Eastern Michigan University Nursing Dissertation

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Zjraqne

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Eastern Michigan University

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The word count should be 5000 words. The work has 2 parts. part 1 is the literature review while part 2 is the implementation plan. I need the parts submitted in 2 different documents. Each part should have a minimum of 15 references not older than 5 years. also, do not repeat a citation. do not cite one reference twice. Kindly check the attachment for further instructions. I will also upload the part I've done so far. kindly take down the literature review and see if you can add anything or remove in the background of the study. the topic is MANAGING ACUTE PAIN IN AN ELDERLY CARE WITH THE AIM TO REDUCE FALLS. USE APA.

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Managing Acute Pain in an elderly care with the aim to reduce falls Chapter 1 1.1 Introduction and Background Falls and its impact is a significant concern in the elderly care because they are linked to a variety of negative outcomes, including fractures, functional deterioration, hospitalization, and Accident and emergency visits (Galvez et al., 2020). Report from National Institute for Health and Care Excellence 2020 states fall as are a leading cause of accidental injury and death among the elderly, and may also contribute to decreased mobility, disability, fear of falling, and a poorer quality of life. According to the Public Health Results Framework 2019/20 (Public Health England (PHE), 2019), there were 220 150 emergency hospital admissions of people aged 65 and up due to falls, with two-thirds of these admissions being for people aged 80 and above. Fall incidents in the home are expected to cost the NHS £435 million in England, not including the £4.4 billion annual cost of fractures in the UK (Florence et al., 2018). The key component in preventing falls is identifying factors that may increase the risk of falls. Pain tends to be an important and potentially significant risk factor that is often ignored, and it is highly prevalent among the older population (Abdulla et al., 2013). I first observed this phenomenon during my first clinical placement in the elderly care ward, I came across a patient that had a fall which was because of acute pain they previously experienced in the body. The American and British Geriatric Societies, for example, offer comprehensive advice on assessing people who are at risk of falling, but there is no mention of pain or its value as a fall risk factor. Report from NICE 2018 characterized acute pain as pain that occurs unexpectedly, lasts for a short time, and is typically caused by a pathological process, illness, or injury. In the UK, millions of people suffer from pain, particularly from 65years and above (WHO, 2018). It is proposed that when we grow older, many people feel pain that is either expected as part of aging or something they must learn to cope with. Dodson (2015) stated that although risk of fall may be as a result of age-related physiological changes, osteoporosis, sensory losses, medication side effect, however, Fall is a frequent occurrence among patients with pain, especially low back pain, which tends to be an age related (Ozturk et al., 2016). 1 The assessment of pain is one of the most critical aspects of pain management of any age group. Owing to age-related changes in the brain, this can be more difficult for older adults, and becoming more difficult for specialist to effectively manage (Jones et al., 2016). Similarly, WHO (2018) states that potential harms can be avoided by implementing proper drug control, conducting a thorough initial assessment of patients before prescribing, and providing routine patient monitoring and education, In other words, appropriate pain management programs and policies should be considered. Therefore, to prevent falls from reoccurring, the aim of this project is to educate health professionals who works in an elderly care setting about best practices for managing pain to prevent falls. Chapter 2 2.1 Literature Review Introduction Tighe et al., (2016) described Acute pain as the physiologic response and experience to noxious stimuli that can become pathologic; normally sudden in onset, time-limited, and motivates behaviours to avoid actual or potential tissue injuries. This project is to explore the best innovative strategy which may contribute to reducing frequent falls in an elderly care setting. Research studies have shown that a combination of different treatments works effectively to treat pain. Healthcare professionals have a role in guiding patients when choosing treatments that they think would work best for them (Dang et al., 2018). Given the nature of acute pain, nurses working in multidisciplinary teams and healthcare professionals need to know how to manage acute pain to prevent falls in elderly care (Wells, Pasero & McCaffery. 2008). 2.2 Aim and Objectives for the literature review 2 The aim of this review is to: • Identify how best acute pain can be effectively managed in elderly care to reduce falls • Explore the evidence related to pain management in an elderly care 2.3 Review Design 2.3.1 Exploratory Question To achieve this aim, it is imperative to formulate a research question using the PICO framework (Aslam et al., 2010). The PICO framework is widely used as the best strategy for framing a foreground’ research question (Sackett et al., 2000). The question: “How can acute pain be effectively managed in elderly care with the aim to reducing falls?” was framed using the following PICO framework. Table 1: PICO Framework Patient/Problem falls in an elderly care due to Acute pain Interventions Pharmacological therapy Comparison None Outcome Fall reduction Pain relief satisfaction Quality of life [QoL] Decreased hospital readmissions The above Table 1 displays the key components used in the PICO framework. When wellconstructed, a PICO framework, facilitated using words and phrases, is believed to break down the literature review question into relevant concepts to describe those concepts (Aveyard, 2018). This review will be analysing quantitative data from the studies found during the literature search. 3 2.4: Search strategy A search strategy is a plan that a researcher/reviewer adopts to search for and identify primary research studies that address questions posed by an academic assignment such as this topic, using a well-structured research strategy. (Polit and Becks, 2017). Databases To conduct comprehensive searches, this author had to use the University of Hertfordshire library to access three selected electronic databases to refine some of the searches: CINHAL, PubMed, Google Scholar and Medline. These bibliographic databases are frequently thought to be user-friendly, especially for inexperienced literature reviewers, such as students (Fink, 2014). They're also known for having many published studies that can be applied to almost any research subject. (Polit & Beck, 2017). In addition, this is a nursing-focused project, and as such, a nursing specific database should be required. At this stage, it was deemed prudent to use Boolean operators to facilitate the comprehensive searches. Boolean operators are linking words or phrases that are used either for expanding or narrowing down literature searches (Aveyard, 2019; Offredy & Vickers, 2010). These words are “AND”, “OR” and “NOT” (Polit & Beck, 2017). The link word “NOT” was intentionally omitted during the search. This decision is reinforced by the argument that some relevant results tend to be lost when “NOT” is used for searching for appropriate materials (Otter & Keen, 2014). The search term used were categorized in population: “elderly patients” OR “hospital* patients” OR “hospital” AND “patients”, condition: “acute pain” OR “acute conditions” OR *pain” OR “injury* AND outcome: “fall”* OR “accidental fall” “management” OR “treatment” OR “care”. Snowballing (or reference list searches) As the searches continued, it became increasingly clear that the volume of papers on “acute pain” was getting smaller than that of “chronic pain” and just plain “pain”. This made it inevitable to expand the searches through the integration of snowballing into the search strategy. While this step was eventually abandoned when it was discovered that the Boolean operators were also producing a sufficient number of primary studies, it was noted that snowballing plays an important role in various types of literature reviews. Also, a hand search 4 of journals was not undertaken due to time constraints. The bibliographies and citations of crucial articles were also searched to identify other relevant studies that were not obtained through the database searches. This meant that the search was not restricted to database searches, which could exclude unpublished studies like, theses, policy documents, and government papers. (Bettany-Saltikov, 2012). Inclusion and exclusion criteria Before the actual searches, a decision was made on which criteria to be used for inclusion and exclusion of papers. These are well-known to be extremely critical in any research project, and to carefully sort out literatures relevant for the topic of review. (Aveyard, 2018). For this essay, the following inclusion and exclusion criteria were used, see Table 2 below: Table 2: Inclusion and exclusion criteria Inclusion Criteria Exclusion Criteria Studies published in English Studies that are non-English Primary research studies Secondary studies Studies published within 10 years Studies published over 10 years Adults (18 years old and above) with acute Children, people with learning disability and pain adults with mental health problems Studies on acute pain management and falls Studies on management of other health conditions Chapter 3 Data Analysis 3.1 Data Synthesis A data synthesis approach is a way of pooling together results from studies to gain a clear answer to a research question. Data synthesis is used to assess an intervention's overall impact on established outcomes and address the research question. According to (Icheku et al., 2018), To answer the research questions the data synthesis method involves tabulating the extracted 5 data. This method enabled the data to represent the effectiveness of pain management intervention numerically and textually to prevent falls. 