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Abstract

Nursing interventions (mention at least 2)

Conclusion

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Patient falls is one of the commonest events within the healthcare facilities that affect the safety of the patients. Preventing falls among patients requires various methods. Recognition, evaluation, and preventing of patient falls are great challenges for healthcare workers in providing a safe environment in any healthcare setting. Hospitals have come together to understand the contributing factors of falls, and to decrease their occurrence and resulting injuries or death. Risk of falls among patients is considered as a safety indicator in healthcare institutions due to this. Falls and related injuries have consistently been associated with the quality of nursing care and are included as a nursing-quality indicator monitored by the American Nurses Association, National Database of Nursing Quality Indicators and by the National Quality Forum. (NCBI)Falls And Falls Risk Reduction In Nursing Essay
When taking steps to analyze and apply intervention strategies for falls, we must examine the factors that cause these occurrences. There are numerous reasons that falls occur, such as intrinsic and or extrinsic risk factors. Intrinsic risk factors for falls may be due to changes that are part of the normal aging process and acute or chronic conditions. According to Zheng, Pan and Hua et al. (2013), about 35-45 percent of individuals who are usually older than 65 years and other 50 percent of the elderly individuals report cases of fall every year. Extrinsic factors are those related to physical environment such as lack of grab bars, poor condition of floor surfaces, inadequate or improper use of assistive devices (Currie). Patient falls is not an easy thing to eliminate.

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The occurrence of patient falls is a very important health concern facing the healthcare
industry. Many patients not only experience falls, but have falls with an injury. This is a patient
safety concern that can have serious effects on patient outcomes, is a leading cause of patient
injuries in hospitals, and are costly adverse events (Trepanier & Hilsenbeck, 2014). It is
important that healthcare professionals determine ways to prevent what has been deemed a
preventable event (Bemis-Dougherty & Delaune, 2008). In 2005 The Joint Commission (TJC)
included patient falls with injury as part of their National Patient Safety Goals (Bemis-Dougherty
& Delaune, 2008). The desire was to reduce these events that cause harm to patients in the
hospital setting.Falls And Falls Risk Reduction In Nursing Essay
In the inpatient hospital setting patients are very unfamiliar with their environment which
places them at a higher risk for falls (McCarter-Bayer, Bayer, & Hall, 2005). The arrangement of
the room is different as the light switches are not positioned where they normally are, the
bathroom is not in the same position it would be in the patient’s home and many of the features
of the environment are different increasing the risk of the patient falling and sustaining injury
(Anderson, Dolansky, Damato, & Jones, 2015).
Patients are also at high risk for falls with injury due to their weak physical state at the
time of their admission to the hospital (McCarter-Bayer et al., 2005). Patients with acute and
chronic diseases are weaker and can subsequently sustain falls with an injury (Anderson et al.,
2015). The purpose of this chapter is to describe the microsystem reviewing any important
findings, present the practice problem and present evidence from the microsystem, give a brief
PATIENT FALLS 3
introduction to the literature supporting the practice problem, and present a brief description of
the nature of the project related to reducing falls with injury.
Microsystem Assessment and Review of the Findings
The microsystem assessment was performed at Midwestern hospital that is a part of an
extensive national macrosystem in the United States. The health system serves 21 states with 86
hospitals. The Midwestern hospital has 2500 employees and has 344 acute beds. Within the 344
acute beds the opportunity presented itself to perform a microsystem assessment. The
microsystem is a 42 bed unit whose primary patient population are oncology patients. This unit is
also the primary unit for bariatric surgery patients. The bariatric surgery census ranges from 15
to 20 patients a week. The balance of the patients on the unit are considered general medicalsurgical overflow. A bariatric trained registered nurse (RN) rounds on a daily basis providing
specialty services for the bariatric patients.Falls And Falls Risk Reduction In Nursing Essay
The oncology patients are the primary patients on the medical-surgical unit. Many
registered nurses on this unit have received special training to provide assessments and provide
interventions for oncology patients. Many times chemotherapy medications need to be
administered on the unit and the nurses are trained to provide that service. After one year of
service on the unit the RNs can work through the process to become chemotherapy certified to
administer these medications. There are 70 RNs on this unit and over half are certified to
administer chemotherapy.
