Introduction: In this critical thinking scenario, nursing care related to the clinical case of Mrs.Aundrey Smith a 75 year old lady who was brought to Emergency Department for the management of fracture NOF (neck of femur), soft tissue injury and bruising to her left shoulder as well as small hematoma to her left forehead will be discussed. A comprehensive and holistic assessment of the case will be done to identify the nursing diagnosis, activities and rational which will be supported by current evidence based practices. Activities will be based on priority and evaluation will be done to assess the effectiveness of care and also to modify the care if needed. Nursing Interventions 1. Safety Patient safety is the first and foremost priority in healthcare system (Huang L. , 2013). Since Audrey is an elderly with femoral fracture, soft tissue injury and small bruising on left shoulder along with hematoma on the left side of head the safety measures will be Eliminate Risk for fall Audrey is vulnerable, so she may fall if not taken adequate measures (Meyer, Kopke, & Muhm, 2005). Appropriate tool kit should be developed according to the patient condition to prevent and manage fall (fisher, 2013). Nursing interventions will be orienting her to the ward and surroundings. Provide safe surrounding to the patient by setting a cluster free environment. Lower the bed and ensure that patient lie in the centre of the bed. Ensure the bed side alarms works properly so that patient can
By understanding nursing sensitive indicators, the nurses in this case could improve the structure, process, and outcomes of their nursing care. The structure of nursing care is indicated by the supply of nursing staff and the skill level of the nursing staff. By the nurses having increased knowledge of the issues hip fracture patients are prone to having, such as decrease mobility, increase need for surgical intervention, and increase risk of falls, could help improve the quality of patient care. A patient with decrease mobility is at higher risk for pressure sores. The nurses in this case may have prevented the one by proper
An assisted fall is when a staff member witnesses a patient's fall and attempts to minimize the impact of descend. Many patient falls occurring during hospital encounters may cause little or no harm but some can result in serious and even possibly life-threatening consequences for many patients such as hip fractures and head trauma. Even when a fall does not lead to death, it can require prolonged hospitalization. Some could suffer disability, loss of function, and lose their independence or premature death. “Patient falls in hospitals are a common and often preventable adverse event. Nurses routinely conduct fall risk assessment on all patients, but communication of fall risk status and tailored interventions to prevent falls is variable at best.” (Hurley,
The purpose of this paper is to conduct an in depth exploration of the nursing care considerations of patients in a specific clinical area. Through the synthesis of prior knowledge, clinical experiences and skills, evidence based best practices, and care of patients a comprehensive care and teaching plan will be composed. Integration of critical thinking and clinical reasoning skills, combined with evidence-based research will provide confirmation of nursing process comprehension. The inclusion of reviewed literature will further support knowledge and understanding.
Patients are medicated, in an unknown environment, attached to lines, drains, and physiologically impaired in some manner. They are at a very high risk for falling. The American Hospital Association explains how participating hospitals have reduced falls by 27% by using the bundles and toolkits from Hospital Engagement Network (AHA HEN), this process requires the interdisciplinary team involvement. Each has their own role, nursing plays a critical role in fall prevention, they are with the patient for 12hours in a hospital setting and have direct care with assessing, creating a care plan, implementation of interventions, and evaluation. They can report any concerns or data to the
During hourly rounds assess the patients pain level and take necessary intervention to alleviate pain, reposition patients who need assistance and make sure that urinals and call light and telephone are within reach of the patient. Taking care of these needs in a timely manner will make the patient comfortable, which will reduce anxiety and stress levels in the patient and reduce the risk of falls. The nurse should always make sure that the environment is safe for the patient by keeping the area clutter free. Comfort measures like tightening the wrinkled bed, giving warm blanket, changing moist dressings or repositioning the tubes or other objects that bothering the patient can enhance their comfort level Monitor high risk patients with delirium, dementia, hypotension, medications, and other conditions which can increase the risk of fall. Providing safety companions for continuous observation and to help the patients will reduce the number of falls. Nurses should educate and encourage patients to use the call light and phone to call for help. Provide patients with appropriate assistive devices like cane, walker as needed to keep them steady. I believe the concept in this theory of comfort can be utilized to reduce the occurrence of falls in health care settings.
Patient falls in hospitals are a critical problem and are used as a standard metric of nursing care quality. According to the Joint Commission, thousands of patients fall in hospitals each year. Approximately 30-50% of falls result in injuries and prolonged hospital stays. Any patient in a hospital is at risk for falling and certain measures should be in place to prevent this. Preventing falls and injuries are not only important for the patient, but also for their families, the hospital, health care team, and insurance companies. It is estimated the average cost of a hospital admission due to a fall is $20,000 and by 2030, an estimated $54 billion will be spent on health care costs due to falls. The purpose of this paper is to explore the risk factors of falls in hospitals and interventions used to combat this problem.
