THE EFFECTIVENESS OF SAFETY COMPANIONS IN REDUCING OF PATIENT FALLS
(NRS 441V: Professional Capstone)
The review isarranged systematically with an aim of providing a quantitative andcomprehensive review of the risk factors leading to falls in nursinghomes. Findings from an analysis of controlled clinical tribunals andexpert panels have given evidence on how to prevent and manage falls.The falls are associated with unstable gait, some medications, andconfusion. Giving attention to these factors helps lower the fallrates (Maddox, 2014). A medical assessment of the risks of fallingand subsequent provision of interventions is problematic given thecomplexity of the falls. To solve this problem, the NurseIntellectual Capacity Theory is put in place. It relates the skillsand knowledge of nurses to the health results of the patients. Italso emphasizes that increase in nursing knowledge is significant forthe betterment of the health of patients in the nursing homes(Massicot, 2015). The proposed solution is evaluated to determine itseffectiveness. Education programs aimed at solving the falls and theincorporation of safety partners will help lower the falls in thenursing homes. Evaluations based on assessments of the staff byasking them questions related to prevention of falls are carried out.The manner of response reflects on how they can reduce the falls inpatients. The frequency and number of the falls and the number ofnurses and time taken to respond to falls are the variables used inthe assessments. The results of the proposal are then disseminated tothe stakeholders. It can be through a presentation on PowerPoint in aboardroom within the organization. This provides a platform for thestakeholders to react to any issues that not clear. Leaflets in theform of Word documents can also be issued alongside the PowerPointpresentation to make the dissemination more effective.
Keywords: Falls, nursing homes, aged and risk factors.
The effect ofintroduction of safety companions in the reduction of falls innursing homes
The aged in thenursing homes often experience cases of falling, and the introductionof safety companions is thought to improve the situation. The safetycompanions are the intervening factor, and the aged represent thepopulation. The comparison entails not providing the aged with safetycompanions. The outcome expected is a decline in patient falls in thenursing homes.
Programs toreduce falls aim at improving staff connections, problem-solvingabilities, and communication in the nursing homes. To incorporate thechanges the nursing homes will have to embrace education programs andintroduce safety companions to escort patients at risk of falling.The management, staff, and all stakeholders need to be informed ofhow important the changes are before putting the plan into action(Hockley et al., 2013). The risk management of the program and itsmonitoring plan require presentations of facts to convince thestakeholders. It will entail training the staff on the significanceof implementing the program and the extent to which it will lower thefalling cases.
The introductionof safety companions is significant as they will accompany thepatients with a record of falling. The safety companions have propertraining on caring for patients with high risk of falling. Thecompanions will continuously observe and offer aid to the patients soas to prevent accidental falls. Successful implementation willrequire the staff and management to be involved actively in reducingpatient falls (Hickey & Brosnan, 2012). The solution will also befeasible since it will take place at the nursing home. Therefore,fewer resources will be employed. Patient fall reduction trainingprograms are seen to reduce teamwork, problem-solving, andcommunication. A twelve percent reduction in falls is seen per bed ina year after training is conducted on care providers.
The programshould be implemented promptly to avoid project delays. Funds shouldbe availed to implement the new program fully. The well-trainednurses will then be chosen to be the safety companions. The fallrates reduced from fifteen to fourteen percent per one thousandoccupied bed days. The management and the characteristics of thenursing home will impact on the possibility of a fall. Improperstructures lead to 12% falls among them 4% lead to fractures (Hegner& Gerlach, 2011). Nursing homes with highly skilled and certifiedcaregivers have few cases of falls among the aged as compared tothose nursing homes with semi-skilled staff.
Theories dealingwith knowledge and skills requirements in nursing practitioners helppatient care by guiding all plans and processes that help identifyrisk factors, management of the aged, developing and implementingsolutions to reduce falls among the aged, and measuring the outcomesafter the implementation.
The NurseIntellectual Capacity Theory is applied in the solution of falls inthe aged in nursing homes. It analyses the skills and knowledge ofnurses as pertains caring for patients (Wunderlich et al., 2010). Itaffirms that increase in nursing knowledge is important in healthimprovement of the aged. The theory was chosen since the solutionsused in preventing falling among the aged entail skills andknowledge. For example stopping some medication to reduce the fallrate requires high nursing knowledge to implement as this reducesdizziness (Morse, 2014). The works are in congruence with theproposed solutions as it aims at improvement of nursing knowledge andskills.
