Running head: Literature Review and PICOT Statement 1 NURSING 3 Literature Review and PICOT Statement Ihuoma Agada Grand Canyon University- NRS 490 December 22nd , 2019 An Analysis of Hourly Rounds and Prevalence of Pressure Ulcer in Hospital The issue of fall-related injuries among elderly individuals is becoming a major concern in the effort of improving quality healthcare services to elderly individuals. There is an increase in trend towards aging demographic; therefore, it is the responsibility of the healthcare to ensure that there is creation or development of the effective strategies aimed at preventing falls among elderly individuals. One of the key strategies that have been recommended is the use of the hourly rounding proposal in the hospital. This strategy is supported by the literature as being a successful approach used for the purposes of preventing the falls and the improvement of patient safety (Dyck, Thiele, Kebicz, Klassen, & Erenberg, 2013). This paper is therefore aimed at comparing the research questions, a sample of the population, limitations of the studies, and making a conclusion and proposing the recommendation for further research. Many healthcare facilities are facing clinical issues related to the acquired pressure ulcers. Acquired pressure ulcers still remains one of the persistent and relevant issue that requires agent response especially in the long-term care facilities. Hospitals are making attempts to implement the evidence based procedures even though there is still an increase in the incidence. Efforts are being made to integrate evidence-based strategies to help in curbing acquired pressure ulcers. Comparing The Research Questions While doing comparison of the research questions as used by the authors of the selected articles, the article by Mchem et al,. (2019) focuses on the teamwork as well as the good leadership as an effective approach towards reduction of the fall rates (MChem, Meredith, Mascioli, & Cunningham, 2019). The same leadership role is talked about in the article by the author Leone and Adams (2016). According to Leone and Adams (2016), nurse leaders, especially in the rehabilitation centers, have the crucial role in influencing the reduction of the fall rates through ensuring that there is successful execution of the fall prevention strategies and the sustenance of the outcome through promoting the stronger culture (Leone & Adams, 2016). In the article by King et al (2018), the concern is on how the communication process among the healthcare providers is helping in the reduction of the fall rates among the elderly individuals (King, Pecanac, Krupp, Liebzeit, & Mahoney, 2018). The research question used in the article by Brown (2016), the target of the question used is to establish the impact of adopting the hourly rounding on the rates of the patient falls. This is done on basis of looking at how successful the adoption of hourly rounding can be when it comes to the ...

1. Running head: Literature Review and PICOT Statement
1
NURSING
3
Literature Review and PICOT Statement
Ihuoma Agada
Grand Canyon University- NRS 490
December 22nd , 2019
An Analysis of Hourly Rounds and Prevalence of Pressure Ulcer
in Hospital
The issue of fall-related injuries among elderly individuals is
becoming a major concern in the effort of improving quality
healthcare services to elderly individuals. There is an increase
in trend towards aging demographic; therefore, it is the
responsibility of the healthcare to ensure that there is creation
or development of the effective strategies aimed at preventing
falls among elderly individuals. One of the key strategies that
have been recommended is the use of the hourly rounding
proposal in the hospital. This strategy is supported by the
literature as being a successful approach used for the purposes
of preventing the falls and the improvement of patient safety
(Dyck, Thiele, Kebicz, Klassen, & Erenberg, 2013). This paper
is therefore aimed at comparing the research questions, a
sample of the population, limitations of the studies, and making

2. a conclusion and proposing the recommendation for further
research.
Many healthcare facilities are facing clinical issues related
to the acquired pressure ulcers. Acquired pressure ulcers still
remains one of the persistent and relevant issue that requires
agent response especially in the long-term care facilities.
Hospitals are making attempts to implement the evidence based
procedures even though there is still an increase in the
incidence. Efforts are being made to integrate evidence-based
strategies to help in curbing acquired pressure ulcers.
Comparing The Research Questions
While doing comparison of the research questions as used
by the authors of the selected articles, the article by Mchem et
al,. (2019) focuses on the teamwork as well as the good
leadership as an effective approach towards reduction of the fall
rates (MChem, Meredith, Mascioli, & Cunningham, 2019). The
same leadership role is talked about in the article by the author
Leone and Adams (2016). According to Leone and Adams
(2016), nurse leaders, especially in the rehabilitation centers,
have the crucial role in influencing the reduction of the fall
rates through ensuring that there is successful execution of the
fall prevention strategies and the sustenance of the outcome
through promoting the stronger culture (Leone & Adams,
2016). In the article by King et al (2018), the concern is on how
the communication process among the healthcare providers is
helping in the reduction of the fall rates among the elderly
individuals (King, Pecanac, Krupp, Liebzeit, & Mahoney,
2018). The research question used in the article by Brown
(2016), the target of the question used is to establish the impact
of adopting the hourly rounding on the rates of the patient falls.
This is done on basis of looking at how successful the adoption
of hourly rounding can be when it comes to the reduction of the
incidences of the patients' falls within the hospitals (Brown,
2016). The same idea is also shared by the author of the article
by Rone (2018) that is targeted at determining whether the
accomplishment of the strategic hourly rounding is helping in

