Falls in The Elderly Essay Discussion Paper
Falls in The Elderly Essay Discussion Paper
This project on patient falls has demonstrated just how this is a major clinical practice issue for nurses. This is especially so for those nurses working in nursing homes and other elderly rehabilitation care facilities. By using evidence-based strategies backed up by research evidence (Melnyk & Fineout-Overholt, 2019), the rate of 3.3 to 11.5 falls per 1,000 hospital stays must be reduced (AHRQ, 2018). According to Venema et al. (2019), the national average for these accidental patient falls in the United States is about 3.44 falls per 1,000 patient stays. This paper takes the position that at least the measures recommended here should be able to reduce the falls rate to below this national average. Therefore, the purpose of this paper is to offer recommendations and conclusions on the clinical practice problem of patient falls among elderly patients. Falls in The Elderly Essay Discussion Paper
Recommendations and Implications for Clinical Practice
Among senior elderly individuals 65 years of age and older, falls are a clinical practice issue that affects patient safety (AHRQ, 2018; Guirguis-Blake et al., 2018). This is a very serious safety concern with enormous consequences for both the patient and the provider. The nurses’ lack of understanding regarding adequate risk evaluation and necessary actions afterwards is one of its reasons. The other two factors are the elderly patient population’s vulnerability and a general paucity in terms of numbers of nursing staff in most settings. The outcomes for patients are significantly impacted by this falls issue. They may suffer factures, a concussion, significant intracerebral bleeding, or only bruises if they are lucky. The consequences for the elderly patients are quite undesirable and include prolonged hospital stays and costs as well as death in the most serious cases. Falls in The Elderly Essay Discussion Paper
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Recommendations
The recommendations that this paper addresses concerning the prevention of patient falls among the elderly are:
- Having a bi-annual (twice-a-year) training program for all the nurses working in a particular setting with elderly patients. This training will focus on falls risk assessment by using assessment tools such as the Morse Falls Scale, the Berg Balance Scale (BBS), the Sit to Stand Test (STST), Romberg Test (Tandem Stand Test), or the Dynamic Gait Index (DGI) amongst other tools (Falcão et al., 2019; Ghahramani, 2016). In a study, it was shown by using the Morse Fall Scale that 45% of the participants were at higher risk of falls (Falcão et al., 2019). The training/ retraining will also equip the nurses with the necessary evidence-based interventions to apply and prevent falls in those identified to be at a higher risk of falls. These interventions are given below.
- Creating a safe environment for the elderly patients always. This is an environment that is devoid of slippery floors, stairs down which cognitively impaired elderly patients can fall, or beds without side rails. According to Falcão et al. (2019) and Smith et al. (2017), the elderly in the hospital or residential care facility must have contact with an environment defined by quality flooring and lighting.
- There should also be purposeful hourly rounds conducted by the nurses on every shift (AHRQ, 2018; Gavaller et al., 2019; Guirguis-Blake et al., 2018; Kenny et al., 2017). These must be consistent as they are aimed at identifying potential risks in every patient before a falls incident occurs. For instance, it is during these hourly rounds that the nurses might discover that a certain patient was struggling to reach a glass of water that was placed far from their bed.
- Procuring and installing innovative technology in terms of sensitive and intelligent bedside alarms (Gavaller et al., 2019; Mileski et al., 2019). These would receive input from motion sensors and sound at the nursing station; indicating the patient’s bed or room number to alert nurses when a patient attempts to get up. They can then take corrective action to forestall the impending fall.
- Applying cognitive therapy to restore some cognitive functions in the elderly patients to help them avoid falls. Interventions such as visual art therapy or VAT can be used to achieve this. It makes use of art and artistic techniques like sketching, clay modelling, drawing, collage, and sculpting amongst others (Masika et al., 2020). Nurses have to do this frequently.
Implications for Clinical Practice
The implications for clinical practice of the above recommendations are far-reaching. To begin with, there will be shorter hospital stays and quicker recovery times. This will save the patients and their kin unnecessary expenditure on healthcare costs. Additionally, mortality rates will fall and the organization’s reporting will indicate better performance. Nurses will experience better job satisfaction with a reduced staff turnover. Last but not least, there will be no loss of revenue due to the 2008 Centers for Medicare and Medicaid Services (CMS) directive that there will be no reimbursement for care given to falls patients (Fehlberg et al., 2017). Reduction of falls will therefore be a cost-effective measure for the organization. Falls in The Elderly Essay Discussion Paper
Summary of Study and Limitations
This study focused on addressing the clinical practice issue of accidental falls among elderly patients. It has been established that the reported falls rate in the United States ranges between 3.3 and 11.5 falls per 1,000 hospital stays. However, the national benchmark is pegged at 3.44 falls per 1,000 patient stays. Through a literature review, it has been established that indeed there are enough evidence-based interventions backed by scholarly evidence for efficacy that can be used to prevent these falls. These include conducting purposeful hourly rounds, installing intelligent bedside alarms, undergoing regular training and retraining, and performing cognitive therapy using measures such as visual art therapy. The limitations include that some of the evidence is more than five years old and may require review; and also some of the scholarly evidence was not high on the hierarchy of evidence.
