Nursing Standard- Preventing Falls And Harm From Falls - Samples

Question: Discuss about the Literature Review On Nursing Standard- Preventing Falls And Harm From Falls. Answer: Introduction Falls among older people is the public health concern. It is the major cause of accidents and injury in the hospital setting and consequently longer length of stay, poor health outcomes and readmission (Gu, Balcaen, Ampe Goffin, 2016; Kami?ska, Brodowski Karakiewicz, 2015 and Said, Batchelor, Shaw, Blennerhassett, 2016). The Australian Commission on Safety and Quality in Health Care (ACSQHC) funded the guidelines to improve the care quality given to older people in Australia. These are designed to guide the health care professionals. It introduced the National Safety and Quality Health Service Standards (NSQHS). The standard 10 focuses on preventing falls and harm from falls. It was designed in response to increasing rate of falls among the older people in hospital setting (Australian Commission on Safety and Quality in Health Care, 2012). The literature review aims to the identify the causes of the fall among older people (65-85 years) and the interventions used to prevent falls. Background Fall prevention has always been challenging for the health care providers. It is attributed to lack of understanding of the effective strategies to prevent fall among the health care providers, poor knowledge on environmental modifications, and risk identification (Lukaszyk et al., 2016; Lannering, Ernsth Bravell Johansson, 2017). Therefore, better understanding is needed to keep the older people in the hospital safe. The accidental falls could lead to disability, reduced life span and increased financial costs to healthcare. The standard 10 of NSQHS was developed to reduce falls through effective governance structures, risk screening, prevention strategies, and informing carers about identified risks from falls and development of fall prevention plan (Australian Commission on Safety and Quality in Health Care, 2012). The main aim of this standard developed in 2009 is to decrease the fall incidences, number of falls and associated harm using action research program. The guidelines s upport the carers for older people in hospital, community and in home care setting. Despite improvement, there is still a large proportion of older people in Australian hospital setting, highly vulnerable to falls. Therefore, the ACSQHC recommends high level of commitment from the carers for successful fall prevention (Lea et al., 2012). Literature review Based on analysis of various studies and the findings the falling themes were obtained. It includes - poor vision as risk factor, mobility limitations, interventions for fall preventions and environmental considerations. Risk factors- poor vision Poor vision and vision impairment is considered a major concern for fall in older adults. Studies have showed that old people with visual trouble or deficit are 1.5-2.0 times more likely to fall when compared to those without such deficit. Vision compromises the balance and posture according to Baril (2013). Lord Lacherez (2016) also supported that vision is highly important for gait and balance. It significantly impairs the locomotion. It consequently increases the risk of fall. Increasing the vision was found to reduce the risk of fall argued Ellison, Campbell, Robertson, Sanderson (2014). Multi-focal and bifocal glasses hamper the contrast sensitivity and depth perception among older adults which results in multiple falls. Frequently updating glasses may be more beneficial. The argument is supported with the findings of Chua, Chang, Lim (2015) that presented the vision-based fall detection technique. This technique has increased the fall detection rate. The limitations are due to excess focus on intervention technique than on the relationship between vision and fall. Mobility limitations The prominent predictor of falling is the component reduced mobility. Mobility limitations are of particular concern in older people attributed to foot pain as per Stenhagen, Ekstrm, Nordell Elmsthl (2013). It affects the activities of daily living. The findings were in consistence with results of Menz et al. (2013). It argued association between foot pain and exacerbation of problems with gait and balance. Therefore, it significantly limits the balance. These