As a neuroscience clinical expert focused on stroke care, I recognize falls as a critical concern for stroke patients due to motor deficits, balance impairments, and cognitive challenges (Powers et al., 2019). The Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update emphasize multidisciplinary fall prevention strategies to ensure safe mobilization and prevent secondary injuries (Powers et al., 2019). Analyzing the provided articles, a research study (Tzeng & Yin, 2017), a quality improvement (QI) study (Khoja & Moosa, 2023), and a DNP evidence-based practice (EBP) project (Bangura, 2024) reveals gaps in knowledge and practice and informs stroke-specific fall prevention strategies.
Gaps in Knowledge and Practice
The research study by Tzeng and Yin (2017) identifies a knowledge gap: the lack of consensus on standardized fall prevention strategies across hospital settings for high-risk groups like stroke patients (Tzeng & Yin, 2017). This gap highlights the need for stroke-specific evidence to guide interventions (Powers et al., 2019). The QI study by Khoja and Moosa (2023) reveals a practice gap: inconsistent application of tailored fall prevention protocols, which is critical for stroke patients whose impairments, such as visuospatial neglect, require individualized approaches (Khoja & Moosa, 2023; Powers et al., 2019). The DNP EBP project by Bangura (2024) addresses a practice gap: the absence of proactive interventions like intentional rounding in a veterans’ long-term care facility relevant for stroke patients with chronic impairments (Bangura, 2024; Powers et al., 2019).
Emergence of the Practice-Focused Question
High fall rates among veterans, including those with stroke-related disabilities, were identified as the problem (Bangura, 2024). A literature review supported intentional rounding as an effective but underutilized strategy (Dang et al., 2021). The resulting PICOT question, likely “In veterans in a long-term care facility (P), does a nurse practitioner-directed intentional rounding strategy (I) compared to standard protocols (C) reduce fall rates (O) over six months (T)?” targets the practice gap and aligns with guideline recommendations for proactive safety measures (Bangura, 2024; Dang et al., 2021; Powers et al., 2019). Stakeholder collaboration ensured feasibility, enhancing relevance for stroke care (Dang et al., 2021).
Comparison and Contrast of Gaps and Questions
The research study’s knowledge gap is theoretical, seeking broadly applicable evidence, while the QI and DNP gaps are practice-oriented, focusing on specific settings (acute care and long-term care, respectively) (Tzeng & Yin, 2017; Khoja & Moosa, 2023; Bangura, 2024). The QI study’s focus on tailored interventions for stroke care aligns with guideline recommendations for individualized plans, while the DNP project’s proactive approach suits chronic stroke management (Powers et al., 2019).
The research study’s exploratory question, “What are the most effective interventions for preventing hospital falls?” is broad and lacks stroke specificity (Tzeng & Yin, 2017; Salkind & Frey, 2019). The QI study’s question, “Does TIPS reduce fall rates in a hospital setting compared to standard protocols?” targets acute care and is relevant for stroke units (Khoja & Moosa, 2023). The DNP project’s PICOT question is precise, addressing the long-term care needs of stroke patients (Bangura, 2024). The research question contrasts with the action-oriented, context-specific QI and DNP questions, with the latter’s PICOT framework ensuring precision for stroke care (Dang et al., 2021; Powers et al., 2019).
Insights for Stroke Care
As a clinical lead focused on stroke, I see these studies informing stroke-specific protocols. The research study (Tzeng & Yin, 2017) calls for stroke-focused research, the QI study (Khoja & Moosa, 2023) supports tailored interventions in acute settings, and the DNP project (Bangura, 2024) offers intentional rounding for long-term stroke care, all aligning with guideline recommendations (Powers et al., 2019). Integrating these strategies can enhance safety and outcomes for stroke patients.
References
Bangura, F. (2024). Development and evaluation of a nurse practitioner–directed intentional rounding strategy, and its impact on decreasing falls in a veterans long-term care facility (Publication No. 30991997) [Doctoral dissertation, Wilmington University]. ProQuest Dissertations and Theses Global.