Introduction
Over the years, many cases of falls have been reported among patients in various healthcare facilities. Whenever these falls occur, they negatively impact the victims by overstaying in hospitals, reducing the life quality, and being costly (Toye et al., 2017). Many of these cases are often associated with a lack of education among the nurses despite having the noble duty to ensure the safety of the patients (Chu, 2017). As a result, healthcare professionals have continued to develop significant ways to reduce falling through interventions such as the education of nurses. According to The Joint Commission (2018), falls can be prevented in hospitals once nurses gain skills and knowledge on how to overcome them through education. The current project examines the lack of fall prevention education in nurses and proposes changes to help healthcare workers enhance their ability to minimize falls in their facilities.
Background
The quality of healthcare is comprised of clinical safety which is considered a crucial component that identifies and reduces the risks faced by patients. Montejano-Lozoya et al. (2020) defined falls as adverse events which occur in a hospital environment and have a significant impact of about 10% of income made by the organization. The effects come in terms of costs, damage, pain, and mistrust of the health system by patients. The environmental improvements can reduce the possibility of falling up to 30 to 50% (McCarty et al., 2018). However, the effects of risk of falls in hospitals remain unclear due to the low quality of evidence despite the interventions put in place. Therefore, the education of nurses has been employed as a single intervention or being treated as part of the multifactorial intervention process for fall prevention programs.
Clinical Problem Statement
In the most recent years, the authority at Community Regional Medical Center (CRMC) Fresno has been receiving numerous complaints from clients who experience falls within the facility. Most of the cases are experienced among patients with lacerations, fractures, and internal bleeding. Reports indicate that many nurses attending to the clients have limited information on how to prevent falling. The project’s focus is on the lack of education among nurses to identify risk factors and work toward preventing falls which requires change.
The Purpose of Change Proposal
The decision to propose the change within the facility is based on previous investigations and the current situation at the facility. Research by Heng et al. (2020) indicated that falls often occur when healthcare professionals are not keen on helping guide clients. This is often contributed by limited skills and knowledge to observe policy standards when handling patients. Whenever falls happen, they are likely to increase the complications of patients, especially those already with injuries and the older people exposed to the risk of falling (Kempegowda et al., 2018). The purpose of the proposed change is to improve the education of nurses when it comes to preventing falls. The measures include nurses’ empowerment to have them lead patient care and curricula strengthening to focus on the skills and concepts needed for one to participate in activities of preventing falls.
PICOT Question
Does the provision of education to nurses on preventing falls in healthcare facilities help reduce the instances of falls among patients in Community Regional Medical Center (CRMC) Fresno? Shaw et al. (2020) identified education as a single intervention or it can be incorporated as part of the multifactorial interventions used in the programs aimed at reducing or preventing falls. Nurses’ education in fall prevention strategies should be comprehensive and versatile in order to cover the various aspects of the problem in question. The educational interventions must support policies and guidelines to create a safe environment and reduce risk factors. Additionally, the prevention strategies explained in the process of education should stimulate engagement in technical aspects to eliminate potential fall hazards. Finally, the last point of nurses’ education should elaborate on raising awareness among patients and communities on the risk factors and prevention measures of falling.
Literature Search Strategy
The change project proposal is based on the literature studies. Relevant articles were retrieved from various sources through search engines that included the GCU library, CINAHL, Google Scholar, Web of Science, and PubMed. The search of these articles involved words related to the topic of the project, such as fall prevention, nurses’ education, patient safety, nursing knowledge and skills, and nurses’ learning. The search only considered articles that have been published over the past five years.
Literature Evaluation
King et al. (2018) identified falls as a major safety concern when it comes to hospitalized patients considering the severe impacts it causes, such as reducing life quality, increasing the stay in hospitals, and being costly to patients. These researchers examined a multidisciplinary approach as a requirement for fall prevention and the need to create a safe environment for patients and reduce injuries. Aguwa (2019) argued in favor of nurses’ education in combination with other fall prevention programs as being crucial to preventing falls. The researchers concluded that those nurses involved in education received a verbal report on the risk of falling among patients.
Montejano-Lozoya et al. (2020) found falls as common events, which majorly happen he older adults, which then result in negative outcomes for hospitals and the patients. The findings showed that the overall incidence of falls was 1.2% following the education of the nurses in charge of the patients. Park et al. (2019) examined adverse events as the cause of mortality and morbidity, considering that they lead to issues of clinical safety hence the need to avoid falls in health institutions. From this study, the fall prevention program was found to be particularly effective for patients in the experimental group as opposed to the control group. Leverenz and Lape (2018) examined how designing and implementing a multidimensional fall prevention educational program can help reduce the cases of injury in health facilities. The findings showed that the improvements in the self-efficacy for falls were statistically significant, especially among the nursing assistants.
