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Evidenced Based Practice Paper Akeeka Davis Gwynedd-Mercy College Nursing 323 Professional Issues in Nursing Dean Andrea Hollingsworth February 13, 2012
The multi-factorial approach allows us as nurses to adopt the ideology that there is more than one way to prevent falls. The research presented will place emphasis on interventions that have been implemented to reduce the risk of falls in the elderly population. proper lighting at night in patient rooms and bathrooms for toileting purposes. A multi-factorial approach that integrates numerous interventions has shown to be beneficial in reducing falls in the elderly population. proper placement of fall patients in close proximity to the nursing stations. proper implementation of bed alarms. Nursing Interventions set in place to reduce falls will place emphasis on many aspects of health practices introduced but not limited to include. This is in part due to many different health issues that are related to the natural aging process. diseases that occur from a degradation of the pathological process contribute to falls as well. . Additionally.Evidenced Based Paper Abstract The goal of healthcare is to promote and foster a restructured system that delivers primary health care in acute and community base settings. The research will further show that one single intervention is not effective in reducing falls in the elderly population. placement of low beds.
procedure or activity . withdrawal from usual activities and loss of independence. but are not limited to poor lighting. This paper will examine the efficacy of current nursing practices in regard to fall prevention in the elderly population. conditions affecting balance. (Taylor. An example of faulty equipment is faulty bed alarms and inoperable call bells. nursing or medical. slippery or wet floors and faulty hospital equipment. 2009) Environmental hazards in hospital settings include. cognitive impairment. in-patient settings should be directed towards improving or maintaining the older adult’s health needs and concerns. The research reviewed placed a clear focus on detailed assessments that specifically targets older adults. LeMone.treatment. health related issues include impaired vision. alterations in bladder function such as frequency or incontinence.Evidenced Based Paper Description of Clinical Nursing Practice A nursing intervention is defined as a single nursing action . Falls are a safety concern for many older adults. and adverse medication reactions. for which the nurse is accountable (Saba. Nursing interventions are to be directed toward the management of health-related conditions as well as the reduction of environmental assessment. . Nursing interventions for older adults in. 2007). Lynn & LeBon. Lillis. foot problems. Most notably. conditions affecting mobility such as arthritis.designed to achieve an outcome to a diagnosis. This allows the nurse to be prepared when he or she treats this specific population. Falls may lead to fear of additional falls. cardiovascular conditions such as postural hypertension or syncope. muscle weakness.
focused on six marker conditions that can help guide the nurse in an assessment of the hospitalized older patient.Evidenced Based Paper Review of the literature Research has shown that through implementation and a detailed focused assessment of the elderly adult. The Pneumonic SPICES serves as an easy guide for nurses to follow and this is how it is presented: *Sl eep disorders * Pr oblems with eating and feeding * In continence * Co nfusion * Ev idence of falls * Sk in breakdown (Fulmer. problems with eating and feeding. incontinence. evidence of falls. The marker conditions focused on conditions such as sleep problems. Fulmer ( 2007). 2007) . and skin breakdown. specific interventions can be set in place for nurses to include in their plan of care to prevent falls in the elderly. confusion.
The focus was placed on integration of patient and family care. A multi-factorial plan of care was presented to minimize fall prevention in the elderly population. Carrol. This was a nurse-led study that utilized a toolkit that focused on the assessment of the older adult. Interventions to mitigate risk factors associated with the elderly hospitalized patient involved the fall prevention tool kit (FPTK). Kilay. without seamless effective communication among healthcare members. mistakes will be made that could affect the life and well-being of a patient and life-threatening illnesses can ensue if preventative measures are not set in place Leveille. Moreover. Benoit. focused on the effects of exercise on falls in elderly adults. …& Bean (2009). Interventions were set in place to . Communication is the focal point of best practices within the nursing community. Lipsitz. What was most compelling about this article is that Dykes. Dykes. Moreover. Benoit. …& Middleton (2010) research placed a focus on enhancing the degree of communication and the results of the assessment to all healthcare team members that treated the patient. Haudsdorff. Hurley. Carrol. The fall prevention tool kit software tailored fall prevention interventions to address patient’s specific determinants of a fall risk. A study was conducted to utilize their proposed plan with a control group and an intervention group. Over-head bed icons were placed at each bed that detailed the patients fall risk. Jones. the treatment modality in regards to the patient will be severely compromised. A complete plan of care for healthcare professionals was implemented to highlight presenting symptoms that correlate with falls. Lipsitz. … & Middleton (2010) added the communication regimen. (2010) focused on prevention of falls in acute care hospitals. Lipsitz. Hurley.Evidenced Based Paper Dykes. … & Middleton. Benoit. Carrol. Hurley. Guralnik.
Behavioral components were implemented but not limited to medication changes. Gerontological nursing offers creative approaches for maximizing the potential for older adults. Proper implementation of nursing interventions creates a safe in-patient setting that will reduce falls. The conclusion of all three articles revealed that the interventions and practices presented did indeed reduce fall rates in the elderly population. and limitations. educational functional activity as well nutrition supplements to enhance protein consumption in the elderly. the nurse and the older adult together along with the family will identify needs and problems and select interventions that maintain the older adult’s physical abilities.Evidenced Based Paper assist the elderly with doing specific exercises that focused on balance. With comprehensive assessment information regarding the older adult’s strengths resources. .
