Falls Prevention Interventions – Critical Appraisal And Analysis

Clinical Governance of Falls Prevention

Introduction

Falls prevention in elderly is a key safety and quality health care area. Clinical governance of the falls prevention in elderly is an integrated element of governance of health service organisations. It ensures that all the relevant professionals ranging from clinicians to managers and members of governing bodies, are accountable to the elderly people for ensuring safe, effective, integrated, high quality and continuously improving care delivery. Elderly population has been suffering injury due to falls. Falls in older population has been recognized as a public health issue globally. World Health Organization defined fall as an occurrence which causes an individual coming to rest unintentionally on the ground or floor or any lower level (WHO, 2016). The elderly population is increasing dramatically with a prolonged life expectancy, and they are at increased risk of falls. Falls prevention including the risk factors and interventions has been studied in various researches. Protocol for a systematic review reported that falls are the chief cause of inadvertent or accidental injury and hospital admission. A link has been found between falls and prolonged length of stay in the hospital, readmissions, and poor treatment outcomes. It suggested that prevention of falls can be apprised through learning reversible risk factors of falls and correct identification of risks (Slade, Carey, Hill, & Morris, 2017). The finding is supported by another study which reports the increase in number injuries and hospitalizations due to falls. It further suggests that falls result in fear of falling, dependence, institutionalization, and death. So, it can be said that falls pose a substantial burden to the health care system. Therefore, the study will benefit by identifying the significance of screening of people at risk of falls like the elderly population and their detailed assessment to prevent falls and associated injuries. It fosters the components of the Clinical Governance including Patient Safety and quality improvement systems and Clinical Performance and effectiveness (ACSQHC, 2017).

An organised critiquing of the research papers involve using a pre-arranged appraisal tool to facilitate a rigorous and strategic approach for critiquing the articles (Whiffin & Hasselder, 2013). Critiquing the research papers is essential as it helps in assessing the quality of the papers so that distinction between good and poor quality of research papers can be made (Harrison, Reid, Quinn, & Shenkin, 2017). Various critiquing tools are available to appraise the papers but Critical Appraisal Skills Programme (CASP) tools has is used as it has a systematic approach to evaluate the rigour of the articles which are to appraised (Smith & Noble, 2016). In addition, the CASP are concise and effectively include all the areas needed for critical review of literature (Nadelson & Nadelson, 2014).

Appraisal of Article 1

Study addressed a clearly focused issue. The focus is to assess the level of independence and find the fall risk factors in elderly population which is clearly depicted through the title. The cohort was recruited in an acceptable way with rigorous inclusion criteria. The study toools were comprehensive as 6 different tools were used to measure different aspect of independece and risk falls in elderly population. The authors have not identified or taken into account the important confounding factors in the research design. The follow up was long enough and complete enough. The result of study was able to answer the objectives of the study. The results were precise as per the C.I. and believable. The results have the potential of generalisation for local population even though the sample size was small, but result of this study is in line with previous studies. The study also has significant implications as it concludes that several risk factors can be modified, therefore, it provides an insight to build a standard procedure to prevent falls in the older adults.

Systematic Review for Falls Prevention

Appraisal of Article 2

For this study, the authors provided a clear statement of the aims of the research. The qualitative methodology used was focus groups which is appropriate as per the aim and nature of the paper. The research design is appropriate to address the aims of the research. Although similar to interviews, the group context of focus groups make them ideal for providing a breadth of experiences and views on a topic, and for gaining access to participants’ collective understandings. Focus groups were an appropriate tool to collect exploratory, qualitative data on this subject given the paucity of research in this area and our aim to ascertain several older people’s views on the research question. They were also ideal as it afforded ease of recruitment across the United Kingdom. The recruitment strategy is also appropriate to the aims of the research. A purposive sampling strategy was utilised to find out the elderly individuals likely to provide a diversity of views with respect to the study topic. Participants were recruited from different geographical contexts which is beneficial for the research topic. The research was ethically rigorous as prior to initiation of the research approval was taken from the Research Ethics Committee of Bournemouth University. Also, for the focus group performed with NHS patients in Scotland, an approval was taken by the local NHS research ethics committee and Research and Development office. For maintaining anonymity during the data analysis, the identity of participants was hidden in the verbatim transcriptions of the focus groups by excluding participants’ names and other possibly recognisable traits. The data analysis was sufficiently rigorous as it included three iterations of coding, reliability checking and refinement of the coding, and comparisons between codes. There was a clear statement of finding. This research demonstrated numerous aspects of the outdoor environment that can be a source of future falls. The results are not generalizable to the national population. However, the research highlighted the areas to be focused in future quantitative researches.

