Relevance of Clinical Governance to your project
The aim of the project is to educate and provide training (Interventions)to the nursing professionals who are working under residential care and aged care settings about the strategies of older adults fall prevention for a tenure of 1 week (Time) in order to reduce the incidences of accidental falls(Measurable).
The four pillars of clinical governance include clinical effectiveness, clinical risk management, patient’s experience and professional development (Australian Government Department of Health, 2012). Here, risk management, coincides, with the scope of this project. The reason behind this is, the project aims to show how education and training of the nurses about the strategies of the accidental fall prevention of older adults helps to reduce the risk of fall in older adults. According to Vlaeyen et al. (2015), educating the nurses about the strategies of fall prevention helps to reduce the chances of recurrent fall among the older adults who suffer from gait problems, visual impairments, neuronal complications or other healthcare problems. Vlaeyen et al. (2015) further highlighted that proper training of the nursing professionals about the interventions of the fall prevention must be provided under the presence of occupational therapist. This will help to increase in knowledge of the nursing professionals, operating in the residential ward to perform proper risk assessment of the older adults who are above 65 years of age and accordingly implement the interventions to prevent the chances of accidental falls. The presence of occupational therapists further helps in better risk management (Vlaeyen et al., 2015).
According to the Australian Institute of Health and Welfare (2017) on an annual basis nearly 1014 elderly people over 65 years of age lose their life due to accidental fall under residential or aged care settings in Australia. This accidental fall among the older adults also results in injury-related hospitalization among this age group. The statistics published by Australian Institute of Health and Welfare (2012), mentions the fall incidence ratio among male and female is 1:3. Women who are aged 65 years and above are 2.8 times more vulnerable than older men in encountering accidental fall due to gait problems or slippage. According to Australian Institute of Health and Welfare (2012), in order to reduce the chances of fall among the older adults,
(i) It is important to generate a low-risk population and thereby promoting independence
(ii) improvement of the outcomes through facilitating local partnerships
(iii) Creating safer environment for the older adults
Evidence that the issue/problem is worth solving
(iv) Increasing the capacity of the healthcare workers towards preventing fall and fall-associated injury among the older adults
(v) Proper development and management through research, information dissemination and training.
The review of the literature highlighted that one of the effective strategies for improvement of the fall prevention among the older adults was providing proper training to the healthcare professionals especially the nurses to improve the compliance of the preventive strategy towards fall prevention (Stephenson et al., 2015). The systematic review conducted by Sherrington et al. (2017) showed that exercise can be regarded as a single intervention for the prevention of fall among the community dwelling older people. In order to increase the overall effect of exercise interventions, proper training must be provided to the nursing professionals. The presence of the occupational therapists helps to increase the overall outcome of the interventions. Thus, from the analysis of the evidence it is clear that rate of fall is higher among older adults and this hampers their overall quality of life due to increased fatal risk and injury related hospitalization. Proper research and training of the healthcare professionals will be helpful in creating a safer environment for the older adults and thereby helping to reduce the risk of falls. Thus, it can be said that the problem is worth solving as it will help to reduce the risk of fall among the older adults.
The main stakeholders for this project are
- Nursing professionals: This is because according to the professional code of conduct of the Nursing and The Midwifery Board of Australia, the nurses are required to practice as per the prevailing standards and that too in a safe and competent manner
- Occupational therapist: According to Robertson and Gillespie (2013) occupational therapists are best suited in order to reduce the chances of accidental fall of the older adults
- Family of carers of the patients: The family of carers are inherently associated with the patients and thus their training is also crucial (Robertson & Gillespie, 2013)
According to NSW Health (2018), CPI is an abbreviated form of Clinical Practice Improvement (CPI) tool, which promotes improvement and training. This training program aims to provide assistance to the healthcare professionals in order to succinctly address the clinical problem which is negatively hampering the quality of life of the patients. In this way this kind of training helps to improve the health-related quality of life of the patients. This education and skills gained from such training can be applied under a variety of clinical settings and thus helping to ensure the patient’s security overall quality of care. NSW Health report (2018) also highlights that this kind of clinical practice training also helps to increase the overall skills of the healthcare professionals. The CPI tool that can be taken into account for this project is PDSA cycle or Plan, Do, Study, Act Cycle. NSW Government Department of Health (2018) stated that PDSA helps to narrow the clinical focus and can be easily implemented over diverse clinical settings be it small or large for continuous improvement. “P” or “Plan” means identification of principal measures of the project and the expected outcome. “D” and “Do” aims towards implementation of agreed plan with a proactive approach to resolve the gaps in clinical practice. “S” or “Study: helps to study or analyse the progress in the care and “A” or Act helps to drafting new modification in the training process.
