Discovery
The topic and the nursing practice issue related to this topic
As a topic for analysis, fall prevention among older patients is used. Improving the health outcomes of the target population is seen as a major nursing practice issue.
The rationale for the topic selection and the scope of the problem
Falls among older patients are a common health problem that entails associated challenges and increases the risk of injury. Due to weak joint mobility and lack of flexibility, some older people cannot move confidently, and in the case of either mechanical obstacles or poor health, they may lose their balance. As a scope of the problem, referral work with older patients after discharge is seen as a strategy that involves promoting health and avoiding falls.
Summary
The practice problem and PICOT question
The practice problem is the need to provide assistance to older people in self-management of their condition, namely stability while walking, to prevent falls. The PICOT question, used as a research background, is as follows: For patients aged 65 and older, does requesting home care referrals upon discharge compared to no referrals for home care can help achieve a decrease in fall rates within a 90-day intervention program?
The systematic review chosen from the CCN Library databases
Tricco, A. C., Thomas, S. M., Veroniki, A. A., Hamid, J. S., Cogo, E., Strifler, L., Khan, P. A., Robson, R., Sibley, K. M., McDonald, H., Riva, J. J., Thavorn, K., Wilson, C., Holroyd-Leduc, J., Kerr, G. K., Feldman, F., Majumdar, S. R., Jagdal, S. B., Hui, W., & Straus, S. E. (2017). Comparisons of interventions for preventing falls in older adults: A systematic review and meta-analysis.Jama, 318(17), 1687-1699. Web.
Other sources used for data and information
Liu-Ambrose, T., Davis, J. C., Best, J. R., Dian, L., Madden, K., Cook, W., Hsu, C. L., & Khan, K. M. (2019). Effect of a home-based exercise program on subsequent falls among community-dwelling high-risk older adults after a fall: A randomized clinical trial.Jama, 321(21), 2092-2100. Web.
Robins, L. M., Hill, K. D., Finch, C. F., Clemson, L., & Haines, T. (2018). The association between physical activity and social isolation in community-dwelling older adults.Aging & Mental Health, 22(2), 175-182. Web.
The main findings from the systematic review and the strength of the evidence
Nursing interventions based on the promotion of physical activity in the older population are valuable incentives to reduce falls in targeted patients (Tricco et al., 2019). The work of medical personnel with older people who have experienced serious falls is a mandatory practice to follow. Appropriate guidelines and exercise programs can be valuable in preventing future falls (Liu-Ambrose et al., 2019). It is essential to pay attention to how effective home activities are for the target audience since individual programs can negatively affect the mental state of older patients (Robins et al., 2018). This outcome is likely primarily due to their social isolation.
Evidence-based solutions for the trial project
Home exercises designed in accordance with established standards of care for older adults are an important practice to consider as a fall prevention mechanism. Secondary fall prevention requires building a stable patient monitoring system to eliminate errors in the implementation and/or development of mental disorders due to social isolation.
Translation
Care standards, practice guidelines, or protocols to support the intervention planning
Home-based balance training programs developed for older adults are meaningful practice guidelines that can be used to advantage in preventing falls in the target audience. The standards of care for older adults under the principle of home care referrals include constant supervision and assistance from nursing staff.
The stakeholders and their roles and responsibilities in the change process
As stakeholders involved in the change process, several healthcare professionals should be listed. A visiting nurse should visit target patients regularly, ask for their views on the proposed home interaction program, and record changes accordingly. One senior specialist, namely the geriatric physician, should record the progress of the work and make recommendations regarding the changes in the program if necessary. A charge nurse should oversee the shift schedule for nurses visiting targeted patients. A specialist from the physiotherapy department should be responsible for developing an action plan that includes a set of exercises for older patients who are monitored at home.
The nursing role in the change process
My nursing role in the change process is to visit and interact with target patients on a regular basis to document progress and offer appropriate recommendations for lifestyle improvement. Other nursing roles involve facilitating this practice and occasional assistance with visits when my work schedule does not allow me to interact with patients.
