NRS-441V Capstone Project essay


Evidence-Based Practice


The effect of introduction of safety companionsin the reduction of falls in nursing homes


(NRS441V: Professional Capstone)



The review is arranged systematically with anaim of providing a quantitative and comprehensive review of the riskfactors leading to falls in nursing homes. Findings from an analysisof controlled clinical tribunals and expert panels have givenevidence on how to prevent and manage falls. The falls are associatedwith unstable gait, some medications, and confusion. Giving attentionto these factors helps lower the fall rates(Maddox, 2014). A medicalassessment of the risks of falling and subsequent provision ofinterventions is problematic given the complexity of the falls. Tosolve this problem, the NurseIntellectual Capacity Theory is putin place. It relates the skills and knowledge of nurses to the healthresults of the patients. It also emphasizes that increase in nursingknowledge is significant for the betterment of the health of patientsin the nursing homes(Massicot, 2015). The proposedsolution is evaluated to determine its effectiveness. Educationprograms aimed at solving the falls and the incorporation of safetypartners will help lower the falls in the nursing homes. Evaluationsbased on assessments of the staff by asking them questions related toprevention of falls are carried out. The manner of response reflectson how they can reduce the falls in patients. The results of theproposal are then disseminated to the stakeholders. It can be througha presentation on PowerPoint in a boardroom within the organization.This provides a platform for the stakeholders to react to any issuesthat not clear. Leaflets in the form of Word documents can also beissued alongside the PowerPoint presentation to make thedissemination more effective.

Keywords:Falls, nursing homes, aged and risk factors.

Problem Description

The effect of introduction of safety companionsin the reduction of falls in nursing homes

The aged in the nursing homes often experiencecases of falling, and the introduction of safety companions isthought to improve the situation. The safety companions are theintervening factor, and the aged represent the population. Thecomparison entails not providing the aged with safety companions. Theoutcome expected is a decline in patient falls in the nursing homes.

Solution Description

Programs to reduce falls aim at improving staffconnections, problem-solving abilities, and communication in thenursing homes. To incorporate the changes the nursing homes will haveto embrace education programs and introduce safety companions toescort patients at risk of falling. The management, staff, and allstakeholders need to be informed of how important the changes arebefore putting the plan into action(Hockley et al., 2013). The riskmanagement of the program and its monitoring plan requirepresentations through facts to convince the stakeholders. It willentail training the staff on the significance of implementing theprogram and the extent to which it will lower the falling cases.

The introduction of safety companions issignificant as they will accompany the patients with a record offalling. The safety companions have proper training on caring forpatients with high risk of falling. The companions will continuouslyobserve and offer aid to the patients so as to prevent accidentalfalls. Successful implementation will require the staff andmanagement to be involved actively in reducing patient falls(Hickey &amp Brosnan, 2012). Thesolution will also be feasible since it will take place at thenursing home. Therefore, fewer resources will be employed. Patientfall reduction training programs are seen to reduce teamwork,problem-solving, and communication. A twelve percent reduction infalls is seen per bed in a year after training is conducted on careproviders.

The program should be implemented promptly toavoid project delays. Funds should be availed to implement the newprogram fully. The well-trained nurses will then be chosen to be thesafety companions. The fall rates reduced from fifteen to fourteenpercent per one thousand occupied bed days. The management and thecharacteristics of the nursing home will impact on the possibility ofa fall. Improper structures lead to 12% falls among them 4% lead tofractures(Hegner &amp Gerlach, 2011).Nursing homes with highly skilled and certified caregivers have fewcases of falls among the aged as compared to those nursing homes withsemi-skilled staff.

Implementation Plan

Theories dealing with knowledge and skillsrequirements in nursing practitioners help patient care by guidingall plans and processes that help identify risk factors, managementof the aged, developing and implementing solutions to reduce fallsamong the aged, and measuring the outcomes after the implementation.