studies focused on relationship between the falls and slow walking speed in elderly. As per the results of Callisaya et al. (2012), high rate of multiple falls was found in those walking fast with fastest quarter of gait speed. Stubbs, Schofield Patchay (2016) argued that the fall risk is associated with the mobility limitations among adults other than that caused by disability and frailty. It is the most common factor in the patients with chronic musculoskeletal pain. The results were supported by the findings of Swenor et a l. (2015). It revealed a positive association between the mobility limitations and visual impairment among the older people. According to the findings, multiple aspects of visual impairment contribute to the mobility limitations which results in functional decline. Interventions for fall prevention The intervention methods have been further divided into a number of effective strategies. Some of which have been discussed over here such as i. Provision of single interventions or exercises, ii. Combination of two or more tailored interventions, such exercise and home hazard modification or home hazard and medications modification, iii. Multiple component interventions where an individual receives exercise, home hazard modification and administration of vitamin D supplements. As supported by El-Khoury, Cassou, Charles Dargent-Molina (2013), single interventions have been more effective in reducing the rate of accidental falls. However as argued by Miake-Lye, Hempel, Ganz Shekelle (2013), combining of the intervention methods is found to be more intuitive and is comparatively less effective. However, as argued by Campbell Robertson (2013), multi-factorial interventions with individually tailored approach has been seen to reduce the rate of fall in the elderly. On the other hand, there has been limited evaluation of multi-factorial fall prevention programmes owing to the variety and diverse nature of the combination intervention methods (Campbell Robertson, 2013; Carande-Kulis et al., 2015; Robertson Gillespie, 2013). However, as argued by Campbell Robertson (2013), the fall intervention programs have been seen to suffer from greater amount of resistance due to several psychosocial factors. As supported by Hempel et al. (2013), the dependence over care supporters and care providers have been seen to led to greater amount of frustrations in the aged community. On the contrary, the care supporter limits the freedom of movement of the patients owing to safety concerns. This often leads to the development of ethical dilemmas within a healthcare setup. As argued by Child et al. (2012), intervention methods are required to reduce the extent of injury caused due to the fall by making the bones stronger. Evidences have supported that supplementing the patients wi th appropriate doses of vitamin D have been seen to make the bones stronger and reduce the level of damage caused from the fall (Practitioners, 2018; El-Khoury et al., 2013; Goodwin et al., 2013). Environmental considerations The environmental considerations refer to analysing the home environment of a patient which can trigger the rate of fall. The environmental hazards such as slipping and tripping over can happen within the home, in the garden, away from the home. As supported by Hempel et al. (2013), modification of home hazards by an occupational therapist cam reduces the rate of fall. In this respect, the risk population consists of the ones with a history of falling, the ones who had fallen more than once, the ones with functional decline and vision impairment. However, as argued by Practitioners (2018), the success rates of the implementation of home safety measures are dependent on the extent to which people actually follow the recommendations provided by the occupational therapists. As mentioned by Goodwin et al. (2014), inclusion of environmental risk factor screening in multi-factorial fall prevention programs have been fruitful in reducing the rate of fall. Meta regression analysis depicted t hat single and multi-factorial both intervention approaches were effective. It was seen that the multi-factorial fall prevention program gave improved results with the inculcation of the environmental risk screening. In this respect, using a number of tools such as the Westmead Home Safety Assessment has been seen to be effective in