This microsystem has a diverse patient population and the patients are at an increased risk
for falls with injury due to the multiple diagnoses that affects their health status. Many of these
intrinsic health factors increase the patients’ dependency and reduces their independence placing
PATIENT FALLS 4
them at a higher risk for falls with injury (McCarter-Bayer et al., 2005). Extrinsic health factors
such as the potent medications administered for the post-operative bariatric patient and those
receiving chemotherapy will place the patient at a higher risk for falls with injury (Anderson et
al., 2015).
Practice Problem and Stakeholders
The practice problem that exists is that patients continue to fall and are sustaining
injuries. Falls can be classified as an unintentional descent by a patient that results in the patient
coming to rest on the floor (Trepanier & Hilsenbeck, 2014). The Midwestern hospital defines a
fall as a sudden change in body position in a downward direction, which may or may not result
in a physical injury. A sudden, uncontrolled, unintentional, downward displacement of the body
to the ground or object, excluding falls resulting from violent blows or other purposeful actions.
This also includes all assisted falls events.
One of quality improvement projects for the microsystem is to reduce falls with injury.
The microsystem was actually doing well in this area over a year ago and the falls rate had
reduced. During the time period from June 2015 to December 2015, there were 20 falls and of
that number four involved an injury. Since January 2016 five falls have occurred with two of
those resulting in a minor injury. Due to the increased incidence of falls and falls with injury the
leadership team is determined to track the root cause and institute or reinforce interventions for
prevention. The unit leadership staff are aware that these falls can result in an injury that can
have harmful effects on the patient. The microsystem attempts to identify those at high risk for
falling by performing the Morse fall risk assessment twice a day. If a score of 45 or greater is
calculated the RN must implement a universal intervention that will hopefully prevent a fall from
occurring. Interventions that are utilized by the staff are gait belts, bed alarms, chair alarms, Falls And Falls Risk Reduction In Nursing Essay
PATIENT FALLS 5
hourly rounds, toileting schedules, and charting near the patient’s room that has been deemed a
high fall risk. The Midwestern hospital tracks falls by the number of falls per patient days
multiplied by 1000. These falls have an effect on the patient, patient’s family, and the hospital
staff and all key stakeholders that work with the patient to provide safe care. When a fall occurs
there is a multidisciplinary response. Interdisciplinary Teams (IDT) are important to effective
fall and injury prevention programs (Quigley, 2016). The IDT can be impactful because they can
approach the clinical problem from different viewpoints and each disciplines has a different
knowledge base that can be used to intervene with the problem (McCarter-Bayer et al., 2005).
The unit communication process for fall events is complex. When a fall occurs on the
microsystem the bedside nurse must contact and involve several individuals responsible for the
patient’s care. The bedside nurse must first call the charge nurse, then the nurse must notify the
provider that a fall has occurred. If the patient has sustained an injury the provider will
subsequently order a CT scan or X-rays depending on the type of injury to rule out any major
traumas. The RN must complete an electronic report for the risk management department to
describe the fall event and why the patient experienced the fall. The RN must notify the Clinical
Nurse Leader (CNL) and the unit manager that a fall has occurred. The RN then will need to
communicate with the patient care assistant regarding any changes in the patients care plan to
improve safety measures to prevent any additional falls.
