e-monitoring (Portegijs et al., 2022, p.6). Our research in this area has the potential to significantly improve patient care and outcomes.
The best research to focus on is peer-reviewed or scholarly sources. The databases used for research were ProQuest, PubMed, CINHAL with full text, and Cochrane Library using the terms “Restraints, Physical” and “Alternative methods in Alzheimer’s and Dementia Patients.” Other phrases were “Physical restraint alternatives used in long-term care dementia units” and “Alternatives to physical restraints use in long-term facilities.” Filters used included but were not limited to source type, publication date, documentation type, and subject.
Clinical practice guidelines are located on the American Nurse Association website, the American Geriatric Society, and the International Society of Psychiatric-Mental Health Nurses. Three articles from my research to consider for use are Development of Management Indicators of Nursing for Minimizing Physical Restraints focused on Older Adult Patients Hospitalized in Acute Care Settings: A Delphi Consensus Study, Physical Restraint Use in Nursing Homes—Regional Variances and Ethical Considerations: A Scoping Review of Empirical Studies, and “We usually choose safety over freedom’’: results from focus groups with professional caregivers in long-term dementia care. These sources are most appropriate in determining best practices and supporting clinical decision-making for this issue because they provide valuable data regarding reducing in advert harm to Dementia and Alzheimer’s diagnosed patients with the need for restraints during long-term care.
References
Minamizaki, M., Doi, M., & Yuka Kanoya. (2024). Development of management indicators of nursing for minimizing physical restraints focused on older adult patients hospitalized in acute care settings: A Delphi consensus study. PloS One, 19(7), e0306920–e0306920. https://doi.org/10.1371/journal.pone.0306920Links to an external site.
Portegijs, S., van Beek, A. P. A., van Tuyl, L. H. D., & Wagner, C. (2022). “We usually choose safety over freedom’’: results from focus groups with professional caregivers in long-term dementia care. BMC Health Services Research, 22(1), 6. https://doi.org/10.1186/s12913-022-07952-0
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