Nursing- Evidence based practice Essay Example

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12Article Critique


Barker, A., Kamar, J., Tyndall, T. & Hill, K. (2012). Reducing serious fall-related injuries in acute hospitals: are low-low beds a critical success factor? Journal of Advanced Nursing; 69(1), 112-121


Writing an article critique involves analyzing and evaluating the article as opposed to merely summarize the article contents. The same goes ahead to identify, evaluate and respond to the ideas of the author both positively and negatively. With this in mind, an article critique can be defined as an objective analysis of the article (either scientific or literary), while at the same time emphasizing on whether the author was able to support their major points using reasonable and relevant arguments based on facts (

Article critiques are beneficial to both the authors and the reviewer. To the authors, they are able to get critical feedback on various aspects of their studies. As such, they get to find out any mistakes they might have made in the study, or areas they would have done better. The reviews also expose reviewers to new hypotheses, approaches and techniques that they may not have been familiar with prior to the review. As a result, they get to sharpen their skills and also benefit from mentorship of the authors (Kerr & Wood, 2010, 68).

The role of this essay is to critique the research journal article “Reducing serious fall-related injuries in acute hospitals: are low beds a critical success factor”. The purpose of the study was to establish whether there was any connection between the frequent occurrence of injuries related to falls by patients, and the introduction of low-low beds at the Northern Hospital, Victoria, Australia. Over a 9 year period, it had been observed that fall-related injuries had reduced dramatically after a program dubbed the 6-PACK had been introduced at the institution. The low-low beds were a chief component of the program whose aim was to reduce the number of fall-related injuries (Cody & Kenney, 2006, 267).

The study assumes that there is a relationship between the falls and the introduction of the low-low beds, which have been assumed to reduce the number of fall-injuries significantly.

Critical Review

Title of the Article

The title of the article is short and to the point, though it lacked the ability to capture the reader’s attention instantly. As such, it does not put-off the reader at first glance as they read endless sentences. However, the title does not offer the reader an automatic understanding of the article. This is because it is ambiguous and on first sight, the reader does not get an idea of what to expect in the article. However, this may also be an advantage to some extent because it creates curiosity on the part of the reader to go ahead and read the finer details so that they may get the information. This means that a potential reader may pass without looking at its contents keenly because it lacks the ability to attract them. (Reedy and Learmonth, 2000, 153-165).

The authors of the article have been sourced from the medical field, a factor which ensures that they bring in their expertise into the research. Anna Barker is a senior research fellow at the Centre of Research Excellence in Patient Safety; Jeannette Kamar is a nurse responsible for injury prevention and also acts as the falls coordinator while Tamara Tyndall is a nurse responsible for injury prevention. Keith Hill, on the other hand, heads The School of Physiotherapy at the Curtin University. With the diversification, they are individually likely to notice a detail that may have been overlooked by the other members of the panel. However, depending on the duration of the study (which is nine years), it would have been more appropriate to integrate more members into the group. These other members, preferably from very different professionals, would assist in other duties pertaining to data collection, analysis and offering expertise advise such as financial advice. Engaging medical practitioners from a different field such as a dentist would have brought in a more vast scope into the study because as it is, it has been narrowed to only one school of thought (Cody & Kenney, 2006, 267).


The abstract of the study is well structured and tends to give the reader a preview of what to expect in the main article. It provides information regarding the connection between the falls and the introduction of the low-low beds, eventually showing that there were reduced falls as a result of introduction of the beds. It also goes ahead to give the duration of the study, and the mode of data collection applied by the researchers (Cody & Kenney, 2006, 268).

The Introduction/ Background

The authors have made use of various studies regarding falls that have been done in the past in their current study. Without clear guidance regarding the specific literature related to the current study; this leaves the reader unsure of what portion of the previous study to integrate into the research. The introduction also goes ahead to state that low-low beds could result in reduced fall-related injuries without giving any concrete evidence to support this. However, it is commendable that the authors used recent studies whose credibility could not be proven. In one study though, there was tangible evidence on how low-low beds were not used appropriately because the staff at the hospitals could not fathom how to use the beds appropriately. A second study was however, able to prove that low-low beds reduce the frequency of falls, though this was alongside the removal of bed-rails, which were also responsible for causing injuries as the patients attempted to get out of bed without assistance (Kerr & Wood, 2010, 67).

All in all, the authors realized that the previous studies were not able to investigate the association between availability of low beds and the and the consequential increase/decrease in the number of fall related injuries. The existence of the gap prompted the current research.

The Study

The researchers used a sample of 356, 158 patients admitted at The Northern Hospital, an acute hospital located in Melbourne, Australia. The period of the study covered January 1999 to December 2009, whereby the facility’s bed capacity increased to 370 from 225 in the 9 year period (Beil-Hildebrand, 2006, 1-15).

From the data provided, the onset of the study recorded 24, 624 patients, with the number increasing to 43, 476 at the end of the study. This shows that the hospital increased its bed capacity during the period of the study. However, the authors fail to indicate whether the bed capacity was increased by low-low beds only or whether the increase was also on the regular beds. This would be important because it would give the reader the actual picture of the institution (Boswell & Cannon, 2011, 344).

