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Reflection Journal: focus topic is Fall Prevention
Benchmark – Capstone Project Change Proposal
Grand Canyon University
NRS-493-O503 Professional Capstone and Practicum
Davida Murphy Smith
October 23, 2022
Benchmark – Capstone Project Change Proposal
Falling incidences are prevalent among older patients. In some specific healthcare settings, the risk of falls may increase. The outpatient radiology clinic is one of the significant examples of these settings (Li et al., 2018). More than 800,00 older patients encounter fall injuries each year and get hospitalized due to head or hip injuries. However, falls without injuries rates are quite higher (CDC, 2021). The fall rates are continuously increasing from 2007-2017, there was an increase of 30% in death rates in the US, which all occur due to falling risks. Incidents of falls are the most common issues in elder patients over the age of 60 years. The risks associated with falls in the elder include broken bones or fractures of the wrist, arms, hips, and ankles. The proposed change discussion focuses on this specific issue and identifies appropriate interventions and practices that may help address falls and fall injuries.
Falls are one of the common and devastating complications that can occur during a healthcare procedure. According to several pieces of information, the United States is high on falls and there are thousands of people who suffer from falling incidence every year. Specifically, the rate of falls in the radiology department is significantly high, and these incidences are more common among older people (Laukhuf, 2020). Fall and injury prevention remains to be a substantial challenge throughout the care continuum.
Clinical problem statement
Falls are the most common and severe risk factors among elderly patients in any healthcare setting. It has been found that disability and morbidity are the leading factors resulting in falls among the elderly. Muscle strength, mobility issues, and imbalance are significant risk factors for falling incidences among older people. Falls cause severe injuries and a significant risk of death. Some additional causal factors, such as chronic conditions, medications, hazards within the environmental setting (outpatient radiology setting), and other age factors, like decreased balance, may have significant risks to the fall. In addition, improper monitoring during diagnostic care procedures is another crucial risk factor for falls. For example, patients who change into hospital-approved gowns before a clinical diagnosis, specifically Magnetic Resonance Imaging (MRI), are not being monitored or supervised for safety (Anugwom, 2021).
Therefore, it is vital to understand that there is a need for help when elderly patients are changing their clothes, as poor balance while changing clothes may result in falls. Since changing clothes is a private act, healthcare staff must provide necessary services or support as needed to protect their privacy and ensure their safety.
Purpose of the change proposal and in the changing healthcare system
The main reason for the change proposal is to prevent outpatient radiology patients to be at risk for falls and prevent falls, and fall injuries. In recent months our department has experienced high levels of falls. The outpatient radiology clinic setting is unmonitored and does not have fall prevention protocols similar to inpatient settings. Most patients are walkie-talkies and mostly in and out for a radiology procedure; falls are the least to happen, however, falls do happen and sometimes with injuries. Implementing fall prevention strategies in an outpatient radiology setting will definitely provide quality patient care in the constantly changing healthcare system. The main purpose of the change proposal is to have fall prevention protocols, continued assessment and monitoring of patients, and education about fall prevention.
In elderly adult patients in the outpatient radiology clinic (P) what is the effect of placing push button alarms while changing in the dressing room (I) compared with no alarm system (C) reducing the incidence of falls (O) within four weeks (T)?
The literature search strategy employed
The research methodology is selected by the extraction of data from the existing information taken from the secondary analysis. Under the research strategy, a criteria appraisal tool was implicated for the evaluation of functional mobility over the fall risks for older people. The collection of the information brings into account by taking the opinions and preferable choices of elder people. There was no need to take consent from them, as no risks to confidentiality breaching were there under research. The eligibility criteria are based on the inclusion and exclusion criteria. Under inclusion, peer-reviewed articles are selected to address the issues and prevention of falls among adults. However, in the exclusion criteria, the papers that do not support fall prevention strategies for older people are excluded from the study (Riazi et al., 2017).
Evaluation of the literature
Fall incidences are very common as well as devastating complications that can arise during a radiology diagnostic procedure. These incidences are high among older people at an outpatient radiology clinic. Hence, the topic is basically focused on bringing change against falling incidences and preventing falls in an outpatient radiology clinic.
Patient fall is a common problem observed in healthcare organizations. This has become a leading factor for disability and morbidity. Patient falls result in several injuries and also develop a risk of death (Bhasin et al., 2020). Changing clothes in outpatient radiology clinics and imbalances may cause falls and the unavailability of healthcare staff can result in falls and fall injuries. An intervention has been developed to save elderly people from falling while changing their clothes. Push button alarm in the clinical setting has supported many patients and it has also provided assistance for balancing (Kandakoglu et al., 2020). The push-button alarm system has been useful in improvement in the overall health of patients. This has been a very effective way of dealing with clinical issues in no time and in decreasing clinical risks. Changing clothes is a basic requirement for radiology diagnostic procedures. The application of push-button alarm systems in dressing rooms in outpatient radiology clinics will help patients while changing to approved MRI-safe hospital gowns.
