Causes of falls and preventive mechanisms in stroke patients
Discuss About The Practice Fall Prevention In Stroke Patients.
The fall in Stroke patients is a common phenomenon during and after treatment. When the patients fall, they get injured and can contact other infections such as fractured bones. In Australia, approximately 14% of stroke patient fall during their movements (Maeda et al., 2015). A recent study showed that 40 individuals in every 150 stroke patients fall during rehabilitation (Cho, and Rhee, 2015). Factors that lead to the falls include little strength in the legs; occasional loss of sight; issues with the foot, and difficulty in sensing objects (Kim, and Kim, 2015). Rectification of the falling includes strategies such as: correcting the eyesight, provision of walking aids for the patients and giving a wheelchair to patients (Maeda et al., 2015). The prevention mechanism is an area that has limited literature. This paper examines the major causes of falling in Stroke patients. Furthermore, it uses the PICO model to develop strategies for preventing the frequent falls in stroke patients. The article gives a well-researched and evidence-based explanation on the fall preventive strategies management. The paper compares and contrasts the literature with the actual methods of falls prevention at the South West Sydney Hospital, Stroke Ward. Moreover, it looks at the barriers to the implementation of evidence-based practices by practitioners. Furthermore, students and researchers should find solutions to the obstacles within this paper. Additionally, the article looks at possible strategies to promote Evidence-Based Practice (EBP) in health facilities.
The issues surrounding falls by Stroke patients and possible preventive mechanisms can be summarized using the PICO format. Letter (P) stands for Patient/Problem/Population (Higson, Emery and Jenkins, 2017). The patients involved are the stroke patients. Letter (I) stands for intervention (dos Santos, Rabiais, and Amendoeira, 2016). The problem is the falling of the patients. Some of the intervention measures include providing the patients with walking aids to prevent them from falling. Letter (C) stands for comparison (Higson, Emery and Jenkins, 2017). There are aspects of similarities and differences between the literature on the prevention measures and the real situation at South West Sydney Hospital. Letter (O) stands for the outcome of the defensive mechanisms (Higson, Emery and Jenkins, 2017). When the measures assume center stage, the number of injuries by falling of stroke patients will reduce. Therefore, the research question is: what are the causes of falls in stroke patients and which are the intervention measures?
Barriers to Evidence-Based Practice (EBP) and ways to overcome them
Causes of falls and preventive mechanisms in stroke patients,
Barriers to Evidence-Based Practice (EBP) and ways to overcome them, and
Strategies that promote EBP at South West Sydney Hospital
The research method involved interviews with health practitioners and nursing students in Sydney, Australia. Additionally, stroke patients at the Stroke Wards filled questionnaires on the possible causes of the falls. The internet helped with the evidence-based literature on the three areas. Some of the sources include (Journal of physical therapy science, International Journal of Nursing, Journal of Continuing Education in the Health Professions) and others. The research narrowed down on the three sources and thirteen others due to their accuracy and reliable evidence.
Stroke results from the blockage of blood entering the brain cells. Moreover, bleeding of the blood vessels leads to the onset of stroke. Red blood cells transport oxygen to the central nervous system (CNS) (Maeda et al., 2015). Once blood cannot reach the brain cells, the CNS, the functioning of the brain slows down. The brain coordinates the maintenance of body balance and movement in humans (Maeda et al., 2015). Therefore, the improper functioning of the brain causes stroke patients to lose balance hence they can quickly fall.
The falling over also results from reduced muscle mass and loss of senses such as that of touch and listening. Other causes of falls include: decline in concentration by the patients and reduced vision by the patients (Cho, and Rhee, 2015). One of the causes of stroke is the shutdown of nerve functions. Once the Peripheral Nervous System (PNS) cannot function normally, an individual loses the ability to sense an approaching object. Thus, the patient strikes the object and falls over.
The cells that coordinate the levels of concentration reside within the CNS. Once the brain cells are malfunctioning, an individual loses the capacity to concentrate on their movement. Such individuals can quickly fall. For an individual to have a clear vision, the eye has to see an object first. Secondly, the neurons transmit that information to the brain cells (Cho, and Rhee, 2015). The CNS interprets the stumbling block, and the individual can now view the block and interprets it. Stroke patients have neurons which are dead (Cho, and Rhee, 2015). Additionally, their brain cells are not functioning well. Therefore, they have reduced vision. Once they cannot see an object ahead of them, the stroke patients stumble on the object and fall.