Utilization of Change or Nursing Theory
The change project proposal is concerned with preventing falls among patients, which requires that nurses get educated on skills of how to achieve the purpose. As a result, the suitable theory to apply would be Lewin’s change theory since it has successfully implemented the clinical changes in the past scenarios by a preceptor who highlighted the success stories with minimal shortcomings (Shirey, 2018). When applied in the clinical settings to advance change, Lewin’s change theory presents three steps which include freezing, moving, and refreezing. Other important phases include reasons and resource evaluation to apply changes, maintaining the change, and leadership stepping into the change agent role with designated responsibilities.
Implementation Plan and Outcome Measures
The implementation begins with the evaluation of the needs, setting goals, and start preparing for the change to prevent falls. The education of nurses is attained by integrating organizational ongoing operation procedures. The strategy starts by defining the responsibilities and roles of nurses in preventing falls and the requirement to change to execute the best approaches (Clayton et al., 2020). The system needs to be monitored to track the changes and sustain the program through constant informing of senior managers on the progress of reducing falls. The expected outcomes are measured by nurses being able to identify and assess various fall risk factors and apply the acquired skills and knowledge to prevent falls.
Use of Evidence-Based Practice in Intervention Plan
Evidence-based practice is adopted in this change project to help evaluate the success of the implementation. This involves data delivery on fall risks in respect to areas and during the discharge of patients. The management should be able to obtain support and assist in improving the educational practices of nurses to prevent patient falls. The program is sustained through constant informing of senior managers on the progress of reducing falls.
Plan for Evaluating Proposed Nursing Intervention
The first part of the evaluation would include risk assessments to identify the patients with the highest possibility of falling, as well as nurses’ skills at preventing these risks. For that, a variety of tools would be used, such as Marginal Analysis, SWOT Diagram, and different risk assessment scales. The effectiveness of the nursing intervention plan would be judged by the results of the assessments. Secondly, a post-fall evaluation would be applied to identify the outcomes of the nursing intervention and the role of education in reducing risk factors for falling.
Potential Barriers to Implementation Plan
The barriers could be associated with limited time for nurses considering that they are already serving employees who should attend to patients and at the same time, undertake education. Some nurses who lack technical knowledge and skills may find it challenging to learn new aspects of how to handle patients. These barriers could be overcome by first introducing nurses to computer literacy before they are taught new ways to prevent falls. Similarly, training on how to prevent falls should be undertaken during weekends or during the nurses’ leaves or days off.
References
Aguwa, H. (2019). Nursing education to prevent resident falls in long-term care. (Publication no. 7455) [Doctoral dissertation, Walden University]. ScholarWorks.
The Joint Commission (2018). Preventing falls and fall-related injuries in health care facilities.Sentinel Event Alert, 55, 1-55.
Chu, R. Z. (2017). Preventing in-patient falls: The nurse’s pivotal role.Nursing2020, 47(3), 24-30.
Clayton, K., Grimm, J., Olguin, S. M., & Tarrant, T. (2020). Impact of falls in the long-term care setting: A guide to prevention.
Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital falls prevention with patient education: A scoping review. BMC Geriatrics, 20, 1-12.
Kempegowda, P., Chandan, J. S., Hutton, R., Brown, L., Madden, W., Webb, J., Doyle, A., & Treml, J. (2018). Focused educational intervention improves but may not sustain knowledge regarding falls management. BMJ Open Quality, 7(3), e000222.
King, B., Pecanac, K., Krupp, A., Liebzeit, D., & Mahoney, J. (2018). Impact of fall prevention on nurses and care of fall risk patients.The Gerontologist, 58(2), 331-340.
Leverenz, M. D., & Lape, J. (2018). Education on fall prevention to improve self-efficacy of nursing staff in long term care: A pilot study. Internet Journal of Allied Health Sciences and Practice, 16(3), 1-10.
McCarty, C. A., Woehrle, T. A., Waring, S. C., Taran, A. M., & Kitch, L. A. (2018). Implementation of the MEDFRAT to promote quality care and decrease falls in community hospital emergency rooms.Journal of Emergency Nursing, 44(3), 280-284.
Montejano-Lozoya, R., Miguel-Montoya, I., Gea-Caballero, V., Mármol-López, M. I., Ruíz-Hontangas, A., & Ortí-Lucas, R. (2020). Impact of nurses’ intervention in the prevention of falls in hospitalized patients. International Journal of Environmental Research and Public Health, 17(17), 1-13
Park, B. M., Ryu, H. S., Kwon, K. E., & Lee, C. Y. (2019). Development and effect of a fall prevention program based on the King’s goal attainment theory for fall high-risk elderly patients in long-term care hospital. Journal of Korean Academy of Nursing, 49(2), 203-214.
Shaw, L., Kiegaldie, D., & Farlie, M. K. (2020). Education interventions for health professionals on fall prevention in health care settings: A 10-year scoping review. BMC Geriatrics, 20(1), 1-13.
Shirey, M. R. (2018). Lewin’s theory of planned change as a strategic resource. JONA: The Journal of Nursing Administration, 43(2), 69-72.
Toye, C., Kitchen, S., Hill, A., Edwards, D., Sin, M., & Maher, S. (2017). Piloting staff education in Australia to reduce falls in older hospital patients experiencing delirium. Nursing & Health Sciences, 19(1), 51-58.