NR 439 Week 2: Search for Literature and Levels of Evidence

NR 439 Week 2: Search for Literature and Levels of Evidence

NR 439 Week 2: Search for Literature and Levels of Evidence

Recently, my clinic was in-serviced on patient safety related to the prevention of fall and injury while using the restroom. Dialysis patients are at increased risk for falls before, during and after dialysis, because of various factors, including medical reasons, and comorbidities.

Here is my PICO for this situation:

P – prevent falls and injury of dialysis patients during the use of the restroom
I – monitor for falls by instructing patient to use call light, staying in close proximity of restroom, and call patient frequently to ensure safety
C – Pt safety compromised while the patient is in restroom
O – The patient will not fall and experience injury while in restroom

T – There will be no bathroom falls within 60 days

Key words here are fall, injury, safety, and prevention

Searchable question: what safety measures can be implemented to prevent patient falls and inury while the patient is in the restroom?

The situation in my clinic that relates to this PICOT is monitoring patients for falls which may result in injury or a medical emergency, in the restroom of the clinic. According to Cable and Schub (2016), a plan which is “designed to anticipate a patient’s risk for falling and provide interventions to reduce the risk”, has to be designed. The what, how, where and who are the questions suggested being addressed when looking at the plan of interventions for fall. Cable and Schub also gave the factors to be considered to prevent falls. These are in the acronym of D.A.M.E., 
D.A.M.E. stands for the drugs patients used, the age of patients, the medical factors or conditions of the patients, and the environment. All these factors have a significant effect on the population of patients in my clinic. Patients on dialysis may be hypotensive during treatment, many are elderly, and have medical conditions or comorbidities that may cause instability or unsteady gait, and altered mental status. The environment is what the E stands for. The area of treatment has to be free from obstruction like equipment, the bed has to remain lower, and lighting has to be adequate, among other environmental factors.
However, even though we have a policy and procedure in place for falls, the Education nurse provided an in-service on the restroom-fall policy and procedure. The purpose is to educate staff on monitoring patients when they go to the restroom. Because of patients’ susceptibility to falls, which may result in injury and medical emergency, and based on the factors mentioned, the clinic added to its fall precaution policy and procedures measures to monitor patients in the restroom. Patients are to be closely monitored, with staff standing outside of restroom and calling out to check on patients frequently.

Schubt and Heening(2016), gave the statistical breakdown of elderly patients falls. They stated falls can lead to severe complications.Because of this, they stated that clinicians need to learn about accidental falls and use an environmental checklist to ensure safety.

Caple, C.; Schub, T. (2016). Fall Prevention Plans: Implementation. Cinahl Nursing Guide. EBSCO Publishing ( Ipswich, Massachusetts), 2016 Jan 22 Retrieved from:

Schubt, T., Heening, H. (2017). Falls, Accidental: Resulting in Injury. Cinahl Nursing Guide. EBSCO Publishing(Ipswich, Massachusetts), 2016 June 17. Retrieved from:

Nursing research is a dynamic process that includes multiple phases: defining the research problem; literature review; selecting a theoretical framework; choosing an appropriate design; defining a sampling strategy; collecting and analyzing data; sharing the findings, and using the evidence in practice.

The Course Outcomes (COs) we will apply in Week 2 include: 

Examine the sources of evidence that contribute to professional nursing practice.
Apply research principles to the interpretation of the content of published research studies.

Reflect on your practice, and identify a significant nursing clinical issue or change project that you would like to search for evidence in online sources. Formulate searchable, clinical questions in the PICO(T) format for your nursing clinical issue.

Next, review the guidelines for the PICOT Assignment due Week 3. Use your PICOT elements to search for one report of a single, original study that has been published within the last 5 years from the CCN Library that is relevant to your nursing clinical issue. Briefly, describe how it is relevant to your nursing clinical issue. Remember to give a complete reference to the study. Post your PICOT and research article in this discussion.

Remember to integrate references.

Class, please remember, you must answer this question by end of Wednesday to gain participation points. 
Thank you,

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Professor and Classmates,

I have been an Emergency Department (ED) nurse for seven years. Many people ask why I would want to work in the ED.  The answer is simple.  I like being the first line of care for the patient.  I like that I don’t have time to build a relationship with the patient and the family.  Some may think that sounds cold, but I am one who would take the relationship home with me.  By that, I mean that if I developed a relationship with the patient and family members, it would hurt too much when illness or death overcame the patient.  I would not be able to leave that at work.  I need for my interactions with the patient to be completely medical.  Do I ever get emotionally attached to repeat patients?  Of course but, it is less common in the ED than it would be on an inpatient unit. The nature of ED nurses is often based on the need to provide emergency care. Many of the nurses I have discussed this with feel the same way.  They are too compassionate to allow themselves to become close to the patient.  Also, many of us feel that we have lost some of our faith in the human race because of our roles in the ED.  Because we often only have contact with the patient for a short period of time and we see many patients over and over, many of us suffer from compassion fatigue. The significant clinical issue that effects my department is compassion fatigue. Evidence-Based Practice or “EBP, considers internal and external influences on practice and encourages critical thinking in the judicious application of evidence to the care of the individual patient, patient population, or a system” (Hain, & Kear, 2015, p 12).

