716-DEVELOPING AN EVIDENCE-BASED PROPOSAL 1

716-Developing an Evidence-Based Proposal

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Abstract

Hospital-acquired conditions basically point to those uncounted complications with old

age but are still prevalent in health facilities despite today's technological and medical

breakthroughs. This is where evidence-based practice (EBP) comes in handy as an important

way of dealing with these issues, such as making clinical decisions with current best-evidenced

knowledge in an attempt to advance client status. The following paper aims to discuss how the

idea of EBP can be effectively used for decreasing patient falls and increasing nurse staffing, as

well as improving patient monitoring. Iowa Model of Evidence-Based Practice: A Road Map for

Adoption and Implementation of Research-Based Practice Interventions. Based on the PICO

framework, this paper develops a clinical question about the effect of staffing patterns and fall

observation on the rate of patient falls. The preceding literature shows that maintaining sufficient

nurse staffing levels and constantly observing patients sharply decreases the risk of actual falls.

Add to this the principles of ethical decision-making that are inherent to the healthcare field

coupled with the biblical teachings of the importance of caring for the sick person, and we see

that patient safety cannot overemphasized. The following paper provides a recommendation that

encourages the implementation of practices supported by evidence in hospitals while insisting

that patient safety must always be a priority. Healthcare institutions are compelled to advance

long-term changes in standards of nursing practices, staff-to-patient proportions, and the

implementation of monitoring systems with the purpose of lessening patient fall rates and other

preventable complications and harm, ultimately improving patient quality and safety.

Keywords: evidence-based practice, patient falls, nurse staffing, Iowa Model, patient

monitoring, PICO framework

716-Developing an Evidence-Based Proposal

Introduction

The responsibilities concerning the patient's safety are among the key concerns of

healthcare-related organizations. The majority of hospital-acquired complications, such as

pressure ulcers, infections, and patient falls, remain the leading and mostly avoidable causes

of patient harm and escalating healthcare expenditures. Pressure ulcers and infections are

well-known outcomes that contribute to an organization's claims and losses by endangering

the lives of patients and raising questions regarding the extent to which they were cared for in

hospitals.; patient falls are a severe problem that is associated with the the safety of the

hospitalized populace (Mondragon & Zito, 2024). EBP promotes patient safety by impacting

healthcare interventions by including the latest research findings with clients' needs, values,

and clinical judgment. Particularly, the questions related to patient falls have attracted much

interest, and several research studies indicated that the approaches to adequate nurse staffing

and continuous patient monitoring can play crucial roles in decreasing the rate of falls. The

Iowa Model of Evidence-Based Practice is the model of practice that can be implemented to

minimize the gap that exists between research and practice. This is made possible by the fact

that, through the guidelines highlighted in the model, healthcare professionals can put

measures in place to curb falls among patients. This paper will outline how the Iowa Model,

when incorporated with a proper clinical question formulated with the aid of the PICO

structure, may enhance patient safety and minimize falls through correct staffing and

observation actions.

Developing a Clinical Question

The first stage in EBP is problem identification; it is the first step that helps recognize

a clinical problem that warrants an evidence-based solution. In LOL, patient falls are an

ongoing challenge that can lead to more significant, acute repercussions, such as higher
716-DEVELOPING AN EVIDENCE-BASED PROPOSAL

morbidity, longer lengths of stay, and ultimately higher mortality (Aiken et al., 2011). Since

the prevention of patient falls is a critical concern, it is allowed to form a pointed clinical

question, the PICO funnel model. The PICO framework has four parts, Population,

Intervention, Comparison, and Outcome, which assist a clinician in asking a question that

could be used in a clinical context. For this clinical question, the subject of interest is the

relationship between nurse staffing levels, patient monitoring practices, and the fall rate in

hospitalized patients. The Iowa Model of Evidence-Based Practice aims at the integration of

research evidence into the healthcare practice, working collaboratively, and as such, can

guide the resolution of this issue by the use of evidence. Using the AOH/T Iowa Model,

patient falls can be conceptualized thoroughly by the healthcare teams in terms of evidence-

based analysis and solution implementation to decrease fall trends or risks.

Iowa Model includes the identification of a clinical problem; a team assembled, the

current evidence collected and assessed, specific practice changes proposed and

implemented, and, finally, an evaluation of the outcome is done. For this study, the clinical

question formulated using the PICO framework is: ''Among hospitalized adults (P), does

higher nurse staffing and improved patient observations (I) decrease the rate of patient falls

(O) when compared to standard staffing levels (C)? This question is very important because it

challenges the dependency on the levels of nursing staff implemented, increases patient

supervision and benefits in lessening patient falls (Buckwalter et al., 2017). The conclusions

and recommendations shall inform clinical practice and management in relation to patients'

safety and the quality of their care.

Literature Review

A significant number of research papers have detailed the effects of nurse staffing and

patient surveillance on falls, and similarly, the outcomes indicate the significance of these

factors in enhancing patient safety. The literature shows that there is a correlation between
716-DEVELOPING AN EVIDENCE-BASED PROPOSAL

nurse staffing levels and the results for end users, such as the prevention of falls. For

example, Aiken et al. (2011) reported that the n/p ratio of < 5 yielded fewer the average

relative risk of patient mortality and adverse changes related to, for instance, falls. Similarly,

Cooke et al. (2022) noted that staffing lets nurses have more time to spend watching patients,

recognizing signs of possible risk factors, and taking action to eliminate the risk of falls. The

study also found that where there were limited nurse staffing levels, the nurses got

overwhelmed with the work and hence could not effectively and sufficiently conduct the

necessary patient surveillance.

