Read a selection of your colleagues' posts below and respond to at least two of your colleagues on two different days by expanding upon their reflections, making connections to your perceptions, and offering additional insights.

Nursing Problems in the Nursing Research Study and the QI/DNP Projects

1. Research Study (Tzeng & Yin, 2017): The nursing problem in the research study is that even though the survey indicated that there were many fall prevention strategies in place, like the use of bed alarms, sitters, and roundings, there were still many falls recorded in the hospitals and the interventions employed were not standardized and consistent fall prevention strategies across the hospital settings.
2. Quality Improvement Project (Khoja & Moosa, 2023): The nursing problem in this article is that there was no effective generic fall prevention strategy that was patient-specific or actively involved in patient safety planning. It was a one-size-fits-all strategy that was employed.
3. DNP Evidence-Based Practice Project (Bangura, 2024): The problem identified is persistently high fall rates among veterans in a long-term care facility despite existing interventions. The issue is compounded by a lack of structured and intentional nurse rounding that proactively addresses patient needs and risks.

2. How Nursing Problems Define Gaps in Knowledge and Practice

Gap in Knowledge (Tzeng & Yin, 2017):

The nursing problem in the research identifies a knowledge gap that was due to the lack of consensus and evidence about which fall prevention interventions are most effective across the different settings in the hospital; thus, the research study identifies a clearer understanding of how the use of data from different survey sites can help in fall prevention interventions.

Gap in Practice (Khoja & Moosa, 2023):

The nursing problem in the QI projects identified a practice gap whereby the existing fall strategies used were not tailored to individual patient's needs, which did not lead to a positive patient outcome; therefore, the implementation of the tailored interventions for patient safety (TIPS) was a measure identified as an effort to bridge with customized care.

Gap in Practice (Bangura, 2024):

The DNP project identifies a practice gap by introducing a structured and evidence-based rounding strategy that directly targets fall reduction, since lack of consistent rounding was the key contributor to higher fall rates.

Comparison:

While Tzeng & Yin focus on understanding the best practices through research, the QI and DNP projects directly apply and test interventions within specific clinical environments. The research study informs broader systemic improvement, while the QI and DNP projects demonstrate localized, actionable changes that can influence nursing practice positively.3. Key Measurement/Variable in each of the three studies/projects.

Tzeng & Yin (2017): The key variable in this study is the perceived effectiveness of specific fall prevention interventions as measured via nurse surveys across multiple hospitals.

Khoja & Moosa (2023): The key variable in this article is fall rate before and after the implementation of TIPS, measured in an acute care unit.

Bangura (2024): The key variablein this study isthe fall rate before and after the implementation of an intentional nurse rounding strategy in a long-term veterans' care facility.

1. Critique of Question Development Tool (Based on Hicks, 2024)

Hicks (2024) emphasizes that effective question development requires clarity and alignment between the that is identified, the evidence-based practice (EBP) question, and the measurable outcome. Evaluating this framework across the three fall prevention articles and the additional CLABSI project highlights the tool's strengths and limitations when applied in different settings.

The strength of Hicks' tool lies in its utility for structured EBP and QI project, as demonstrated in the CLABSI initiative and DNP projects. These projects illustrate the value of a tightly constructed question that informs intervention and evaluation.

However, the tool may have limited application in exploratory research like Tzeng & Yin's, which focuses more on identifying variables than testing a defined intervention. In such cases, research questions may be broader or hypothesis-generating rather than conforming to a narrow problem-intervention outcome model.

This suggests the tool might benefit from incorporating contextual analysis as an additional step in question development.

Conclusion

The integration of all the studies, which included the nursing research, QI initiatives, and the DNP-led EBP projects, explains how a comprehensive approach can be used to address clinical problems and improve patient outcomes, thus the synthesis of evidence across the different types of scholarly work. Ultimately, the synthesis of evidence across different types of scholarly work supports the evolution of nursing practice. The reviewed projects demonstrate the importance of precise question formulation and outcome measurement and reinforce the need for leadership engagement, context awareness, and ongoing education to sustain practice change. Applying Hicks' tool within the real-world complexities of healthcare can empower nurses to lead evidence-based improvements and close the gap between research and practice.

References