The effectiveimplementation of the intervention is enhanced by adequate knowledgeof nurses concerning patient fall prevention. The incorporation ofthe theory into the proposal will be through an assessment of skillsand knowledge the nurses have pertaining patient falls. It isimportant to find out if the nurses are aware of the preventivemeasures and their implementations. Lack of proper knowledge willcall for training as seen in patient outcomes (Goroll & Mulley,2013). Nurses conduct the implementation process, therefore, knowingtheir skill and knowledge level will enable the implementationchannel to take place. Nurses make simple and complex decisions on adaily basis with the help of the nursing theory because through themthe practice of nursing is born. The theory is, therefore,significant in the implementation of safety companions in nursinghomes. The theory is full of intellectual knowledge, therefore,determining the correct number of caregivers, training to be given,the patients at high risk, and identifying the risk factors areeasily defined by the nurses. The concepts obtained are practicallyemployed in solving problems because the proper practice is obtainedfrom documented theories.
The middlecollection of nursing theory is developed to help understand hownursing knowledge impacts the outcomes in the organization and amongthe patients. The concepts in support of the theory are the nursingstructural capital and human capital. Nursing human capital isaffected in the place of work by nurse employment and the support ofthe employer for continued professional growth is related toorganizational and patient outcomes. The nursing essential capital isonly related to the outcomes in patients. Proper training, forexample, that of the safety companions is in line with the goals ofthe theory aiming to improve the professional growth of the nurses.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 isdone to determine the effectiveness of the proposed intervention inreducing number and frequency of patient falls. Different evaluationtools are put in place for proper evaluation of the proposal to beachieved. Assessment technique is conducted on those entrusted withproviding nursing care. The staff can be interviewed, and answerquestions about the prevention of patient fall through the proposedintervention. The responses of nurses to the questions reflect theirunderstanding of the proposed solution and how to use it for reducingpatient falls. The assessment of attitudes of the health care teamtoward the intervention provides insights of the willingness of thehealthcare team to implement the proposed intervention. Skillassessment can also be used to evaluate the safety partners andnurses who are assigned the responsibility of providing healthcare.The variables used in the assessments include the number of patientfalls, the frequency of falls (time), and the number of nurses whoresponds to the patient falls.
After the implementation of the intervention, there is a need tomonitor the progress of the intervention in reducing patient falls inthe hospital. Evaluation tools are used in monitoring the progress ofthe intervention. The evaluation tools to be used include a screeningof overall patient falls and measuring the level of response of thecaregivers and the patients to the falls in the hospital. The numberof patient falls in the healthcare center correlates with theeffectiveness of the intervention. Reduced number of falls indicatesthe effectiveness of the proposed intervention. Reduction in thenumber of patients who fall is an indication of the effectiveness ofthe intervention. Screening the level of response of the caregiversand patients towards the fall shows the preparedness at the hospitalto address falls. Preparedness may involve the skills and knowledgeof nurses in reducing patient falls.
The feedback andreaction of the staff towards the proposal are also recorded toevaluate clearly the organization’s position as regards fall ratesreduction. Questionnaire administering is also an evaluation tool inthe form of the open end and closed end questions, questions withmultiple choices, and checklists. The caregivers will respond to thequestions concerning the new solution implementation and how itimpacts in their normal schedules. Their attitude towards thesolution will also be understood depending on how they answer thequestions (see Appendix for more information on evaluation tools).
The stakeholderswill require a presentation of the findings of the introduction ofthe proposal. PowerPoint presentation to a board within theorganization will be of significance in relaying the information. Thediscussion will be by the analysis pertaining patient falls in thenursing home (Cooper, 2010). It will identify the assessments madebefore the proposed solution is introduced and the improvement afterthe introduction. An analysis of the results will be conducted withdeep discussion to enhance the understanding of the stakeholders. Thestakeholders should, in turn, be given a platform to raise theirconcerns as regards the ideas being presented together with properfeedback provision (Selvaggi, 2013). To enhance the understanding ofthe project leaflets in the form of Word documents can also be issuedout during the meeting. The issues raised would be spoken aboutduring the presentation.
The outcome ofthe research is important for the reduction of cases of falls in thenursing home. The nurses require proper education on fall reductionsas per the findings of the project (Cohn-Sherbok & Cohn-Sherbok,2014). Communication of the outcomes will be through brochures on thenotice boards in areas highly affected by patient falls. Mandatorymemos will be issued to circulate information to the caregivers onthe findings and how to reduce the cases. The customers can also bemade aware through incorporating the information in newspapers andjournals.
Studies havedemonstrated the importance of giving safety companions to the agedin the nursing homes. There are many risk factors in the nursinghomes that lead to patient falls for example confusion, unstablegait, and some medications. The change process is put in place toemploy safety companions in helping to eradicate the menace. Thewhole organization pertaining the staff and management will berequired to be actively involved so as to reduce patient falls. TheNurse Intellectual Capacity Theory is employed to ensure the solutionof fall reduction among the elderly is reduced. The theory isappropriate since preventing falls in the aged require skills andknowledge. Improper knowledge will prompt training to be done toenhance the skills of the caregivers. The proposed solution is thenevaluated to determine its effectiveness through assessing thecaregivers and an attitude test of the staff concerning the solution.The assessed variables include the number of falls, time, andfrequency of fall, and the number of nurses responding to the fallcases. Appropriate training of the caregivers enhances theformulation and implementation of intervention. Lastly, thestakeholders should be harnessed and given the report about thesolutions to the patient falls cases. It can be through boardmeetings with PowerPoint presentations, leaflets circulation, memosdistribution, and incorporating the same in journals and newspapers.
