Nursing Evidence Based Practice and Research

Patient Falls

Medical practitioners, especially the nurses face various challenges associated to their performance within the healthcare setting. One of the major aspects that the healthcare centers face is the patient falls, where patients sometimes roll over their beds and other hospital laying structures onto the floor. In other words, the patients suffer through seizures and other violent actions that push them to fall hard onto the floor as they suffer consequential conditions. Therefore, they end up undergoing different types of suffering according to the fall. The major consequences of the fall include injuries, pain, fractures and even death when in critical conditions. It is therefore important to assess the various aspects associated to the challenges facing hospitals and nurses especially when a patient falls. In addition, the discussion also reviews the significance of the issue as well as the PICO analysis of the situation. Significance of the Issue The situation of the patient falls is a crucial issue that affects the performance of the nurses and affects patient care. There are various types of patient falls depending on how the patient fell as well as the involvement of the nurses. The major falls occur through physiological reasons such as fainting or even environmental reasons such as slipping due to slippery floor as well as assisted falls, especially when a nurse or a staff member tries to minimize the effects of the fall. It is important to point out that this can be a critical issue for hospitals and nurses, particularly on how they should handle the falling of patients. Another point is that the patient fall leads to increased length of stay in hospitals, increased pain due to the injuries, slowed healing of the patients as well as decreased satisfaction. In some cases, nurses are usually sued for negligence while some are liable for these falls. This destroys the reputation of the nurses and sometimes affects the health of the persons. Therefore, the assessment of the major issues concerning the patient fall is highly crucial in understanding how to overcome these challenges. Overall, the challenges associated to patient falls highly impact the performance of the nurses and the hospitals at large. The major impact of this issue is that nurses become prone to making medical mistakes. There are concerns especially in the cultural set up where patient fall is popular. There are external pressures about how patients should be taken care of; the nurses have the medical responsibility and mandate in providing quality health services at appropriate time and affordable costs. After the relationship between the patients and that of the hospital is destroyed, the reputation of the hospital and the nurses in the public domain is affected. Therefore, the solutions to these challenges will be influential in improving the positive culture within the hospital and hence improved quality care. In other words, due to these issues, the main impacts include increased pressure and stigma majorly affecting the relationship between nurses and the patients.

PICO evaluation

P (patient/problem) Patient falls in health care centers I (intervention/indicator) Using standardized fall prevention tool C (comparison) Reduction antipsychotic drugs and exercise programs O (outcome) Decreased patient fall rates The PICO question is: in solving the challenges of patient falls, using standardized fall prevention tools decreases the patient fall rates as compared to exercise programs performed for patients or reduction of antipsychotic drugs.

