Discovery (Identify topic and practice issue)
Identify the topic and the nursing practice issue related to this topic. (This MUST involve a nursing practice issue.) (Elderly Patient falls)
Falls of older people often cause loss of their independence, disability, and even mortality. Nurses are critical to preventing drops in older people and are able to reduce this pressing problem significantly. With their unique position at the forefront and direct teaching of risky patient behavior, nurses can develop care plans that target cases at high hazard of falling and prevent potentially life-threatening incidents. That is why the debarment of tumbles of elderly cases is a task of nursing practice. It needs a detailed analysis and the development of effective preventive measures in situations of falls.
Briefly describe your rationale for your topic selection. Include the scope of the issue/problem
Since this problem has a global scale, it is vital to identify possible ways to solve it. According to the World Health Organization, it remains a grave public health issue and reaches epidemic proportions. France et al. (2017) claim that at least 30% of people over 65 live independently and 50% of nursing home patients tumble annually. Moreover, it is a significant safety issue for hospitalized elderly cases, increasing the length of their hospital stay, reducing their quality of life, and growing costs for both patients and hospitals. Thus, the fall of the elderly is an acute problem in modern society that deserves close attention.
Summary (Evidence to support the need for a change)
Describe the practice problem in your own words and formulate your PICOT question
The nursing practice applies a wide variety of measures to reduce drops in older patients. Chu (2017) notes that to solve this issue, such measures as bed sensors, active communication with cases, medication review, and hourly rounding are being taken. The problem is that, despite the practical implementation of these measures, the frequency of declines in skilled nursing facilities is still high. (PICO) format (the population, intervention, comparison, and outcome) was used for formulating the capstone question. P: Nursing staff in a skilled nursing facility; I: Applied nursing measures; C: Multicomponent fall prevention program; O: Reducing drops among elderly patients. Therefore, the PICOT question is as follows: How can a multicomponent fall prevention program reduce the number of drops in older cases?
List the systematic review chosen from the CCN Library databases. Type the complete APA reference for the systematic review selected
The following article was chosen as a systematic review: Bargmann, A. L., & Brundrett, S. M. (2020) Implementation of a multicomponent fall prevention program: Contracting with patients for fall safety. Military Medicine, 185(2) 28–34. Web.
List and briefly describe other sources used for data and information. List any other optional scholarly source used as a supplement to the systematic review in APA format
Furthermore, there are additional sources:
Chu, R. Z. (2017) Preventing in-patient falls The nurse’s pivotal role. Nursing, 47(3), 24-30. Web.
France, D., Slayton, J., Moore, S., Domenico, H., Matthews, J., Steaban, R. L., & Choma, N. (2017) A multicomponent fall prevention strategy reduces falls at an academic medical center. The Joint Commission Journal on Quality and Patient Safety, 43(9), 460-470. Web.
Briefly summarize the main findings (in your own words) from the systematic review and the strength of the evidence
A multicomponent fall prevention program focused on personnel and patient education has proven to be effective. According to Bargmann and Brundrett (2020), the incidence of declines diminished by 55% during the first four months. This program consists of assessing the risk of a case dropping using the Johns Hopkins Hospital Fall Assessment Tool, daily educating the patient on the factors that influence the risk of a patient dropping. Moreover, there are training information material on risk factors, enforcing pre-existing measures of fall prevention, and an agreement on case safety in the event of a drop.
Outline one or two evidence-based solutions you will consider for the trial project.
Medical institutions need to realize a multicomponent program to exclude falls among elderly cases since this measure demonstrates high indicators of reduction in this problem’s rates. In this matter, the training of both nurses and patients and their detailed information deserves special attention. According to France et al. (2017), educational initiatives should consist of a whole range of activities. Thus, success is possible when using the multicomponent approach.
Translation (Action Plan)
Identify care standards, practice guidelines, or protocols that may be in place to support your intervention planning (These may come from your organization or from the other sources listed in your Summary section in Star Point 2)
Multicomponent fall prevention consists of training for both the elderly and nurses. Moreover, in this matter, an important aspect is physical exercise for the elderly. Thus, education can be conducted in various formats, including poster presentations and lectures, newsletters, videos on internal TV channels inwards, and audio accompaniment in corridors of medical institutions. France et al. (2017) assert that training can be organized through lectures and study booklets in weekly sessions of 30-40 minutes. Physical activity should include light to heavy stretching and exercises to strengthen and improve balance. Initially, each lesson took 30 minutes, but the duration of training gradually increased to 45-60 minutes. It is essential to note that a physician must closely supervise exercise sessions.
