Fall Risk Reflection

Falls are a big concern for all employees in a hospital setting daily. The worst thing that can happen to a patient while being hospitalized is a fall, or a major fall, that could result in skin damage (i.e. wounds, skin tears, or abrasions), a fracture or break, thus limiting their independence. This student’s goal was to develop a way to educate staff members in ways they can help reduce the number of falls that occur. Developing a sample Fall Risk Prevention Policy as well as a Staff in-service on fall risk and Prevention achieved this goal.

Most hospitalized patients of 65 years and above have been established to be more vulnerable to falling within their homes or in a facility. These falls have been attributed to various causative agents that need to be assessed and managed in an attempt to completely avert falls (Wilbert, 2010). Prevention of falls should be mandatory since they cause more danger to patients, including breakage of the main bones and even death. As a result, the patient may develop a more serious condition such as decrease functional immobility in addition to that which caused hospitalization. Most of these falls have been found to be caused by therapeutic impacts and ignored diagnostic information (Naqvi, Lee & Fields, 2009). For instance, a great number of elderly people who are hospitalized are diagnosed with dementia at the time of admission; hence, such information needs to be taken into consideration during the care of such a patient. Dementia is likely to cause disorientation and confusion which may result in recurrent falls. Therefore, falls may be described as the abrupt and unintended loss of uprightness that leads to body displacement towards the ground falls (Wilbert, 2010). The purpose of this paper is to develop a falls prevention, management program that will reduce the number of falls occurring within an organization.

The ASPIRE framework, also referred to as the nursing process (Barratt, Wilson and Wollands, 2012) was used to structure and develop Susan’s care plan. Introduced by Barrett, Wilson and Wollands (2012), following on from APIE developed by Yura and Walsh (1967), ASPIRE stands for assessment, systematic nursing diagnosis, planning, implementation, recheck and evaluation. Hogston and Marjoram (2006) believe that systematic nursing diagnosis was added to offer direction and time for the nurse to reflect on gathered information and systematically develop a diagnosis. Also the aspect of rechecking is to enable the nurse to monitor and plot a patient’s progress contributing to the final stage of evaluation of care and if its successfulness (Barratt, Wilson and Wollands, 2012).

This work has significance because staff and patient education can help prevent falls. Specific interventions decrease falls. Nurses have a responsibility to their patients and their facility to be competent and confident in their abilities to do all that they can to prevent falls. Facilities have the responsibility to provide the tools and the training that is required to carry out fall prevention

Falls among any individual can cause significant trauma, often leading to an increase in mortality. According to the Centers for Disease Control and Prevention (2012), one in every three adults over the age of 65 falls each year. Long-term care facilities account for many of these falls, with an average of 1.5 falls occurring per nursing home bed annually (Vu, Weintraub, & Rubenstein, 2004). In 2001, the American Geriatric Society, British Geriatric Society, and the American Academy of Orthopaedic Surgeons Panel on Falls Prevention published specific guidelines to prevent falls in long-term

Nurses help to ensure patient safety, which includes preventing falls and fall-related injuries (Quigley, Neily, Watson, Wright, & Strobel, 2017). The general population is at risk for falls and fall-related injuries, more specifically the elderly, 65 and over (Quigley, Neily, Watson, Wright, & Strobel, 2017). Patient falls are one of the top events for hospitals and long-term care facilities due to loss of physical function or cognition (Quigley, Neily, Watson, Wright, & Strobel, 2017). Fall-related injuries are a serious health issue for the elderly population (Quigley, Neily, Watson, Wright, & Strobel, 2017). Nurses make a major contribution to patient safety by assessing fall risk and designing patient-specific fall prevention

Assessment in the nursing process will establish the patients' ongoing needs and provide a quality of care best suited to the individual, to achieve a desirable health outcome.

The first stage of the process is assessment. Roper et al (2001) refer to this process as ‘assessing’ indicating an ongoing activity; this encourages nurses to recognise the on-going nature of this initial phase. The assessing stage includes gathering information about a patient, reviewing this information, identifying actual and potential problems and prioritising (Roper et al 2001). Roper et al (2001) explain the importance for assessing, as early as possible in the patient’s stay. Extensive, in-depth information may not be gathered on an initial assessment, however any information obtained contributes towards individualised care (Roper et al 2001). Ambrose and Wittig (1998) explain that the initial assessment becomes a foundation for ongoing assessing and holistic care. Barrett, Wilson and Woollands (2009) concord with Roper et al and Wittig in that assessing is an ongoing process and elaborate on this explaining that assessment should not be confused with admission. They state “an admission tends to be a one-off process when you first meet the patient, whereas assessment carries on throughout your relationship with the patient” (pg22). Assessment enables the nurse and patient to identify actual and potential problems. Although, some problems can be directly related to biological needs, holistic needs must be considered, i.e. psychological state and cultural/social standing

My target population for this project was geared towards the elderly group. "About 40% of this age group living at home will fall at least once each year, and about 1 in 40 of them will be hospitalized. Of those admitted to the hospital after a fall, only about half will be alive a year later."(Rubenstein, 2006) This group although not the highest incidence of falls but rather the highest susceptibility to injury from falls.

Inform and educate patients and /or family members regarding a plan of care to prevent falls.

The aim of this essay is to demonstrate the assessment process of a patient using the Roper Logan and Tierney (RLT) model of nursing framework and to show how the nursing process works alongside this model. This will be shown by a holistic history of the patient being shown, followed by how the RLT model is applicable to this patient. This is then followed by one nursing intervention being discussed showing how the nursing process is applied to patient care. The patient will be referred to as Mr Frederick Valentine to protect the patient’s anonymity as stated in the Nursing and Midwifery Council Code of Conduct (2008) guidelines.

Assessment is described as”The first stage of the nursing process, in which data about the patient’s health status is collected” (Oxford dictionary of nursing, 2003, p23), following this phase a care plan can be devised.

This was reinforced with the administration of pain medication. Part of my discharge education for Tina when she goes home is to be able to tell me five fall potentials when she gets home as well as five interventions that will decrease the risk. I will start my education by reminding Tina what she has already shared of being clumsy and injury to foot related to a fall. By doing this Tina understands, though her own experiences, that what we are discussing is trying a concern. Another teaching method I will use is giving Tina scenarios of possible fall situations and see if she can identify the risk as well what she can do to decrease. The scenarios will include vision acuity, trip hazards, stairs, medication, proper footwear and her disease process (Centers of Disease Control and Prevention, 2013). By having her pick out the safety issues in scenarios and explaining the safer methods to be utilized Tina will increase her critical thinking and be able to recognize these hazards on her own. Another excellent discharge plan in regards to falls is doing a in house therapy session to identify hazards and have Tina make the recommended changes to her home environment that were identified during this session. Tina will be on crutches and the goal of to be able to safely maneuver in her environment would be crucial. Therapy would have been working with her in regards to ambulation in crutches and Tina would demonstrate that she can safely maneuver her crutches in her room and confined spaces, such a bathroom, up and down

It is during the second phase that the nurse must establish a nursing diagnosis. Only diagnosis approved and listed through The North American Nursing Diagnosis Association (NANDA) may be used. Ineffective airway clearance, risk for impaired skin integrity, risk for infection and ineffective coping are just a few examples of NANDA approved diagnosis. A nursing diagnosis is a clinical judgment about actual or potential individual, family, or community experiences/responses to health problems/life processes. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability (Defining the Knowledge,” 2012).

The first stage of the nursing process is assessment. This is a continuous process from hospital admission to discharge. It is about compiling objective and subjective information