My PICOT would be:

P – The population of interest for this project is registered nurses who worked in the Emergency Department full time

I – The intervention is educational training about compassion fatigue.  The intervention takes place off the unit and during a scheduled work tour.

C- The comparison is a survey taken by RNs prior to the education.

O- The outcome is reduction of compassion fatigue after the education.

T- The time frame is 6 months.

At 6 months, ED RNs take the same survey and values are compared. “Clinicians must critically evaluate research before attempting to implement the findings into practice” (Peterson,, 2014, p 67).

My PICOT question is “Are RNs who work in the ED, who are educated about compassion fatigue, less likely to suffer from CF?”

According to the article I found, “compassion fatigue (CF) is a relatively recent concept that refers to the emotional and physical exhaustion affecting healthcare providers, usually as a consequence of caring” (Hamilton, Tran, & Jamieson, 2016, p 1).  The article goes on to state that nurses have been more vocal than doctors about the effects of compassion fatigue over the years.  It also states that the ED is a breeding ground for CF.

This article is extremely relevant to my clinical question. As with any other issue, education is usually key to prevention and treatment. 


Hain, D. J., & Kear, T. M. (2015). Using evidence-based practice to move beyond doing                things the way we have always done them. Nephrology Nursing Journal42(1),                11–21.

Hamilton, S., Tran, V. & Jamieson, J. (2016). Compassion fatigue in emergency                           medicine: The cost of caring. Emergency Medicine Australasia, 28(1), 100-103.               doi:1111/1742-6723.12533

Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.).            Sudbury, MA: Jones & Bartlett.

Peterson, M. H., Barnason, S., Donnelly, B., Hill, K., Miley, H., Riggs, L., & Whiteman, K.            (2014). Choosing the best evidence to guide clinical practice: Application of AACN             levels of evidence. Critical Care Nurse, 34(2), 58–68. doi:10.4037/ccn2014411

Jul 9, 2017Jul 9, 2017 at 11:02am

Manage Discussion Entry

     Great post, I also understand the aspect of not forming a relationship with the patient and family.  Working as a circulator in surgery we do not form those relationships as our patients don’t even remember us.  It isn’t that I’m not compassionate its just that I would take it home as well and sometimes still do when we lose a patient.  Prior to Nursing I worked with MR adults who lived in group homes.  I was so involved in their lives that when I graduated Nursing I knew I no longer wanted that one on one involvement.  I know your role is difficult due to so many repeat patients for mental instability and drug seeking and I am so very thankful to have you and others in your role.   I think this is a great research topic.


Manage Discussion Entry

Candee this is a great PICOT and subject matter. Compassion fatigue and caregiver stress are tow highly undervalued issues that affect many nurses. I do like both of the articles you have shared. Good work. You could use this for your assignment. Please look at the template provided. Dr Joy

Manage Discussion Entry


     I really enjoyed your post this week. It is a very interesting benefit you highlight in the atmosphere of the emergency room-decreased risk of forming relationships with patients/patient’s families. I think your PICOT is very suitable for your question and that your reference is appropriate. Thank you so much for your personal insight. Great post!

Good evening Ms.Candee, enjoyed reading your post as I was educated about this particular issue. I have never really heard of this so thank you so much for choosing this issue to share. I must admit that at first I thought you were not a caring nurse but as I read on and you explained why you have an unattachment to your patients it then made sense of what you need to do your job effectively. I discovered an article that may assist with the question you pose on it educating ER Nurses about CF. There are public tools available to measure compassion fatigue It states “These recognized tools may be utilized by staff to evaluate their compassion fatigue. Tools may be considered by organizations to investigate the trends within units or specialties. The Professional Quality of Life Scale (ProQOL) by Stamm (2005) is a 30 item free self-report tool accompanied by a self-score document to provide interpretation.  The Green Cross Academy of Traumatology website provides the Secondary Traumatic Stress Scale (STS) and the Compassion Fatigue Self-Test for Helpers (CFST).Both utilize self-report liked items to determine scores related to compassion fatigue, compassion satisfaction, and burnout levels or risks.” Carter,C (2013). Case Study: Compassion Fatigue Among Emergency Department Staff: A Patient Safety Consideration. Thank you for sharing this issue as it was informative.

Kind regards,