The evidence-based practice (EBP) research project is devoted to the exploration of how various factors affect self-care quality in people of advanced age. Considering this, the formulated PICO question is as follows: in elderly patients from 60 to 80 years old (P), do the environmental factors such as family support (I), compared to the genetic/physiological factors (C), relate more to self-care problems (O)? To answer this question, several variables must be measured and, therefore, a few types of data collection tools will be utilized.
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Patient self-reports and questionnaire surveys are the most common instruments applied in descriptive epidemiological and clinical studies. According to Saczynski, McManus, and Goldberg (2013), by using them, researchers often investigate individuals’ socio-demographic characteristics, lifestyles, medical history, health beliefs and attitudes, knowledge of particular diseases, predisposing factors, and so forth. Therefore, it is valid to assert that self-reported data is appropriate for the present study as well.
First, basic socio-demographic data will be collected by using a survey with items about participants’ age, gender, and education. The questions about such environmental factors as their current living conditions (income, and so forth) and the level of social support (marital status, and so forth) will be more detailed. Secondly, researchers will apply a questionnaire divided into two sections aimed to explore another independent variable, genetic/physiological factors, and the dependent variable – performance of self-care activities. Initially, information about the history of diseases will be collected from patients’ medical records.
Additionally, information about their body mass index and blood pressure at the moment of data collection will be recorded by the researcher. Secondly, patients’ level of self-care will be identified by using a slightly altered H-SCALE instrument, clarifying the number of days per week in which they are engaged in self-care activities. The H-SCALE is developed by Warren-Findlow and Seymour (2011) based on the existing validated scales and aims to “explore a dose-response relationship between the various hypertension self-care activities and blood pressure” (p. 505). Since the present project will not target hypertension patients alone and will study a randomized sample, some items in the questionnaire will be generalized.
In one more questionnaire, participants will be asked to evaluate each factor as a barrier to or a facilitator of better self-care. For this purpose, Likert scale measures comprised of five items (strongly agree, agree, neither agree nor disagree, disagree, and strongly disagree) will be implemented. An example of the statement, which respondents will evaluate, is as follows: greater family involvement improves my self-management outcomes.
Dörnyei (2014) notes that this tool helps capture positive and negative attitudes toward objects and phenomena. In the present research project, it will assist in gaining knowledge about patient perceptions of various factors and their links to self-care performance.
The researcher will aim to recruit at least 50 participants who meet the eligibility criteria (at least 60 years of age and have a record at the medical setting). Consequently, the total population will be divided into two groups: intervention (exposed to modification in social/environmental factors) and control. One family care hospital will serve as the primary location for data collection. There, participants will be recruited either through personal approach or by the invitation of their practitioners with whom the researcher will discuss the terms and purposes of the EBP in advance. It is expected to collect all necessary data within three months and two weeks after participants are recruited.
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The main reason for this is the need to collect data before and after the intervention, as well as throughout the research administration. Moreover, the intervention must be carried out during a sufficiently extended period because behavioral and perceptional changes do not occur immediately. Thus, it is suggested that three months is a minimum required timeframe to achieve significant results through the modification of environmental factors. Additionally, the timeline is selected because the sample size is relatively small and, thus, it will be feasible to record all the objective and subjective data during this period.
To improve data quality, it may be suggested to carry out a pilot test. This method allows understanding how a data collection tool should be implemented (Gliklich, Dreyer, & Leavy, 2014). The results of pilot testing can be used to modify questionnaires and surveys to increase their efficiency and readability and, consequently, reduce the risk of data biasing. Another good method for data quality improvement is sample randomization.
Normally, random allocation techniques (such as block randomization and simple randomization) are implemented in clinical control trials that study two population groups (Kim & Shin, 2014). Since a similar research design is implied in the present EBP project, it is also important to ensure that the sample reflects characteristics of the general population and that any demographic group is not under- or over-represented in the study.
To achieve this, the researcher will firstly strive to recruit an equal number of females and males. Ethnic and racial diversification will be an essential objective as well. After the total sample is final, stratified randomization technique will be applied to allocate participants to different study groups. The method refers to creating randomization of participants based on particular confounding variables, such as gender (Kim & Shin, 2014). Thus, female and male participants will be assigned with random sequences of numbers and then will be equally distributed across the control and intervention groups.
Such a measure of central tendency as the mean will be administered to analyze the socio-demographic characteristics of the sample, including age, gender, marital status, income, and so forth. To obtain the average score, the sum of all values in a socio-demographic category will be divided by the number of values in a data set. It is also possible to calculate means for self-care behaviors (namely, physical activity, medication intake, healthy eating, and others) for different genders, education levels, and ages (namely, 60-69 years and 70-80 years). In this case, it is appropriate to measure standard variability within distinct groups of patients as well.