Review of Literature
Colon-Emeric, McConnell, E., Pinheiro & Earp, K. M. (2013),Improved Fall Stoppage in the Nursing Homes: Outcomes from PilotMediation research, The Journal of the American GeriatricsCulture. 61(12), 2150-2159
The articlefocuses on how to improve the connection among the staff, theircommunication, and skills in problem-solving to see the effect theimplementation of a reduction in falls education offers. It studiesnurses in a nursing home to see the employment of education withoutenhancement of staff connection, problem-solving, and communication.The article emphasizes that nurses with improved skills enhanced theimplementation of a reduction in falls and offered improved care. Thearticle contains immense data collection and justifies its conclusionto be practical. The research employs a control group that addscredibility to the research. The conclusion is based on facts fromdata collected. It used 497 participants to determine the reductionin fall rates.
Teresi, J. A., Ramirez, D., Ellis, M., Remler, J. & Boratgis,(2013), The Comparative efficiency of employing evidence learning andperformances in our nursing homes: Sound effects costs to society andon falls, The Global Periodical of the Nursing Trainings.50(4), 448-463 16p
It is a researchstudy that assessed the effect of applying evidence-based educationprograms and practices in the fall of patients and how it was costlyin the health sector. The result was that application of this reducedcost and patient falls. It applied the quasi-experimental strategywith three groups each containing fifteen nursing homes. There wasdata collection, analysis, and publication and it was seen that areduction in falls was recorded.
Berry, S., Zhang, Y., Lipsitz Y, M., Solomon, L., & Mittleman(2011), The Antidepressant prescriptions: a critical window for thefalls in the nursing home. The Journals of Gerontology SequencesA: Biological & Medical Sciences. 66A(10),1124-1130
It is a studythat found out the consequences of antidepressants of falling innursing homes. It discovered that antidepressant increased theprobability of a fall. It used 1181 participants hence very reliableresults were attained. Employment of control group made theconclusions reliable.
Leland, N. E., Gozalo, J., Mor, & P., Teno, (2012). The falls inthe Lately Admitted Residents in Nursing Homes: A CountrywideStudy: the Journal of American Geriatrics Community. 60(5),939-945
It aimed to findout how the probability of a fall is related to the characteristicsof an organization. Aspects like funding, the number of beds, andavailability of a special care unit were analyzed. Nursing homeswhose nurses are certified experienced fewer falls as compared tothose lacking a certified staff. Two-hundred and thirty patients wereanalyzed in one year hence proves that sufficient time was availed.
Burland, E., Martens, P., Fuchs, D. & Doupe, M., (2013), Theassessment of a fall administration program in the nursing homespopulation, The Gerontologist, 53(5), 828-838
Conducted inManitoba 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. & Resnick, B. (2010), Preventing falls and cracksin our nursing homes: The Journal of American Geriatrics,55(3), 464-466
The journal has 4articles that sought to find interventions in nursing homes thatwould lower the fall rates especially those leading to deaths andinjury. Many of the falls occur in the nursing homes and not in thecommunities. Sufficient information has been gathered to propose thenumerous intervention measures like use of bed alarms and bed rails.The four articles are similar hence implies the conclusions aretruthful.
Rubenstein, (2012). Falls in older people: risk factors andapproaches for avoidance. Age & Ageing.
It asserts thatthe falls are common and highest causes of injuries, morbidity, anddeath. They mainly occur among the aged and the risk factors includemedication, environmental causes, and weak muscles. Thirteen percentof the population and sixty-five percent of people older than 65years often experience falls. Immense data was obtained to come upwith the data.
Avorn, J., & Parikh, S., (2010). Pharmacological controlling ofosteoporosis in the nursing homes: a methodical review, TheJournal of American Geriatrics, 57(2), 327-334
It asserts manyfalls occur in nursing homes unlike in the community. It sought tofind out how osteoporosis medication affected the patients. Mineralslike calcium and some vitamins help reduce fracturing during falls.It depended on literature since 1974 hence sufficient data wasavailable regarding the falls and its reduction.