Introduction to the Literature
Falls with injury increase morbidity, mortality, and costs to the healthcare system. The
literature supports that this is a significant practice problem. In the United States nearly 11,000
patients will die annually related to complications after sustaining a fall with injury (Anderson et
al., 2015). The incidence of falls in the inpatient hospital setting has been documented to be as
PATIENT FALLS 6
high as 15% and of this number up to 42% will sustain an injury (Anderson et al., 2015). Patients
who sustain an injury from a fall could have up to 60% higher costs for their treatment or
hospitalization (Bemis-Dougherty & Delaune, 2008). According to the Center for Disease
Control (CDC) in 1990 (as cited in Bemis-Dougherty & Delaune, 2008) the treatment of all falls
with injury was $20.2 billion and is estimated to rise to between $30 and $40 billion by 2020.
Center for Medicare and Medicaid Services (CMS) has identified falls with injury as a
preventable hospital acquired condition, therefore they will no longer reimburse costs associated
with the treatment of these falls (Quigley, 2016).
Nature of the Project
The nature of this project is to determine if a multifactorial approach would help reduce
falls with injury. Studies show that it is not just one particular factor that increases the risk of a
patient falling (Kwan & Straus, 2014). The clinician must assess if there are risk factors that
place the patient at risk for falls beyond the usual indicators such as age, gender, recent falls, and
mobility deficits. The clinician must use their clinical judgment with thorough clinical
assessments in determining fall and injury risk factors (Quigley, 2016). No matter what the risk
screening shows or scores the nurse must use clinical judgment to assess the patient’s risk for
falling.
For the Morse Fall Risk assessment, a score of 45 or greater means the patient should
receive some preventative measures to prevent a fall. If the patient receive a score of less than 45
the nurse must use their clinical judgment to determine if other factors exist that increase the risk
of the patient falling (Tzeng & Yin, 2015). The causes of falls are multiple so the interventions
should be multifactorial (Kwan & Straus, 2014). Single interventions can be ineffective, but
PATIENT FALLS 7
multifactorial and RN tailored interventions are demonstrating some success in reductions in
falls and fall-related injuries (Mion, Chandler, Waters, Falls And Falls Risk Reduction In Nursing Essay Dietrich, Kessler, Miller, & Shorr, 2012).
In order to determine if patient falls and patient falls with injury can be reduced at the
microsystem level, the clinical question should be considered using a PICOT (population,
intervention/issue, comparison of interest, outcome) format:
• Could patients in the microsystem experience reduced falls with injury as a result
of a multifactorial falls risk assessment and interventions compared to the usual, universal fall
risk prevention practice by year end of 2016?
PATIENT FALLS 8
Chapter 2
Literature Review
The Center for Disease Control (CDC) reports that falls are a leading cause of death
among the elderly in the US (McCarter-Bayer, Bayer, & Hall, 2005). CMS has decided that falls
is a hospital acquired injury and is considered serious and should be preventable (Anderson et
al., 2015). It is estimated that 42% of falls will result in injury (Anderson et al., 2015). It is
estimated that by the year 2020 the consequences of falls will cost $32 billion annually
(Dougherty & Delaune, 2008). One proposed idea to prevent falls and falls with injury from
occurring is to take a multifactorial intervention and assessment approach. A multifactorial
approach is when the plan of care is designed specifically according to the patient assessment to
target specific risk factors (Cameron et al., 2010). Multifactorial assessments have been shown to
reduce falls and falls with injury. Dupree, Fritz-Campiz, and Musheno (2014) demonstrated by
using targeted interventions, tailored based on the patient assessment they were able to present
data that reduced falls with injury by 62% from the pre-intervention status. Many of these
interventions are implemented by nurses. Nurses are the keepers of the bedside and are closest to
the patient and family, thus in a position to educate and intervene to prevent harmful fall events
(Dupree et al., 2014).
Review of the Literature
A review of the literature was conducted using CINAHL, PubMed, ProQuest, and The
Cochrane Library. The search terms used were: “falls with injury”, “falls in hospitals”,
“preventing falls”, “and preventing falls with injury in hospitals”. The search of the databases
was performed to obtain the highest level of evidence such as systematic reviews and
PATIENT FALLS 9
randomized control trials. The search yielded 5,122 publications, then the search was narrowed
to full text articles, and then by type/level of the study. The end result was nine articles deem
relevant to the clinical problem. The studies met the inclusion criteria if by focusing on reducing
falls or falls with injury. Each study is summarized with the strengths and weaknesses reviewed.
