Strategies for Preventing Falls in Elderly Patients

Research Literature Support

Article 1. Matarese, Ivziku, Bartolozzi, Piredda, and Marinis (2014) explore the means of determining the risk of falls among elderly patients. The study was designed as a systematic review. Therefore, the study was not represented by a sample or a specific intervention. The use of the STRATIFY and Hendrich Fall Risk Model II was proven to have the most tangible effect. The application of the Youden index, in turn, had considerably less significant effects. The focus on the latest approaches toward fall risk management can be deemed as the primary strength of the article. The use of a review as the primary research method, however, limits the study to a considerable degree.

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Article 2. Wolf and Hignett (2015) focus on the exploration of how patients perceive the risk of falling in the hospital setting. The grounded theory approach was used to conduct the research. A sample of 30 patients was used to produce the research results. The active promotion of patient education was viewed as the primary intervention that was supposed to assist in managing falls. According to the study outcomes, patients are unaware of the risks of a fall in the hospital environment and, therefore, are exposed to a consistent threat. The promotion of a connection between a patient and a nurse can be viewed as the strength of the study, though the lack of emphasis on patient education is its limitation.

Article 3. Hempel et al. (2013) carry out a systematic review of the strategies used for fall prevention. A sample of 766 cases was taken to explore the issue. A change in leadership techniques and the active support of patients was proven to have the greatest effect on the recovery rates. The results show that the incidence ratio drops with the adoption of the techniques aimed at patient education. The large number of techniques embraced in the analysis is an obvious strength of the paper, whereas the lack of the analysis of the proposed intervention is its key limitation.

Article 4. Flimban et al. (2016) study the effects of a multicultural approach for the nursing staff on fall management. The observational study including a sample of 4,799 patients was used in the study. The study showed that, by taking the specific characteristics of the patients such as the precipitation rates, one could improve the fall management process significantly. The focus on a multicultural approach is the primary strength of the article, whereas the lack of alternative interventions is the main limitation.

Literature and PICOT. The identified sources are linked directly to the PICOT question since they shed light on how patient falls are currently managed and outline the problems thereof.

Solution. The studies indicate that there is a lack of a patient-centered approach. Furthermore, the management of the hospital space is not addressed properly. Thus, the clutter management technique may be viewed as a possible solution (Johnson et al., 2014).

Theoretical Framework and Change Model

Henderson’s Need Theory: what patients require. Implying that the patient should be assisted yet provided with a significant amount of independence, the Henderson’s Needs Model will be especially important in managing the needs of elderly patients, who will require guidance from nurses yet will also demand certain independence in their choice of actions (Peate, Wild, ‎& Nair, 2014). Thus, the passive strategy based on removing clutter as opposed to aggressive instructions concerning the movement trajectories for the target population is bound to have a positive impact as soon as it is supported by the values and concepts of Henderson’s model (Arora, 2015).

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Kotter’s change management framework. To promote active change in the environment of the hospital, one will have to consider Kotter’s model. The identified approach allows for efficient management of the transfer from one framework to another, at the same time making sure that the resistance among the staff members should be reduced to a minimum (Sare & Ogilvie, 2016). The model will imply that eight crucial steps should be taken:

  • Creating a series of guidelines for the staff concerning the hospital space management;
  • Building a comprehensive guide of the nurses;
  • Forming the strategic vision based on meeting the needs of the patients successfully and promoting their safety as the ultimate goal;
  • Enlisting the volunteers that will support the concept and encourage the rest of the staff to accept it as the best possible framework;
  • Enabling the nurses by promoting patient-centered values;
  • Generating short-term wins by setting minor objectives (e.g., determining the optimal design for a particular area);
  • Sustaining acceleration by stressing the importance of consistent support for patients and supervision thereof;
  • Instituting change by introducing the concept of clutter removal as the foundation for a fall prevention framework (Wolf & Hignett, 2015).

Research Approach and Design

Using the quantitative method. It is crucial to determine the efficacy of the approach for patient fall management based on removing clutter from the area compared to other approaches to inpatient safety. Therefore, it is necessary to quantify the information retrieved in the course of the research. Thus, a quantitative approach is crucial.

Research approach: quasi-experimental. To make sure that the suggested framework is efficient, one will have to test it by introducing it to the environment of a hospital. However, a full-scale experiment is impossible due to the inability to embrace the entire target population. Therefore, a quasi-experimental design implemented at a local nursing facility will be appropriate.

PICOT elements: determining the focus of the study. The patients at risk of falls will be introduced to the intervention based on the strategy of removing clutter from the target environment. The approach will be compared to the traditional intervention that does not involve supervision or the removal of clutter. The intervention will be provided throughout the length of the hospital stay.

Design approach description: Randomized Controlled Trial (RCT). An RCT strategy will be used. Particularly, the target population will be split into the control group and the group to which the intervention will be provided. Thus, the efficacy of the strategy will be assessed successfully.

The rationale for the design approach. The reasons for using the RCT framework are quite basic. Particularly, the identified strategy allows for carrying out an efficient comparison between the two groups at the identified time slot. As a result, the evaluation of the intervention can be conducted successfully (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014).