conducting a review of the home and outdoors environment. The tool has been found to be useful in identification of the hazards, design the solution and develop an effective action plan. However, as argued by Robertson Gillespie (2013), the environmental factors also fails to take into consideration the cognitive abilities and normal thinking capacity of the patient. In the dearth of effective decision making skills, the interests of the patient can conflict with that of the occupational therapists which further acts a hindrance (Miake-Lye et al., 2013; Hempel et al., 2013; Child et al., 2012). Some of the environmental factors which could be modified f or reducing the risk of fall in the patients are- reducing the glare of lights, modifying slippery floors, removing loose carpets, fixing of uneven pathways. However, in order to implement the changes support from the family members of the patient is required along with vesting sufficient amount of finances for the same (Practitioners, 2018). As argued by Carande-Kulis et al. (2015), modification of the environment can further increase the agitation level of the older people by making them uncomfortable as they used to their home environment in a certain way. Additionally, the multidisciplinary involvement required for environmental screening may not be possible within the rural settings. The average cost of implementing the home safety program was A$325 which could not be easily afforded and thus acted as a hindrance (Practitioners, 2018). Patient centered care As supported by Goodwin et al. (2014), exercise, patient education and home safety medications have been seen to contribute significantly to fall prevention. However as argued by Campbell Robertson (2013), limited mobility has been seen to affect the rate of acceptance of care provided to the elderly patients. It was unwise to think that most of the elderly had sufficient finances to finance a full time fall management program (Robertson Gillespie, 2013). It calls for understanding the patient centered fall risk awareness of perspective of patients. Verghese (2016) argued subjective fall risk perceptions of patients should be considered for fall prevention strategies. Fall rate may be reduced in acute care hospitals, by patient centered care along with tailored patient education as per Avanecean et al. (2017). However, there is limited evidence supporting the efficacy of patient centered care. There is a need of randomised trial for estimating the efficacy in robust manner. Relevance to clinical practice The literature review helps in understanding the importance of designing of effective evidence based programs for reducing the rate of fall in the elderly. However as supported by Miake-Lye et al. (2013), there are a number of factors which act as barriers to the implementation of the evidence based fall prevention strategies within the hospital premises. Some of the barriers are limited finances and reduced access to support and intervention tools. Lack of help from expert care channels have been seen to limit the benefits provided by the evidence based fall intervention programs (Robertson Gillespie, 2013). Vision impairment is considered one of the major risk factors which are missed by nurses during assessment of fall risks. Mobility limitations are the other cause that is poorly identified among the nurses as the concern for fall. Most cases the nurses perceive that the disability and fragility are the major cause of mobility limitations as per Crizzle et al., (2015). Screenin g of environment is neglected in rural hospitals and modification of household environment is rarely considered as part of fall prevention in some hospitals. Factors like foot pain and walking speed are not taken into consideration for care plan. Similarly, interventions by nurses are more focused on single aspect. Multi-focused interventions and patient centered care are neglected although found to be most effective in reducing fall and is supported by Pfortmueller et al., (2014). These barriers and limitations result in increasing falls. It could be ascertained from the review that the intuitive nature of designing the combinatorial evidence based fall prevention programs makes the success of the program rather questionable in nature. Conclusion Falls among older people in hospital are associated with secondary