Capstone Project Change Proposal (RN-BSN)

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Capstone Project Change Proposal (RN-BSN)

Introduction

A Comparison of Research Questions

The research question in Heng et al. (2020) is, “What are the findings of the current literature regarding patient falls prevention education in hospitals?” This question aimed to identify available evidence about patient falls prevention education in healthcare organizations. Lopez-Jeng et al. (2018) had implicit research questions aimed to determine how the safety culture for falls prevention can be improved using interdisciplinary health education. The research question in Johnson et al. (2020) is “How reliable and valid are fall risk prevention strategies in hospitals?” This question aims to identify effective fall prevention interventions in healthcare organizations. The research question in Vonnes et al. (2017) is implicit and aimed to determine the significance of involving patients and their families in fall prevention. Similarly, in Duckworth et al. (2017), the research question is implicit and aimed to find out the impact of patient engagement in regard to falls. The implicit research question in Hills et al. (2015) aimed to find out how hospitalized older adults can be engaged in a fall prevention education program. The research question in the study by Barker et al. (2019) is implicit and aimed to determine the impact of a patient-centered program in preventing falls among the geriatric population presented to the emergency department after sustaining a fall. Finally, the research question in Hill et al. (2019) is implicit and aimed to identify the impact of personalized multimodal fall prevention programs.

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A Comparison of Sample Populations

The study by Heng et al. (2020) is a systematic review where analysis of 43 journal articles was done. The study sample in the study by Lopez-Jeng et al. (2018) included healthcare providers who provided patient education to patients about falls. The sample population in Johnson et al. (2020) includes unit-level and patient-level data for inpatients at the medical-surgical ward at Scottsdale Thompson Peak Medical Center. The study sample in Vonnes et al. (2017) includes master’s degree-prepared nurses while the sample population in the study by Duckworth et al. (2017) includes patients admitted in various hospitals within the US. The study sample in Hills et al. (2015) includes older adults admitted in an eight aged care rehabilitation hospital while the study sample in the study by Barker et al. (2019) includes patients who presented to the emergency department in an Australian hospital after sustaining falls. Finally, the sample population in Hill et al. (2019) included patients aged over 60 years and were hospitalized for rehabilitation. The sample populations in these studies include patients with the likelihood of sustaining falls during hospitalization, and thus, patient education is important to reduce the risk of falls.

A Comparison of the Limitations of the Study

The major limitation in the selected studies is that the process of data collection exclusively relied on the self-reports and information from the study participants; this may be influenced by subjectivity. Moreover, components like demographics of participants might have affected the outcome measures for the selected studies. In addition, all the selected studies have used different methodologies, have different objectives, population samples, and this may make the synthesis of the evidence from the selected studies a challenge. Finally, qualitative studies have relatively small sample sizes, and this may introduce bias and consequently limit the generalization of the studies’ findings.

Conclusion and Recommendations for Further Research

The reviewed literature indicated patient education and engagement are among the fall prevention interventions effective in preventing and reducing the rate of falls. Individualized patient education and integration of patient-centered fall prevention strategies in the routine care of hospitalized patients can play a big role in reducing the rate of falls among hospitalized patients. Patient education helps patients to understand their risk for falls and understand the measures to adhere to prevent falls.

Further research is recommended to determine how the existing fall prevention education programs can be modified to fit each specific patient, for example, patients with cognitive impairment and how best educational outcomes can be measured in patients with cognitive impairment.

References

Barker, A., Cameron, P., Flicker, L., Arendts, G., Brand, C., & Etherton-Beer, C. et al. (2019). Evaluation of RESPOND, a patient-centered program to prevent falls in older people presenting to the emergency department with a fall: A randomized controlled trial. PLOS Medicine, 16(5), e1002807.Capstone Project Change Proposal (RN-BSN)

Duckworth, M., Adelman, J., Belategui, K., Feliciano, Z., Jackson, E., & Khasnabish, S. et al. (2019). Assessing the Effectiveness of Engaging Patients and Their Families in the Three-Step Fall Prevention Process Across Modalities of an Evidence-Based Fall Prevention Toolkit: An Implementation Science Study. Journal of Medical Internet Research. Retrieved from https://www.jmir.org/2019/1/e10008/