Incorporating Theory

TheNurse Intellectual Capacity Theoryis applied in the solution of falls in the aged in nursing homes. Itanalyses the skills and knowledge of nurses as pertains caring forpatients(Wunderlich et al., 2010). Itaffirms that increase in nursing knowledge is important in healthimprovement of the aged. The theory was chosen because the solutionsto prevent falling among the aged entail skills and knowledge. Forexample stopping of some medication to reduce the fall rate requirehigh nursing knowledge to implement as this reduces dizziness(Morse, 2014). The works are incongruence with the proposed solutions as it aims at improvement ofnursing knowledge and skills. The presence of nursing knowledge toprevent the aged from falling will ensure effective implementation ofthe solutions. The incorporation of the theory into the proposal willbe through an assessment of skills and knowledge the nurses havepertaining patient falls. It is important to find out if the nursesare aware of the preventive measures and their implementations. Lackof proper knowledge will call for training as seen in patientoutcomes(Goroll &amp Mulley, 2013).Nurses conduct the implementation process, therefore, knowing theirskill and knowledge level will enable the implementation channel totake place. Nurses make simple and complex decisions on a daily basiswith the help of the nursing theory because through them the practiceof nursing is born. The theory is, therefore, significant in theimplementation of safety companions in nursing homes. The theory isfull of intellectual knowledge, therefore, determining the correctnumber of caregivers, training to be given, the patients at highrisk, and identifying the risk factors are easily defined by thenurses. The concepts obtained are practically employed in solvingproblems because the proper practice is obtained from documentedtheories. The middle collection of nursing theory is developed tohelp understand how nursing knowledge impacts the outcomes in theorganization and among the patients. The concepts in support of thetheory are the nursing structural capital and human capital. Nursinghuman capital is affected in the place of work by nurse employmentand the support of the employer for continued professional growth isrelated to organizational and patient outcomes. The nursing essentialcapital is only related to the outcomes in patients. Proper training,for example, that of the safety companions is in line with the goalsof the theory aiming to improve the professional growth of thenurses. The theory also aims at improving patient outcomes and theorganization is implementing a new solution to reduce falls among theaged hence in line with the theory to enhance patient outcomes.

Evaluation Plan

Theproposed solution is to be evaluated for its effectiveness to bedetermined. Different evaluation tools are put in place for properevaluation of the proposal to be achieved. One tool can be throughthe evaluation of the focus group whereby random selection of theaged is done. The group should comprise 10-15 patients who will besubjected to questions pertaining the fall rates after theimplementation of safety companions to take care of them. Properdocumentation should be done by the evaluators concerning any rise orfall in the number of the falls. Interviews is another evaluationtool that can be employed. In this case the caregivers and the agedin the nursing homes can be interviewed after a random selection. Itshould be conducted no longer than two weeks after the proposal isimplemented. The interviews should not go beyond thirty minutes andshould be in informal settings to make the interviewee comfortable.Body language signs should be noted to be of help to conclude thenon-verbal cues especially in the aged as they could indicate someunspoken reaction. Proper keeping of a project notebook is also agood evaluation tool. It should track the proposal from the beginningand continual updating is done till the last step when the project issigned off signifying a full evaluation report. The thoughts andquestions of the management pertaining the implementation of safetycompanions to lower the fall rates require documentation. Dates andtime should be recorded accurately for reference purposes as thesolution implementation go on. The feedback and reaction of the stafftowards the proposal are also recorded to evaluate clearly theorganization’s position as regards fall rates reduction.Questionnaire administering is also an evaluation tool in the form ofthe open end and closed end questions, questions with multiplechoices, and checklists. The caregivers will respond to the questionspertaining the new solution implementation and how it impacts intheir normal schedules. Their attitude towards the solution will alsobe understood depending on how they answer the questions(see Appendix for more information on evaluation tools).

Dissemination Plan

The stakeholders will require a presentation ofthe findings of the introduction of the proposal. PowerPointpresentation to a board within the organization will be ofsignificance in relaying the information. The discussion will be bythe analysis pertaining patient falls in the nursing home(Cooper, 2010). It will identifythe assessments made before the proposed solution is introduced andthe improvement after the introduction. An analysis of the resultswill be conducted with deep discussion to enhance the understandingof the stakeholders. The stakeholders should, in turn, be given aplatform to raise their concerns as regards the ideas being presentedtogether with proper feedback provision(Selvaggi, 2013). To enhance theunderstanding of the project leaflets in the form of Word documentscan also be issued out during the meeting. The issues raised would bespoken about during the presentation.

The outcome of the research is important forthe reduction of cases of falls in the nursing home. The nursesrequire proper education as pertains fall reductions as per thefindings of the project(Cohn-Sherbok &amp Cohn-Sherbok, 2014).Communication of the outcomes will be through brochures on the noticeboards in areas highly affected by patient falls. Mandatory memoswill be issued to circulate information to the caregivers on thefindings and how to reduce the cases. The customers can also be madeaware through incorporating the information in newspapers andjournals.