3.2 Assessment of Heterogeneity The collective of studies brought together in this review will unavoidably vary, known as heterogeneity (Icheku and Graham, 2018). It is essential to assess whether there is heterogeneity between the studies to decide which analysis methods will synthesise the data. The five studies were identified as heterogeneous due to significant differences in their populations, methodology and interventions (Cochrane 2011). 3.3 Discussion of Results There are five primary studies that met the eligibility criteria for final review. It is essential to repeat that these five academic studies were identified and accessed from CINHAL, PubMed, Google Scholar, BNI and Medline databases 3.3.1: Article 1 Kizza I.B and Muliira JK (2015) carried out the first quantitative study. The study aimed to focus on how nurses’ practices related to acute pain assessment practices of nursing care for critically ill patients in a limited resource setting. The study found that the majority of the nurses have poor management/ assessment practice. The workload was the main barrier to pain assessment. They lack familiarity with assessment tools, lack of education, and poor communication documentation of pain assessment priorities. 6 3.3.2: Article 2 The study in this research article was conducted by Motov et al. (2019) to compare the analgesic effectiveness and efficacy of administering oral ibuprofen at 3 entirely different doses for adult emergency department patients suffering from acute pain. To clarify, the word “analgesic” has been defined as a painkiller (National Institute for Health and Care Excellence [NICE], 2021). Motov et al. (2019) used a randomised double-blind trial to conduct their investigation, which compared oral ibuprofen at 400, 600 and 800 micrograms in adult patients presenting in hospital emergency departments acute pain. The study found that the use of 400, 600 and 800 milligram ibuprofen has similar analgesic effectiveness for short-term relief of pain in adult patients presenting to the emergency departments with acute pain. 3.3.3: Article 3 This research was a quantitative cross-section method of critically ill patients (CIAPs) at Mulago Hospital in Uganda national largest hospital with 1500 beds. The study aimed to focus on how nurses’ practices related to acute pain assessment with critically ill adult patients can verbalise pain. The study reported factors that contribute to insufficient pain control and are often associated with the patients, nurses, and healthcare systems. The factors related to patients include fear of drug effects, reluctant to report pain, and reluctance to take opioids (Duignan & Dunn 2009). There is a need, therefore, for a multidisciplinary approach regarding pain control; clinical practice emphasises adequate documentation of pain management and outcomes of pain control 7 measures because it promotes effective communication among the healthcare team (Gordon D.B et al. 2005) 3.3.4: Article 4 In their study, Colloca et al. (2019) set out to test the hypothesis that dose-extending placebo interventions can be equally effective for treating acute clinical pain in patients suffering from trauma. The researchers are keen to emphasise that their objective in this study was to establish alternative methods of reducing the use of opioid in the treatment and management of acute pain in hospitalised patients. Colloca et al. (2019) found that pain management improvements could be achieved when the amounts of total drug intake are reduced following reinforcement learning principles. Moreover, they argue that using placebo as a supplement rather than using only active medication may reduce the overall intake of acute pain treatments over the same duration of time. 3.3.5: Article 5 Moskowiitz et al. (2018) aimed to test the hypothesis that gabapentin could be as effective as a placebo in improving acute pain control among critically-ill patients who had sustained rib fractures. They further hypothesised that this intervention would also reduce the use of narcotics in managing acute pain. The study found the degree of pulmonary contusion and injury severity score were similar between groups. The use of loco-regional anesthetic modalities did not differ between groups. Daily numeric pain scores, opioid consumption, oxygen requirement, respiratory rate, and incentive spirometry recordings were similar between both groups. No benefit was observed 8 when adding gabapentin to a multimodal analgesic regimen for rib fractures. There were no instances of pneumonia, respiratory failure, or mortality in either group. Hospital and intensive care unit length of stay was similar between groups. Both overall and chest-specific quality of life was equivalent between groups at one month follow-up. The above studies vary in approaches to acute pain management among adult patients in hospital settings. For example, one emphasises the need for a multidisciplinary approach regarding pain control; clinical practice emphasises adequate documentation of pain management and outcomes of pain control measures because it promotes effective communication among the healthcare team. Another highlighted the issues of workload as the main barrier to pain assessment. The researchers also found a lack of familiarity with assessment tools, lack of education, and poor communication and documentation of pain assessment priorities as a significant barrier to effective pain management. The evidence from this study provides valuable information to the nurses to make the best use of different interventions and make the best clinical outcome for acute pain management among adult patients in hospital settings. Implementing changes within a healthcare setting is often perceived as unfavourable because the employee feels threatened and less likely to participate; getting people to embrace this change might be difficult (Boje, 2012). Gerrish (2015) suggested there was a need to overcome this before attempting to implement any changes. In line with this view, chapter 4 will discuss models that will help to implement the change. 9 Part 2: The implementation plan Introduction and background Introduce your choice of change model and briefly explain why you have made that choice. Change management plan Move on to look at supporting theories for preparing for change - such as SWOT analysis, stakeholder analysis (these are suggestions not requirements) You need to describe the step by step process of your plan. There should also be a discussion with evaluative commentary. You should highlight any strengths and acknowledge any limitations of your plan. Evaluating the success of the innovation You need to return to the aims and outcomes of the innovation plan and discuss how you will know if they have been achieved. Your discussion should be informed by theory related to evaluation methods as well as give practical examples of measure or data collection tools that could be used. Part 1: Literature review Introduction and background • Put the innovation in context of local and National policy • Give a rationale for the focus of your project and say why it is important • State the aims and outcomes of the proposed innovation Literature review • State the purpose of the literature review and identify the different types of literature included in the review • Describe how you searched, selected and appraised the literature • Discuss and summarise your findings. Give a picture of the overall body of knowledge in this field – point out its strengths and weaknesses and highlight any gaps • Make a critical analysis of the evidence informing the need for your innovation. Critically analyse the evidence that informs your innovation. • You should demonstrate your ability to systematically search for research, select and appraise research, analyse several studies and form conclusions linked to your innovation plan.
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IMPLEMENTATION PLAN: MANAGING ACUTE PAIN IN AN ELDERLY CARE WITH
THE AIM TO REDUCE FALLS