3. the reduction of the falls (Rone, 2018).
In a study by Angela (2017), the research question is
different from other research questions since it tries to address
the issue of falls through comparing the two practices i.e.
elimination of the alarm program and the use of the alarm
programs. Responding to this question will help determine the
perfect strategy which can be used for example either to
continue using an alarm program or to do away with it (Angela,
2017). On the other hand, the research question used by Slade et
al (2017) is used to determine how various methods used in the
prevention of the fall are effective towards a reduction of the
fall rates (Slade, Carey, Hill, & Morris, 2017). This is similar to
the study by Dyer et al (2018) who research question was also
aimed at getting the answers regarding the impacts of the
interventions that are used to help in the reduction of the falls
among the elderly individuals within the acute care facilities
(Dyer, Panagoda, Murray, Hill, Cumming, & Kerse, 2018).
In the article presented by Mervis and Philips (2019), the
research question presented is aimed at some of the prevention
and the processes of managing the pressure ulcers (Mervis &
Philips, 2019). Concerning the study by Pittman et al (2015),
the research question used was to guide the authors towards
looking at the available present evidence and the clinical
practice that is being recommended to help in the reduction of
the hospital acquired pressure ulcers (Pittman, Beeson,
Kitterman, Lancaster, & Shelly, 2015).
In the study by Engels et al (2016), the research question
guided the authors to determine the factors that led to the
development of the pressure ulcers among patients undergoing
the surgical procedures (Engels, Austin, McNichols, Fencl,
Gupta, & Kazi, 2016). In a study by Whitehead (2008), there is
no mentioning of the research question, however, it is based on
explanation on the understanding nursing research i.e. building
an evidence-based practice (Whitehead, 2008).
Comparison of the sample populations
In the article by Engels (2016), there is no mentioning of

4. the total number of participants used in the study. However, the
sample used by the authors included adult patients who had
acquired pressure ulcers that was absent at the time of their
admission and developed it during the postoperative stay in the
facility. On the other hand, the other three studies on the
hospital acquired pressure ulcers do not have information about
the sample used in the study.
In a study by Mchem et al. (2019), there is no specification
about the number of study participants that were used.
Nevertheless, the study targeted the patient at two units with the
pre and post-implementation assessment to help in the
determination of the patient-centered practical hourly rounding
concerning the falls of the patients. This is similar to other
studies except in the study by Dyer et al (2018) whereby the
number of participants used in the study is specified to be 77,
879 participants from the 24 healthcare facilities were included
in the study. In the studies by King et al (2018), Brown (2016),
and Leone and Adams (2016), the explanation of the
participants used in the study is based on the bed capacity i.e.
27 registered nurses and certified nurses in the two healthcare
facilities in Wisconsin; 241-bed acute hospital within Southern
United States; and 61 bed for inpatient in the rehabilitation and
1070 bed tertiary teaching healthcare facilities respectively.
Comparing the Limitations of the study
According to the study by Mchem et al. (2019), the
primary limitation is based on the limited number of days that
were used for this particular study (30 days). This, therefore,
implies that more time was required to determine the impact of
the hourly rounding could have been investigated further so that
it can be proven that it is a sustainable intervention. In the
article by King et al (2018), the limitation was based on the fact
that the observation made was beyond the interviews could have
analyzed to be stronger and that other rehabilitation centers
could produce different results since the study was only
concentrated on the two hospitals in Wisconsin.
The research by Brown (2016) includes localized data to a

5. single unit and was not involved in the collection of patient
information about the fall. The study by Rone (2018) did not
have any limitations stated and this means that it is impossible
to determine what factors hindered the success of the research
work. Based on the research work by Leone and Adams (2016),
the limitations are brought by the fact that the authors failed to
perform the root cause analysis concerning the reason behind
the two interventions that were not successful when used on
their own to help in lowering the rate of falls. The limitations of
the study by Angela (2017) were related to the calculation of
the rough estimates for the adherence to the hourly rounding
forms. The forms were never used as part of the electronic
charting completed by the staff, therefore, it was hard to find
accurate outcomes as a result of the missing forms and improper
documentation methods. The study by Slade et al (2017) also
had some limitations and this was related to the inclusion of the
English language. Since there was no translation resource, it
implies that the potential for the cultural and publication biases
was higher. This is also the same case to the study by Dyer et al
(2018) whereby the limitation of the study was based on the
publication bias in addition to inconsistency of the effect,
imprecision, and indirectness. However, the studies on the
hospital acquired pressure ulcers have no information about the
limitation of the study.
Conclusion
The issue of falls among elderly individuals continues to
be on the rise, therefore, this calls for an instant adoption of
strategies to help in the reduction of the reported cases of adult
falls. Falls among elderly individuals are common due to
physical impairment and the ability to maintain their body. This
increases the rate of complications and deaths in hospitals.
Therefore, future research should be aimed at looking at clinical
decision making support is helping in driving the rounding
compliance with the high fall risks patients. Healthcare
providers need to ensure that there is an incorporation of the
strategies aimed at assisting elderly individuals when going to

6. the toilets. It is also important to evaluate the risks of falls
among elderly individuals as well as to assess the psychological
well-being of the patients during admission into the facilities.
The prevention and the management of the pressure ulcers
requires effective practices, therefore, it is important to engage
in a study and the implementation processes on some of the
procedures that are considered effective in the prevention of the
pressure ulcers. Future research and the practical procedures
needs to look into the factors that contribute to the increase in
the development of the healthcare acquired pressure ulcers. The
identification of the medical devices that are prone to hospital
acquired pressure ulcers helps in the prevention of the spread of
this infection.
References
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Brown, C. H. (2016). The Effect of Purposeful Hourly Rounding
on the Incidence of Patient Falls.
Dyck, D., Thiele, T., Kebicz, R., Klassen, M., & Erenberg, C.
(2013). Hourly rounding for falls prevention: a change
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Dyer, S. M., Panagoda, C. E., Murray, G. R., Hill, K. D.,
Cumming, R. G., & Kerse, N. (2018). Interventions for
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