Patient safety is number one in hospitals. Every staff member that comes into contact with a patient should always have the question, “Will the patient be safe?” in the back of
As a nurse we want to ensure that our patients receive a high quality of care. Patients should feel safe and satisfied while hospitalized. Many hospitals are continually looking for answers and implementation to significantly reduce the inpatient fall incidents. According to Bechdel et al (2014), the top priority of health care organizations nationwide is to reduce and eliminate falls within the clinical care settings. One of the serious problems in acute care hospital is the patient’s fall. The unfamiliar environment, acute and co-morbid illnesses, prolonged bedrest, polypharmacy, and the placement of tubes and catheters are common challenges that place patients at risk of falling. Most of the falls that I have encountered while working involves
Current nursing practices are based on strict standards and requirements issued by The Center for Medicare and Medicaid Services (CMC) and The Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The CMS requires facilities to provide a safe environment for care and failure to do so risks losing Medicare Medicaid funding. In fact, facilities no longer receive payments for treating injuries caused by in-hospital falls. The JCAHO National Patient Safety Goal (NPSG) requires nursing home to reduce the risk of patient harm resulting from falls and to implement a falls-reduction program. The NPSG has been upgraded to a standard that requires facilities to assess and manage the patient’s risks for falls and implement interventions to reduce falls based on this assessment. The current nursing practice for fall interventions begins with assessment. Patients are assessed and reassessed to identify and address any risks factors including underlying medical or medication conditions. Risk Assessment Tools for predicting falls score each category identified as a potential risk. For example, categories include Medication, Activity/Mobility, Elimination, Previous Falls, Length of Stay, Mental Status, and Age all can influence the
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
L. Holtz, a registered nurse (RN), mentions even with the use of tab alarms, residents still experience falls (personal communication, February 3, 2017). When a resident is first admitted into long term care, they undergo various assessments. One assessment is the Morse Fall Scale (MFS). The MFS is a rapid and simple method of assessing a patient’s likelihood of falling. It consists of six variables that include: history of falling, secondary diagnosis, ambulatory aid, intravenous (IV)/Heparin lock, gait/transferring, and mental status. There are three risk levels based on scoring: no risk, low risk, and high risk. L. Holtz pointed out interventions for high risk residents would include: tab alarms, floor alarms, and lower beds (personal communication, February 3, 2017). She also mentioned each resident is identified as a fall risk by a falling star poster which is attached to their name tag outside their door (L. Holtz, personal communication, February 3, 2017). Other interventions to reduce the occurrence of falls include: regular toileting, clutter-free areas, and well lighted area. Efforts and interventions are placed to assure the safety of the residents. However, even when these interventions are in place, falls still
Patient safety one of the driving forces of healthcare. Patient safety is defined as, “ the absence of preventable harm to a patient during the process of healthcare or as the prevention of errors and adverse events caused by the provision of healthcare rather than the patient’s underlying disease process. (Kangasniemi, Vaismoradi, Jasper, &Turunen, 2013)”. It was just as important in the past as it is day. Our healthcare field continues to strive to make improvement toward safer care for patients across the country.
“The primary root causes of fatal falls as reported by healthcare organizations involved inadequate staff communication, incomplete orientation and training, incomplete patient assessment and reassessment, environmental issues, incomplete care planning, unavailable or delayed care provision, and inadequate organizational culture of safety.” (Joint Commission, 2007) If a client is high-fall-risk, implementing continuous observation by bringing in a sitter for the patient would be best. If there are patients that are demented or confused, it
It was found that the nurses had insufficient recording of wound care and the staff were not monitoring the wounds consistently or keeping Mr Selir’s GP up to date on his condition. After this incident, the nursing home introduced new staff, systems and processes to improve the quality of care to residents. I felt frustrated and disturbed as coming from overseas, my family background has always taught us to respect and look after our elderly therefore back in our country we don’t believe in nursing homes. According to Nursing and Midwifery Board of Australia [NMBA] 2016, health professionals ought to provide safe, appropriate and responsive quality nursing practice.
Issues related to a lack of patient safety have been going on for a lot of years now. Throughout the first decade of the 21st century, there has been a national emphasis on cultivating patient safety. Patient safety is a global issue, that touches countries at all levels of expansion and is one of the nation's most determined health care tests. According to the Institute of Medicine (1999), they have measured that as many as 48,000 to 88,000 people are dying in U.S. hospitals each year as the result of lapses in patient safety. Estimates of the size of the problem on this are scarce particularly in developing countries; it is likely that millions of patients worldwide could suffer disabling injuries or death every year due to unsafe medical care. Risk and safety have always been uninterruptedly been significant concerns in the hospital industry. Patient safety is a very much important part of our health care system and it really