Apart from staffing, monitoring of patients all the time has also been identified to

reduce the incidents of falls. Al-Ghraiybah et al. 's study conducted in 2024 showed that if

high-risk patients get timely invigilation along with advanced monitoring techniques, the rate

of falls is greatly reduced. These studies are in concord with the proposal that checking and

real-time examination decrease the rate of falls and enhance the safety of the patient. This

view is again supported by Malinowska-Lipień et al. (2024), showing that hospitals that

increased staffing of nurses and patient observation experienced a significant decline in falls

and mortality among such patients.

The components of monitoring extend to observational oversight that will further

encompass communication between nursing staff, patients, and families and contribute to the

prevention of falls. Nurses with knowledge of the fall risks and with prior increased staffing

are more prepared to empower the patient and the family concerning the implementation of

measures to prevent falls with everybody being on the lookout (Malinowska-Lipień et al.,

2024). This clearly structured prevention approach, including adequate staffing, constant

surveillance, and information exchange, increases safety in healthcare organizations. There is

even less doubt that this multifaceted intervention reduces patient falls and enhances other
716-DEVELOPING AN EVIDENCE-BASED PROPOSAL

safety realms, as well. When these elements are incorporated, there are ways through which

caregivers can better manage patients and systems and experiences to reduce errors.

Ethical Considerations

It is, therefore, important to address the principles of ethics in order to advance the

way EBP is done in healthcare facilities. Healthcare givers have a moral duty to respect the

good that may come to the patient; this corresponds with the two principles of beneficence

and non-malicious intent (Cheraghi et al., 2023). Beneficence, which focuses on the

obligation to do good to patients, takes center stage, and non-malfeasance, which means the

principle against causing harm. With regard to disturbing patients, these principles call for

more comprehensive protective and patient safety interventions. The results of this study

have important implications for healthcare organizations seeking to improve nurse staffing

levels and monitor to meet their ethical obligation to provide optimal care.

Scriptural Considerations

In line with these, biblical principles also stress the ethic of bi/value responsibility of

persons for the welfare of others. Proverbs 3:27 underscores the ethical responsibility in

doing good where one has it within his/her power to help; this has been revealed by the

scripture, which says, 'Do not withhold good from those to whom it is due (Insideout, 2024)".

This backs up the stipulation that when a healthcare provider can positively affect patients'

outcomes, it should make necessary changes. Additionally, 1 Peter 4:10 states that soulmates

call on people to work for others, and each person ought to employ talents and strength in

order to help others as God's stewards of grace. The above biblical teachings call for the

right-proclaimed responsibility of healthcare practitioners to harness their competence and

assets to the patients and their safety.

Implementing Change
716-DEVELOPING AN EVIDENCE-BASED PROPOSAL

Iowa Model provides a structural plan for the usage of research-based practice

interventions in healthcare practice settings. The next step after composing a clinical question

is to assess the evidence to support the intercessions needed. There is clear support in the

literature for raising nurse staffing levels and improving patient surveillance as useful

techniques for preventing patient falls. The next step to putting into practice these strategies

is to conduct a feasibility trial of the interventions in a clinical area like a hospital admitting

unit that has a problematic high Figure rate of falls (Randell et al., 2024). The intervention

can involve staff nursing supplementation during the higher risk of falls, placing moist

alarms, and post-fall risk assessments for the patients.

Evaluation and Scaling

After using the interventions, it is necessary to assess the impact of these interventions

by paying keen attention to the rate of falls within the health facility as well as the patient's

response to the interventions. This data will help determine if the changes will indeed result

in positive changes corresponding to patient safety. Based on previous findings, if the pilot

intervention would work, then the following step would be to expand the intervention to other

hospital units. Ongoing supervision and follow-up are imperative for the effectiveness of

implementation so that the strategies can be modified to adapt to the organizational changes;

there is a need for dollarization (O’Cathain et al., 2019). Because nursing practice involves

many people, such as nurses, physicians, and administrators, the changes must be made in

coordination with all these people for their sustainability.

Conclusion

In conclusion, the prevention of patient falls can be listed as one of the major

objectives of healthcare organizations around the World. Iowa Model, among other models of

practice known as Evidence-Based Practice, creates a framework for solving this problem.

Through the asking of a well-defined clinical question with the help of the PICO technique,
716-DEVELOPING AN EVIDENCE-BASED PROPOSAL

the multifaceted interconnection between nurse staffing, patient monitoring, and fall

prevention can be highlighted. Current literature indicates that increasing staffing and

monitoring do help reduce fall incidences and that both ethical and biblical mandates require

the protection of patients, especially from falls. Utilizing these research-based practices,

programs can be developed and piloted to produce positive patient results and decrease fall

injury rates. These measures should be promoted in hospitals so as to improve the safety of

their patients and the effectiveness of their care delivery environments.

References

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systematic review of the literature. International Journal of Nursing Studies, 48(5),

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Al-Ghraiybah, M., Al-Dosari, A., & Al-Harbi, T. (2024). Impact of continuous monitoring on

fall prevention in hospitalized patients. Journal of Nursing Care Quality, 39(3), 213-

220. https://doi.org/10.1097/NCQ.0000000000000547

Buckwalter, K. C., Cullen, L., Hanrahan, K., Kleiber, C., McCarthy, A. M., Rakel, B.,

Steelman, V., Tripp‐Reimer, T., & Tucker, S. (2017). Iowa Model of Evidence‐Based

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