The studies are grouped by risk factors, interventions, and the level of evidence.
Risk Factors
Kwan and Straus (2014) conducted a review of the evidence related to assessing risk
factors and interventions for falls. The objective was to identify relevant high quality systematic
reviews and meta-analysis that address assessment of risk factors and studies that evaluated
interventions to prevent falls.
Kwan and Straus (2014) reviewed 14 studies evaluating risk factors for falls. Of the 14
studies nine were systematic reviews that consisted of various levels of evidence such as
prospective cohort and cross sectional design of case control and cohort studies. There were also
five meta-analysis studies that consisted of two randomized control trials (RCTs), and three
prospective studies. The risk factors reviewed by Kwan and Straus (2014) were age, previous
falls, cognitive impairment, visual impairment, medications, functional limitations, home
hazards, orthostatic hypotension, balance impairment, and impairment of gait or balance.
The statistical significance for the risk factors for falls among the various studies did
yield statistically significant results. The probability of falls by age increased from 31% at age 65
up to 37% for age > 80 (Kwan & Straus, 2014). There was an increased likelihood ratio (LR) of
2.3-3.8 greater odds of falling if the participant had fallen within the past year.
PATIENT FALLS 10
Two of the studies on cognitive impairment two had evidence that participants with a
history of dementia and > one fall had an increased LR of 17 times greater odds of falling (Kwan
& Straus, 2014). There were significant results of increased LR of falls with visual impairment
(3 studies), functional limitations (5 studies), impairment of gait or balance (6 studies), and home
hazards (2 studies). Orthostatic hypotension showed no association with falls when other risk
factors were considered. The review yielded results that multiple drug usage had an increased LR
of falls.
Staggs, Mion, and Shorr (2014) conducted a cross-sectional analysis of falls in 2011
available data in 1,464 general hospitals that participate in reporting to the National Database of
Nursing Quality Indicators (NDNQI). The purpose of this study was to review data from the
NDNQI to determine if falling assisted versus unassisted would increase the likelihood of injury
or a specific level of injury. The study also looked at whether having a specific falls prevention
protocol would affect the outcomes of the fall.
Evidence that patients who fall and do not have a fall prevention protocol in place were
more likely to fall unassisted and were more likely to result in injury. The authors presented the
concept that falls that are assisted are a result of the clinician properly assessing and identifying
the patient as high risk for falls. Staggs et al. (2014) discussed that unassisted falls suggest that
system failures or the lack of a fall prevention protocol has an increased likelihood that patients
at high risk would not be identified. This gap in identifying the patients at high risk will result in
the patients moving independently increasing the potential for an unassisted fall and increase the
potential for a patient injury.
Results of the data analysis revealed that 19,607 falls were classified as assisted and
134,717 as unassisted. These study results revealed that the patients in units without a fall
PATIENT FALLS 11
prevention protocol in place had statistically significantly higher odds of falling unassisted.
There were a significantly higher odds for injury with falls that are unassisted than falls that are
assisted.
This study had several limitations. One limitation of the study could possibly be the
reporting of inaccurate or biased data due to the voluntary reporting guidelines of NDNQI.
Another limitation was the variation in the size and type of hospitals and units that could
generate biased results.Falls And Falls Risk Reduction In Nursing Essay
Interventions
Kwan and Straus (2014) reviewed 19 studies evaluating interventions for preventing falls.
Of the 19 studies ten were systematic reviews that consisted of various levels of evidence such as
controlled trials, quasi-RCTs, and one study that was a systematic review and meta-analysis of
RCTs. There were also 7 meta-analyses of RCTs reviewed. There was one meta-regression of
RCTs included in the review. In the studies there were 11 with single intervention, 5 with
multiple interventions, and 3 with both single and multifactorial interventions. The interventions
were Otago exercise, home assessments, exercise combined with other approaches, progressive
resistive training, primary care interventions, vitamin-D, Tai chi, and whole body vibration.