Additionally. bathroom call bells. (Dick. walkers. etc. The Northeast Health System. 2002) A multi-pronged approach including administrative. The falls prevention program coincided with the purchase of many new beds that were equipped with bed alarms. (NHS) in Beverly Massachusetts developed a risk assessment tool. Nurse managers receive daily reports of at-risk patients and place them on units where falls are closely monitored. Finally. the Joint Commission introduced a national patient safety goal requiring all hospitals to reduce the risk of patient harm resulting from falls and to implement a falls-reduction program. along with the appropriate risk-reduction strategies and interventions associated with each patient’s risk level. wheelchairs. In 2010. which is used to assess patients at admission and at each shift change. (Dick. an update to the administrative database allows better unit-specific information for trending and the ability to develop intervention ns that are appropriate to the patient population. The team revises the falls report to include more information on the factors that contribute to falls. and equipment initiatives included identifying patients with a high risk fall score by placing a . this requirement was upgraded to a standard. 2002) The team worked with plant operations to examine potential environmental fall factors and performed checks on beds. The assessment is based on the Morse Scale. the team established definitions for both fall and injury that could be used facility-wide.Evidenced Based Paper Comparison of Selected Nursing Practice with Current Research In 2005. and is recorded in an electronic log. handrail placement. direct care. environmental.
Benoit. Most notably. and physician/family notification after a fall. ensuring they had adequate lighting at night and appropriately placing patients near the nursing station. (Dick. and so the research and the current protocol show a correlation in that aspect of care as well. In addition. The committee conducts falls rounds during which they provide direct education regarding current fall assessments.Evidenced Based Paper gold star on the unit. Carrol. Lipsitz. treatment. 2002) To achieve this. then regularly toileting those patients. NHS developed an assessment and reporting flow sheet for nurses and physicians to provide standardized monitoring. and equipping those patients’ beds and chairs with alarms. 2010) and the Northeast Health System Fall-Reduction program. NHS created a falls committee and a clinical educator was assigned to provide ongoing falls education to staff and physicians. Hurley. The . The Morse Fall Scale was utilized by (Dykes. the comparison of the research against the current protocol discusses the importance of a multi-factorial approach. The flow sheet outlines very concise responsibilities and steps for staff to follow after a patient experiences a fall. Using a wide range of interventions has proven to be more effective than single interventions. meaning that there is no one single nursing intervention that can solely prevent falls. …& Middleton. Current research has proven that the multi-factorial approach reduces falls in the elderly population. the educator is available to nursing units to conduct a falls prevention consult and recommend interventions.
patients and families.Evidenced Based Paper Northeast Healthcare System was able to connect the multi-factorial approach in more detail than the current research. Communication and teaching was also addressed and encouraged between healthcare providers. alarms and placards were implemented to reduce falls. The key facts of the research and the current protocol at the Northeast Healthcare System addressed the use of fall scales to guide nursing care. new equipment such as low beds. . Tremendous strides are being made in fall-reduction programs but its work is yet to be completed.
Placards should be posted on the outside doors. Proper bed/chair -alarms should be set in place to alarm if patient begins to ambulate un-accompanied. A single nursing intervention to reduce falls in the elderly in acute patient settings is not effective. These referrals will encourage patients to engage in activities to reduce their risk of falls. Implementation of a fall scale is important and upon completion of the assessment the data should be entered into the data base for all assigned health care providers to view. nursing and medicine.Evidenced Based Paper Recommendation for Incorporating Research into your Practice Collaborative projects to reduce patient falls. and in time strengthen bone and muscle mass which will help with gait and balance techniques. medication reviews and environmental changes should be implemented. including safety walk-rounds. including physiotherapy. research has proven that it takes several interventions to reduce falls in the elderly. Maintenance of falls equipment should be checked at . sharing lessons learned and testing new ideas to reduce falls in the elderly. Teams from different disciplines. work together towards common goals. with accompanying bracelets. Beds should be kept in the lowest position at all times when the patient is un-assisted. The multi-factorial approach is key to the success of reduction of falls. Upon discharge from the hospital referrals should be made if needed to nutritionists and exercise programs for the elderly. occupational therapy. Nursing notes should accurately documented and updated as necessary. Safety rounds of high risk patients should be implemented to ensure that proper lighting and toileting procedures are set in place for at-risk fall patients.
. and smoking cessation measures to reduce the risk of falls. dehydration. Health promotion recommendations for older adults include good nutrition. stabilize chronic conditions. Nurses should teach. exercise. whether accomplished in the older adult’s home or in long-term care institutions. Restorative nursing interventions. and measures to reduce adverse medication reactions.Evidenced Based Paper every shift to ensure devices are working at maximum capacity. Acute care settings place older adults at risk for delirium. Nurses should stay current with Evidenced-Based Practices as well as Best Practice nursing literature that substantiate and prove that interventions proposed reduce falls in patients. urinary incontinence and falls. advocate for and educate the families about the importance of detecting at-risk fall episodes and the prevention of falls. A review of the data should be compiled and a report should be prepared quarterly by the falls review board and improvements should be made based on the data presented via the summative report of findings. malnutrition. and promote independence and activities of daily living. promote health. nosocomial infections. Nurses should establish health programs that promote older adults’ wellness and work hard to recommend and promote preventative measures.
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