Strategies that promote EBP at South West Sydney Hospital
The first cause of falling is dizziness due to brain dysfunctions. Other causes include drug side effects, hypertension, visual impairments, and diet-related issues (Amorim, Goddard, Forbes, and Davis, 2016). The physician should issues drugs that have minimal side effects to the stroke patients. Every victim of stroke should observe balanced diet (Amorim et al., 2016). The patient should go for eye check-ups to correct possible visual cataracts. Furthermore, the clinician can suggest specific physical activities and particular foods that improve an individual’s vision.
The second cause of falling is body imbalance and the inability to walk correctly. The physicians should recommend a regular exercise plan to improve an individual’s roaming capabilities (Watabe et al., 2018). Furthermore, stroke patients should stand for long hours as they practice to maintain body balance. The patient should change the brace that the nurses offered them. They should visit a nearby health facility to acquire a new brace (Watabe et al., 2018). When a stroke patient realizes that the legs are continuing to swell, they should contemplate getting another brace. The nurse should propose an effective strategy to improve the movement of the patient.
Stroke patients and any other persons can fall when in the bathroom or when moving in and out of the room. Most bathroom floors are slippery due to the spilled water that stagnates on the floor. Relatives of stroke patients should adequately maintain bathrooms. They should get rid of split water after taking a shower (Watabe et al., 2018). Additionally, the floor should incline to prevent water stagnation. Apart from the bathroom, the room of the patient should have sufficient lighting. Poor lightning leads to poor vision hence someone cannot see objects on their paths.
Memory loss is another cause of falling. The usage of a few drugs impairs memory. Additionally, an unbalanced diet and lack of physical exercise lead to forgetfulness (Walsh, Horgan, Walsh, C.D. and Galvin, 2016). The physicians should prescribe medicines that lack serious side effects to the patients. The patients should observe a balanced diet and do regular physical regiments. Poor vision also leads to falling of stroke patients during rehabilitation (Walsh et al., 2016). The patients should go for vision check-ups. Additionally, they should ensure that their residential places are devoid of destructive objects. Moreover, the patient should improve the lighting system in their homes.
Other health issues apart from Stroke can cause stumbling and eventual falling of individuals. Diabetes Mellitus and depressions are some of the causes of falls (Watabe et al., 2018). Additionally, untreated arthritis leads to falls in stroke patients. The individuals should ensure that they treat any ailment that may cause falling.
The methods in the evidence-based literature sources are similar to the suggestions in the healthcare facilities in Australia. South West Sydney Hospital suggests specific physical activities to improve the balancing act in stroke patients. Similarly, evidence-based research emphasizes on the need of regular regiments to correct body imbalance. The health facilities urge patients to do regular physical exercise to reduce the deficits of gait (Watabe et al., 2018). The Sydney hospital carries out athosis of the foot and the ankle to strengthen the two body structures (Watabe et al., 2018). The hospital and the literature believe that strong feed aids in movement. Moreover, stroke care ward in South West Hospital is offering an instrument to aid patients in their moves from one place to another. A majority of the health centers stimulate the muscles of the legs of stroke patients. The electrical strengthening of the walking structures leads to fall-free movement.
EBP refers to the usage of information that has a scholarly background in the medical field (DiCenso, Guyatt, and Ciliska, 2014). When nurses rely on information that lacks enough evidence, they can make wrong treatment decisions. Consequently, adverse medical choices put the life of patients at risk.
Most physicians find EBP to be a waste of time. They always apply the medical knowledge learned at the college levels to administer treatment. However, a proper medical practice requires that the practitioner attaches proof the method of care that they are using. Furthermore, the specialist should distinguish between resourceful and skewed evidence before settling on the mode of treatment (Jirojwong, Johnson, and Welch, 2014). Clinicians have a tight schedule of attending to a large number of patients on a daily basis. Thus they get little time to do extensive research.
There are some steps that they can consider to offer evidence-based care. Firstly, is to use the internet to find relevant information on preventing falls in stroke patients (Jirojwong et al., 2014). Secondly, nurses can utilize the numerous online e-books to research on appropriate information on treatment methods (Jirojwong et al., 2014). Online sources are easy to access and highly reliable. Thirdly, the physicians can use the questions raised by patients to develop an appropriate plan of treatment. Nurses can raise issues of doubts at their meetings to get an insightful solution from colleagues.