Of the 19 studies reviewed 13 produced statistically significant evidence that the tested
interventions reduced falls. There were five of the 13 studies that utilized multifactorial,
multicomponent, and multidisciplinary interventions that reduced the rate of falls. The
multifactorial study Cameron et al. (2010) as cited by Kwan and Straus (2014) used a
combination of exercise, medications, environmental modifications, knowledge, and measures to
PATIENT FALLS 12
address other factors and yielded statistical results of a reduced LR of .69 or 31% decreased odds
of a fall in the hospital setting.
The preponderance of evidence does suggest that multifactorial interventions do reduce
falls. Kwan and Straus (2014) suggest that the cause of falls and falls with injury are many and
the care provided should reflect a multifactorial approach tailored to the patient risk factors
established from a thorough history and physical examination. The assessment and management
of this preventative care should be handled by a multidisciplinary team based on the falls risk
factors identified. When following the proper care plan there is a potential for a reduction in
these harmful events.
Goodwin et al. (2014) conducted a systematic review and meta-analysis related to the use
of multiple component interventions for preventing falls and fall-related injuries. The objective
of the review is to determine the effectiveness of a multiple component intervention to reduce
falls and fall related-injuries. There were 18 papers reporting on 17 studies reviewed by the
authors. Studies met the inclusion criteria if they were RCTs, making a comparison of multiple
component interventions for fall prevention on fall rate, number of fallers, or fall-related injuries
compared with no intervention, placebo, or usual care. Multiple component approach was
distinguished from the multifactorial approach to fall prevention and intervention. A
multifactorial approach included a patient assessment and an individualized plan of care. While
the multiple component approach does not require an individual assessment or tailoring of fall
prevention interventions, a fixed combination of interventions was used. Of the 17 studies 14 had
one intervention group, and three studies had two or more intervention groups. Twelve of the
studies included exercise as part of the multiple component intervention and one additional
intervention. Two studies consisted of medication and nutritional supplements or medication and
PATIENT FALLS 13
sunlight exposure as interventions. The control groups were described as usual care which
included information sharing, social visits, and no intervention.

NOW

The study had several limitations. The article did not give comparison statistics for the
usual care but only the multiple component outcomes. The statistical results for the multiple
component intervention should have been listed with more statistical detail. It would have been
more informative for the researchers to explain the statistical significance and how they arrived
at their conclusions. The review failed to present evidence that the multiple component approach
was more effective than or as effective as a multifactorial approach, because no comparison was
made between the two types of interventions.
In summation, Goodwin et al. (2014) was able to present evidence that multiple
component interventions can produce a statistically significant reduction in falls in comparison to
controls. The systematic reviews and meta-analysis presented evidence that multiple component
interventions that are not tailored individually to the patient can reduce falls. Future studies will
be needed to compare the effects of a multicomponent intervention versus a multifactorial
intervention to reduce falls and related injuries.Falls And Falls Risk Reduction In Nursing Essay
Cameron et al. (2010) conducted a systematic literature review to assess the effectiveness
of multiple interventions that are used in skilled nursing facilities and hospitals to reduce falls
among older people. The research team reviewed 41 RCTs that were evaluated out in 13
countries. These studies were randomized such that fifteen studies used a cluster randomized
design and in the remaining 26 studies the subjects were randomized individually. Of the 41
studies, 30 were conducted in skilled nursing care facilities and the remaining 11 studies were
conducted in the hospital setting. The primary outcome measures the researchers were seeking
was studies that determined the number of falls and the number of people who fall. The study
PATIENT FALLS 14
results revealed that single interventions did not produce a reduction in falls. In skilled nursing
care facilities the single interventions were inconsistent. For skilled nursing care facilities
statistical significance for reduction of falls was found only with the combination of a
multidisciplinary team and multifactorial interventions. In hospitals multifactorial interventions
reduced falls and the risk for falls.
