Qualitative Assessment

A1. Describe a Health care problem

Falls are one of the major causes of injuries for inpatient as well as outpatient population. A fall is defined as an unforeseen, sudden and unintentional incident in which a person comes to rest on the ground due to environmental or bodily conditions. Falls are reported as the chief source for patients to extend their duration in a hospital and increase medical bills both from their end as well as the hospitals. This hinders the population to complete their day to day tasks as well as raise few noteworthy complications namely confidence and physical suffering. In older communities with people who experience a fall, it can lead to decreased flexibility, loss of independence, decreased response to therapy programs and also in some cases death. Balance confidence is defined as a person’s opinion of their balance capability and readiness to perform activities within their limits. The interaction between the people and environment plays a huge factor for these falls. The other  causes of these falls in communities is mainly due to earlier falls, age, walking manner and balance and visual deficiencies due to diseases and medication.

A2. Significance of the problem

Joseph (2015) mentioned that falls account to $34 billion dollars to hospital expenses among the 2% of the older population admitted. Megan (2015) stated that 34% injurious falls have a devastating effect on the family members and the hospital as a whole. The programs and preventions have not been able to retain the older members and pass on the learning to a larger population base. Prevention programs also lose their mainstay due to their inability to verify the results post sessions. Interventions and programs have been conducted to give a valuable research evidence but the widespread administration implementation of these programs has been non-existent and any assessed parameters to promote these activities. There is a lack of knowledge among the hospital staff and other medical personnel to make a fall risk assessment at an individual level. Nurses play a vital role in decision making and evaluating fall risks for an inpatient setting. They are the most effective intervention there is for the in-patients treatment.  Programs centered for educating and contributing for the prevention and safety measures is very minimal.

A3. The current practice

        Normally, there are set of programs and intervention techniques introduced in every hospital district to prevent and asses the risks of a fall, even though sometimes the nurses with direct patient care could give these programs some recommendations regarding the way to this program is delivered. After receiving the right education and practice set, nurses are responsible for inserting the key techniques to their work and assess the situation before it occurs which in this case is a fall. Many of the fall preventions techniques are still at a nascent stage and their wide spread application is yet to come into picture. There are no pre-defined procedure to replicate programs. Group exercise have been one of the most efficient methods to reduce the rate of falls. The inclusion of modern technology and techniques are also being introduced in hospitals to educate and reduce the risks of future falls. In my hospital, we keep the patient with the highest fall risk in the rooms closest to the nursing station for immediate attention if needed and provide the patients with yellow gowns and yellow bands to create awareness on the floor for the medical staff. We also keep the patient bed at the lowest position and place a bed alarm if the patient tries to get up to alert the nursing staff. However, lack of implementing these techniques for a larger audience is the common problem.

A4. How the Issue impacts the organization and/or patient’s cultural background

        Since most of the fall prevention programs are short lived and the widespread application into communities is still missing, there is a financial burden for the hospital as well as the patients themselves and their families. Not only does the hospital have to pay for the support required but also the resources needed to treat a patient. Patients themselves have to pay a hefty price for fall related injuries and their treatments. The second impact is that of patient’s psychological burden leading to a decreased personal confidence level for themselves and their families and friends surrounding them. The patients develop a habit to neglect day to day activities which leads to decrease in their flexibility and are more prone to injuries due to a fall. The nurse-patient relationship could be compromised when fall occurs within a hospital. The alert patient might be able to converse their apprehensions about a fall, however the confused patient, especially the elderly, or patients with improper or inadequate education might not be able to or the inability to communicate for themselves. As healthcare providers, we all vow do no harm. Nonetheless, a fall acquired during the hospital stay is indeed harmful for patients. Also, the underlying thing is that there have been a lot of studies and research pertaining to interventions and programs to reduce falls but no baseline has been discovered to be implemented across various demographics. Researchers and writers have assumed principles that best apply to their study.  Therefore, there is a need to implement a strategy based on a widely accepted thumb of rule to reduce and prevent falls.

B. PICO table and question

PICO question:

Will educational guidance reduce in-patient and out-patient falls as compared to the current practice?

C. 1 Keywords

My search words were:

1. patient education on fall risk
2. patient education to prevent falls

C.2 Search Strategy

        I used WGU library to search for research and non-research articles related to my focus research. Initially I used the keywords “patient education to prevent falls” to start my research in WGU library. Using the limit filters, I clicked “full text” and “peer review” which gave me 1.4M search results. Since this task required paper published in the last five year, I added 2012-2017 as a filter to narrow down my results to 58,410. I picked two articles from the first 40 results which caught my attention. I scanned thru the articles to read the problem statement to determine if they match my research topic. I then added “clinical trials” on the limit filters and added “quality improvement” in the advanced search field, reducing the results to 26,454. I also tried advanced search fields “practical guidelines” and “consensus panel” but the articles did not catch my attention. Since my focus was to study the impact of education to reduce the rate of falls, I scanned thru the first 150 articles to determine the papers that fit my research the best.