A Nursing Home for Elderly Individuals - Research Paper Example

?Do elderly patients who receive proton pump inhibitors for gastric reflux symptoms have more incidents of fractures compared to elderly patients whodo not take proton pump inhibitors. 1). Describe the setting and access to potential subjects. If there is a need for a consent or approval form, then one must be created. The setting for a prospective study would be a nursing home for elderly individuals over the age of 60 years. This nursing home would be located in an area geographically accessible to the researchers, estimated within the city or town where the researchers are located. The potential subjects shall be accessed in the nursing home by establishing an inclusion and exclusion criteria for subjects. The inclusion criteria shall be: elderly at least 60 years old, with or without history of falls, with or without history of using proton pump inhibitors. Exclusion criteria set shall include: elderly patients in the nursing home below 60 years of age. As soon as the inclusion and exclusion criteria is established, as well as the sample number of respondents, the prospective respondents shall be informed about the research with their informed consent hopefully gained. The research shall be explained, including its risks, processes, and their participation required in the study. The informed consent shall also be explained to the respondents in a language they can understand and clarifications on the research and their participation will also be ensured (Ortiz, et.al., 2008). Patients not wanting to be part of the research shall not be coerced to participate and other prospective respondents shall be considered. Their confidentiality and anonymity during the data gathering process will also be ensured (Wiles, et.al., 2006). 2) Describe the amount of time needed to complete this project. Create a timeline. Make sure the timeline is general enough that it can be implemented at any date. This research will take at least two years and four months to complete. The first month will include the following itinerary a. Week 1 – research on existing statistics and background information about elderly and falls, as well as elderly falls and the use of proton pump inhibitors. This research will mostly involve library research and internet searches. b. Week 2 – research on the existing literature on the subject matter, mostly on elderly and falls, including elderly falls and proton pump inhibitors. Research on related literature will mostly be library and internet searches via Google search engines, including 2002 to 2012 related studies. A critical analysis of these studies will also be carried out, evaluating gaps in the research knowledge as well as issues in the methodology and research processes. Potential information proving theoretical and clinical data on the topic will also be established through the literature review. Limitations of these studies will then be used to build potential recommended future studies. c. Week 3 – potential research methodology for the paper will be established, including research design, methodology, nursing home to be covered, as well as appropriate statistical methods and sample population. d. Week 4-5 – shall cover the submission of the paper to the Ethics Committee, awaiting approval, and making necessary changes based on recommendations of the Committee. Second Month a. Week 1 – approval of committee and potential changes made on the paper. b. Week 2 – seeking approval of the nursing home administrator. - Potential discussions with the nursing home administration (including staff) - Making the questionnaire or research tool. c. Week 3 and 4– preparing and scheduling research observation with the potential respondents 2 years – research proper a. Respondents chosen to be observed for two years with the following outcome measures observed: number of falls, dosage and frequency of proton pump inhibitor intake. Four months: Post data gathering a. 1 month – Collation, tabulation, and computation of data gathered. b. 1 month – Analysis in relation to variables and research goals c. 1 month – Write-up for discussion and conclusion d. 1 month – Final write-up and editing. 3) Describe the resources (human, fiscal, and other) or changes needed in the implementation of the solution. Consider the clinical tools or process changes that would need to take place. Provide a resource list. Human resources needed for this research would include at least three main researchers. These researchers would have to be experts in health sciences medicine (Williams and Vogt, 2011). A statistician would also have to be employed for this study in order to carry out the necessary data collation and statistical computation (Romesburg, 2009). Resources for this study include the following: a. Researcher/technician b. Principal investigator, co-investigator, and research co-investigator c. Travel and subsistence d. Other directly incurred costs (laptops, PCs, and office supplies). e. Other directly allocated costs (shared staff costs) 4) Describe the methods and instruments, such as a questionnaire, scale, or test to be used for monitoring the