Advantage of the RCT: detailed cause-and-effect analysis. When considering the benefits of RCT as a tool for conducting a study, one must mention that it allows establishing very strong cause-and-effect links between the variables considered in the research.

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The disadvantage of the RCT: the narrow focus of the study. Unfortunately, RCT also has its limitations. Since it implies that a study should be carried out with a limited number of participants, it does not allow for a full representation of the target population.

Sampling Method

Target population: description. The study will be carried out among elderly patients. Particularly, the people aged 60-80 will be recruited for participating in the research. The inclusion criteria will incorporate the propensity to fall displayed by the research participants. The condition that the target population may have, as well as the severity thereof, will not be considered an essential characteristic and, therefore, will be disregarded. It is expected that different ethnicities will be represented by the target population. Thus, a comprehensive multicultural framework for meeting their needs will be designed.

Probability sampling: justification. In the course of the study, a probability sampling technique will be used. Seeing that the probability sampling technique allows for a random selection of the participants, it is expected that it will increase the possibility of retrieving objective data and, therefore, receiving the results that will represent all members of the target population. To be more specific, the identified approach implies that all groups included in the target population have approximately equal opportunities to be selected. Granted that the issue of fall among elderly patients is defined by a range of factors, some of which are associated with the cultural issues and the efficacy of communication, as well as other culture-specific issues, there are reasons to assume that all elderly people are prone to falls disregarding their cultural specifics (Hempel et al., 2013). Therefore, a simple random sampling strategy as the probability technique that will help represent all target groups successfully will have to be utilized.

Sampling process description and the sample size. The technique based on random numbers will be used to select the participants that will represent the population sample. The sample size, in turn, will be calculated based on the formula suggested for case-control studies: Sampler + 1 (Charan & Biswas, 2013). According to the authors of the study, the specified formula allows for determining the sample size for the case studies where a group to which a specific intervention is introduced is compared to a control group (Charan & Biswas, 2013).

Advantages of the sampling method. When considering the advantages of the identified approach, one must mention the fact that it does not require a deep understanding of the specifics of the groups which the target population represents. As a result, the participants of the study are viewed as homogenous, and the outcomes of the research are interpreted as general. Consequently, the prerequisites for building a comprehensive framework that will help address the needs of any population are created (Hirose et al., 2015).

The disadvantage of the sampling method. However, the specified approach also has its problems. For instance, larger errors can be observed in the studies that deploy the identified framework as opposed to other types of sampling. Furthermore, the tool cannot be used in environments where the population can be characterized as naturally heterogeneous. Nevertheless, it is expected that the random sampling technique will help deliver the results that will promote the further development of a fall prevention strategy.

Participants protection: password protection. To make sure that the personal data of the participants should remain safe and should not be disclosed to a third party, one will have to consider using password-protected databases.

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Data Collection Methodology

Data collection process. Seeing that the research data will have to be quantified, it will be reasonable to consider analyzing the information retrieved from incident reports. The latter will provide not only exhaustive data about the number of falls that have occurred at a certain time slot but also the circumstances that contribute to the occurrence thereof. Particularly, the external and internal factors will be mentioned, thus, providing the foundation for determining the strategies that will help avoid the incidences of falls successfully. The answers to the questionnaires dispersed among the nursing staff will also shed light on the nature of falls and the frequency of their occurrence in the hospital setting. Therefore, questionnaires and report analysis will have to be viewed as the key sources of the required data.

Data collection points. The information that will have to be collected for the research will need to be gathered in a manner as subtle and natural as possible so that the essential nursing processes occurring in the target setting should not be disrupted. Therefore, it is suggested that the questionnaires should be provided to the nurses twice throughout the length of the study, i.e., at the beginning of the quasi-experiment and the end thereof. The information from the reports will be collected daily so that the latest data about the incidences of falls in the target setting could be received.

Length of time. The application of the new intervention that will allow for a drop in the instances of falls among the elderly patients will require substantial time. Therefore, it is reasonable to suggest that the study will take approximately a month. In other words, the process of data collection will take a total of 30 days, with a detailed analysis of the reports submitted by the nursing staff. It is expected that, by the end of the month, the promotion of the new approach based on the elimination of clutter in the hospital setting will have its effects on the fall statistics among the patients.

Source of data. As stressed above, reports and questionnaires will serve as the main source of the necessary information. It will be crucial to make sure that every incidence of a fall should be documented properly by the nursing staff. Thus, providing the nurses with detailed guidelines about the intervention and the data management process will be essential to the outcomes of the research. The questionnaires, in turn, will also point to the possible factors that may have been overlooked in the process of meeting the needs of the target population and, therefore, affecting the fall statistics. Furthermore, the falls that may have been undocumented for one reason or another will be identified successfully with the help of questionnaires and, therefore, taken into account when carrying out the data analysis.

Data quality. It is expected that the information obtained from the identified sources will be of rather high quality. Because of the rigid standards deployed at nursing facilities, reports submitted daily to showcase the issues faced by patients in a quite clear and efficient manner. As a result, a detailed overview of the fall statistics among the elderly residents of the target facility will become possible. Furthermore, the significance of workplace honesty and responsibility will have to be fostered among nurses so that the incidences of falls should not be concealed from the researchers. Thus, apart from increasing the quality of the data, one will be able to promote integrity among the staff, consequently, triggering a rise in the quality of the nursing services.