The directions for future research that may be suggested include the use of higher random samples in studies on falls, controlling for cognitive impairment as a confounding variable, and the conducting of more systematic reviews and meta-analyses. Systematic reviews and meta-analyses confer the highest possible levels of evidence. On theoretical constructs, these will remain the same with no change. These are the theory of Human Caring by Jean Watson, and the Self-Care Deficit Theory (SCDT) by Dorothea Orem.
The suggestions for public policy and/or changes in practice are several. One is that organizations should focus on staff motivation and retention by giving incentives. The other is that the appropriate staffing models must be adopted for nurses (who must be adequate in number). Last but not least, the nurse leaders must be transformational leaders that inspire, motivate, and empower their subordinates Falls in The Elderly Essay Discussion Paper to deliver.
Implications/ Relevance of the Theoretical Framework to the Practice Issue
In applying the Self-Care Deficit Theory (SCDT) by Dorothea Orem, it is taken into account that the elderly patients suffering falls are experiencing a care deficit. This means that they cannot prevent themselves from these falls and so the nurses have to fill the care deficit. Also, in applying the theory of Human Caring by Jean Watson and its ten caritas factors; the nurse is able to offer holistic care through selflessness, compassion, and empathy.
Conclusion
Patient falls are a significant clinical practice problem for nurses working with the elderly. Luckily, there is enough scholarly evidence that supports the efficacy of a number of interventions. These can be used in practice settings to reduce and prevent the occurrence of accidental patient falls. They include hourly rounding, bedside alarms, and periodic training/ retraining of nurses. In all, this project has established that patient falls among the elderly are preventable. Falls in The Elderly Essay Discussion Paper
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References
Agency for Healthcare Research and Quality [AHRQ] (2018). Preventing falls in hospitals. https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/index.html
Falcão, R.M.M., Costa, K.N.F.M., Fernandes, M.G.M., Pontes, M.L.F., Vasconcelos, J.M.B., & Oliveira, J.S. (2019). Risk of falls in hospitalized elderly people. Revista Gaúcha de Enfermagem, 40(e20180266), 1-8. http://dx.doi.org/10.1590/1983-1447.2019.20180266
Fehlberg, E.A., Lucero, R.J., Weaver, M.T., McDaniel, A.M., Chandler, M., Richey, P.A., Mion, L.C., & Shorr, R. I. (2017). Impact of the CMS no-pay policy on hospital-acquired fall prevention related practice patterns. Innovation in Aging, 1(3), 1-7. http://dx.doi.org/10.1093/geroni/igx036
Gavaller, M., Gavaller, M., & Oh, H. (2019). Impact of bed alarm removal and implementation of hourly rounding to reduce falls. Journal of the American Medical Directors Association, 20(3), B19. https://doi.org/10.1016/j.jamda.2019.01.080
Ghahramani, M. (2016). Fall risk assessment in older people. The International Journal of Engineering and Science, 5(11), 1-14. http://dx.doi.org/10.9790/1813-05110114
Guirguis-Blake, J., Michael, Y., Perdue, L., Coppola, E., & Beil, T. (2018). Interventions to prevent falls in older adults. JAMA, 319(16), 1705. https://doi.org/10.1001/jama.2017.21962
Kenny, R., Romero-Ortuno, R., & Kumar, P. (2017). Falls in older adults. Medicine, 45(1), 28-33. https://doi.org/10.1016/j.mpmed.2016.10.007
Masika, G.M., Yu, D.S.F., & Li, P.W.C. (2020). Visual art therapy as a treatment option for cognitive decline among older adults. A systematic review and meta-analysis. Journal of Advanced Nursing, 76(8), 1892-1910. https://doi.org/10.1111/jan.14362
Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4th ed. Wolters Kluwer.
Mileski, M., Brooks, M., Topinka, J.B., Hamilton, G., Land, C., & Mitchell, T., Mosley, B., & McClay, R. (2019). Alarming and/or alerting device effectiveness in reducing falls in long-term care (LTC) facilities? A systematic review. Healthcare, 7(1), 51. https://doi.org/10.3390/healthcare7010051
Smith, A.A., Silva, A.O., Rodrigues, R.A.P., Moreira, M.A.S.P., Nogueira, J.A., & Tura, L.F.R. (2017). Assessment of risk of falls in elderly living at home. Revista Latino-Americana de Enfermagem, 25(e2754). https://doi.org/10.1590/1518-8345.0671.2754
Venema, D.M., Skinner, A.M., Nailon, R., Conley, D., High, R., & Jones, K.J. (2019). Patient and system factors associated with unassisted and injurious falls in hospitals: An observational study. BMC Geriatrics, 19(348), 1-10. https://doi.org/10.1186/s12877-019-1368-8 Falls in The Elderly Essay Discussion Paper