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IMPLEMENTATION PLAN: MANAGING ACUTE PAIN IN AN ELDERLY CARE WITH
THE AIM TO REDUCE FALLS
Introduction: Background
In acute care hospitals, with or without injury, cases are quite prevalent but can be stopped
if intervention programs to address this problem are in place. Research has shown that falling
factors are complex, interconnected, and multifactorial. Falls are primarily an issue for the elderly,
and 70% of bedding days are spent in hospitals in the U.S. over 65 (LeLaurin, & Shorr, 2019).
Personality traits have a higher risk of decreasing during hospitalization. In many hospitalized
patients, transient factors that change over time are typical and associated with an increased risk
of falling. Furthermore, there are increasing differences in the physical environment. Even though
80%–90% of cases in hospitals are not seen, we know that 50–70% occur in bedrooms, bedside
chairs, or during the transmission, with 10–20% occurring in the bathroom (Falcão et al. 2019).
We know, in particular, which variables could lead to a fall, yet how we could not resolve this
information is translated into programs, which prevent hospital fall injuries.
The primary emphasis of investigation is on the literature on the prevention and treatment
of acute pain in fall patients in nursing homes. The findings from the literature review show that
older patients are more likely to fall than other populations. Thus, by investigating the best-suited
intervention which would be beneficial in the long run and reducing the impact of the disease and
lowered costs, we need to address these problems. The research was developed through qualitative
and quantitative analyses. The PICO is used to select the best items for the prevention and
treatment of pain management acute falls. This ensures the maximum use of available information
on the online library and database. This is followed by a systematic review of the literature. Based