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A., & Morris, M. (2020). Hospital falls prevention with patient education: a scoping review. BMC Geriatrics. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7161005/

Hill, A., McPhail, S., Haines, T., Morris, M., Etherton-Beer, C., & Shorr, R. et al. (2019). Falls After Hospital Discharge: A Randomized Clinical Trial of Individualized Multimodal Falls Prevention Education. The Journals Of Gerontology: Series A, 74(9), 1511-1517. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330456/

Hill, A., McPhail, S., Francis-Coad, J., Waldron, N., Etherton-Beer, C., & Flicker, L. et al. (2015). Educators’ perspectives about how older hospital patients can engage in a fall’s prevention education program: a qualitative process evaluation. BMJ Open. Retrieved from https://bmjopen.bmj.com/content/6/12/e013414 .

Johnson, K., Scholar, H., Stinson, K., NEA-BC, Sherry Razo, M., & NEA-BC. (2020). Patient fall risk and prevention strategies among acute care hospitals. Applied Nursing Research, 51, 151188. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31786041/

Lopez-Jeng, C., & Eberth, S. (2019). Improving Hospital Safety Culture for Falls Prevention Through Interdisciplinary Health Education. Health Promotion Practice. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30966813/

Vonnes, C., & Wolf, D. (2017). Fall risk and prevention agreement: engaging patients and families with a partnership for patient safety. BMJ Open Quality. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29450267/

Falls and the ensuing injuries are a major public health problem due to the associated adverse outcomes such as serious injuries like head injuries and fractures, reduced quality of life, anxiety; prolonged length of hospital stay; increased healthcare costs; and even death. About 25% of falls during hospitalization are injurious and cause serious fractures, anxiety, and soft-tissue injuries (Lopez-Jeng et al., 2018). Multiple interventions are available for prevention of falls in the hospital inpatient settings. The effectiveness of these strategies depends with the patient and health provider engagement and they seek to reduce the risk of falls, improve the physical and psychological wellbeing of the patient as well as create a safe and secure environment for all individuals. Most fall prevention strategies focus on staff education, environmental modifications, and organization systems and the role that patients play in falls prevention (Barker et al., 2019). Therefore, investigating the role of the patient in preventing falls is crucial.

Clinical problem statement

This paper seeks to address falls in the adult inpatient care setting. Falls are defined as the involuntary coming to rest of an individual from a higher ground to a lower level and thus can be either intentional or unintended. Hospital falls remain a debilitating problem globally. In-patient hospital falls lead to injuries, prolonged hospital stays, and increased hospital costs. Falling can be traumatic causing anxiety and fear of falling in the future which can be mentally and physically disturbing. As such, victims can easily lose interest, strength and independence to engage in the activities that interested them previously. On the other hand, falls pose notable economic burdens associated with the treatment cost. For instance, the estimated annual cost of falls by 2020 is $54.9 billion with the projected rate of adult falls being one out of three adults (Johnson et al., 2020). They also present a social impact whereby the fall victim acquires disabilities that render them dependent on other members of the society. This in turn lowers the quality of life of both the individual, caregiver and the society at large. The continued increase of fall rates in the inpatient hospital setting therefore poses a significant challenge to the individual, hospital, community and entire healthcare system.Capstone Project Change Proposal (RN-BSN)

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Purpose of change proposal

The purpose of incorporating fall prevention program to primary care services offered to the patients is to prevent fall cases in the healthcare facility. This program involves the adjustment of bed alarms. The ringing duration of hospital bed alarm is reduced from 10 minutes to two minutes (Windsor & Dix, 2017). This action, in turn, seeks to reduce the duration that the patients could stay out of bed without being noticed and intervention measures incorporated. Another purpose for the change initiative is to introduce safety rounds. Nurses will thus conduct safety rounds hourly on high-risk patients. The program also involves incorporating fall precautions, such as providing the patients with an armband (Becker’s Hospital Review, 2013). Finally, the program entails keeping the patients busy to prevent them from moving out of bed when bored, thus reducing the chances of falling. In this intervention, family members might act as safety companions. They keep the patient busy to divert her attention elsewhere, thus reducing the urge to move out of the bed that might result in a fall.