The best way to do it is to use the standard deviation equation, which allows identifying the differences among individual scores in a particular sample (Holcomb, 2016). Through this method, it will be possible to see if the outcomes of interest (good or bad self-care performance) are characteristic of a certain socio-demographic feature, whereas a smaller standard deviation within one group or, in other words, greater uniformity of scores will indicate a stronger link between these variables. Overall, the comparison of average scores in different populations of the sample may facilitate data interpretation and provide suggestions for further research.
As for the inferential statistics method, a logistic regression model will be utilized to calculate the odds ratios for measuring the correlations between various risk factors and performance of self-care activities. In this type of analysis, the dependent variable/outcome is always dichotomous, which means that there are merely two possible outcomes (“Logistic regression,” 2018). In the present project, they include
- success in adherence to self-care behaviors
- failure in adherence to self-care behaviors.
The relationships between the dependent and independent variables (genetic/physiological factors and environmental factors) will be identified by using the logistic regression formula, which aims at the generation of coefficients, standard errors, and significance levels. In this way, it will be possible to understand the probability values for links between outcomes and factor characteristics.
The implementation of research into practice is a complex process, and the evaluation of study activities can help facilitate it and achieve better healthcare outcomes. In this EBP project, a formative evaluation method will be utilized. This assessment tool focuses on processes and proceeds in intermediate steps. Unlike summative evaluation, it would foster ”
- identification of programs that have little prospect of showing a significant effect, or
- technical assistance in strengthening implementation integrity so they have a better shot at being deemed successful by a rigorous impact evaluation” (Akin et al., 2014, p. 355).
In other words, through this type of intervention assessment, it will be possible to clarify possible and actual effects on the research progress, as well as the effectiveness of project implementation.
The objective and subjective data (namely, self-care adherence, changes in social/environmental factors, and patient perceptions of those changes) needed to measure the variables identified previously in the proposal will be collected before, during, and after implementation in order to maximize the opportunity for success and comprehend more efficiently the nature of the proposed research initiative. The comparison and assessment of preliminary and ongoing data will also help identify needs for refinement, whereas the evaluation of post-research data will allow seeing if the project is worth extending to other settings.
In case the initiative is realized successfully with the help of ongoing formative assessment, various stakeholder groups may experience improved outcomes. The stakeholder group that will potentially benefit the most comprises home-dwelling elderly patients because they are directly affected by the problems related to poor self-care. Many people of advanced age, especially those with increased vulnerability due to physical function impairments and diseases, usually show lower levels of therapeutic self-care than other age groups (Sundsli, Espnes, & Söderhamn, 2013). Research evidence makes it clear that physical health status is not the only factor contributing to reduced engagement in health-promoting processes.
Sundsli et al. (2013) note such significant conditioning factors as perceived helplessness (both psychological and psychological) and the actual level of received support. The proposed EBP project targets each identified type of factors and aims to provide information about their roles in defining self-care in older patients. Consequently, the obtained evidence will allow developing effective, individualized approaches to patient education and cognitive-behavioral interventions that will assist in improving the quality of life among the members of this target group.
The second group of stakeholders that will be impacted by the initiative consists of patients’ family members. The formulated question and proposed intervention involve their participation in the improvement efforts and possible changes in behaviors and health-related literacy. By actively engaging in their elderly relatives’ self-care practices, they will obtain a chance to improve their own health-promoting capacity and deepen the understanding of the interconnections between individual health and the environment. The project also provides other benefits, such as an opportunity to strengthen family ties and enhance relationships, although the ability to realize them will largely depend on personal-level factors.
Family nurse practitioners comprise another group of stakeholders who can experience positive outcomes of the EBP. The initiative will allow improving practice at the micro level by developing knowledge regarding the connections between a person’s health and environment. This evidence can potentially inform nurses about elderly patient needs, interests, and preferences, contributing thus to the enhancement of their intervention design and implementation skills. Secondly, with the help of previous research evidence, nurses will become able to improve their patient communication and education skills throughout the research project.
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The theoretical frameworks, as well as scholarly and scientific observations on the constructs of self-care agency and the factors of effective communication (such as health literacy, education content, and so forth), will be used by practitioners to create holistic strategies aimed to promote the health of study participants. It is possible to say that through these practices, nurses may develop a new set of professional values or refine the existing ones, including pro-activeness, compassion, and even self-awareness. In this way, the EBP project will contribute to the improvement of care quality in the hospital.