List your stakeholders (by title and not names; include yourself) and describe their roles and responsibilities in the change process (no more than 5)
An interdisciplinary approach is vital because fall prevention programs that involve only nurses are ineffective. Thus, it takes a united team to make a difference. First of all, two parties are interested in reducing tumbles among patients: the medical staff and the elderly cases themselves. The medical personnel will directly implement and monitor the program. In turn, the elderly should strictly follow the recommendations of doctors and nurses.
What specifically is your nursing role in the change process? Other nursing roles?
The nurse is the patient’s mentor who is the closest person to a medical facility. In the process of multicomponent prevention of declines, the medical professionals engage in educational and explanatory work among patients. Importantly, it is their direct responsibility to keep cases informed. It is essential that the diseased at high risk of falling knows how to handle situations and has particular skills (for example, using call lights). Nurses should patiently explain to the case how important to comply with regulations, take certain medications, and exercise.
List your stakeholders by position titles (charge nurse, pharmacist, etc.). Why are the members chosen (stakeholders) important to your project?
The medical personnel includes nursing, rehabilitation, and medical staff, and facility administrators, each of whom has a specific role and responsibilities. For facility administrators, it is crucial to organize the introduction of this program and monitor its implementation. Doctors develop training complexes, conduct lectures, and compose educational materials. Based on educational programs, nurses directly care for patients at significant risk of falling, give them special attention, and help prevent potentially life-threatening incidents.
What type of cost analysis will be needed prior to a trial? Who needs to be involved with this?
Multicomponent fall prevention requires a significant investment and accurate calculations. It is necessary to count the finances to develop information materials, record audio and video clips, and remunerate personnel. Thus, it is essential to involve a specialist who could draw up a precise cost estimate.
Implementation
Describe the process for gaining permission to plan and begin a trial. Is there a specific group, committee, or nurse leader involved?
To implement the program, it is necessary to have a drawn-up plan so that each stage is described in full detail and does not cause doubts among the facility administrators. For this purpose, a specific group of doctors and nurses should be formed, which will organize the work as efficiently and effectively as possible.
Describe the plan for educating the staff about the change process trial and how they will be impacted or asked to participate
Irrespective of the payments entailed, participation in the program is voluntary. The research assistant will conduct fall prevention training through daily lectures of 30–40 minutes. The teaching materials will cover risk factors for drops and the best stretching, strengthening, and balance exercises to prevent tumbles.
Outline the implementation timeline for the change process (start time/end time, what steps are to occur along the timeline)
The educational program for healthcare workers and the elderly will last for one month. The material should be structured by topic, consistent and logical. Theoretical studies must be accompanied by practical sessions. Thus, one month after the start of training, the healthcare professional will be able to decrease the number of falls among elderly patients.
List the measurable outcomes based on the PICOT. How will these be measured?
The first step is to identify older people who are prone to falls. The most widely used risk assessment method is the Johns Hopkins Hospital Fall Assessment Tool. This method is often used to identify cases who are likely to drop due to inherited or acquired risk factors.
It is also essential to trace the dynamics of falls before the implementation of the program, during its realization and at the end. For this purpose, statistical data will be collected, and graphs will be compiled that reflect this trend.
What resources are available to staff (including yourself) during the change pilot?
As for the available resources, the staff will have a wide variety of materials, training and methodological manuals, texts of scientific articles, and video materials.
Will there be meetings of certain stakeholders throughout the trial? If so, who and when will they meet?
Stakeholders will continuously interact with each other throughout the program. The nursing staff meets with patients during the practice sessions. Furthermore, periodic meetings will be organized with family members of cases to inform them about the specifics of caring for older people at significant risk of falling.
Evaluation
How will you report the outcomes of the trial?
A detailed report will be drawn up on the program’s outcomes, reflecting the prerequisites and starting, intermediate, and final indicators of the fall of elderly patients. Information will be presented using graphs, tables, and diagrams for a more clear perception of information.
What would be the next steps for the use of the change process information?
Based on the obtained results, conclusions will be drawn about the degree of success of the changes. If positive dynamics are observed, it is advisable to develop this program and perfect indicators, improving the used methods. If the program’s implementation does not give success, then a more detailed consideration, search for errors, and revision are necessary.
References
Bargmann, A. L., & Brundrett, S. M. (2020) Implementation of a multicomponent fall prevention program: Contracting with patients for fall safety. Military Medicine, 185(2) 28–34. Web.
Chu, R. Z. (2017) Preventing in-patient falls The nurse’s pivotal role. Nursing, 47(3), 24-30. Web.
France, D., Slayton, J., Moore, S., Domenico, H., Matthews, J., Steaban, R. L., & Choma, N. (2017) A multicomponent fall prevention strategy reduces falls at an academic medical center. The Joint Commission Journal on Quality and Patient Safety, 43(9), 460-470. Web.