| Course | D219 Scholarship in Nursing Practice |
|---|---|
| Task | Task 1 |
| Paper type | PICO question and evidence appraisal |
| Length | About 1,200 words, 6 pages |
| Format | APA 7 |
| School | Western Governors University (WGU) |
| Program | RN to BSN |
| Updated | September 2026 |
Free sample paper for D219 Task 1
Overnight Video Monitoring for Confused Older Inpatients at High Risk of Falling: A PICO Question and Johns Hopkins Evidence Appraisal
Student Name
Leavitt School of Health, Western Governors University
D219: Scholarship in Nursing Practice, Task 1
Course Instructor
Month Day, Year
Overnight Video Monitoring for Confused Older Inpatients at High Risk of Falling: A PICO Question and Johns Hopkins Evidence Appraisal
Clinical Practice Problem and Its Impact
The clinical practice problem is overnight falls among older adults with confusion or impulsive behavior on acute medical units. In this composite scenario the unit is a 28-bed medical ward where most falls happen between 2200 and 0600, when staffing is thinnest, patients wake disoriented and try to walk to the bathroom alone. Bed alarms sound after the patient is already standing, and there are rarely enough one-to-one sitters for every patient who needs one.
For patients, a fall can mean a hip fracture, a head injury, a longer stay and a loss of confidence that changes where they can live after discharge. For the organization, falls add cost and staff time. In a study of more than 9,000 high-risk inpatients, the median adjusted hospital cost was $1,969 higher for patients who fell than for those who did not (Sosa et al., 2024). Falls with injury are also reportable safety events, so each one brings a review, a disclosure conversation with the family and pressure on a unit already short of staff.
PICO Components
P (patient, population or problem): adults aged 65 and older on acute medical units who are at high risk of falling and show confused or impulsive behavior.
I (intervention): overnight video monitoring, in which a camera at the bedside sends a live image and movement alert to a monitor the nurse carries.
C (comparison): usual overnight fall prevention without video monitoring, including bed alarms and scheduled rounding.
O (outcome): the overnight fall rate per 1,000 occupied bed days.
Evidence-Based Practice Question
In confused older adults at high risk of falling on acute medical units, does overnight video monitoring, compared with usual care of bed alarms and scheduled rounding, reduce the overnight fall rate per 1,000 occupied bed days?
Appraisal of the Research Article
The research article is Woltsche et al. (2022), a clinical evaluation of portable overnight video monitoring on three aged care wards in two hospitals in Melbourne, Australia.
Background and Purpose
The authors begin from the point that overnight falls are especially hard to predict and prevent. Their aim was to evaluate whether portable video monitoring, used as an addition to existing strategies, reduced falls among high-risk patients, and to learn how nurses experienced using it (Woltsche et al., 2022).
Research Methodology
Over three months in 2021, the three wards received commercially available baby monitor sets with movement alerts. Patients were eligible if they were assessed as high falls risk, showed confused or impulsive behavior and did not already have a one-to-one sitter. Cameras were switched on between about 2000 and 0730, and nurses carried the handheld monitors on their shifts. Fall rates during the three months were compared with a preceding three-month period on the same wards, and 31 of 48 nursing staff completed a short survey about their experience.
Level of Evidence
The authors describe the work as a cohort study. Because the team introduced the intervention and compared outcomes against an earlier period without randomization or a concurrent control group, I classify it as quasi-experimental, which is Level II in the Johns Hopkins hierarchy (Dang et al., 2022).
Data Analysis
Falls were expressed per 1,000 bed days using occupancy data, and the rates for the two periods were compared statistically. The overall overnight fall rate fell from 4.54 to 2.26 per 1,000 bed days (p = .003). Every ward improved, with the largest drop on the geriatric evaluation unit, and only four falls occurred during 494 monitored episodes. Survey answers were summarized descriptively (Woltsche et al., 2022).
Ethical Considerations
The project was reviewed and judged exempt from full human research ethics committee review as low risk, and the authors report that verbal and written informed consent were obtained. Video was viewed live and not recorded, which limits the privacy risk that bedside cameras otherwise raise for patients who may not understand they are being watched.
Quality Rating
I rate this study as good quality (B). It reports clear eligibility criteria, a defined rate with a denominator, a statistical comparison and an honest list of limitations. Its weaknesses are the short three-month window, a historical comparison that falls in different months of the year, no patient demographic data, consumer rather than clinical equipment, and three wards in one health system, which limits how far the results can be generalized.
Results and Connection to the EBP Question
The results answer my question in the direction I expected: overnight falls on the study wards were roughly halved while video monitoring was in use, and nurses said they felt better equipped to prevent falls. The design cannot rule out other changes over the period, but it supports video monitoring as a practical addition to usual care for exactly the population in my PICO.
Appraisal of the Non-Research Article
The non-research article is Hogan Quigley et al. (2022), a quality improvement report on continuous video monitoring with a virtual sitter in a United States hospital.
Background and Purpose
The unit's fall rate already met national benchmarks, but the team wanted to lower falls and fall injuries further. The purpose was to test whether two-way cameras watched by a virtual sitter would reduce falls and injuries among patients at risk (Hogan Quigley et al., 2022).
Type of Evidence
This is a quality improvement report. The authors collected descriptive statistics and used run charts in two-week increments over six months to follow falls and injuries, rather than testing a hypothesis under a research design.
Level of Evidence
Quality improvement reports are non-research evidence and are placed at Level V in the Johns Hopkins hierarchy (Dang et al., 2022).
Quality Rating
I rate the article as good quality (B). The local problem, the intervention and the measures are clearly described, and the report covers cost as well as safety. It is limited to one setting, a short period and descriptive statistics, so it shows a trend without testing whether the change could have occurred by chance.