Gauging from the mean age provided in the data table, it is clear that the older persons were admitted at the high falls risk wards. It would be natural to assume that gauging from their advanced age; they may not be physically fit to be placed in the normal wards. However, the authors should not leave the reader to make assumptions regarding the reason behind being admitted in the high fall risk wards. The data also goes ahead to provide information regarding the average number of days that the patients get to stay at the hospital. At the high falls risk wards, the average number of days are double that of the patients at the normal wards as noted through the period of the study (Reedy and Learmonth, 2000, 153-165).

In January 1999, the average number of days that patients in the whole hospital spend at the hospital is 3.46 days while 5.09 days are the average number of days that patients in the high fall risk wards stay at the hospital. Towards the end of the study in 2009, patients in the entire hospital spend an average of 2.85 days while those at the high fall risk wards spend on average 5.75 days. This data is important because it gives the reader an overview of the acuteness of those admitted at the high fall-risk wards. However, an average of 5.75 days is not adequate time to provide credible information on the number of falls among those admitted in the high fall risk wards. It would also be important to note that there is not much difference between the number of falls in the normal wards and those in the high fall risk wads. It would be appropriate if the hospital would introduce the low-low beds in the entire hospital as opposed to only the high falls risk wards. Judging from the fact that the number of fall-related injuries in the entire hospital did not bear much variance with those in the high risk wards, the relevance of the low-low beds are also in question (Wall, 2010, 145 — 166, 145 — 166).

As the study progressed and the number of low-low beds was introduced was increased, the data provided shows that the number of falls suffered as well as the number of resultant injuries increased gradually. At the beginning of the study, the number of falls totaled 218 in the entire hospital, while those at the high fall risk wards were 192. Toward the end of the study in 2009, the number of falls in the entire hospital was 533 while those in the high falls risk wards were 496. This increase could be attributed to the increased bed capacity in the entire hospital, which obviously leads to an increased number despite a constant percentage through the study period (Beil-Hildebrand, 2006, 1-15). The proportion of fall related injuries decreased by approximately 40 percent through the period, and this can be attributed to the introduction of the low-low beds. By the end of the study 9 years later, the same had decreased to only 84 in the entire hospital, with the high fall risk ward having only 78 injuries. This was a commendable effort on the part of the program, because it is also evident that serious fall-related injuries also dropped significantly from 7 at the beginning of the study to only 2 at the end of the study in the entire hospital, while those in the high fall risk wards dropped from 6 to 2 (Funnell & Koutoukidis, 2008, 44).

The methods of data collection were done using audit of the hospital incident reporting database. The falls were reported, and a nurse would then examine to determine the extent of injury suffered. This method was inappropriate because some would pass unnoticed if there were no medical personnel in the vicinity to record it. Also, the judgment on the seriousness of an injury wholly depended on the person examining it. As such, a specific injury could be judged as serious by one nurse, while another would judge it as a minor injury. This would result in incorrect data being recorded (Taylor, Kermode & Roberts, 2006, 85).

Data analysis was done using the Poisson regression model, a model that is prone to errors. Also, gauging from the fact that the data was collected over nine years and could prove to be cumbersome and result into wrong calculations. For instance, the study shows that there was a decrease in fall-related injuries though there lacks evidence of a coinciding decline in the total number of falls through the study period. This warrants an evaluation with the aim of finding out the possibility of such findings. This would only mean that the use of low-low beds would not automatically result in reduced falls because a patient may roll out and fall to the floor. This would then be recorded by the attendants as a fall, but because it would most likely not result to an injury, then it would lead to increased falls and reduced injuries (Wall, 2010, 145 — 166).

For this reason, the study fails to prove that the low-low beds are responsible for reducing the number of falls in the hospital. The number of attendants at the wards could be less than the required minimum to reduce the number of falls, and the study has failed to provide these statistics. In addition, the review stated earlier that the average number of days spent with the patients at the hospital is not adequate to come up with a conclusive report regarding the number of falls, or better still, the number of fall-related injuries. The study does not provide information showing whether during their stay in the hospital, they could shift from the low-low beds to the regular beds and vice-versa. This information would have helped the reader to make a comparison between the number of falls the patient had while on a regular bed, and those on a low-low bed (Boswell & Cannon, 2011, 344).

Finally, there could have been other reasons that led to the reduction of falls because as the study suggests, the introduction of the low-low beds was only a section of a program dubbed 6-PACK, and it had other methods of reducing falls. As such, the study does not provide any evidence to show that the introduction of low-low beds led to the change in the number of falls and injuries (

Research Methodology

As stated earlier in the review, the methodology used in the collection of data was not a randomized controlled trial, and this only means that the falls observed and recorded could have been caused by other factors. These other factors include the environment, population at the hospital and policy. For this reason, some of the observations did not come as a result of the presence of the low-low beds but due to some or all of those other factors. This cannot be quantified, and this translates to unrealizable methodology (Beil-Hildebrand, 2006, 1-15).