(Please see Literature Evaluation Table)
Applicable change or nursing theory utilized.
Changes bring a multitude of different reactions to different individuals. Change may have two sides – the positive which brings forth advancement to the person, to an organization, or community; the negative brings downsizing, changes in routine, and sometimes an uproar among employees. There are multiple change theories that can be used. For my change proposal, Lewin’s Theory of Planned Change Theory will be applied.
Lewin’s Theory of Planned Change has three stages: unfreezing, change, and refreezing. Unfreezing is the first stage, which involves the process of finding a method to assist individuals in letting go of an old pattern of behavior and facilitating individuals in overcoming resistance and group conformity (Kritsonis, 2005). The second stage is change which involves the process of a change in thoughts, feelings, and/or behaviors (Udod and Wagner, 2018). The third stage involves establishing the change as a new habit (Udod and Wagner, 2018).
Lewin’s three-step change theory can be applied to a change proposal project. This change theory is more rational and realistic due to the linearity of the theory. The driving factor in my project is the prevention of falls. Education about falls brought about by the decreased mobility and age of the elderly population and making safety a priority is the unfreezing stage. The second stage is patients having the awareness of fall prevention and fall safety. The third stage would be patients and staff have established the standard of patient safety and fall prevention when having testing and procedures in the outpatient radiology clinic. The continual realization of the change proposal is supported by reeducating and encouraging the nurses to adopt the proposed evidence-based practice for fall prevention.
Proposed implementation plan with outcome measures
Nurses are an essential part of a healthcare organization. Creating a strategic plan for a capstone change proposal permits nurses to effectively use their unique nursing skills. A strategic plan will define how to improve patient safety and quality of care. This may include multiple stages to work toward a single goal which is fall prevention. Centers for Disease Control and Prevention recommends frequent assessments to help identify patients who are at high risk for falls.
· The chief strategy in the nursing practice interventions that will be implemented is screening patients for falls. All patients will be screened upon check-in for their scheduled outpatient radiology diagnostic testing. Assessment and proper monitoring will assist to recognize patients as high risk for falls.
· Integrating trained and efficient patient care technicians to provide assistance for patients as needed.
· Educating elderly adults about fall prevention and the factors of falls is another key strategy to be implemented.
· Providing a safe environment such as clean non-slippery floors, and handrails in hallways, bathrooms, and dressing rooms.
1. Develop a fall guideline questionnaire or screening questions for ages 60 and above.
Rationale: An assessment tool to help detect at-risk fall patients. Help educate patients on key factors and external or environmental factors that cause falls. Approaches to prevent falls and decrease injury. 2. Placement of push button alarms in high-risk areas of falls such as bathrooms and dressing rooms will prevent or decrease the incidence of falls. Rationale: Having a tool near you for safety like a push button alarm will alert healthcare workers of patient needs. The push button alarm is a safety net that would prevent the incidence of falls and other injuries. 3. Having an extra staff like a patient care technician (PCT) would be a positive effect on elderly patients. Rationale: The availability of a PCT would be a big help for elderly patients that come to the outpatient radiology clinic alone. There is a percentage of older adults with no companion or family members with them that come for radiology diagnostic testing. Having a PCT or extra staff would be beneficial for these patients for safety and decrease the incidence of falls.
Discussion of how evidence-based practice was used in creating the intervention plan
Under the interventions, nurses can choose the standard risk assessment and implicate the appropriate prevention strategies. Under the risk assessment plan, they need to assess the following interventions such as:
· Maintaining mobility and agility of patients
· Helping outpatients change from their own clothes to the approved hospital gowns with the assistance of a patient care technician (PCT)
· Improving the check-in process by incorporating fall questionnaires and assessments for patients in the outpatient radiology clinic
· The placement of push-button alarms must be accessible to patients in the outpatient radiology clinic, especially when they are in the dressing room while changing
· The need to educate patients on the dangers of falls, especially in unmonitored settings
Nurses can incorporate evidence-based practice to minimize the negative impact of environmental and cultural perspectives that way outpatients can feel comfortable and be aware of falls in outpatient settings. Technical interventions and clinical-based interventions can be applied and utilized. Technicians doing the radiologic testing must remember to adjust procedure table height according to patient height – not too low nor too high, proper lighting, and call light if assistance is needed. Environmental measures, such as non-slippery floors in hallways and in radiology rooms. Patients having outpatient radiology procedures can be at a higher risk because of unmonitored settings. These patients need monitoring so that fall injuries can be prevented among the elder people (Barker et al., 2019). The push-button alarms for the outpatient radiology clinic should be applicable to all outpatients and educate them about fall prevention. A sole nurse should not be responsible for intervention, but the whole team should be involved (Guerbaai et al., 2022).