Studies have demonstrated the importance ofgiving safety companions to the aged in the nursing homes. There aremany risk factors in the nursing homes that lead to patient falls forexample confusion, unstable gait, and some medications. The changeprocess is put in place to employ safety companions in helping toeradicate the menace. The whole organization pertaining the staff andmanagement will be required to be involved actively so as to reducepatient falls. The Nurse IntellectualCapacity Theory is put in place toensure the solution of fall reduction among the elderly is reduced.The theory is appropriate since preventing falls in the aged requireskills and knowledge. Improper knowledge will prompt training to bedone to enhance the skills of the caregivers. The proposed solutionis then evaluated to determine its effectiveness through assessingthe caregivers and an attitude test of the staff concerning thesolution. The assessed variables include the number of falls, time,and frequency of fall, and the number of nurses responding to thefall cases. To devise the solution, proper education will be requiredto train the caregivers. Lastly, the stakeholders should be harnessedand given the report pertaining the solutions to the patient fallscases. It can be through board meetings with PowerPointpresentations, leaflets circulation, memos distribution, andincorporating the same in journals and newspapers.

Review of Literature

Colon-Emeric,McConnell, E., Pinheiro, Earp, K. M. (2013). Improved Fall Stoppagein the Nursing Homes: Outcomes from Pilot Mediation research. TheJournal of the AmericanGeriatrics Culture.

Thearticle focuses on how to improve the connection among the staff,their communication, and skills in problem-solving to see the effectthe implementation of a reduction in falls education offers. Itstudies nurses in a nursing home to see the employment of educationwithout enhancement of staff connection, problem-solving, andcommunication. The article emphasizes that nurses with improvedskills enhanced the implementation of a reduction in falls andoffered improved care. The article contains immense data collectionand justifies its conclusion to be practical. The research employs acontrol group that adds credibility to the research. The conclusionis based on facts from data collected. It used 497 participants todetermine the reduction in fall rates.

Ramirez,D., Ellis, M., Remler, J., Boratgis, (2013). The Comparativeefficiency of employing evidence learning and performances in ournursing homes: Sound effects costs to society and on falls. TheGlobal Periodical of theNursing Trainings.

Itis a research study that assessed the effect of applyingevidence-based education programs and practices in the fall ofpatients and how it was costly in the health sector. The result wasthat application of this reduced cost and patient falls. It appliedthe quasi-experimental strategy with three groups each containingfifteen nursing homes. There was data collection, analysis, andpublication and it was seen that a reduction in falls was recorded.

Y.,Lipsitz, M., Solomon, L., Mittleman, (2011). The Antidepressantprescriptions: a critical window for the falls in the nursing home.TheJournals of GerontologySequences A: Biological &amp Medical Sciences.

Itis a study that found out the consequences of antidepressants onfalling in nursing homes. It discovered that antidepressant increasedthe probability of a fall. It used 1181 participants hence veryreliable results were attained. Employment of control group made theconclusions reliable.

Gozalo,J., Mor, &amp P., Teno, (2012). The falls in the Lately AdmittedResidents in Nursing Homes: A Countrywide Study: the Journalof American Geriatrics Community. Itaimed to find out how the probability of a fall is related to thecharacteristics of an organization. Aspects like funding, the numberof beds, and availability of a special care unit were analyzed.Nursing homes whose nurses are certified experienced fewer falls ascompared to those lacking a certified staff. Two-hundred and thirtypatients were analyzed in one year hence proves that sufficient timewas availed.

Martens,P., Fuchs, D. &amp Doupe, M., (2013). The assessment of a falladministration program in the nursing homes population. TheGerontologist.

Conductedin Manitoba in Canada and tried to find out if the nursing homes fallmanaging programs were efficient in reducing the falls. Use of theprograms lessens the falls in the nursing homes. The data wascollected for five years hence the outcomes are not by chance. Thecontrol groups also indicated that that the results were genuine.

Magaziner,J. &amp Resnick, B. (2010). Preventing falls and cracks in ournursing homes: TheJournal of American Geriatrics

Thejournal has 4 article that sought to find mediations in nursing homesthat would lower the fall rates especially those leading to deathsand injury. Many of the falls occur in the nursing homes and not inthe communities. Sufficient information has been gathered to proposethe numerous intervention measures like use of bed alarms and bedrails. The four articles are similar hence implies the conclusionsare truthful.

Rubenstein,(2012). Falls in older people: risk factors and approaches foravoidance. Age &amp Ageing.

Itasserts that the falls are common and highest causes of injuries,morbidity, and death. They mainly occur among the aged and the riskfactors include medication, environmental causes, and weak muscles.Thirteen percent of the population and sixty-five percent of peopleolder than 65 years often experience falls. Immense data was obtainedto come up with the data.

Avorn,J., &amp Parikh, S., (2010). Pharmacological controlling ofosteoporosis in the nursing homes: a methodical review. TheJournal of AmericanGeriatrics.