implementation of the proposed solution. Develop the instruments. A data gathering instrument which shall mostly include a table where observations are written will serve as the primary tool for this study (United Nations ESCAP, 2012). This instrument will include the following information for each respondent: a. Demographic characteristics. Cases and controls information on sex, age, duration of stay in the home, and race/ethnicity. b. Proton pump inhibitor use, including dose and cumulative duration of use, in relation to frequency of falls. c. Two years use of proton pump inhibitor and frequency of falls This instrument shall record demographic information on each respondent (UNESCAP, 2012). Each respondent shall be personally asked such information and a separate information sheet shall be built on each patient respondent. The frequency, dosage, and duration of use of proton pump inhibitors (PPI) shall also be recorded on each information sheet. For non – PPI user respondents, only essential information would be recorded. Each data sheet on the patient will be filled up, especially those which relate to PPI intake. The information sheet for each patient will also include a portion where number of falls will be indicated (Sims and Wright, 2000). The characteristic of each fall shall also be specified, including the injuries suffered, as well as the impact of the fall on the patient. 5) Explain the process for delivering the (intervention) solution and indicate if any training will be needed. In delivering the intervention, respondents shall be randomly assigned to the proton pump inhibitor group or the non-PPI group (NIMH, 2012). Respondents given PPI shall be recorded for observations, mostly on dosage, frequency, and duration of intake. Recording shall be carried out by the researchers. Non-PPI respondents will be administered placebo, but still under the same circumstances as the PPI group. All respondents would not be informed which type of solution is being administered to them. The nurse administering the drug would also not be informed of the type of medication is being administered to the patient (Nesbitt, 2004). No special medical training is required in delivering the medication. The delivery of the medication does not require technical knowledge aside from the following: infection control, aseptic techniques, and observation of the essential “rights” in administration of medication, including right medicine, right patient, right route, right dosage, and right time (Daniels, 2004). For most nurses, pharmacists, and doctors who are most likely to deliver medications to patients, observing the proper techniques in medication administration is an inherent part of their training, hence no additional special training is needed in delivering the medication (Daniels, 2004). 6) Provide an outline of the data collection plan. Describe how data management will be maintained and by whom. Furthermore, provide an explanation of how the data analysis and interpretation process will be conducted. Develop the data collection tools that will be needed. The data shall be recorded by the researchers in each separate patient/respondent sheet. The data shall record the medication taken, dosage frequency, as well as duration. This recording shall be carried out for two years. Data on any falls shall also be recorded in the information sheet. The three principal researchers shall be the primary record keepers for each information sheet. Each information sheet shall be secured in a place only accessible to the researchers (National Human Research Protections Advisory Committee, 2002). At the end of each month, data shall be cumulated based on crucial information needed to fulfill research objectives. At the end of the two years all data cumulated shall be given to the statistician for computation and collation. Data analysis will follow after the statistician submits the results of the data, tabulated with corresponding related variables. The data analysis shall utilize the outcome measures, relating the frequency, dosage, and accumulated time of use of PPI and the frequency/impact of falls for respondents. Interpretation will be based on the duration of PPI use and frequency of falls, as well as the impact of the PPI use on the bones, especially the hip bones of elderly patients. Bone density and regeneration will also be measured for respondents, comparing those who have used PPI and those who have not. Data information sheets shall be kept in a secure place by the researchers for at least five years after the research is published, soon after the sheets would be shredded and destroyed (National Human Research Protections Advisory Committee, 2002). Data evaluation tool: Fracture risk assessment tool (World Health Organization, 2011) 7) Describe the strategies to deal with the management of any barriers, facilitators, and challenges. In relation to any barriers in the research process, including access to patients, this matter shall be discussed with the nursing home administration. Barriers in relation to patients refusing to take the medications will be resolved by calmly discussing with the patient the purpose of the medication as well as the benefits which the medication can bring. Facilitators forgetting or making mistakes in the administration of the medication shall be corrected or reminded before or soon after the incident. Challenges may include respondents dropping off or withdrawing from the research (Oliver, 2010). Research drop-offs can be kept to a minimum by the initial inclusion of a larger population. Challenges in the interpretation of data can also be resolved by discussing with the other researchers possible interpretations for the data, letting the data be independently be verified by the statistician (Oliver, 2010). Interpretation will be resolved by referring to previous existing data and more relevant odds for data extrapolation. 