Evidence-Based Practice for Nurses-Free-Samples for Students

Question: Do carers in aged care facilities provide Passive exercise for Clients Daily? Answer: Research question/hypothesis and purpose: With the rise in ageing population, wide array of service and support are now available for elderly people in Australia. The aged care facilities play an active role in providing specific assistance to people aged over 65 years. Active motion exercise is essential for physical fitness and functional independence in older people. However, in aged care facilities, there are many older adults who lack the ability to perform active exercise. As older people above 70 years are most likely to stay in bed or wheelchair, providing them passive exercise is necessary for functional fitness in them. The benefit of passive exercise is that it helps maintain muscle strength and flexibility and pain management (Takahashi et al. 2015). The effectiveness of passive exercise is seen when it is provided by carers in aged care facilities on a daily basis. However, there is little idea regarding the frequency of passive exercise provided to elder. Hence, the main purpose of this research is to evaluate whether carers provided passive exercise to elders on a daily basis or not and find out the frequency of participation and continuation of exercise in these facilities. The main research question related to the topic is: Do carers in aged care facilities provide passive exercise on a daily basis?. The six steps of evidence based practice will support in identifying current weakness in aged care practice and planning future priorities for nurse to enhance their performance. The six steps includes assessing the patient, asking the question, acquiring the evidence, appraising the evidence, applying it to patient and self-evaluation of performance (Schmidt and Brown, 2014). The findings of the research might contribute to evidence based practice because the results will give idea about the rate at which passive exercise is provided and the health status of older clients. In the presence of these data, it will be easy to critically analyze the evidence and find out the best element that can be taken from the result to inform and improve future nursing practice. The result regarding the duration and schedule of passive exercise provided to elders at aged care facilities will also contribute to nursing practice as it will give nurses the idea regarding the barriers and facilitators t o passive exercise regimen. With this insight, they can adopt strategies to reduce barrier and promote active participation of elders in passive exercise routine on a daily basis. It will support nurses to provide restorative care to elderly. In this research, the physiotherapist will significantly contribute to the research as their collaboration would help to understand the types of physical exercise and its benefits for elderly. Their knowledge and experience will also help in determining the duration and frequency at which the passive exercise will provide health benefit to elderly. Literature review: The importance of doing research to investigate about the role of carers in providing passive exercise to elderly people is understood from the review of previous research literature related to the topic. The core idea of the research is the importance of passive exercise for elderly people and the research by Takahashi et al. (2015) was found important in relation to the research topic as it compared passive exercise with active exercise to determine its effectiveness on functional fitness in elderly nursing home residents. The participants were divided into active motion and passive motion exercise group and functional fitness of each group was evaluated after the intervention. The adherence rate and improvement in fitness was found equally in both groups proving that both active and motion exercise are equally effective for optimal health and functioning of older adults. The only negative outcome was that functional reach was not achieved by people in the passive exercise group. I n the research, the duration of the exercise program was 3days/week for 12 weeks. The key gap in the study was that it did not explained the mechanism of how passive exercise produced positive effect for participants. The main contribution of new research on the topic is that it will help to find out the possibility of passive exercise on a daily basis as well as the mechanism by which the underlying benefit is achieved. Takahashi et al. (2015) has carried the research with automatic passive motion exercise machine, however the uniqueness of current research proposal is that it will implement those passive exercise which be provided by carers like nurses in aged care setting. Hence, the results would be a useful piece of evidence to determine alternative mode of exercise for those older adults who cannot tolerate active exercise. In aged care facilities, there are older adults who are strictly on bed rest, however carers also need to consider best mobility exercise for them too. Due to the severity of illness and effects of drugs, some older adults remain completely immobilized. Younis and Sayed Ahmed (2015) considered about the role of passive exercise for such type of patients and aimed to analyze the effect of passive exercise on hemodynamic parameters and behavioral pain intensity pat in mechanically ventilated patients. Although the research was not carried out specially with older adults, however the research had about half of patients between the age of 50-61 years. The outcome is important considering patients who are completely immobilized. The condition of immobilization relates to older people above 65 years of age. The study also proved that most critically ill patients are old. In terms of outcome in patient after implementing the intervention, it was found that passive exercise protocol has posi tive impact on patient and physiological variables of participants remained in normal range. Participants also reported no pain after 20 minutes of intervention. Hence, this study contributed to the fact that apart from functional efficiency, passive exercise can also improve pain intensity and physiological variable in completely immobile people. However, as this study has not defined the optimal time interval at which such exercise should be performed, the current research is crucial to determine how often do cares provide passive exercise to older adults in aged care setting. Stretching exercise are common in passive range of motion exercise and the contribution of the study by Gallon et al. (2011) is it investigated about the effects of stretching on flexibility, functionality and muscle performance of older women under residential care. Elderly women from nursing home were randomly assigned to control and stretching group. 