Appraisal of Article 3

The systematic review addressed a clearly focused question. The authors look for the right type of papers. Varying range of key words were included to identify all the relevant studies. Specific inclusion and exclusion criteria based on the age of participants, technologies related specifically to falls prevention, detection or monitoring, nursing practice, etc. were taken into account. However, I believe not all the important, relevant studies were included. The authors do enough to assess quality of the included studies. The Joanna Briggs Institute (JBI) tool and the Quality Assessment Tool for Quantitative Studies by the Effective Public Health Practice Project (EPHPP) were used. The precision of the results is good enough as they are in line with previous studies. The results be applied to the local population. I believe that not all the important outcomes were considered in the study. It is hard to tell whether the benefits worth the harms and costs for this study.

I believe the systematic review is the most rigorous in the three critiqued articles. The research was strong as the studies included in the review were checked for quality. Further, the findings of the qualitative and quantitative researches will need further examination in a larger and more varied sample for generalisation and the findings of the review is most generalizable of all.

Critical Appraisal of Falls Prevention Studies

Main Findings

Literature includes the importance of screening and comprehensive assessment of the older people particularly those who are at high risk. A proactive approach by the health professionals to prevent the occurrence of falls is needed emphasized in the literature. The need for a tailored intervention program as per the location, age, comorbidities, severity is also identified in the review. It also identifies various interventions based on education and practice.

Falls lead to ER visits frequently for older adults as they sustain injuries, so, quality of trauma care may have a substantial effect on the health outcome of the injured patient. A study which compared nature and outcomes of falls among older adult for different age groups found a link between age group and fall height, location, and alcohol use (Chippendale, Gentile, & James, 2017). Another study also identified various risks factor of falls and found that age, history of falls, reduced mobility, balance and gait issues, and medicines are associated with occurrence or increasing the risk of fall. It also included sensory and environmental aspects and the fear of falling in the risk factors (Enderlin, et al., 2015). Regarding the feelings, the older people reported that they usually suffered minor or moderate injury, felt embarrassed and experienced anxiety about falling again. The study found the importance of consideration of outdoor and indoor environments by health professionals while recommending interventions for falls prevention to older adults (Nyman, Ballinger, Phillips, & Newton, 2013). Next, a study focused on the frequent mistake while managing fall-related injury and that management without finding the underlying cause. So, the study identified the need for a proactive approach to detecting the chances of fall for the older people.

Clinical governance should be established and maintained by all the health care professionals to promote safety and quality. Nursing practice must be able to The identify safety and quality measures, and find out areas which has scope of improvement in delivering safety and quality to the elderly population at the risk of falls. They should include the service users or their families while reviewing safety and quality performance and systems (ACSQHC, 2017).

References

ACSQHC. (2017). National Model Clinical Governance Framework. Sydney: Australian Commission on Safety and Quality in Health Care.

Chippendale, Gentile, & James. (2017). Characteristics and consequences of falls among older adult trauma patients: Considerations for injury prevention programs. Aust Occup Ther J., 64(5), 350-7.

Enderlin, Rooker, Ball, Hippensteel, Alderman, Fisher, . . . Jordan. (2015). Summary of factors contributing to falls in older adults and nursing implications. Geriatr Nurs, 36(5), 397-406.

Harrison, J. K., Reid, J., Quinn, T. J., & Shenkin, S. D. (2017). Using quality assessment tools to critically appraise ageing research: a guide for clinicians. Age and Ageing, 46(3), 359-365.

Hawley-Hague, Boulton, Hall, Pfeiffer, & Todd. (2014). Older adults’ perceptions of technologies aimed at falls prevention, detection or monitoring: a systematic review. Int J Med Inform, 83(6), 416-26.

Nadelson, & Nadelson. (2014). Evidence-Based Practice Article Reviews Using CASP Tools: A Method for Teaching EBP. Evidence-Based Nursing, 11(5).

Nyman, S. R., Ballinger, C., Phillips, J. E., & Newton, R. (2013). Characteristics of outdoor falls among older people: a qualitative study. BMC Geriatrics, 13(125).

Qin, & Baccaglini. (2016). Distribution, Determinants, and Prevention of Falls Among the Elderly in the 2011-2012 California Health Interview Survey. Public Health Rep, 131(2), 331-9.

Slade, Carey, Hill, & Morris. (2017). Effects of falls prevention interventions on falls outcomes for hospitalised adults: protocol for a systematic review with meta-analysis. BMJ Open, 7(11).

Smith, J., & Noble, H. (2016). Reviewing the literature. Evidence-Based Nursing, 19, 2-3.

Whiffin, & Hasselder. (2013). Making the link between critical appraisal, thinking and analysis. British Journal of Nursing, 22(14), 831.

WHO. (2016). Falls. World Health Organisation.

Order an Essay Now & Get These Features For Free:

Turnitin Report

Formatting

Title Page

Citation

Outline

Place an Order