8) Establish the feasibility of the implementation plan. Address the costs for personnel, consumable supplies, equipment (if not provided by the institute), computer related costs (librarian consultation, database access, etc.), and other costs (travel, presentation development). Make sure to provide a brief rationale for each. Develop a budget plan. The implementation plan is feasible. The cost for personnel would be affordable based on personal researcher budget which would also cover consumable supplies, computer-related costs, and travel costs. Estimate total cost is at: ____________ 1. Personnel – research technician/assistant and statistician (paid standard minimum rates) Budget:_________________ 2. Consumable supplies – food, office supplies – to cover two years. Budget:________________ 3. Computer-related costs – electricity, database access, internet fee (for research and write-ups) Budget:_______________ 4. Travel – for travel to and from the nursing home; travel to and from the university library. Budget:______________ 9) Describe the plans to maintain, extend, revise, and discontinue a proposed solution after implementation. Plans to maintain this research would likely require the researchers evaluating nursing homes appropriate for this study. Moreover, elderly patients in the community setting may also be covered for this study. Elderly patients in the community setting can be included for comparative purposes. However, these patients may not be easy to monitor because they would be staying in their homes without regular monitoring during medication intakes (Centers for Disease Control, 2008). Nevertheless, they are also viable subjects for this study and there would be no need to have to seek the permission of the nursing home administrator before including these elderly patients as respondents. Informed consent can instead be directly and immediately gained from the patients. This research may also be extended for three years in order to evaluate the length of use of PPIs and the rate of falls for patients. Recommendations on the discontinued use of PPI on elderly patients may also be considered one of the recommendations for this research because previous literature strongly links PPI use to the frequency of falls and hip fractures for the elderly (CDC, 2008). Alternatives in PPIs can be recommended instead. This research may also be carried out with revisions on the use of PPI among elderly patients and the risk of fractures. This would directly relate PPI to their common impact on bone degeneration, as well as the length of their use of PPI with the frequency of falls and fractures. 10) Apply a change model to the study Roger's diffusion of innovation theory is a particularly good theoretical framework to apply to an EBP project. However, students may also choose to use change models, such as Duck's change curve model or the transtheoretical model of behavioral change. Other conceptual models presented such as a utilization model (Stetler's model) and EBP models (the Iowa model and ARCC model) can also be used as a framework for applying your evidence-based intervention in clinical practice. The diffusion of innovation can be used in order to establish a change model for this innovation or evidence-based change (Rogers, 1983). In this case, the innovation is the idea or the practice which is considered by individuals or health professionals as new or innovative. For implementation, this innovation would require communication channels, and such channel is the primary way by which messages are communicated from one group or one person to another (Rogers, 1983). In this case, this channel would include the other health professionals involved in the elderly patient’s care. The innovation-decision period would be the length of time upon which the innovation-decision is required to pass (Rogers, 1983). In this case, the length of time may be very lengthy, or in some cases, relatively short. Depending on the channels which the innovation would have to pass through, the current change to be implemented may take years or months to implement. Finally, the social system refers to the set of interrelated units which are involved in joint problem solving with the end goal of securing the common goal (Rogers, 1983). The units involved would be the doctors, especially those involved in geriatric care, the nurses, pharmacists, and other researchers who need to carry out other studies to support the current innovations. 