Dissemination of Results
To foster the uptake of received research evidence, it is possible to implement several dissemination instruments. At the hospital level, findings can be communicated with practitioners and leaders through research reports while, at the community and national levels, they may be spread through peer-reviewed studies. In general, the two dissemination tools are similar in many ways as they imply a thorough description of data, its analysis, findings, and their implications.
Nevertheless, it is valid to assert that research report intended for the use of hospital personnel alone can be less formalized although a sufficient level of rigor and structuring can help increase the trustworthiness of observations made by the researcher. Besides writing the report, it is important to involve relevant hospital employees and team members in a conversation regarding potential evidence-based ways to implement the studied solutions. The inter-professional dialog and mutual feedback will help consider every barrier and facilitator to the translation of evidence into practice.
The publication of a peer-reviewed paper can be considered an initial step in achieving the necessary influence for shifts towards improvements in nursing practice and well-being of target stakeholders at a broader level. As stated by the World Health Organization (WHO, 2014), the main difference of this dissemination tool from research reports is in the size and qualities of its audiences. It is particularly important to ensure high quality of evidence before submitting such a paper to a journal because it will define whether the findings will be accepted by the community or not. Additionally, after a publication of the study, it may be possible to disseminate the main ideas for the improvement efforts through a policy brief.
This tool is characterized by a focus on a specific problem, presentation of a professional opinion on the issue, utilization of research evidence, and identification of practical steps for goal accomplishment (WHO, 2014). The writing of a policy brief is a final step in the information communication process, but it can be regarded as the most significant one because it helps promote potentially effective healthcare solutions at the state and national levels.
As for stakeholder groups comprised of elderly patients and their families, it would be better to provide them with a more simplified version of the report. As the WHO (2014) states, the implementation of the CHSRF’s “graded-entry” approach is appropriate in this case (p. 157).
It implies that researchers write a brief document, summarizing the main findings and implications in just one page. Such a report is intended for the general audience mainly and, in particular, for those whose level of healthcare literacy may be low. After the initial step is complete and the audience reacts positively to the provided information, researchers can proceed to develop more thorough papers and reports, which were discussed previously in this section.
However, it is worth noticing that the creation of information products may not be the only way to communicate information. It will be beneficial to establish a feedback system that would enable all major stakeholders, including, patients and practitioners, to provide researchers with responses needed for improvement. Thus, the establishment of trustful relationships with study participants and the ongoing conversation with them about their perceptions of the EBP project efficacy and value is important.
The purpose of the suggested EBP project is to evaluate the contribution of different types of factors towards elderly individuals’ self-care capacity and evaluate the effects of environmental interventions on their adherence behaviors. The research of this topic is significant mainly because of a high prevalence of elderly patients with low motivation and knowledge needed for proper self-care. Many people of advanced age are incapable of taking care of themselves, and it results in low quality of life. It is hypothesized that the elimination of environmental barriers to regular engagement is health-promoting activities through patient education, training, and holistic interventions may help solve this issue.
In order to ensure a high degree of findings credibility and validity, the EBP research will be based on the randomized control trial design. It means that quantitative data collection and analysis tools will be utilized. To gather objective and subjective information, validated questionnaires and surveys will be employed, including a variant of the H-SCALE designed to measure the dose-response links between self-care activities and health outcomes.
Then the data will be analyzed through both descriptive and inferential statistical methods, which will assist in categorization and finding correlations among different variables. Moreover, the sampling will be paid great attention as well to ensure the random allocation of participants in the control and intervention groups. Thus, it will be possible to increase the quality of findings. Additionally, the evaluation will be performed through formative assessment at different stages of the research process to minimize the risk of errors and understand the nature and implications of the proposed initiative better.
Lastly, the findings will be disseminated through various information production products, including research reports and peer-reviewed paper, and stakeholder communication techniques, including participants’ feedback and inter-professional hospital meetings.
The main potential contribution of the EBP project is the enhancement of quality of care in the setting. It can be manifested as increased patient satisfaction, which is regarded as a primary sign of high-quality medical services. Patient satisfaction is expected to rise not just because of the possibility to improve physiological health indicators of patients but through the consideration of a broader range of their needs, including the social and psychological ones.
As a result of developing the cognitive-behavioral strategy aimed at the modification of one’s environment, the hospital will shift towards a more holistic care delivery model. Additionally, at the level of family care, the proposed research will inform nurses about the characteristics of a specific population group with whom they can regularly work within the scope of their practice. The deepening of understanding of elderly patients’ needs and other peculiarities will allow nurses to increase their efficacy and professionalism.
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