Plan for evaluating the proposed nursing intervention
Tai chi (functional mobility with gentle exercise) is one of the specific strategies, which is used in many countries to implicate in health centers and clinics to prevent falls among adults (Huang et al., 2020). Tai chi is a type of functional exercise, which can be provided to patients who have crossed 60 years and admit frequently to hospitals. Under this technique, mind-to-body exercise is carried with slow movement to make the muscles active and strengthen to move. This type of intervention also includes gentle massage and improving postural balance. Slow exercises are highly effective for the management of the condition and improve the functional capacity of older people. The systematic review and meta-analysis of Huang et al. (2020) have found that Tai Chi improves the rates of fall prevention by 31% (Nyman, 2020). Concerning the different demands of the patients, not all the strategies can fit in an intervention, as the needs of the patients differ according to their requirements, circumstances, and situations. yoga, meditations, and appropriate diet. The diet is enriched in vitamins such as vitamin D. The evaluation of a nursing care plan for improving fall intervention in older patients is done using the appraisal tool, named “fall risk factors”.
Identification of potential barriers to plan implementation, and a discussion of how these could be overcome
The potential patients’ self-imposed barriers that inhibit them to undergo effective care plans include:
· Patients may not be confident about how to relate the precautions with fall prevention strategies
· Older people who are restricted to their beliefs may not support massage and other logistical support.
· Sedentary behavior, lower self-efficacy, stigmatization, denial of risks, and failures of availability of adequate nurse staff to provide critical care support to patients are some of the specific barriers that can encounter major fall risks, which may impact patients’ health outcomes (Edminster et al., 2021).
Thus, in order to overcome these issues, the incorporation of the tai chi program into the U.S. National Institute of Health’s National Centre has resulted in a significant improvement in the health of older people, by improving the risks of falls, flexibility, coordination, muscle strength, and physical condition. Also, intervention suggested that Tai chi had a positive impact on the economy of the U.S. by reducing falls among patients who had Parkinson’s disease, vestibular rehabilitation, cognitive impairment, dementia, and osteoarthritis (Chen et al., 2022).
REFINE (Reducing Falls in In-patient Elderly) is one of the trusted techniques to assess the health and life quality of older people. Under this technique, their bedside sensor ring (telecare) tends to monitor all the healthy activities of patients and provide them with benefits to utilize in the future use (Vass et al., 2009).
The inclusion of various strategies and implementation of practices need to be incorporated to reduce the incidence of falls among older people, such as the inclusion of gait, balance, Tai chi, functional training, and vitamin D supplements. Nurses and radiology staff should also focus on fall education as well as on determining high-risk fall patients by including a fall questionnaire at the check-in of patients. Environmentally appropriate lighting in rooms and bathrooms and hallways and having handrails to assist patients for extra stability. The placement of push alarm buttons strategically will allow patients to be able to seek help when needed. The proposed extra staff for patients such as patient care technicians (PCT) is part of the intervention that will be able to prevent falls or fall injuries. Along with these interventions, nurses should encourage and maintain the mobility and agility of elderly patients, so that their muscles do not stiffen to perform any activities. A patient care provider (or technician) should also monitor patients’ activities while they are changing or dressing, or walking to the bathroom without support. Continuous assessment and monitoring of patients while in the outpatient radiology clinic may prevent falls. Being vigilant with our elderly patients about fall prevention, being safe, and heightened awareness of their personal routines may help decrease falls.
An appendix section, for evaluation tools and educational materials, etc.
