Literature Review On Minimizing Hospital-Based Falls

Why Do a Literature Review?

According to Chu (2017 p.31), clinical governance is defined as the process through which healthcare institutions are held accountable for enhancing the quality and standard of the services they offer while fostering high notch values of care through advancement of clinical environments in which medical excellence flourishes. Consequently, Grealish and Chaboyer (2015 p.1286) said that clinical governance audits pertinent healthcare issues such as incidence and management as well as quality assurance and improvement based on the pillars of clinical performance and evaluation, professional development and management, clinical risk and consumer value . Risk management is one of the most essential aspects of fostering the ,minimization of falls through delivery of high quality services in medical settings. Consequently, prevention of falls in medical settings is a role acquainted to nurses that needs to be analyzed with optimal degrees of care. Furthermore, (Morgan et al. 2017 p.116), hospital based falls is a major issue of safety based on its detrimental effects in increasing the patient’s length of stay and reduction of the affected client’s quality of life. Coppedge, Corner and Se (2016 p. 64) report that about 30% of the 700,000 patient falls that occur on a yearly basis could be prevented. The scholars reveal that the longer stays that result from such incidences increase the patient care costs by over 60% resulting from unplanned intracranial harms, fractures and dislocations.

Nurses play a significant role in preventing hospital based falls. Grealish and Chaboyer (2015 p.1286) explain that older patients aged over 65 years are at a greater risk of encountering falls in comparison to their younger counterparts.  Moreover,(Morgan et al. 2017 p.118) underscore hourly rounding as an aspect of enhancing the availability of nurses; adoption of effective channels  of communication; institutionalization of medication reviews and educating stakeholders in order to enhance fall prevention awareness as the most effective ways of  minimizing the effects of this menace. On the other hand, Basic and Hartwell (2015 p.1637) reveal that nurses dealing with older patients need to adopt a wider variety of process improvement tools to avail the system with long lasting solutions.

The critical analysis identifies pertinent research issues proposed by the three articles through examination of the quality of the pieces of evidence proposed, identification of the areas of bias, relevance of the scholarly works in fostering the reduction of falls, as well as the aspects of validity and reliability. The Critical Appraisal Skill Programme (CASP) tool will be applied to foster the critical analyses advanced. According to Carter, Creedy and Sidebotham (2015 p.864), CASP vets the efficacy of a scholarly material by evaluating the appropriateness of the methodologies applied, the degree of credibility of the findings presented and the relevance of these results to the questions under scrutiny. Similarly, CASP audits the effectiveness of the research design adopted by scholars in addressing the underlying aims of the study and the degrees of efficacy in establishing relationships among variables.

What Literature Should be Included?

Colón-Emeric  et al. (2017 p.1634) present a study aimed at assessing the extents to which a “complexity science–based staff training intervention”  dubbed CONNECT meets its desired levels of effectiveness minimizing falls through enhancement of high quality interactions among caregivers in clinical settings. The researchers fulfill the 10 propositions of CASP. The goal established for this scholarly material play a crucial role in contributing to the wide body of literature by proposing new frameworks of implementing the interventions of reducing falls in healthcare settings. Further, the scholars adopt a cluster-randomized trial in an effective way as evidenced by their inherent capabilities to include a control group and an intervention group. Similarly, the recruitment strategies reveal higher degrees of appropriateness to the objective of the research. For instance, the participants only qualified for inclusion if they worked in healthcare settings with patients facing the risk of falls. On the other hand, issues of ethics were put into consideration. For instance, there is evidence that informed consent was acquired for the participants. Similarly, privacy was ensured by initiating patient record abstractions about 6 months prior to the intervention.

Vlaeyen et al. (2017) present a systematic review aimed at identifying the factors that hinder as well as those that act as facilitators for programs established to prevent falls in residential care facilities. A critical analysis of the research reveals that the scholars were highly effective in adopting their articles from five databases (MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science) which boast of their capacities in wealth of journals. Further, the quality of the study is enhanced by the fact that the researchers implement quality appraisal by the use of the Mixed Method Appraisal Tool. Most importantly, the researchers enhance both the degrees of reliability and validity of the scholarly work by implementing thematic explorations for the qualitative data obtained and descriptive analysis for quantitative data. Additionally, the review puts into consideration multiple agencies (Grol and panelists) to foster the processes of synthesizing the data obtained through identification of the barriers and facilitators of implementing programs aimed at minimizing falls in hospital settings. The strength of the scholarly material emanates from its dynamic abilities to include a multi-sector perspective that reviews the effects of social, political and economic issues in preventing falls rather than focusing on nurses alone.