11) Apply one of the above models and carry your implementation through each of the stages, phases, or steps identified in the chosen model. The diffusion of innovation theory can be applied in establishing an evidence-based intervention in the clinical practice. This would include a change of medicine for gastric reflux symptoms. The first stage of the theory is on knowledge, where there is an initial exposure to an innovation, but there is not enough information about the innovation as yet. The knowledge gained in the initial research for this paper already provides a framework for this innovation, indicating how PPIs are not the best choices for elderly patients because of the risk of falls they can bring to these patients. The persuasion stage indicates that there is interest in the innovation, as well as active seeking of information about the innovation. The innovation here would be an alternative to proton pump inhibitors for gastric reflux symptoms. Alternatives or innovations would prioritize concerns which relate to the elderly. For the decision stage, individuals involved would take the concept of change and weigh the advantages and disadvantages of utilizing the innovation, deciding whether to adopt of reject the said innovation. In this case, other health professionals, especially those involved in elderly care would have to evaluate the use of the innovation, in this case, the alternative to PPI and decide whether or not to apply it to their patients. Adopting it initially into their practice may eventually lead to a more widespread practice. Implementation is the stage where the innovation is applied depending on the attendant situation. This would include the process of changing prescription medications, and the appropriate applicability of the innovation to each individual patient. The alternative innovation may not fit the individual circumstances of a patient, and some may not respond to the alternative well. Some may also experience adverse effects from the alternative. In such situations, another alternative medication for gastric reflux symptoms should be considered. In the final stage of confirmation, the doctor involved in the care of the elderly patient would then finalize his decision about what best to prescribe for the patient’s gastric reflux symptoms. This would involve individual considerations for each patient. One medication prescribed to all patients may not be appropriate because of individual patient circumstances and qualities. This is one of the hallmarks of evidence-based care or patient-centered care, where the patient is primarily considered in his care options. 12. Conceptual model The intervention group would be the group given the proton pump inhibitor The control group would be the group to be placed on placebo Measurement of outcomes and other variables would include dosage, frequency, duration of PPI and number of falls for the elderly. References Centers for Disease Control and Prevention (2008). Preventing falls: how to develop community- based fall prevention programs for older adults. Retrieved from http://www.cdc.gov/homeandrecreationalsafety/images/cdc_guide-a.pdf Daniels, R. (2004). Nursing fundamentals: caring & clinical decision making. California: Cengage Learning. National Institute of Mental Health (2012). What is randomization?. Retrieved from http://www.nimh.nih.gov/health/publications/a-participants-guide-to-mental-health-clinical-research/what-is-randomization.shtml Nesbitt, L. (2004). Clinical research: what it is and how it works. New York: Jones & Bartlett Learning. Oliver, P. (2010). The student's guide to research ethics. USA: McGraw-Hill International. Ortiz, A., Hagemann, J., Mestaz, P., and Rose, S. (2006). Informed consent in human subjects research. University of Southern California. Retrieved from http://www.usc.edu/admin/oprs/private/docs/oprs/brochures/IFC_Booklet.pdf Romesburg, H. (2009). Best research practices. California: Lulu.com. Rogers, E. (1983). Diffusion of innovations. New York: Free Press. Sim, J. and Wright, C. (2000). Research in health care: concepts, designs and methods. Michigan: Nelson Thornes. The National Human Research Protections Advisory Committee (2002). Recommendations on confidentiality and research data protections. Retrieved from http://www.hhs.gov/ohrp/archive/nhrpac/documents/nhrpac14.pdf United Nations Economic and Social Commission for Asian and the Pacific (2012). Training manual on disability statistics. Retrieved from http://www.unescap.org/stat/disability/manual/Chapter3-Disability-Statistics.asp Vogt, W. and Williams, M. (2011). The Sage handbook of innovation in social research methods. California: SAGE Publications Ltd. Wiles, R., Crow, G., Heath, S., and Charles, V. (2006). Anonymity and confidentiality. University of Southampton. Retrieved from http://eprints.ncrm.ac.uk/423/1/0206_anonymity%2520and%2520confidentiality.pdf World Health Organization (2011). New Updated WHO Fracture Risk Assessment Tool (FRAX). Retrieved from http://marodyne.wordpress.com/2011/06/03/new-updated-who-fracture-risk-assessment-tool-frax-now-available/ Read More