Fall Prevention Program
Fall Prevention Program
Instances of fall, especially in older adults, are a major cause of mortality and morbidity according to research. However, these consequences fall under an essential class of probable preventable injuries. These falls may include dropping from stepladders and ladders as well as dropping from standing positions. The degree of the injury largely depends on the height from which the patient falls. Moreover, patients may lose independence and hence rely on assistance from family, friends and other caregivers such as nurses to carry out daily activities (Williams et al., 2014).
- Background of the Study
- Results of the Study
- Ethical Considerations
Consequently, research shows that behavioral change and analysis of barriers to implementation of fall preventions programs influences professional practice. This study sought the views and perception of various nurses regarding the implementation of, facilitators of, barriers to fall- care especially for older patients. As such, this study aims at assessing the perceived barriers and hindrances to adoption of Fall Prevention and Treatment Programs in health care facilities (Fortinsky, 2008). The key words included: barriers, control and prevention, accidental falls, program, hindrances, practice patterns, nurses, physicians, equipment, resources, decision-makers and standards.
The following PICOT format was adopted. Time was not applicable in this case.
P- In regard to nurses
I- Adoption of Fall Prevention and Treatment Program
C- Training and motivation of nurses
O- Improved care and handling of fall patients
1.1 Method of the Study
To conduct the study, a survey design was selected to investigate the barriers to care of fall patients in healthcare facilities (Williams et al, 2014). The study aimed at getting nurses’ opinions regarding the various barriers that they encounter on a daily basis in the implementation of prevention measures to reduce, prevent and treat fall patients especially older adults. As such, the study utilized both qualitative and quantitative research methods. The study employed the use of questionnaires which were administered to nurses in five different hospitals.
Each of the hospital had an average capacity of 120 beds and had the same characteristics regarding nursing staff strength, types of patients, medical services provided as well as the bed capacity. A total of 200 nurses working in 10 geriatric units in the five hospitals were involved in the four week survey process. The nurses were issued with questionnaires which they filled and submitted accordingly. The study welcomed participation of nurses from the geriatric department owing to the fact that most fall patients were aged above 65 years.
The questionnaire titled “Barriers to care and treatment of fall patients” was administered to each of the nurses. The process took four weeks to complete, with a total of 200 questionnaires being issued. More specifically, 40 were issued to each hospital meaning that 40 nurses from each of the five hospitals participated in the study. These questionnaires were sent to each nurse in an envelope accompanied by a letter of invitation as well as an explanation sheet with guidance on filling the questionnaire.
In order to facilitate convenient distribution, these enveloped were developed by hand to the heads of Geriatric Department by the researchers and were consequently handed over to the nurses. The questionnaires were brief, simple and straight to the point. As such, it took approximately 13 minutes to fill them out. After that, the nurses were requested to place them in an envelope which was then collected by the researcher on the same day. Within four weeks, all the questionnaires had been filled out and returned for compilation.
A total of 195 questionnaires were returned with accounted for 97.5% of the total number that was issued. Additionally, the respondents had a mean age of 30 years. The identified barriers to the implementation of Fall Prevention and Treatment Program were arrived at after combining the percentages of answers that varied from “fully disagree” to “disagree” as well as “fully agree” to “agree” for the negative and positive questions respectively. The questionnaire had a total of 20 questions among which five main barriers were identified (Vos et al, 2013). In general, the results showed five acute barriers which were common in all of the five hospitals.
The barriers include: motivation and knowledge (80%), availability of efficient support staff (75), access to fall- care facilities (72%), poor health of older patients (68%) and staff education (55%). These barriers were consistent in the five hospitals. More specifically, “motivation and knowledge” and “staff education” in this case referred to the characteristics that were required for fall patients’ caregivers. “Availability of efficient support staff” referred to lack of fall-care nurse specialists and change champions in the hospitals (Vos et al., 2013).
Moreover, “access to fall-care facilities”, also classified as context barriers, includes lack of equipment and resources such as bed alarms. “Poor health” referred to the characteristics of the patients which included prior instances of fall. Furthermore, the study identified other barriers which include: didactic benefit, attractiveness and adoptability of the guidelines as well as leadership. These barriers were identified as innovation barriers although they were weren’t perceived as main barriers (Stewart et al., 2010).