Key Stakeholders
In this said project, “P” signifies analysis of the nature and the strategies, which will be incorporated in the training process. The expected outcome will be increase in awareness of the nursing professionals in fall prevention approaches. To Do (D) is rigorous training and awareness program of the nursing professionals or healthcare workers under the residential or aged care settings under the governance of an occupational therapist. The training will be conducted through power-point presentation and poster presentation along with informative oration. Study (S) of the outcome will be done through questionnaire-based surveys in order to judge the level of knowledge acquired by the participants of the training. A (ACT) in order to bring change in the overall implementation process, feedbacks from the participants of the training will be taken. Furthermore, in order to bring change in the overall implementation process, the overall set up of the residential care or aged care will be revamped and nurses will be educated in proper arrangements of the furniture, use of traction shoes and practice of exercise for the prevention of fall(Stephenson et al., 2015).
Problem highlighted: Increase in the number of accidental falls among older adults under residential care or aged care settings.
Intervention proposed: Training of the nursing professionals under the supervision of occupational therapists in domains like exercise training of the older adults for the improvement of the gut performance, training to provide assistance and maintenance of the interior arrangement of the room to prevent fall arising from resistance
The successful application of the intervention will be done through proper education and training of the nursing professionals along with the family of carers. The training and education will help to increase the skills of the nursing professionals towards prevention of fall.
Project design: Education and training of the nursing professionals about strategies of preventing accidental fall among the older adults. Training will be given by occupational therapist with the help of power-point presentation. The residential care settings or aged settings with be selected for the training purpose. The family of carers and the nursing professionals will be trained together. According to Hägvide, Larsson and Borell (2013) older adults with dementia suffers from falls due to over-crowded interiors that is stuffed with furniture. Proper arrangements of the interior décor, use of proper lights ad slip resistant floor or removing carpets can reduce fall among the older adults. Hägvide, Larsson and Borell (2013) further highlighted proper physical exercise training helps to improve the gut performance and thus increasing the mobility of the joints and prevention of accidental fall among the older adults.
CPI Tool
Project audit: Mid-point review of the training program will be done after 3 days of face-to-face training in order make any amendments in the training process. The amendments will be based on the quality feedbacks of the participants. Other audits will be conducted based on the application of the MCQ or multiple-choice questions in order to access the level of knowledge acquired by the participants. Additional audits will be done in order to analyse the decrease in the occurrence of accidental fall among the older adults in the residential care settings(NSW Government Healthy, 2018). This will further help to measure the outcome of the training.
The time period of training is 1 week and evaluation of the outcome will be done post 3 months of training.
The main barriers in training implementation will be lack of financial resources, time limit and lack of necessary skills. The structuring of the training will demand proper setup and presence of a professional occupational therapists and this will require proper financial funding. However, at times it becomes difficult to arrange proper funding and thereby hampering the overall quality of training (Andrew Scanlon et al., 2014). Prolong training for a period of one week can hamper the shift timings and job schedule of the nursing professionals. Nurses can be unwilling to practice or to take part in the audit process creating a barrier in effective training (Andrew Scanlon et al., 2014). The educators can lack the necessary skills leading to decrease in the overall quality of training (Andrew Scanlon et al., 2014).