Search strategy

The major search strategy for articles regarding patient falls is done through the Google Scholar sites using key words. However, it is important to point out that the articles found within these areas should be effectively considered before being selected for discussions. Keywords: the type of key words that the researcher utilized in conducting the study includes patient falls, interventions for solving patient falls, causes of patient falls and the consequences of patient falls, standardization fall prevention tool, fall rates, exercise programs for reducing patient falls, antipsychotic drugs and patient falls. These phrases and word choices are all important because they provide the researcher with the variety of articles that describe much about the topic of study especially the problems as well as the options for solving the challenges. The researcher evaluated various articles before making concrete choices. There were more than 100 articles that were found to contain various issues regarding the reduction of fall rates among patients using the research terms expressed above. These articles were either evidence based or just normal research studies. Among the more than 100 articles searched, the researcher considered 9 articles that contained diverse study methodologies as well as designs of study. The first four articles described the PICO analysis of the issue while the five articles were crucial in understanding the various aspects associated to the evidence matrix. DuPree, Fritz-Campiz, & Musheno (2014) on ‘A new approach to preventing falls with injuries’ The study majorly focused on the diverse approaches that should be considered in preventing falls leading to injuries. The authors discussed the importance of working with other stakeholders at the medical centers in meeting the target of solving the challenges affecting patient falls. Some of the methods that are considered include adopting organizational culture that is geared towards commitment especially to fall safety, discussing the fall safety process with patients and families, using a validated assessment tool that prevents falls, hourly rounding as well as patient partnering. The study however based its focus more on the assessment tool, which included various aspects or elements such as the implementation and enforcement of standardized assessment tool that evaluates cognitive processes in order to comprehend and rating the critical fall risk. The study focused on quantitative analysis type of study as it engaged in finding the improvement of the fall assessment tool, with the target population being 83 targeted solutions. Ambrose, Paul, & Hausdorff, (2013) on “Risk factors for falls among older adults: a review of the literature” The study revolved around the literature analysis of the risk factors associated to the patient falls among older patients. The discussion focuses on how falls leads to morbidity or mortality among older adults. In their estimation, annually, at least 30 percent of patients that are over 65 years old will fall at least once. In addition, the study also described the costs of treating or handling fall related pain and injuries is high in the United States and European countries. However, some of the major risk factors that were assessed in the study included gait and balance, polypharmacy as well as previous history concerning falls. These factors may also be associated to gender, age as well as other physical factors. One important point that is considered is the avoidance of these factors while evaluating the ways of improving the body of the old persons from having falls. Capezuti, Wagner, Brush, Boltz, Renz, & Talerico, (2007). “Consequences of an intervention to reduce restrictive side rail use in nursing homes” The study focused on the major consequences associated to interventions that assist in reducing the fall rates in nursing homes. The main objective of the study is to evaluate the effects of advanced intervention for practice nurse on the usage of restrictive side rail in nursing homes, utilizing a sample of 251 persons. The study utilized direct observations as the major form of handling various aspects associated to the rails at the bedside. From the results, one nursing home had a significant reduced use of restrictive side rail which showed a reduced fall rate. In other words, the discussion and the study aimed at understanding an APN model of consultation which reduces the use of side rail. It is important to point out that the nurses have the responsibility of utilizing various materials and model in developing a framework of reducing the fall rates in nursing homes. Thapa, Gideon, Fought, & Ray, (1995). “Psychotropic drugs and risk of recurrent falls in ambulatory nursing home residents” The discussion focuses on the psychotic drugs that are major utilized by old persons or home residents and how they are associated to the falls that affect the patients. However, the discussion also weighs on the idea that, in as much as these drugs are heavily associated to the high fall rates, there are other concepts such as the issue of depression and dementia affecting the performance of the older persons. The discussion therefore focused on 282 ambulatory residents in terms of the role of these risk factors and the antipsychotic drugs on the fall rates. From the study, the persons that had the highest fall rates were those that were using antipsychotic drugs as compared to the non-users. This explains that the antipsychotic drugs are highly influential for the performance of the individuals as far as fall rates is concerned. However, the antipsychotic drugs have combined effects with depression and dementia, which means that the reduction of antipsychotic drugs alone may not help in improving the situation – reducing the fall rates.

Evidence Matrix

Authors Journal Name/ WGU Library Year of Publication Research Design Sample Size Outcome Variables Measured Level (I–III) Quality (A, B, C) Results/Author’s Suggested Conclusions Nardi, D. and Gyurko, C Ovid 2013 Metasynthesis 181 Data management, international collaboration in research; increased funding of the full-time school positions I B The authors suggested that there is need to design or come up with new models of education which fit the global healthcare standards and also pooling teaching resources Björn, C., Lindberg, M., & Riss©n, D. Journal of clinical nursing 2016 Correlational 147 Relationships, leadership as well as status I B Various issues should be considered, especially the team relationships, status and leadership in improving attractiveness of the nursing work. Byrne, D. M., & Martin, B. N. Nurse educator 2014 Quantitative analysis 5 Nursing department head leadership style, the professional satisfaction and the organizational commitment II C There are significant associations between the variables, meaning the leadership style critically affects these aspects Chen, Davis, Daraiseh, Pan, & Davis Journal of nursing management 2014 Cross-sectional study 130 chronic fatigue, acute fatigue as well as inter-shift recovery II B There is need of establishing the fatigue intervention for the 12 hour shift physicians and also engage in teamwork and collaboration in improving the performance as well as satisfaction Laschinger, Nosko, Wilk, & Finegan Elsevier 2014 longitudinal survey design 550 psychological empowerment and self-evaluation II B It is important to mention that the job satisfaction of nurses is directly affected by combination of contextual and individual factors. From the discussions above, there are various concepts that should be highly taken into consideration. There were three options for solving patient falls, with the major issues including the reduction of antipsychotic drugs, the introduction of standardized fall reduction tool as well as the engagement in exercise programs. From the analysis, the reduction of antipsychotic drugs is important in reducing fall rates, although there are concerns about the other risk factors such as depression and dementia. In addition, the exercises are mainly meant for the younger patients, as the older patients especially those above 65 years of age cannot be able to improve their fall rates through exercises. Only limited exercises will assist in them overcoming the challenges. From the analysis, that leaves the best option to be the use of standardized fall reduction tool which is effective as it mainly associates with the abilities of the patients. Nurses are able to modify this aspect and weigh on the condition of the patients while administering the medications required. Therefore, the option should be highly taken into consideration while assessing the needs of the patients as well as those of their families.

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