It asserts many falls occur in nursing homesunlike in the community. It sought to find out how osteoporosismedication affected the patients. Minerals like calcium and somevitamins help reduce fracturing during falls. It depended onliterature since 1974 hence sufficient data was available regardingthe falls and its reduction.


Cohn-Sherbok, D. &amp Cohn-Sherbok, L.(2014).&nbspWhat to do when yourparents live forever Winchester, UK:O Books.

Cooper, J. (2010).&nbspDrug-relatedproblems in geriatric nursing home patients.New York: Pharmaceutical Products Press.

Dilks-Hopper, H. (2013).&nbspCapacityto consent to health care in adults with intellectual disabilities.

Franklin, D. (2013).&nbspNursinghomes explained. New York: AlgoraPub.

Goroll, A. &amp Mulley, A. (2013).&nbspPrimarycare medicine. Philadelphia:Lippincott Williams &amp Wilkins.

Hegner, B. &amp Gerlach, M. (2011).&nbspAssistingin long-term care.

Hickey, J. &amp Brosnan, C. (2012).&nbspEvaluationof health cares quality in advanced practice nursing.New York: Springer Pub. Co.

Hockley, J., Froggatt, K., &amp Heimerl, K.(2013).&nbspParticipatory researchin palliative care.

Maddox, G. (2014).&nbspTheencyclopedia of aging. New York:Springer Pub. Co.

Massicot, P. (2015).&nbspAppropriatetechnology information dissemination plan.[Baltimore, Md.]: [The Office].

Morse, J. (2014).&nbspPreventingpatient falls. New York: SpringerPub. Co.

Nilsen, K. (2012).&nbspTheimpact of information policy.Westport, Conn.: Ablex Publishing.

Selvaggi, L. (2013).&nbspEffectsof nursing modality on the quality of care.

Thomas, K. (2011).&nbspPatientSafety in Nursing Homes.

Wunderlich, G., Sloan, F., &amp Davis, C.(2010).&nbspNursing staff inhospitals and nursing homes.Washington, D.C.: National Academy Press.

Berry, S., Zhang, Y., Lipsitz, L., Mittleman,M., Solomon, D., &amp Kiel, D. (2011). Antidepressant Prescriptions:An Acute Window for Falls in the Nursing Home.&nbspTheJournals Of Gerontology Series A: Biological Sciences And MedicalSciences,&nbsp66A(10),1124-1130.

Burland, E., Martens, P., Brownell, M., Doupe,M., &amp Fuchs, D. (2013). The Evaluation of a Fall ManagementProgram in a Nursing Home Population.&nbspTheGerontologist,&nbsp53(5),828-838.

Colon-Emeric, C., McConnell, E., Pinheiro, S.,Corazzini, K., Porter, K., &amp Earp, K. et al. (2013). CONNECT forBetter Fall Prevention in Nursing Homes: Results from a PilotIntervention Study.Journal Of TheAmerican Geriatrics Society,&nbsp61(12),2150-2159.

Leland, N., Gozalo, P., Teno, J., &amp Mor, V.(2012). Falls in Newly Admitted Nursing Home Residents: A NationalStudy.&nbspJournalOf The American Geriatrics Society,&nbsp60(5),939-945.

Magaziner, J., Miller, R., &amp Resnick, B.(2007). Intervening to Prevent Falls and Fractures in Nursing Homes:Are We Putting the Cart Before the Horse?.&nbspJournalOf The American Geriatrics Society,55(3),464-466.

Parikh, S., Avorn, J., &amp Solomon, D.(2009). Pharmacological Management of Osteoporosis in Nursing HomePopulations: A Systematic Review.&nbspJournalOf The American Geriatrics Society,&nbsp57(2),327-334.

Rubenstein, L. (2006). Falls in older people:epidemiology, risk factors and strategies for prevention.AgeAnd Ageing,&nbsp35(Supplement2), ii37-ii41.

Teresi, J., Ramirez, M., Remler, D., Ellis, J.,Boratgis, G., &amp Silver, S. et al. (2013). Comparativeeffectiveness of implementing evidence-based education and bestpractices in nursing homes: Effects on falls, quality-of-life andsocietal costs.&nbspInternationalJournal Of Nursing Studies,&nbsp50(4),448-463.


Evaluation tools

Evaluationis important in ensuring the clarity of the objectives and aims of aproject. It provides information on the results of an event togetherwith the suggestions of improving it. The evaluation process alsoaims at finding out those that attended the event. It emphasizes thefact that the efforts employed are worthwhile.

Otherevaluation tools that could be employed include the evaluationassessment checklist, evaluation matrix, radar diagram, confidencelog, blobtree, and observation framework.