Evaluation of the CPI project will be done with the help of surveys and the use of open or close ended questionnaire.
The close ended questionnaire like multiple choice questions will help to analyse the increase the level of awareness and knowledge of the nursing professionals in fall prevention of the older adults. For each correct answer score 1 will be allocated and incorrect answer will have no score or zero score. The total score acquired will help to judge the final output of training (Ross et al., 2013).
The effective implementation of the nursing knowledge in the field area will be judge through the analysis of the residential care data in order to denote the ratio of fall among the older adults. This will be done after 3 months of training cessation and last one month of the data will be analysed(Ross et al., 2013).
The overall set-up of training will be judged as per the feedbacks gained from the participants of the training. The feedbacks will be gained through confidential interview and with the help of open-ended questionnaire(Ross et al., 2013).
References
Andrew Scanlon, D. N. P., Denise Hibbert, R. G. N., Freda DeKeyser Ganz PhD, R. N., Linda East PhD, R. N., & Debbie Fraser MN, R. N. (2014). Addressing issues impacting advanced nursing practice worldwide. Online Journal of Issues in Nursing, 19(2), 1.
Australian Government Department of Health. (2012). 5.5 Clinical governance. Access date: 31st October 2018. Retrieved from: https://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-e-evalnurs-toc~mental-pubs-e-evalnurs-b~mental-pubs-e-evalnurs-b-5~mental-pubs-e-evalnurs-b-5-5
Australian Institute of Health and Welfare. (2012). Trends in hospitalisations due to falls by older people, Australia 2002–03 to 2012–13. Access date: 31st October 2018. Retrieved from: https://www.aihw.gov.au/getmedia/5f84eadd-6f25-4429-82fc-5e9072278335/aihw-injcat-182.pdf.aspx?inline=true
Hägvide, M. L., Larsson, T. J., & Borell, L. (2013). Fall scenarios In causing older women’s hip fractures. Scandinavian journal of occupational therapy, 20(1), 21-28.
NSW Government Healthy. (2018). Clinical Practice Improvement (CPI) Training Program. Access date: 29th October 2018. Retrieved from: https://www.eih.health.nsw.gov.au/initiatives/clinical-practice-improvement-training-program
NSW Government Healthy. (2018). Plan, Do, Study, Act Cycle. Access date: 29th October 2018. Retrieved from: https://www.health.nsw.gov.au/pfs/Pages/pdsa.aspx
Nursing and Midwifery Board of Australia [NMBA]. (2018). Code of Professional Conduct of Nurses in Australia. Access date: 31st October 2018. Retrieved from: https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards.aspx
Robertson, M. C., & Gillespie, L. D. (2013). Fall prevention in community-dwelling older adults. Jama, 309(13), 1406-1407.
Ross, A. J., Anderson, J. E., Kodate, N., Thomas, L., Thompson, K., Thomas, B., … & Jaye, P. (2013). Simulation training for improving the quality of care for older people: an independent evaluation of an innovative programme for inter-professional education. BMJ Qual Saf, 22(6), 495-505.
Sherrington, C., Michaleff, Z. A., Fairhall, N., Paul, S. S., Tiedemann, A., Whitney, J., … & Lord, S. R. (2017). Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. Br J Sports Med, 51(24), 1750-1758.
Stephenson, M., Mcarthur, A., Giles, K., Lockwood, C., Aromataris, E., & Pearson, A. (2015). Prevention of falls in acute hospital settings: a multi-site audit and best practice implementation project. International Journal for Quality in Health Care, 28(1), 92-98.
Vlaeyen, E., Coussement, J., Leysens, G., Van der Elst, E., Delbaere, K., Cambier, D., … & Dejaeger, E. (2015). Characteristics and effectiveness of fall prevention programs in nursing homes: A systematic review and meta?analysis of randomized controlled trials. Journal of the American Geriatrics Society, 63(2), 211-221
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