on the research appraisal, the themes that come out of the topic are those of hydrotherapy, use of
technology, nurses training, and use of safety companions for patient monitoring.
Implementation Plan
Implementing a revised autumn protocol in the acute care hospital for medical-surgical
units can reduce the rate of decreases resulting in better social, financial, and physical results. As
noted, this project is designed to address weaknesses in the implementation protocol on fall
prevention at the hospital and suggest procedure adjustments to the organization's medical-surgical
units. A systematic examination of the literature presented proof-based fall preventive strategies,
resulting in a decrease in medical-surgical units in hospitals for acute treatment, giving answers to
questions in the exercise. The implementation plan can be implemented in two forms comprising
hydrotherapy, use of safety companions, nurses training, and use of technology for patient
monitoring for acute pain management, which results in falls (Khalifa, 2019).
Hydrotherapy means the active or passive scientific use of water for treating different
diseases (Mirmoezzi et al., 2021). Various studies have shown that hydrotherapies' effects in
substantial parts of the body system are combined with the therapeutic and physiologic exhibits.
When it is implemented in pain management, hydrotherapy can have certain short-term benefits.
Scientist studies have shown that several patients with acute anal or knee pain have a greater
chance to reduce pain if applied to cold water temperatures below 15°C (Khalaji et al., 2017).
There are shortcomings in current interventions based on further research because specific
intervention based on evidence demonstrates their effectiveness in improving the lives of patients
in critical conditions in ICUs. However, there are many deficiencies in this procedure, as much as
there are complications for the approaches. Their evaluation demonstrates that the majority of