Berry, S., Zhang, Y., Lipsitz, L., Mittleman, M., Solomon, D., &Kiel, D. (2011). Antidepressant Prescriptions: An Acute Window forFalls in the Nursing Home. The Journals Of Gerontology Series A:Biological Sciences And Medical Sciences, 66A(10), 1124-1130.http://dx.doi.org/10.1093/gerona/glr113
Burland, E., Martens, P., Brownell, M., Doupe, M., & Fuchs, D.(2013). The Evaluation of a Fall Management Program in a Nursing HomePopulation. The Gerontologist, 53(5), 828-838.http://dx.doi.org/10.1093/geront/gns197
Cohn-Sherbok, D. & Cohn-Sherbok, L. (2014). What to do when yourparents live forever Winchester, UK: O Books.
Colon-Emeric, C., McConnell, E., Pinheiro, S., Corazzini, K., Porter,K., & Earp, K. et al. (2013). CONNECT for Better Fall Preventionin Nursing Homes: Results from a Pilot Intervention Study.Journal OfThe American Geriatrics Society, 61(12), 2150-2159.http://dx.doi.org/10.1111/jgs.12550
Cooper, J. (2010). Drug-related problems in geriatric nursing homepatients. New York: Pharmaceutical Products Press.
Dilks-Hopper, H. (2013). Capacity to consent to health care in adultswith intellectual disabilities.
Franklin, D. (2013). Nursing homes explained. New York: Algora Pub.
Goroll, A. & Mulley, A. (2013). Primary care medicine.Philadelphia: Lippincott Williams & Wilkins.
Hegner, B. & Gerlach, M. (2011). Assisting in long-term care.
Hickey, J. & Brosnan, C. (2012). Evaluation of health caresquality in advanced practice nursing. New York: Springer Pub. Co.
Hockley, J., Froggatt, K., & Heimerl, K. (2013). Participatoryresearch in palliative care.
Leland, N., Gozalo, P., Teno, J., & Mor, V. (2012). Falls inNewly Admitted Nursing Home Residents: A National Study. Journal OfThe American Geriatrics Society, 60(5), 939-945.http://dx.doi.org/10.1111/j.1532-5415.2012.03931.x
Maddox, G. (2014). The encyclopedia of aging. New York: Springer Pub.Co.
Magaziner, J., Miller, R., & Resnick, B. (2007). Intervening toPrevent Falls and Fractures in Nursing Homes: Are We Putting the CartBefore the Horse?. Journal Of The American Geriatrics Society,55(3),464-466. http://dx.doi.org/10.1111/j.1532-5415.2007.01088.x
Massicot, P. (2015). Appropriate technology information disseminationplan. [Baltimore, Md.]: [The Office].
Morse, J. (2014). Preventing patient falls. New York: Springer Pub.Co.
Nilsen, K. (2012). The impact of information policy. Westport, Conn.:Ablex Publishing.
Parikh, S., Avorn, J., & Solomon, D. (2009). PharmacologicalManagement of Osteoporosis in Nursing Home Populations: A SystematicReview. Journal Of The American Geriatrics Society, 57(2), 327-334.http://dx.doi.org/10.1111/j.1532-5415.2008.02119.x
Rubenstein, L. (2006). Falls in older people: epidemiology, riskfactors and strategies for prevention.Age And Ageing, 35(Supplement2), ii37-ii41. http://dx.doi.org/10.1093/ageing/afl084
Selvaggi, L. (2013). Effects of nursing modality on the quality ofcare.
Teresi, J., Ramirez, M., Remler, D., Ellis, J., Boratgis, G., &Silver, S. et al. (2013). Comparative effectiveness of implementingevidence-based education and best practices in nursing homes: Effectson falls, quality-of-life, and societal costs. International JournalOf Nursing Studies, 50(4), 448-463.http://dx.doi.org/10.1016/j.ijnurstu.2011.07.003
Thomas, K. (2011). Patient Safety in Nursing Homes.
Wunderlich, G., Sloan, F., & Davis, C. (2010). Nursing staff inhospitals and nursing homes. Washington, D.C.: National AcademyPress.
Evaluation isimportant 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.
Theimplementation of the project and its success need to be determinedthrough proven tools. The first tool that can be employed toascertain the outcome of the project is a screening of overallpatient falls in the hospital. For example, after the introductionand implementation of the project, it would be mandatory to have ateam appointed that seeks to monitor the patient falls that occur inthe healthcare center. The number of patient falls that are witnessedcorrelates with how best the project has been regardingtransformation of the situation. If there is a reduction, it shouldbe evidence of the success of the project. Contrary to the same, ifit is determined that the number of patients who fall in thehospitals continues to be high, that would be a reflection of thefailure of the project. However, as stipulated in the projectproposal, through the implementation of the stated steps, it shouldbe possible to reduce the overall number of patients who experiencepatient falls. The next tool to be used in measuring the outcome ofthe project is the level of response of patients and caregivers whenit comes to dealing with the issue.
Other evaluationtools that could be employed include the evaluation assessmentchecklist, evaluation matrix, radar diagram, confidence log, blobtree, and observation framework.