Running Head: A8 NURSING CARE MANAGEMENT 1

A8 Nursing Care Management

Western Kentucky University

Wadiah Abu Saeed

10th April, 2020

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Abstract

The diverse people in the long-term care facilities suffer from multiple health conditions.

This implies that that they need proper and critical care all the time. There is need to pay

attention to special areas of nursing care management like high prevalence preventable falls

and misuse of restraints particularly the rails.

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Special Areas of Nursing Care Management

Nursing care deals with a variety of health conditions that various groups of the

elderly people are suffering from. Caregivers and nursing managers need to pay critical

attention to these conditions the elderly are suffering from as they can be minimized or

eliminated. Thus, high quality of care is needed to help improve health conditions of this

population. The two issues this paper addresses include falls and fall prevention as well as

use and misuse of physical restraints. The people I have chosen to be in my special issues

team include the human resource manager and a case manager. This is because the human

resource manager will address the issues surrounding staff training and policies as these are

not clear in the facility. The case manager will provide insights on issues surrounding the

facility and the resources needed to meet the patient needs which are the areas where I am

fairly inexperienced in. Working with the two will help streamline the operations of the

special areas in nursing care management.

Issue 1: High Preference of Preventable Falls

There are common falls in the facility which can be prevented. The falls are leading to

the fatal and nonfatal injuries leading enhanced complications for the elderly (Singh, 2016).

The structuring of the facility and other environmental factors are contributing to the falls

among the old. Thus, the environment in the facility does not offer adequate supportive

services to enable the elderly in the facility avoid unnecessary falls.

The common causes of include the physical obstacles, inadequate assessment of the

possibilities to fall, improper maintenance of safety equipment in the facility, poor internal

supervision and inadequate supervision (Sagelink.ca, n.d). The absence of physical obstacles

enhances the chances of falling as the elderly have no supportive tools. Failure by the

management to adequately assess the possibilities of failing minimizes the chances of finding
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the risk factors that contributes to falling and thus they cannot be rectified in advance. Safety

equipment require proper maintenance to keep them in a state that improves safety of the

elderly. Lack of this maintenance increases the chances of falling. Lack of supervision makes

the management not to identify the existing risks contributing to falls. It thus contributes to

more falls in the facility.

My planned interventions addressing the environmental measures and fix them

immediately to minimize falls contributed to by interior design and physical structures. As

well, I will undertake proper assessment of the existing risks to identify them, and come up

with a plan to address these causes of fall (PSNet, 2019). I will do this within a week and

have everything fixed. Finally, I will conduct frequent supervisions to assess the physical

conditions of the facility and identify any flaw to be fixed.

My plan on monitoring and keeping the improvement going is by conducting

continuous supervision in general regarding the condition of the facility. Through continuous

supervision, it is possible for me to identify the risks that might contribute to the fall and fix

them immediately. As well, through supervision, I will identify any precautionary measures

that need to be taken to improve and minimize chances of falling.

Issue 2: Misuse of Restraints (Specifically Side Rails)

A restraint refers to the device used to restrict the movement of these elderly people

while in the facility (Singh, 2016). The use of side rails is meant to restrict the movement of

patients and in that process reduce the chances of falling. However, improper use of side rails

may worsen the matters and lead to more injuries instead of helping the patients minimize the

rate of falls.

The causes of misuse of restraints particularly is side rails include lack of education

on the elderly for them to identify how to effectively use the rails (Lachance and Wright,
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2019). These elderly people are sometimes not properly trained on how to use the rails

effectively. This leads to improper usage of the equipment thereby increasing the chances of

falling instead of reducing them. The other cause is lack of trained and skilled staff to

enhance better patient outcomes. Such staff know less concerning handling elderly patients

with high risks of falling. Finally, lack of proper patient supervision facilitates falling because

this people struggle with the side rails without the help of anyone thereby increasing their

chances of falling.

My planned intervention includes properly training and educating the elderly on how

to use the rails. The elderly needs a clue on how to use the rails (Gunawardena and Smithard,

2019). I will put this into use immediately and I expect that by the end of one week the

exercise will be complete. As well, I intend to train and hire trained staff to attend to the

elderly at their facilities. These staff will help monitor the elderly always to help them where

necessary to avoid falling. This exercise will take approximately one week to be complete.

To monitor and keep improvement ongoing, I will always assess the number of

recorded falls as a result of misusing rail restraints. I will then determine what contributed to

the fall and rectify immediately.

Conclusion

The elderly people in the healthcare facilities are prone to numerous issues. Some of

the common issues in LTC facilities is high rates of preventable falling and misuse of

restraints. There is need to fix physical obstacles and exercise and do frequent supervision to

identify and correct factors that lead to falls. This is essential in minimizing the chances of

preventable falls. Likewise, the elderly in these facilities should be educated on how to use

the rails. The staff members need to frequently monitor these old people at these facilities.
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References

Gunawardena, R & Smithard, D. (2019). The Attitudes towards the Use of Restraint and

Restrictive Intervention amongst Healthcare Staff on Acute Medical and Frailty

Wards – A Brief Literature Review. Geriatrics, 4(3), 50 doi:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6787583/

Lachance, C & Wright M. D. (2019). Avoidance of Physical Restraint Use among

Hospitalized Older Adults: A Review of Clinical Effectiveness and Guidelines.

Canadian Agency for Drugs and Technologies in Health. Retrieved from:

https://www.ncbi.nlm.nih.gov/books/NBK545889/

PSNet. (2019). Falls. Retrieved from https://psnet.ahrq.gov/primer/falls

Sagelink.ca. (n.d). Preventing Falls and Injuries in Long-Term Care (LTC). Retrieved from

https://sagelink.ca/sites/default/files/clinical-resources/preventing_falls_injuries_ltc_r

esource_manual.pdf

Singh, D. A. (2016). Effective Management of Long-Term Care Facilities. Burlington, MA:

Jones & Bartlett Learning LLC.