medical, psychological, and emotional interference will be far more critical in the reduction,
treatment, and control of chronic pain in patients. Technology cannot be exempted, nevertheless,
and staff formation is also crucial to the effectiveness of attention through the skills required for
employees (Morris, & O'Riordan, 2017)). The integration of all the topics within a single model
gives researchers the ability to evaluate the technological role of severe pain diagnosis and
intervention. In a number of situations, the research shows that old patients are more susceptible
than other patients and that, due to insufficient know-how to mitigate or handle them, they are
categorized as highly probable to prevent (Resnick & Boltz, 2019). Many patients can also be
monitored remotely and consulted in real-time worldwide by the nurse. Thus, it develops at the
regional and international level as a centralized involvement with the authorization of various acute
pain management panels.
Mission and Objective
The goal is to build an appropriate intervention for the management of acute pain relating
to falls and especially those in intensive care units, given that existing healthcare initiatives are
efficient and reducing to the elderly. This report is intended to continue providing insight and
information on the effectiveness of treating older patients using innovation, given the available
literature. Influencing training models, clinical, psychological, and technological combinations.
This proposal will involve researchers, clinical psychologists, local and community
policymakers, medical institutions, global health panels, interested parties, patients, and anyone
willing to help combat falls in the form of acute pain, thus improving quality of life.
Method: A structural analysis of the current initiatives, medical conditions, policy evaluations,
and interpretation of the efficiency of the already existing evidence-based treatments on
highlighting clinical preferences will be conducted as a first step, through much of that various

training programs joint effort between research groups and society and academic institutions as it
is the performance requirements and sharing phase. The second stage is the completion of
documentation and demonstration, educational lectures, discussions, and exhibitions in the
community. The third stage concerns the formation of the procedure and its final design and
performance assessment.
Changes Management Plan
The main research focus is a study that focuses on appropriate treatments for prevention
and treatment in preventative care for patients with acute pain and falls. Reduced research to a
single intervention model in technological, training, psychological, and supporting colleagues’
interventions. The report makes use of the SWOT analysis to support its theory and
implementation plan. The introduction of the proposed models includes an evaluation that shows
all their strength when managing the functionality that has been specified in the long term as
changes in developmental programs are anticipated. The report also shows the weakness of its
application and then how to minimize it, the opportunities it provides, and the risk of long-term
and short-term threats that could be inclined to present in the proposed system.
SWOT Analysis
Strengths
According to Fridman (2019), technology plays a significant role in defining health
problems of critical care pain assessment. One of the abilities that the evaluation in comparison
with manual estimates is timely and accurate. Analyzes that pre-set the monitoring alert for patients
in the ICU also allow for automation and detection of any patient falls. The ongoing research and

evidence of evaluations integrating technology on the model would also enhance user data access
through the need for a digital patient database.
The patient procedure information presented in the study indicates efficient governance of
acute pain development, patient nursing, and fall prevention. With the set guidance on pain
management using a therapeutic diagnosis, it is possible to sufficiently decrease the rate of acute
pain and prevent it from being continued and preventively used. At the same time, psychological
and other initiatives, like patient positioning...


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