PICOT question

Among adult patients in an inpatient healthcare setting (P), does the incorporation of a fall prevention program (I) compared to no fall prevention program (C), reduce cases of patient fall (O) in three months (T)?

Literature search

The literature research strategy was characterized by exploration of databases using crucial terms related to the topic. The search employed phrases, keywords and terms which helped in the generation of exact results for the search query. The literature research began with the framing of the main research question, followed by definition of terms and writing down the main concepts. In addition, the main points were brainstormed to create a more understanding of the topic. Synonyms were also identified for the phrases, terms and words and used in the to expand the search results. Boolean search was identified as the most effective strategy and hence “OR”, “NOT” and “AND” operators helped to return more specific search results related to fall prevention. It also limited and narrowed down the findings to the most relevant and sought for results within the applied keywords, terms and phrases. Consequently, the search was conducted in a wide range of databases including PubMed, PubMed and CINAHL. From these literature sources, I obtained hundreds of search results which I narrowed down to eight articles that were more specific, current and relevant to my project.

Evaluation of literature

The literature used in this project is evidence-based, reliable, current, relevant and specific to the topic. The selected sources are limited to the clinical problem and are applicable in the contemporary clinical setting, community and the entire healthcare system. The sources also present crucial theoretical frameworks that support the clinical problem and its resolution thus assisting in answering the research question. They also are based on primary data studies which provides firsthand evidence and are current ranging from 2016 to 2020.Capstone Project Change Proposal (RN-BSN)

Change or nursing theory

Fall prevention is a clinical issue demanding the adoption of various interventions to ensure reduction and prevention of their risks and occurrences. These intervention programs impose an organizational change related to Rogers’ Change Theory. This theory entails four elements that affect the introduction and adoption of new ideas, practices or objects through cultures, channels of communication, social systems and time. The application of this theory in this project will help in communicating the proposed intervention and its importance to the stakeholders, development of timelines, planning and convincing the involved parties of the necessity for prevention of falls (Hill et al., 2015). It will also help recognize the potential resistance and acceptance of the change through the use of its Multi-Step Flow.

Implementation plan and outcome measures

The main objective of the proposed change in the organization is to reduce the fall prevention rates, improve health and safety in the inpatient setting as well as decrease long hospital stays and high costs of care. The implementation plan of the proposed change will begin with the identification of the fall prevention intervention programs to use in the hospital and the requirements for their adoption. The stakeholders will then be notified and creation of awareness be initialized within the organization to allow engagement of patients and the staff without much resistance in (Vonnes et al., 2017). This will be followed by the actual imposition of changes, monitoring and eventual evaluation of the outcome measures which include the expected reduction of fall rates in the adult inpatient units. The success of the fall prevention interventions implementation will result in adoption on a large scale across the whole hospital setting.

Use of evidence-based practice in intervention plan

The intervention plan will be informed by evidence-based practice. The review of the past literature material related to the topic provides informed research evidence for effective implementation of the intervention as well as the anticipated results from the fall intervention programs. Moreover, the initial proposal change is conducted in the adult inpatient ward to collect the necessary information and evaluate the outcome measures to ensure that they can be applied to the general healthcare setting (Duckworth et al., 2017). Therefore, evidence is the main guide to a successful intervention implementation plan.

Plan for evaluating proposed nursing

The plan for proposed nursing change evaluation will involve the collection of data regarding the rate of patient falls occurring in the hospital within the intervention period. The statistical data obtained will be compared to the rates obtained when the fall intervention programs were not implemented and then, the effectiveness of the change will be determined by the differences obtained. A process evaluation will measure the progress during the course of the project while an impact evaluation will test the changes that will have occurred by the end of the intervention.Capstone Project Change Proposal (RN-BSN)

Potential barriers and plan to overcome barriers

The most probable barriers for the proposed change include lack of resources (Hill et al., 2019). These would include human resources, funds and implementation resources to support the program. Another barrier would be resistance from the staff members as well as lack of cooperation by patients. However, these barriers can be overcome through patient education on fall prevention and creation of awareness to the organization staff about the importance of the intended change. Seeking for donors and sponsors of the project could also help raise implementation funds and purchase the required items while requesting for volunteers can help resolve the human resource issue.

References

Capstone Project Change Proposal (RN-BSN)

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