3 session of active exercise was provided for every week for 8 weeks. Muscle strength is an important element to characterize functional capability in people and assessment of muscle tendon flexibility was an important consideration in the research. The stretching program was found to be beneficial in providing hamstring flexibility compared to initial outcome of participant. Positive results were demonstrated in the study by stretching protocols only three times a week. The new research on how often do carers provide exercise can help to determine whether similar 3-4 session protocol per week is followed by carers in aged setting or they provided the passive exercise protocol on daily basis. The outcome of the research will also help to assess older peoples view and perception regarding preparedness of passive exercise on a daily basis. Methodology, data collection and analysis method Research method: As the main purpose of this research is to investigate whether carers in aged care setting provide passive exercise to clients on a daily basis or not, mixed method study will be employed to inquire about passive exercise protocol followed in aged care setting in Australia. The interview with research participants will help to gather details about the passive exercise protocol in aged care setting, type of illness and disabilities in older adults and functional efficiency in participants engaging in passive exercise program. The qualitative approach will be useful in identifying the barrier and facilitator in implementing passive exercise program by cares whereas the quantitative approach will help to analyze numerical numbers regarding the frequency of these programs and improvement in functional and physical parameters of elderly client. The functional parameters that will be analyzed in the research include upper body strength, lower body strength and balance and agility of older adults. Reliable and validated tools will be used to record functional parameters of client and this data will also help to evaluate the effectiveness of passive exercise program on the basis of duration (Mijnarends et al. 2013) Data collection: The main research participants for this research will include carers like nurses working in aged care setting to provide mobility support to elderly people. The data regarding passive exercise program will be collected from 2-3 aged care facilities in Australia. This would give an estimate about the number of passive exercise session usually provided in aged care setting. It is estimated to take about 100 participants for the research to adequate analyze the research data and validate it applicability for future practice. The inclusion criteria for sample selection will include: Carers working in aged care facilities since 1 year Age of carers between 20-50 years All carers must have provided passive exercise to older clients in aged care setting The exclusion criteria for sample selection include the following: Newly placed carers having no experience in providing passive exercise Carers engaging in other routine care for participants. The survey method with the use of survey questionnaire will be employed to collect data from research participant. All participants will be informed about the purpose of interview and the survey questionnaire will be distributed to participants online and they will be given 24 hours time limit to submit their response. The three questions that would be useful in designing the interview questionnaire are as follows: Do you provide passive exercise to carers on a daily basis? How many sessions are provided per week? What barriers and facilitators you have found in providing passive exercise to older clients? What are the improvement in functional parameters of older client before and after performing passive exercise? Data analysis: The qualitative part of the data collected from interview (barriers and facilitator to passive exercise) will be analyzed by an experience physiotherapist and he will categorize the data on the basis of barriers and facilitators identified. In addition, the data regarding frequency of session/week and functional parameters of older clients before and after passive exercise will be analysed by statistical method. The effect of passive exercise will be studied with repeated measure analysis of variance (ANOVA). The advantage of using ANOVA is that it helps to evaluate significant difference between mean in case of functional paremeters of older client before and after passive exercise. This will be useful in evaluating the impact of passive exercise on elderly residents in aged care facility (Kraemer and Blasey 2015). The two potential uses of the data from the research are as follows: Creating standard passive exercise protocol in aged care setting Mitigating barriers experienced in providing passive exercise to older clients The WHO document on standards and operational guidance for ethics review of health-related research with human participants would help to meet the statutory requirements for data collection and documentation (WHO | Ethical standards and procedures for research with human beings 2017). Validity of the research: The dependent variable for this research includes physiological, social and personal variable as capacity for exercise as this will have an effect on frequency and regular participation in passive exercise. On the other hand, socioeconomic variable and emotional variable are the independent factor in research because this research considers only those