complications. However, in most cases these are easily preventable. It is an attractive target to lower the health care costs by increasing the care quality. Nurses play a vital role in fall prevention and must be well trained. The nurses must be able to recognise the patients with poor vision at risk of fall, environmental barriers and mobility limitations due to varied reasons other than disability. Nurses are implied to assess the benefits of different fall prevention strategies such as multi-focused interventions and patient centered care. It is the best way to cultivate the culture of safety in the hospital setting. It will eventually help in systemic reduction of falls. The nurses must be given the autonomy to implement the best possible strategy. Additionally, providing thenursing professionals with adequate amount of training can help in improving the quality of care. References Avanecean, D., Calliste, D., Contreras, T., Lim, Y., Fitzpatrick, A. (2017). Effectiveness of patient-centered interventions on falls in the acute care setting compared to usual care: a systematic review.JBI database of systematic reviews and implementation reports,15(12), 3006-3048. DOI: 10.11124/JBISRIR-2016-003331 Baril, F. (2013). Prevention of falls among seniors with a visual impairment. Retrieved from: https://www.inlb.qc.ca/wp-content/uploads/2015/01/Prevention-of-falls-among-seniors-with-VI-Final.pdf Callisaya, M. L., Blizzard, L., McGinley, J. L., Srikanth, V. K. (2012). Risk of falls in older people during fast-walkingthe TASCOG study.Gait posture,36(3), 510-515. DOI: DOI:https://doi.org/10.1016/j.gaitpost.2012.05.003 Campbell, A. J., Robertson, M. C. (2013). Fall prevention: single or multiple interventions? Single interventions for fall prevention.Journal of the American Geriatrics Society,61(2), 281-284. Retrieved from: https://doi.org/10.1111/jgs.12095_2 Carande-Kulis, V., Stevens, J. A., Florence, C. S., Beattie, B. L., Arias, I. (2015). A costbenefit analysis of three older adult fall prevention interventions.Journal of safety research,52, 65-70. Retrieved from: https://doi.org/10.1016/j.jsr.2014.12.007 Child, S., Goodwin, V., Garside, R., Jones-Hughes, T., Boddy, K., Stein, K. (2012). Factors influencing the implementation of fall-prevention programmes: a systematic review and synthesis of qualitative studies.Implementation Science?: IS,7, 91. Retrieved from: https://doi.org/10.1186/1748-5908-7-91 Chua, J. L., Chang, Y. C., Lim, W. K. (2015). A simple vision-based fall detection technique for indoor video surveillance.Signal, Image and Video Processing,9(3), 623-633. Retrieved from: https://sci-hub.tw/https://link.springer.com/article/10.1007/s11760-013-0493-7 Crizzle, A. M., Myers, A. M., Roy, E. A., Almeida, Q. J. (2015). Associations between falls, balance confidence, driving speed, braking, and other driving practices in Parkinson's disease.Physical Occupational Therapy In Geriatrics,33(1), 72-86. DOI: https://doi.org/10.3109/02703181.2014.991057 El-Khoury, F., Cassou, B., Charles, M. A., Dargent-Molina, P. (2013). The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials.BMj,347, f6234. doi: https://doi.org/10.1136/bmj.f6234 Ellison, A. C., Campbell, A. J., Robertson, M. C., Sanderson, G. F. (2014). Prismatic displacement effect of progressive multifocal glasses on reaction time and accuracy in elderly people.Clinical ophthalmology (Auckland, NZ),8, 891. DOI: 10.2147/OPTH.S58193 Goodwin, V. A., Abbott, R. A., Whear, R., Bethel, A., Ukoumunne, O. C., Thompson-Coon, J., Stein, K. (2014). Multiple component interventions for preventing falls and fall-related injuries among older people: systematic review and meta-analysis.BMC Geriatrics,14, 15. Retrieved from: https://doi.org/10.1186/1471-2318-14-15 Gu, Y. Y., Balcaen, K., Ni, Y., Ampe, J., Goffin, J. (2016). Review on prevention of falls in hospital settings.ChineseNursing Research,3(1), 7-10. DOI: https://doi.org/10.1016/j.cnre.2015.11.002 Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., ... Ganz, D. A. (2013). Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness.Journal of the American Geriatrics Society,61(4), 483-494. Retrieved from: https://doi.org/10.1111/jgs.12169 Kami?ska, M. S., Brodowski, J., Karakiewicz, B. (2015). Fall risk factors in community-dwelling elderly depending on their physical function, cognitive status and symptoms of depression.International journal of environmental research and public health,12(4), 3406-3416. DOI: 10.3390/ijerph120403406 Lannering, C., Ernsth Bravell, M., Johansson, L. (2017). Prevention of falls, malnutrition and pressure ulcers among older personsnursing staff's experiences of a structured preventive care process.Health social care in the community,25(3), 1011-1020. DOI: https://doi.org/10.1111/hsc.12400 Lea, E., Andrews, S., Hill, K., Haines, T., Nitz, J., Haralambous, B., ... Robinson, A. (2012). Beyond the tick and flick: facilitating best practice falls prevention through an action research approach.Journal of clinical nursing,21(13-14), 1896-1905. DOI: https://doi.org/10.1111/j.1365-2702.2012.04121.x Lord, S. R., Lacherez, P. (2016). Vision Impairment and Fall Risk in the Elderly. InFall Prevention and Protection(pp. 83-94). CRC Pres Retrieved from: https://www.taylorfrancis.com/books/e/9781482217155/chapters/10.1201%2F9781315373744-14 Lukaszyk, C., Harvey, L., Sherrington, C., Keay, L., Tiedemann, A., Coombes, J., ... Ivers, R. (2016). Risk factors, incidence, consequences and prevention strategies for falls and fall?injury within older indigenous populations: a systematic review.Australian and New Zealand journal of public health,40(6), 564-568. DOI: https://doi.org/10.1111/1753-6405.12585 Menz, H. B., Dufour, A. B., Casey, V. A., Riskowski, J. L., McLean, R. R., Katz, P., Hannan, M. T. (2013). Foot pain and mobility limitations in older adults: the Framingham Foot Study.Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences,68(10), 1281-1285. DOI: https://doi.org/10.1093/gerona/glt048 Miake-Lye, I. M., Hempel, S., Ganz, D. A., Shekelle, P. G. (2013). Inpatient fall prevention programs as a patient safety strategy: a systematic review.Annals of internal medicine,158(5_Part_2), 390-396. DOI: 10.7326/0003-4819-158-5-201303051-00005 National Safety and Quality Health Service Standards. (2012).National Safety and Quality Health Service Standards..Safetyandquality.gov.au. Retrieved 24 March 2018, from https://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-2012.pdf Pfortmueller, C. A., Lindner, G., Exadaktylos, A. K. (2014). Reducing fall risk in the elderly: risk factors and fall prevention, a systematic review.Minerva Med,105(4), 275-81. Retrieved from: https://www.researchgate.net/profile/Carmen_Pfortmueller/publication/261605389_Fall-Related_Emergency_Department_Admission_Fall_Environment_and_Settings_and_Related_Injury_Patterns_in_6357_Patients_with_Special_Emphasis_on_the_Elderly/links/544672540cf2f14fb80f3c76/Fall-Related-Emergency-Department-Admission-Fall-Environment-and-Settings-and-Related-Injury-Patterns-in-6357-Patients-with-Special-Emphasis-on-the-Elderly.pdf Practitioners, T. (2018). RACGP - Falls prevention in older adults assessment and management. Racgp.org.au. Retrieved 24 March 2018, from Retrieved from: https://www.racgp.org.au/afp/2012/december/falls-prevention/ Robertson, M. C., Gillespie, L. D. (2013). Fall prevention in community-dwelling older adults.Jama,309(13), 1406-1407. doi:10.1001/jama.2013.3130 Said, C. M., Batchelor, F., Shaw, K., Blennerhassett, J. (2016). Preparing patients at high risk of falls for discharge home after rehabilitation: Do we meet the guidelines?.Geriatrics gerontology international,16(5), 570-576. DOI: https://doi.org/10.1111/ggi.12511 Stenhagen, M., Ekstrm, H., Nordell, E., Elmsthl, S. (2013). Falls in the general elderly population: a 3-and 6-year prospective study of risk factors using data from the longitudinal population study Good ageing in Skane.BMC geriatrics,13(1), 81. DOI: https://doi.org/10.1186/1471-2318-13-81 Stubbs, B., Schofield, P., Patchay, S. (2016). Mobility Limitations and Fall?Related Factors Contribute to the Reduced Health?Related Quality of Life in Older Adults With Chronic Musculoskeletal Pain.Pain Practice,16(1), 80-89. DOI: https://doi.org/10.1111/papr.12264 Swenor, B. K., Simonsick, E. M., Ferrucci, L., Newman, A. B., Rubin, S., Wilson, V. (2015). Visual impairment and incident mobility limitations: the health, aging and body composition study.Journal of the American Geriatrics Society,63(1), 46-54. Verghese, J. (2016). Person?Centered Fall Risk Awareness Perspectives: Clinical Correlates and Fall Risk.Journal of the American Geriatrics Society,64(12), 2528-2532. SOI: 10.1111/jgs.14375