Dykes et al. (2017) present a study aimed at advancing the Fall TIPS instrument aimed at enlightening and engaging patients in the processes of preventing hospital based falls with the help of nurses. The researchers adopt a pilot testing method for the Fall TIPS program in two medical centers that enjoy both geographical and ethnic diversities; an aspect that enhances its ease of generalizability to the wider global population of people facing the risks of hospital based falls. Despite the aforementioned diversities, the levels of reliability and validity of the results obtained is limited from the narrow sample of hospitals (n = 2) adopted. Further, such a shortfall exposes the research to the vulnerabilities of institutional and regional biases hat could be avoided by including a wider population of healthcare organizations. On the other hand, the study fails to reveal the ethical issues put into consideration when conducting patient surveys. However, the study’s strength emanates from the scholars’ ability to make observations for a long period of time. For instance, the researchers adopt a total of 2,000 patient-days in 2015 and 2016.

How Should I Do a Literature Review?

Colón-Emeric et al. (2017) reveal that the application of complex multifactorial interventions plays a significant role in alienating the adverse outcomes associated with hospital based falls among patients with an advanced age. The scholars further explicate that despite the institutional policies set to ensure that these falls are reduced; nurses have failed in ensuring that clinical trials are effectively translated into practice. Similarly, the researchers find out that poor collaboration between nurses and other healthcare practitioners hinders effective flow of information and therefore, the effectiveness of the initiatives set to minimize falls. Similarly, the dons recommend that medical institutions must come up with new frameworks of implementing evidence based practices as a way of reducing falls in clinical settings.

Comparatively, the studies advanced by Dykes et al. (2017) and Vlaeyen et al. (2017) play a crucial role in establishing the conditions that exacerbate falls in healthcare settings. However, while Vlaeyen et al. (2017) conduct a systematic review to identify the institutional barriers and facilitators to effective adoption of programs aimed at reducing falls, Dykes et al. (2017) use a pilot testing approach to assess the efficacy of the Fall TIPS Toolkit. In the qualitative study advanced by Dykes et al. (2017), proper education of patients on the factors that increase their levels of vulnerability towards hospital based falls was found out to be the most essential way of tackling this menace. Similarly, Vlaeyen et al. (2017) establish 17 facilitators and 27 barriers to the proper adoption of fall prevention initiatives. The latter establish that the success of these programs is greatly dependent on the multifactorial interventions put in place in different levels of the institution.

References

Barrett, M.B., Vizgirda, V.M. and Zhou, Y., 2017. Registered Nurse and Patient Care Technician Perceptions of Toileting Patients at High Fall Risk. Medsurg Nursing, 26(5), pp.317-323.

Basic, D. and Hartwell, T.J., 2015. Falls in hospital and new placement in a nursing home among older people hospitalized with acute illness. Clinical interventions in aging, 10, p.1637.

Carter, A. G., Creedy, D. K., & Sidebotham, M. (2015). Evaluation of tools used to measure critical thinking development in nursing and midwifery undergraduate students: a systematic review. Nurse education today, 35(7), 864-874.

Chu, Ruby Z. “Preventing in-patient falls: The nurse’s pivotal role.” Nursing2018 47, no. 3 (2017): 24-30.

Colón-Emeric, C.S., Corazzini, K., McConnell, E.S., Pan, W., Toles, M., Hall, R., Cary, M.P., Batchelor-Murphy, M., Yap, T., Anderson, A.L. and Burd, A., 2017. Effect of promoting high-quality staff interactions on fall prevention in nursing homes: a cluster-randomized trial. JAMA internal medicine, 177(11), pp.1634-1641.

Coppedge, N., Conner, K. and Se, S.F., 2016. Using a standardized fall prevention tool decreases fall rates. Nursing2018, 46(3), pp.64-67.

Dykes, P.C., Duckworth, M., Cunningham, S., Dubois, S., Driscoll, M., Feliciano, Z., Ferrazzi, M., Fevrin, F.E., Lyons, S., Lindros, M.E. and Monahan, A., 2017. Pilot Testing Fall TIPS (Tailoring Interventions for Patient Safety): a Patient-Centered Fall Prevention Toolkit. The Joint Commission Journal on Quality and Patient Safety, 43(8), pp.403-413.

Grealish, L., & Chaboyer, W. (2015). Older, in hospital and confused–The value of nursing care in preventing falls in older people with cognitive impairment. International journal of nursing studies, 52(8), 1285-1287.

Morgan, L., Flynn, L., Robertson, E., New, S., Forde?Johnston, C., & McCulloch, P. (2017). Intentional Rounding: a staff?led quality improvement intervention in the prevention of patient falls. Journal of clinical nursing, 26(1-2), 115-124.

Vlaeyen, E., Stas, J., Leysens, G., Van der Elst, E., Janssens, E., Dejaeger, E., … & Milisen, K. 2017. Implementation of fall prevention in residential care facilities: A systematic review of barriers and facilitators. International journal of nursing studies, 70, 110-121.

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