The study could have made use of criteria that differentiated between any other factors that could have influenced the data presented in the findings section. For instance, the number of patients could have been influenced by the available bed space or the climatic conditions at a certain period. There could also have been an infection outbreak at a certain period that increased the population at the hospital, while the number of falls at a given period could have the result of sleepwalking. The study leaves such details unknown to the reader, making the information unreliable (Reedy & Learmonth, 2000, 153-165).


The findings of the study are very exhaustive, and the authors could be commended for that. However, the representation of data is very ambiguous, and the reader has to go through it a number of times before they can make out what it is all about.

In such a research study, the authors should have ensured that they use clear and concise tables that clearly separated the amount of information being represented. Bearing in mind that the data was collected for a period of 9 years, it was only proper that the representation is made in a simpler and more comprehensible method. For instance, they could have input all the data in vertical tables, which would have made it easier to understand and compare (Wall, 2010, 145 — 166).

Ethical Issues

The authors have not mentioned any issues regarding ethics in the research study. This is not professional on their part because the study involved patients who were not aware that their personal information was used for the study. As such, the patients should have given consent that details regarding their illness were used to conduct a research study that was to be made public thereafter. In the instance where the researchers are prohibited from alerting the patients of their intentions, then it is advisable that the hospital management takes it upon themselves to alert the patients of an impending exercise. (Reedy &Learmonth, 2000, 153-165).

This would prevent future misunderstandings and possible litigationS. For instance, if a patient admitted to the hospital at any one time during the research period stumbles on the report, they could sue for damages because they did not expressly or by implication give consent of their illness to be used for the study. These are just some of the ethical issues that the authors left out, and they happen to be very delicate and important (Funnell & Koutoukidis, 2008, 45).

Validity and Reliability of Study

As stated in the course of the paper, the aim of the study was to evaluate whether there existed any connection between the frequent occurrence of fall-related injuries, and the introduction of low-low beds at the Northern hospital, Victoria, Australia. From the conclusion, the number of falls throughout the study period did not decrease, and for the purposes of this paper, it was assumed that the increase in bed capacity at the hospital could have caused this. As pertains to the number of fall-related injuries, it was concluded that they reduced over time with the introduction of the low-low beds, and the more their proportion to the regular beds increased, the corresponding number of fall-related injuries reduced (Wall, 2010, 145 — 166).

It would be normal to relate these results to the presence of the low-low beds, but the study does not tell the reader whether these were the absolute cause of the reduction in these injuries. Other factors could have resulted to the decrease, and the study fails to address this area. For instance, if a patient fell but did not get an injury, it could have been that he was lucky not to, as opposed to the fact that the hospital had introduced low-low beds. It could also have been that the patients admitted at the time were not so weak and could fall but were alert enough to hold on to support to avoid injury. On the same note, other factors such as the population, hospital policy and environment could have affected the various variables under observation (Reedy and Learmonth, 2000, 153-165).

Discussions, Conclusions, Implications, Limitations and Recommendations of the Study

The authors were able to give discussions, implications, limitations and recommendations of the study though as stated earlier, the only credible conclusion would be that the study did not manage to prove its hypothesis. As such, the authors should have recommended further study to test the hypothesis, which was not provided. It would therefore, be fit to state that the study did not provide any further leads for the reader, or the public at large (Beil-Hildebrand, 2006, 1-15).


Despite the fact that the study was conducted over a long duration, and conducted by professionals in their field, the study fails to give adequate evidence that the introduction of low-low beds to the Northern Hospital was responsible for reducing the number of fall related injuries. It would therefore, be proper if the authors conducted more research to achieve more concrete evidence to prove their hypothesis (Beil-Hildebrand, 2006, 1-15).

Reference List

Beil-Hildebrand, Margitta 2006, the implications of management by walking about: a case study of a German Hospital. Leadership in Health Services. 19, 4; 1-15

Boswell, C & Cannon, S, 2011, Introduction to nursing research: incorporating evidence based practice. Jones & Barlett Learning. Pp 344-346

Cody, WK & Kenney, JW, 2006, Philosophical and theoretical perspectives for advanced nursing practice. Jones & Barlett Learning. Pp 267-270

Funnell, R & Koutoukidis, G, 2008, Tabbner’s nursing care: theory and practice. Elsevier Australia.Pp 43-45

How to read and write a scientific journal article: writing summaries and critiques.

Kerr, JC & Wood, M, 2010, Basic steps in planning nursing research: from question to proposal. Jones & Barlett Learning. Pp 67-74

Reedy, Patrick and Learmonth Mark, 2000, Nursing managers, transformed or deformed?-A case study in the ideology of competence. Journal of Management in Medicine. 14, 3/4; 153-165.

Taylor, B, Kermode, S & Roberts, K L 2006, research in nursing and health care: evidence for practice. Cengage Learning, Australia. P, 85.

Wall, Sarah 2010, Critical Perspectives in the study of nursing work. Journal of Health Organization and Management. 24(2)