How the Recommendations Answer the EBP Question
The report found a 14% decline in the fall rate and a 6% decrease in fall-related injuries after video monitoring began, with a positive effect on the budget, and the authors recommend video monitoring as a fall and injury prevention strategy (Hogan Quigley et al., 2022). This supports my question from a different angle. Where the research article shows a statistically significant drop in overnight falls, the quality improvement report shows that a hospital can run the intervention with a dedicated virtual sitter and recover its cost.
Conclusion
A Level II study and a Level V quality improvement report both point toward the same answer: overnight video monitoring is associated with fewer falls among confused, high-risk older inpatients and can be delivered at acceptable cost. The evidence is limited by short time frames and single settings, but it is strong enough to justify a planned trial of video monitoring on the unit in this scenario, measured by the same overnight fall rate used in the PICO question.
References
Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2022). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.
Hogan Quigley, B., Renz, S. M., & Bradway, C. (2022). Fall prevention and injury reduction utilizing continuous video monitoring: A quality improvement initiative. Journal of Nursing Care Quality, 37(2), 123-129. https://doi.org/10.1097/NCQ.0000000000000582
Sosa, M. A., Soares, M., Patel, S., Trujillo, K., Ashley, D., Smith, E., Shukla, B., Parekh, D., Ferreira, T., & Gershengorn, H. B. (2024). The impact of adding a 2-way video monitoring system on falls and costs for high-risk inpatients. Journal of Patient Safety, 20(3), 186-191. https://doi.org/10.1097/PTS.0000000000001197
Woltsche, R., Mullan, L., Wynter, K., & Rasmussen, B. (2022). Preventing patient falls overnight using video monitoring: A clinical evaluation. International Journal of Environmental Research and Public Health, 19(21), 13735. https://doi.org/10.3390/ijerph192113735
What the D219 Task 1 instructions ask
D219 Task 1 asks you to move from a problem you see at work to evidence that addresses it. You describe a clinical practice problem and its impact on patients and the organization, break it into PICO components and write an evidence-based practice question from them. You then appraise one research article and one non-research article using the Johns Hopkins model: background and purpose, methods, level of evidence, data analysis, ethics, quality rating and results for the research article, and type, level, quality and recommendations for the non-research one. Each appraisal ends by connecting the source to your question. The prompts are detailed, and evaluators expect every part answered under its own heading.
How this D219 Task 1 example is built
The paper states the problem as something nurses can change at night and splits its impact between patients and the hospital. Each PICO element gets its own line, and the question reuses them almost word for word, so the link is visible. The research appraisal follows the prompt's seven parts as subheadings and explains why the writer's evidence level differs from the authors' own label. The non-research appraisal follows its five parts and shows what the report adds, cost and a staffed model, that the study lacked. A short conclusion weighs a Level II and a Level V source together and states how far they answer the question.
Where the D219 Task 1 rubric puts the marks
D219 Task 1 is scored one aspect at a time on WGU's competent, approaching competence or not evident scale. The problem aspect wants a clear clinical issue with its impact on patients and the organization. The PICO aspects check that each component is identified and that the question is built from them. The appraisal aspects are numerous and closely tied to the Johns Hopkins tool: level of evidence, quality rating and methods each need an accurate answer with a reason. Evaluators also check that both articles meet the task's source requirements, such as recency and type, and that APA citations and references are correct. Missing one appraisal element can hold back an otherwise strong paper.
D219 Task 1 help: what sends it back
The most frequent return on this task is a mismatched evidence level. Assign the level from the design you read in the methods, not from the article's title, and say why. A second problem is a PICO question that drifts from its components, often by adding a new outcome. Build the question directly from the four lines. Third, non-research articles are often chosen poorly; a quality improvement report, guideline or expert opinion fits, while a second research study does not. Fourth, students skip the ethics element or the quality rating because they seem minor. Every prompt item is an aspect, so answer each one, even briefly, under a clear heading.
Get a D219 Task 1 example written to your instructions
Send the Task 1 instructions and rubric from your D219 course of study, plus the practice problem you want to use. We write a custom PICO question and appraisal to those aspects, with two articles inside the date window, and return it in 24-48h. The first custom sample is free.
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D219 Task 1 questions, answered
What counts as a non-research article in D219 Task 1?
In the Johns Hopkins model, non-research evidence includes quality improvement reports, clinical practice guidelines, expert opinion, case reports and organizational experience. A quality improvement project published in a peer-reviewed journal is a common choice because it reports real data from a real setting while not being designed as research. Check your instructions for which types they accept.
How do I decide the Johns Hopkins evidence level?
Start with the design. Randomized controlled trials are Level I, quasi-experimental designs such as before and after comparisons without randomization are Level II, and nonexperimental and qualitative designs are Level III. Non-research evidence sits at Levels IV and V. State the design in your appraisal before you give the level, so the evaluator can see how you reached it.
What if the authors call their study something different from the level I assign?
Explain your reasoning. Authors often label a before and after study a cohort study or a clinical evaluation, while the Johns Hopkins model looks at whether the investigators introduced an intervention and whether they randomized. Name what the authors call it, then say which features decide the level. That is the judgment the quality and level aspects are reading for.
How recent do D219 articles need to be?
Follow your task instructions, which often require articles from the last five years. The sample uses a 2022 research study and a 2022 quality improvement report on video monitoring for falls.
Where can I find a free D219 Task 1 sample paper?
The PICO question and both appraisals are reproduced here, with notes on why each part scores well. If your topic is different, send the D219 task and a first tailored paper will be drafted at no cost.