clients who already residing in aged care facility. There might be two obstacles in conducting this research. It includes the following: The first obstacle in this research would be getting enough participants to include them in research. The problem may arise because many carers may not have enough time to take part in interview due to busy work schedule. This may have an impact on taking adequate sample size for this research. However, this problem has been addressed by engaging in online survey instead of face-to-face interview with participant. This will save time as well as encourage carers to take 5-10 minutes out for giving their response to the questionnaire. Due to this issue, only 3 questions have been included in questionnaire. The second obstacle will be taking permission from aged care facility to allow their carers to take part in research. The possibility of short time in online survey and detailed information of the main purpose of this research might help to address this obstacle in research. One of the strength of the research method is the use of online survey questionnaire to collect data from participants. This will save time and reduce the hassle of analyzing a large amount of data. By developing only 3 important and specific questionnaire, there is less chance of biasness and more accuracy in research finding. The weakness of the research method is that it will be taking participants only from 2-3 aged care facility, however this may affect the reliability of research because 2-3 institute cannot give idea about the standard passive exercise protocol followed in aged care facility in Australia. One approach that would strengthen the validity of the study is maintaining proper balance between sample size and research design. This will ensure that research proceeds in a smooth manner and it can be easily replicated by other parties. The two questions can evaluate the quality of the study includes: Can the research finding be applied and generalized to other aged care setting? Is the variability in research outcome adequately explained in the research study? Ethical, cultural and religious considerations: The physical effect that the study may have on the life of participants relative is that it may have an impact on to physical activity need of their relatives and loved ones. The participant may help to correct faulty method or inadequate period of physical activity in their relative. The study may have emotional impact on participants relative because they may feel stressed out due to poor results of their client. Emotional tensions can be addressed by developing the confidence of carers in overcoming professional issues in practice. While collecting data from research participant, people from certain ethnic group may not be comfortable during interview method in an enclosed room. Hence, anticipating cultural and religious consideration in conducting face to face interview, online survey method has been adopted for this research. While researching and participating in the study, it will be necessary to follow all of the mentioned professional standards of practice. While conducting this research, it be necessary to identify review the Human Research Ethics Committee document of the country and ethical guideline for biomedical research on human subjects. The Human Research Ethics Committee (HREC) will ensure that ethical approval is obtained before starting the research on the topic. Appropriate guideline will be provided to all research staffs giving all detail about research design, research methods and ethical requirement in research to ensure that all research staff apply their duty of care. The confidentiality and privacy of participants will be protected by keeping the name and identity of participants anonymous and only using professional data to analyze research data. Schedule, funding and dissemination of research: Research Timeline Provided in Appendix A Research Budget Provided in Appendix B If the research is approved, then conducting conference will be the best way to share the work findings with Research Committee as well as staffs in aged care. Reflection 9.1 While planning this research proposal, I had to work with a team of other researcher to plan the best topic that would be of interest in the field of aged care. We engaged in positive team work and worked together to take best approach for each stage of research h. We discussed with each other and took suggestion from other regarding the best way to conduct the research. On the basis of team work and collaboration, we could finally decide the research participant as well as the methods to conduct the research. References Gallon, D., Rodacki, A.L.F., Hernandez, S.G., Drabovski, B., Outi, T., Bittencourt, L.R. and Gomes, A.R.S., 2011. The effects of stretching on the flexibility, muscle performance and functionality of institutionalized older women.Brazilian Journal of Medical and Biological Research,44(3), pp.229-235. Kraemer, H.C. and Blasey, C., 2015.How many subjects?: Statistical power analysis in research. Sage Publications. Mijnarends, D.M., Meijers, J.M., Halfens, R.J., ter Borg, S., Luiking, Y.C., Verlaan, S., Schoberer, D., Jentoft, A.J.C., van Loon, L.J. and Schols, J.M., 2013. Validity and reliability of tools to measure muscle mass, strength, and physical performance in community-dwelling older people: a systematic review.Journal of the American Medical Directors Association,14(3), pp.170-178. Schmidt, N.A. and Brown, J.M., 2014.Evidence-based practice for nurses. Jones Bartlett Learning. Takahashi, T., Takeshima, N., Rogers, N.L., Rogers, M.E. and Islam, M.M., 2015. Passive and active exercises are similarly effective in elderly nursing home residents.Journal of physical therapy science,27(9), pp.2895-2900. WHO | Ethical standards and procedures for research with human beings. 2017.Who.int. Retrieved 21 November 2017, from https://www.who.int/ethics/research/en/ Younis, G. and Sayed Ahmed, S., 2015. Effectiveness of Passive Range of Motion Exercise on Hemodynamic parameters and Behavioral pain Intensity among Adult Mechanically Ventilated Patients.IOSR Journal of Nursing and Health Science,4(6), pp.1-18