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

  1. 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.
  2. 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.
  3. Briefly describe how it is relevant to your nursing clinical issue. Remember to give a complete reference to the study.

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.

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

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:


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