Stakeholders by position titles
The visiting nurse is an important link in the project under consideration because her work is based on direct interaction with target patients, fixing the results of ongoing activities, and delivering up-to-date information. The geriatric physician is the professional responsible for the credibility of the intervention and for overseeing compliance with all community outreach guidelines, including the adequacy and success of the current practice. The charge nurse performs the function of a supervisory specialist and is involved in the work of distributing the working load. The physiotherapist is also an important link in the change project and is responsible for developing practical recommendations and personal guidelines for target patients.
Cost analysis needed prior to a trial
Prior to a trial, it is crucial to perform a cost-effectiveness analysis to identify the optimal outcomes to achieve within the proposed work, as well as the funds that should be spent. Based on this assessment, the desired outcomes of the change project will be identified. The senior staff of the geriatric department should be involved in this activity, as well as the employees of the accounting department, to calculate the necessary financial costs.
Implementation
The process for gaining permission to plan and begin a trial
As a body capable of issuing formal authorization to begin a trial, the Intervention Evaluation Committee (IEC) may be involved. This committee reviews registered nurses’ requests for performing relevant interventions. In addition, the head physician of the hospital must also give permission for specific activities and approve budgetary expenditures.
The plan for educating the staff about the change process trial
The personnel involved should receive appropriate training to implement the steps of the change process. In addition to describing the main objectives to achieve within the targeted interaction with older patients, namely to reduce the risk of falls, the purpose and features of practical recommendations to the population should be discussed. After the appropriate briefing, the roles should be distributed in accordance with the aforementioned composition of the team of specialists.
The implementation timeline for the change process
It is assumed that the planned change process will take 90 days. The program will start at the beginning of winter when people spend less time outside. In the first month, nurse visits will take place weekly to monitor the progress and learning of the targeted patients. In the second month, visits will take place once every two weeks, which is due to the fact that older people will understand the tasks that they face and will be able to report on the work done. In the third month, there will be a single nurse visit, and at the end of the three-month program, feedback from patients will be received. In addition, they will be invited to see a physiotherapist so that the specialist can identify potential health changes and learn about the effectiveness of the work older adults have done.
The measurable outcomes based on the PICOT
Based on the PICOT question, as measurable outcomes, the level of mobility of older patients enrolled in the program will be utilized, as well as the degree of their satisfaction with the outcomes of the intervention. The level of mobility will be assessed based on the personal responses of patients and their comparison of lifestyle compared to the period before the intervention. Satisfaction levels will be identified based on individual feedback, and appropriate rating scales can be proposed to identify shifts in the perceived effectiveness of the training program.
Forms for recording purposes during the pilot change process
For recording purposes during the pilot change process, relevant information may be included in the morbidity and mortality forms. In addition, epidemiological forms may be used to improve program reliability. To efficiently calculate the budget to spend on the planned program, financial forms will need to be used to display the resources spent. Progress can be reflected in the forms containing the step-by-step outcomes of the intervention.
Resources available to staff during the change pilot
During the pilot change process, the budget of the healthcare facility is available as the resource allocated to the intervention. In addition, the personnel involved can use educational materials and digital courses containing relevant guidelines. The resource base may also include access to hospital databases to obtain the necessary information about target patients.
Meetings of certain stakeholders throughout the trial
Throughout the trial, periodic meetings of the stakeholders involved are required. In the first month, after each patient visit, nurses will need to submit a report to the head nurse, who, in turn, will report the relevant information to the physiotherapist. In the second and third months, the number of meetings can be limited by making them single. After the end of the program, a final meeting with all interested participants should be held.
Evaluation
Reporting the outcomes of the trial
To report the outcomes of the trial based on the interim reports, one complete report for the hospital needs to be compiled. The main information to include will relate to the effectiveness of the change project and the assessment of its significance with regard to the problem under consideration, namely falls prevention after hospitalizations instead of readmissions. The report will be presented at the general meeting and discussed by the stakeholders.
The next steps for the use of the change process information
To put the change process information to good use, the results need to be shared. The outcomes of the program can be presented at a scientific conference. The project may be offered to other healthcare institutions to pay attention to these results. In addition, appropriate publication in an academic journal may allow for disseminating the outcomes of the work done.