Analysis

Data analysis explanation. To carry out a detailed analysis of the information retrieved from the reports and questionnaires, one will have to consider using both descriptive and bivariate statistics. Thus, the foundation for an in-depth assessment of the suggested framework can be built. The suggested approach to data analysis will also help promote more accurate processing of the information. Consequently, the research results will help build the foundation of a very efficient strategy for managing and preventing the instances of falls among elderly patients.

Descriptive statistics: central tendency. The focus on the central tendency among the target population will shed light on the urgency of the problem as a whole. By identifying the mean and the median of the number of falls among the elderly patients of the hospital, one will be able to determine the severity of the issue, as well as determine possible improvements in the patient statistics after the implementation of the proposed intervention. Therefore, the use of the central tendency as the primary means of locating the current trends among the elderly patients must be considered a necessary addition to the analysis.

Bivariate statistics: t-tests. However, to determine the actual efficacy of the strategy based on the removal of clutter and the reorganization of the hospital space, one must consider using Student’s t-test as the key analysis tool. The identified test will help determine whether there is a connection between the application of the approach based on clutter removal and the change in the incidences of falls among the hospital patients. The further analysis of the data sets that will be formed after the essential information is collected will provide the foundation for proving the initial hypothesis either right or wrong. Therefore, a t-test must be considered the next step in the analysis of the study data and the identification of the research results.

Conclusion

Summary: key points and their interpretation. The incidences of falls among inpatients remain dangerously frequent, thus, affecting the recovery rates among elderly patients and impeding their recovery. Furthermore, falls may contribute to not only a prolonged hospital stay but also the development of additional severe health issues. Therefore, a strategy based on the reconsideration of the hospital space and the removal of clutter must be viewed as a possible intervention. It is expected that the identified approach will serve as the foundation for a rapid increase in the number of positive patient outcomes.

Self-reflection: what has been learned. An overview of the problems associated with falls among elderly inpatients has shown that patient outcomes are affected greatly by not only the factors related to global and deadly diseases such as Alzheimer’s but also much more basic and simple factors that can easily be avoided. The observed lack of initiative when it comes to preventing the instances of patient falls shows that there is a need to redesign not only the current approach to managing falls but also the very focus of the nursing services and ethics, making them patient-centered. As a result, a gradual improvement in patient outcomes can be expected.

References

Arora, S. (2015). Integration of nursing theories in practice. International Journal of Nursing Science Practice and Research, 1(1), 8-12.

Charan, J., & Biswas, T. (2013). How to calculate sample size for different study designs in medical research? Indian Journal of Psychological Medicine, 5(2), 121-126. doi:10.4103/0253-7176.116232

Flimban, M. A., Abduljabar, D. A., Dhofar, K. O., Deiab, B. A., Gazzaz, Z. J., Bansuan, A. U., … Suliman, M. I. (2016). Analysis of patient falls among hospitalized patients in the Makkah region. Journal of the Pakistan Medical Association, 66(1), 994-998.

Hayden, J. K., Smiley, R. A., Alexander, M., Kardong-Edgren, S., & Jeffries, P. R. (2014). The NCSBN national simulation study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2), 53-90. doi:10.1016/S2155-8256(15)30062-4

Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., … Ganz, D. A. (2013). Hospital fall prevention: A systematic review of implementation, components, adherence, and effectiveness. Journal of the American Geriatric Society, 61(4), 483-494. doi:10.1111/jgs.12169

Hirose, M., Nakabayashi, N., Fukuda, S., Yamaguchi, S., Igawa, M., Egami, K., … Shima, H. (2015). Additional medical costs due to hospital-acquired falls. Journal of Patient Safety, 1(1), 1-7.

Johnson, R. L., Duncan, C. M., Kyle, A. S., Schroeder, D. R., Horlocker, T. T., & Kopp, S. L. (2014). Fall-prevention strategies and patient characteristics that impact fall rates after total knee arthroplasty. Anesthesia & Analgesia, 119(5), 1113–1118. doi:10.1213/ANE.0000000000000438

Matarese, M., Ivziku, D., Bartolozzi, F., Piredda, M., & Marinis, M. G. D. (2014). Systematic review of fall risk screening tools for older patients in acute hospitals. Journal of Advanced Nursing, 7(6), 1198-1209. doi:10.1111/jan.12542

Peate, I., Wild, K.,‎& Nair, M. (2014). Nursing practice: Knowledge and care. New York, NY: John Wiley & Sons.

Sare, M., & Ogilvie, L. A. (2016). Strategic planning for nurses: Change management in health care. New York, NY: Jones & Bartlett Publishers.

Wolf, L., & Hignett, S. (2015). Are patients at risk for falling? … Not if you ask them. In Proceedings 19th Triennial Congress of the IEA, Melbourne 9-14 August 2015 (pp. 1-8). Melbourne: IEA Press.

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