Anugwom, O. (2021). Effective Implementation of Hourly Rounding Using the 4Ps Reduces the Fall Rate among Older Adults 65 Years and Older in a Skilled Nursing Facility (Doctoral dissertation, University of Massachusetts Global).https://search.proquest.com/openview/a6dda1793a0abc573bbaabff878a5296/1?pq-origsite=gscholar&cbl=18750&diss=y
Barker, A., Cameron, P., Flicker, L., Arendts, G., Brand, C., Etherton-Beer, C., & Hill, K., (2019). Evaluation of RESPOND, a patient-centered program to prevent falls in older people presenting to the emergency department with a fall: A randomized controlled trial. PLoSMedicine, 16(5). https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002807
Bhasin, S., Gill, T. M., Reuben, D. B., Latham, N. K., Ganz, D. A., Greene, E. J., & Peduzzi, P. (2020). A randomized trial of a multifactorial strategy to prevent serious fall injuries. New England journal of medicine, 383(2), 129-140. https://www.nejm.org/doi/full/10.1056/NEJMoa2002183
Chen, J., Xue, X., Xu, J., Zeng, J., & Xu, F., (2022). Emerging trends and hotspots in tai chi fall prevention: analysis and visualization. International Journal of Environmental Research and Public Health, 19(14), 8326. https://www.mdpi.com/1715824
Edminster, B. S. N., CFRN, T., & CEN, N. B., (2021). Community-Dwelling Older Adult Fall Prevention Improvement Project. https://repository.usfca.edu/capstone/1360/
Guerbaai, R. A., Kressig, R. W., Zeller, A., Tröger, M., Nickel, C. H., Benkert, B., & INTERCARE Research Group., (2022). Identifying appropriate nursing home resources to reduce fall-related emergency department transfers. Journal of the AmericanMedicalDirectorsAssociation. https://www.sciencedirect.com/science/article/pii/S1525861022001037
Huang, Y., Wu, C., Peng, H., Chen, Q., Fan, X., Xiao, L., … & Wan, L. (2020). The correlation between fall prevention knowledge and behavior in stroke outpatients. Journal of neuroscience nursing, 52(2), 61-65.https://journals.lww.com/jnnonline/FullText/2020/04000/The_Correlation_Between_Fall_Prevention_Knowledge.6.aspx
Kandakoglu, A., Sauré, A., Michalowski, W., Aquino, M., Graham, J., & McCormick, B. (2020). A decision support system for home dialysis visit scheduling and nurse routing. Decision Support Systems, 130, 113224. https://www.sciencedirect.com/science/article/pii/S0167923619302532
Kritsonis, A.(2005). Comparison of change theories. International Journal of Scholarly and Academic Intellectual Diversity, 8(1): 1-7.
Li, F., Harmer, P., Fitzgerald, K., Eckstrom, E., Akers, L., Chou, L. S., … & Winters-Stone, K. (2018). Effectiveness of a therapeutic Tai Ji Quan intervention vs a multimodal exercise intervention to prevent falls among older adults at high risk of falling: a randomized clinical trial. JAMA Internal Medicine, 178(10), 1301-1310.https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2701631
Laukhuf, G. (2020). Patient Falls in Radiology. In Advanced Practice and Leadership in Radiology Nursing (pp. 205-212). Springer, Cham. https://link.springer.com/chapter/10.1007/978-3-030-32679-1_18
Nyman, S. R., (2020). Tai Chi for the prevention of falls among older adults: A critical analysis of the evidence. Journal of Aging and Physical Activity, 29(2), 343-352. https://journals.humankinetics.com/view/journals/japa/29/2/article-p343.xml
Riazi, A. M., (2017). Mixed methods research in language teaching and learning. Equinox Publishing. https://researchers.mq.edu.au/en/publications/mixed-methods-research-in-language-teaching-and-learning
Udod, S.A., and Wagner, J. (2018). Common Change Theories and Application to Different Nursing Situations. Retrieved from https://leadershipandinfluencingchangeinnursing.pressbooks.com/chapter/chapter-9-common-change-theories-and-application-to-different-nursing-situations/
Vass, C. D., Sahota, O., Drummond, A., Kendrick, D., Gladman, J., Sach, T., & Grainge, M., (2009). REFINE (Reducing Falls in In-patient Elderly)-a randomised controlled trial. Trials, 10(1), 1-9. https://link.springer.com/article/10.1186/1745-6215-10-83
Reflection Journal 10
Students are required to maintain weekly reflective narratives throughout the course to combine into one course-long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum course.
In your journal, you will reflect on the personal knowledge and skills gained throughout this course. The journal should address a variable combination of the following, depending on your specific practice immersion clinical experiences:
Please focus on the topic: Fall Prevention in Outpatient Radiology Clinic
New practice approaches
Healthcare delivery and clinical systems
Ethical considerations in health care
Population health concerns
The role of technology in improving health care outcomes
Leadership and economic models
Students will outline what they have discovered about their professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and finally, how the student met the competencies aligned to this course.
While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This benchmark assignment assesses the following programmatic competencies:
RN to BSN
1.3: Understand and value the processes of critical thinking, ethical reasoning, and decision making.
2.6: Promote interprofessional collaborative communication with health care teams to provide safe and effective care.
3.2: Utilize patient care technology and information management systems.
4.2: Preserve the integrity and human dignity in the care of all patients.
5.5: Provide culturally sensitive care.