A few limitations was noted in this study. Sixty-eight percent of the outcome assessors
were not blinded increasing the potential for bias in the interpretation of the data. None of the
studies provided a cost analysis for the interventions as this would help institutions to realize the
potential fiscal impact of using interventions. The study participants were not broad in diversity
of age groups, and therefore not generalizable to a younger population. Only eleven
hospitals/acute care settings were included.
In summary the evidence of this review does support that multifactorial interventions
targeted at specific risk factors for the patient will potentially reduce falls in skilled nursing care
facilities and hospitals. More studies will be needed that focus solely on hospitals to determine if
a stronger statistical and clinical effect can be ascertained indicating success at reducing falls and
falls with injury.
Dykes et al. (2010) conducted a cluster RCT comparing patient fall rates in four urban
United States (US) hospitals. The inclusion criteria was medical units with a mean falls rate
higher than the institution and were matched with units with similar fall rates and total number of
patient days. There were a total of eight hospital units that met the inclusion criteria. Four of the
units served as the control units receiving usual care and the other four units served as the
intervention group. The objective of this study was to determine if a fall prevention tool kit
PATIENT FALLS 15
(FPTK) using health information technology (HIT) could decrease patient falls in the acute care
setting.
The control group received the usual care of a fall risk assessment with the Morse Falls
Scale (MFS), for a score above 45 on the MFS the patient would have a fall risk sign placed
above the bed, patient and family was educated and given printed materials on fall prevention,
and the plan was documented either manually or in the electronic health record (EHR). The
intervention group received MFS using the FPTK, interventions were automatically triggered
and were tailored by the nurse (RN) based on the assessment of the patient, educated patient and
family education using tailored handouts, and the FPTK generated a tailored plan of care based
on the fall risk assessment. The study was conducted over a six month period. The control group
and the intervention groups were studied simultaneously as they were on separate units.
The primary outcome sought was to reduce falls in the hospital, and a secondary outcome
was to reduce falls with injury. The study noted a reduction in falls and falls with injury. Patients
65 and older in the intervention groups experienced the most benefit from the FPTK. The study
revealed a decrease in falls with injury, but it was deemed not to be statistically significant.Falls And Falls Risk Reduction In Nursing Essay
Overall the study results presented that potentially the FPTK could prevent one fall every four
days or 90 falls annually across the studied units.
A few limitations was noted. The first limitation was that the study was performed in
hospitals that were a part of the same health care system which could potentially affect the
generalizability of the FPTK. The authors did state that this was probably overcome due to the
fact that the units chosen were diverse in their patient population. Another limitation is that the
FPTK intervention was not blinded, therefore the intervention potentially introduced some bias
PATIENT FALLS 16
by the caregivers. The FPTK was not successful with patient’s less than 65 or younger patients
possibly because staff were more lenient with implementing interventions.
The study did produce evidence that the multifactorial FPTK did reduce falls and
produced clinically significant indications that fall related injuries were reduced. Overall the
generalizability of this study could potentially be used across different health care systems, but it
would be best to confirm by performing a randomized study across multiple health care systems.
Ang, Mordiffi, and Wong (2011) conducted a randomized controlled trial (RCT) to
determine if multiple interventions could reduce the number of patient falls in the acute care
hospital. The inclusion criteria was the patients had to be 21 or older and have a Hendrich II Fall
Risk score of 5 or greater. The objective of the study was to determine if targeted multiple
interventions could reduce falls in those identified as high risk for falls in comparison to the
usual care. The control group would receive the usual care provided to high fall risk patients. The
usual care consisted of a fall risk assessment, the call light and bed locker within the patients
reach, bed rails raised, and the bed would be in the lowest position. The intervention group
received all the interventions contained in the usual care and also received an educational session
on targeted multiple interventions specific to the patients assessed risk factors.