Implications to Nursing
From the study, nurses who supported an evidence-based approach to the implementations of guidelines in the treatment of fall patients outlined the requirements for such a plan to prosper (Grimshaw et al, 2004). More specifically, prior to selecting the best set of guidelines, decision makers should familiarize themselves with the condition of fall. This involves understanding the target group which mainly comprises of older patients. Additionally, they should set up the barriers to and potential facilitators of change. The barriers which were outlined in the study were directly related to the nurses themselves as well as the hospitals’ decision makers.
More specifically, motivation and knowledge of the condition by the nurses accounted for the largest percentage of hindrances. This data means that majority of the nurses in the hospitals were not trained adequately on how to handle fall patients (Sims-Gould et al., 2010). They were neither trained on evidence-based practice nor exposed to research within their curriculum. The results also indicate that 54% of the nurses lacked research exposure and only 34% had a degree in nursing. The rest had diplomas and certificate qualifications. Moreover, the appropriate attitude and knowledge were not sufficient for the required guideline implementation.
As much as knowledge is vital, the nurse may still encounter problems when adopting the guidelines as a result of patient attitude and willingness to receive care and treatment, environment and social factors as well as the content of the guideline itself. Additionally, adherence to and adoption of the guidelines requires acquisition of equipment, facilities and resources, all of which are beyond the nurses’ control (Flodgren et al, 2012). This means that the nurses may be willing to adopt these guidelines but lack the corresponding material support from the decision-makers in the various health institutions. Moreover, lack of opinion leaders and insufficient staff are also beyond the nurses’ control.
Nurses should receive the right training which will consequently equip them with skills pertaining to handling of fall patients. Moreover, they should be adequately motivates which ensures that they are receptive of evidence-based practices such as adoption of programs that pertain to proper prevention and treatment of fall among older patients (Otaka et al., 2016). Additionally, nurses should be vocal and resilient when it comes to identifying and implementation of such programs by using the right channels to communicate such information to decision makers. They should also handle such patients with the required care owing to their sensitive age.
The study was approved and authorized by ethics advisory group of the learning institution. Issuance, filling and completion of the “Barriers to care and treatment of fall patients” questionnaires was completely voluntary to all the respondents. Agreement to participate was marked by return of the filled questionnaires by the participants. Moreover, all the nurses who participated in the study were assured of anonymity during, before and after the study. Regardless of the nurses’ decision to participate in our survey, they were assured that they would maintain their employment status in the different hospitals they were attached.
Finally, the study’s survey design was vital in eliciting nurses’ views and perceptions pertaining to the adoption and successful implementation of Fall Prevention and Treatment Program in their different hospitals. The study used questionnaires as the method of collecting the required data. The questionnaires were issued to 200 nurses in 5 different hospitals and this led to identification of five main barriers to implementation of fall prevention and treatment program. They included: limited access to facilities, lack of education and lack of motivation and limited knowledge of the condition. Consequently, the study provided the need for development and successful implementation of Fall Prevention and Treatment Program (Otaka et al., 2016).
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Fortinsky, R. H., Baker, D., Gottschalk, M., King, M., Trella, P., & Tinetti, M. E. (2008). Extent of Implementation of Evidence-Based Fall Prevention Practices for Older Patients in Home Health Care. Journal of the American Geriatrics Society, 56(4), 737-743. doi:10.1111/j.1532-5415.2007.01630.x
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Otaka, Y., Morita, M., Mimura, T., Uzawa, M., & Liu, M. (2016). Establishment of an appropriate fall prevention program: A community-based study. Geriatrics & Gerontology International, 17(7), 1081-1089. doi:10.1111/ggi.12831
Sims-Gould, J., Scott, V., & McKay, H. (2010). Barriers and facilitators to the adoption of fall injury prevention technology in long-term care. Gerontechnology, 9(2). doi:10.4017/gt.2010.09.02.106.00
Stewart, J., Kendrick, D., Towner, E., Pitchforth, E., Sealey, P., Goodenough, T., & Deave, T. (2010). Patients perceptions of barriers to and facilitators for injury prevention: a qualitative study. Injury Prevention, 16(Supplement 1), A281-A281. doi:10.1136/ip.2010.029215.1001
Vos, H. M., Adan, I. M., Schellevis, F. G., & Lagro-Janssen, A. L. (2013). Prevention in primary care: facilitators and barriers to transform prevention from a random coincidence to a systematic approach. Journal of Evaluation in Clinical Practice, 20(3), 208-215. doi:10.1111/jep.12108
Williams, T., Szekendi, M., & Thomas, S. (2014). An analysis of patient falls and fall prevention programs across academic medical centers. Journal of nursing care quality, 29(1), 19-29.