The study yielded a reduction in falls with the intervention group. A total of 18 high risk
patients fell and of that number 4 were of the intervention group and 14 were of the control
group. The proportion of those that fell were significantly lower in the intervention group
compared to the control group. This study had several limitations. The study may not be
generalizable to other patient settings because it was conducted at acute care setting. The study
effect may not be sustainable because the research nurses had time to implement the targeted
PATIENT FALLS 17
multiple interventions for the intervention group. The regular unit nurses will probably have less
time due to their many responsibilities with patient management.
In summary Ang et al. (2011), study yielded statistically significant evidence that tailored
multiple interventions strategies in comparison to usual care reduced falls in the acute care
setting. Most units will not have a research RN on staff to lead a fall prevention interventions.
For future studies it will be important to allow the bedside RN instead of a research RN to lead
the interventions to establish realistically if the results can be duplicated. It will be beneficial for
future research teams to track fall related injuries as well as falls and determine if evidence of a
reduction in injuries can be detected using a tailored multiple intervention strategy.
Tzeng and Yin (2014) conducted a cross-sectional nurse survey at five US healthcare
systems studying interventions to prevent falls with injury. The objective of the study was to
identify the top ten interventions to prevent falls with injury from the RNs perspective in an
acute care hospital. The study was performed across 10 different types of specialty units. The
specialty units were medical, surgical, medical-surgical, telemetry, oncology, orthopedics,
cardiac, women’s health and delivery, behavioral health, and rehabilitation. The research team
sent out 2170 surveys and of this number 560 were completed with an overall response rate of
25.81%. The authors focused on 75 possible interventions that were categorized into three focal
areas. The focal areas were (1) patient room and environment-related interventions, (2) treatment
and personnel support interventions, and (3) institution and unit-level interventions. A survey,
performed by the RNs, was used to identify the top ten interventions. The survey tool has 75
preventative interventions listed and the RNs had to rate the frequency and effectiveness of use.Falls And Falls Risk Reduction In Nursing Essay
The ratings from the effectiveness column is what was used to answer the research question. The
study results revealed that each specialty unit is unique related to effective interventions to
PATIENT FALLS 18
prevent falls with injury. The study results revealed that in most of the specialty areas, focal area
one (patient room and environment-related interventions) was perceived by the RNs as highly
effective with the one exception of the behavioral health units. This provides evidence the RNs
perceived that patient interventions focused on the patient room and environment are effective
interventions to prevent fall related injuries. The study results also revealed that interventions
must be tailored to fit the uniqueness of the patient and the clinical environment.
The study had several limitations. One limitation identified was the low response rate
from the RNs overall (25.81%) and for the behavioral RNs only 3 or 4 responded. The study
would not be generalizable because only health systems in one region of the US was involved in
the study. This wide range of variability of the different specialty units and types of hospitals
could produce very different risk factors since larger hospitals tend to have more medically
complex patients. Variability of the units could also reduce the transferability of the perceived
effective interventions.
In summary, Tzeng and Yin (2014) study produced evidence that the perception of the
RN perception on a specific unit will yield specific and unique interventions based on the
patients risk factors. Future studies will need to capture the autonomy of the RN utilizing their
critical thinking skills to establish tailored interventions to prevent fall related injuries. Higher
level methodological studies will need to follow patients as RNs implement their perception of
the highly effective interventions to prevent inpatient fall related injuries.
Barker, Kamar, Tyndall, and Hill (2013) conducted a retrospective cohort study of the
inpatients admitted to the Northern Hospital in Victoria, Australia between the years of 1999-
2009. The study focused on patients that experienced a falls related-injury during their
PATIENT FALLS 19
hospitalization. The objective of the study was to report the association of low-low beds as an
intervention to reduce serious fall-related injuries.Falls And Falls Risk Reduction In Nursing Essay

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