The internet may be a reliable source of information but may lack evidence-based information. For example, the web may outlay the fall prevention measures but do not give a detailed explanation of the strategies (Schmidt and Brown, 2014). Therefore, the clinicians may rely on outdated information when conducting treatment. To solve this issue, the clinicians should seek knowledge on the location of evidence-based details (Sadeghi?Bazargani, Tabrizi, and Azami?Aghdash, 2014). Health facilities should avail accurate treatment facts to health practitioners. Moreover, the Australian Midwifery and Nurses board and other health fraternities should offer free access to treatment procedures for nurses.
At some occasions, the physician may fail to adequately explain the causes of falls in stroke patients and possible prevention techniques (Sadeghi?Bazargani, Tabrizi, and Azami?Aghdash, 2014). When patients use incomplete information due to poor communication from the clinician, they may fall and fracture their bones. On other occasions, nurses and patients do not speak the same language.
The impediment in language prevents the patient from getting the right information (Sadeghi?Bazargani, Tabrizi, and Azami?Aghdash, 2014). Other practitioners have a poor mastery of the fall prevention measures, thus giving the inaccurate information to stroke patients. In case the patient cannot understand the physician’s language, the hospital should employ a translator to boost communication (LoBiondo-Wood, and Haber, 2017). The health facility should train the physicians on proper communication skills. Additionally, health associations should train health specialists on the strategies of appropriate medical practice and expose them to the essence of EBP.
In few occasions, clinicians do not know the real meaning of EBP. Those who understand the practice may lack the appropriate knowhow to apply it. Other practitioners do not engage self in thorough research to ascertain the importance of EBP (Aarons, Ehrhart, Farahnak, and Hurlburt, 2015). The Australian government should introduce a mandatory course in EBP in all medical schools (Harding et al., 2014). Additionally, health facilities should conduct regular exposure to the meaning and essence of EBP. Moreover, medical regulatory bodies should make EBP mandatory for all practitioners.
Other patients fail to adhere to EBP on preventing falls that the doctor has recommended. The patient may rely on their understanding hence abandoning the doctor’s piece of advice. In rare cases, EBP may clash with the personal preferences and beliefs of patients (Williams, Perillo, and Brown, 2015). To avoid such circumstances, the physicians should explain the essence of using EBP to the patient. Other patients may be uncomfortable with the procedures that the doctor has suggested. Therefore, the physician should consider the needs of the patients before delivery EBP.
Clinicians should build a habit of searching for EBP. Additionally, physicians should critique the treatment methods that they doubt. Moreover, physicians should get used to carrying out thorough research on databases to find the appropriate EBP. Doctors should use information from sources that are accepted worldwide (Melnyk, Gallagher?Ford, Long, and Fineout?Overholt, 2014). Furthermore, the nurses should do an in-depth analysis of resources before using them. Before making treatment decisions, the physicians should incorporate their experiences with the patient’s tastes and available EBP literature.
References
Aarons, G.A., Ehrhart, M.G., Farahnak, L.R. and Hurlburt, M.S., (2015). Leadership and organizational change for implementation (LOCI): a randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation. Implementation Science, 10(1), p.11.
Amorim, A., Goddard, Y., Forbes, P., and Davis, K., (2016), January. How to reduce falls in stroke patients admitted to stroke care centre?-a Quality improvement project. In Cerebrovascular Diseases (Vol. 41, pp. 51-51). Allschwilerstrasse 10, CH-4009 Basel, Switzerland: KARGER.
Cho, K., Yu, J. and Rhee, H., (2015). Risk factors related to falling in stroke patients: a cross-sectional study. Journal of physical therapy science, 27(6), pp.1751-1753.
DiCenso, A., Guyatt, G., and Ciliska, D., (2014). Evidence-Based Nursing-E-Book: A Guide to Clinical Practice. Elsevier Health Sciences.
dos Santos, P.A.F., Rabiais, I.C.M. and Amendoeira, J.J.P., (2016). Therapeutic Model of Rehabilitation: The Contribution of Nursing «Supported Fast Track Multi-Trauma Rehabilitation Services». International Journal of Nursing, 3(2), pp.30-38.
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Higson, J., Emery, A. and Jenkins, M., (2017). Improving children’s nurses’ knowledge of caring for people with mental health problems. Nursing Children and Young People (2014+), 29(1), p.25.
Jirojwong, S., Johnson, M. and Welch, A.J., (2014). Research methods in nursing and midwifery pathways to evidence-based practice.
Kim, O. and Kim, J.H., (2015). Falls and use of assistive devices in stroke patients with hemiparesis: association with balance ability and fall efficacy. Rehabilitation Nursing, 40(4), pp.267-274.
LoBiondo-Wood, G. and Haber, J., (2017). Nursing Research-E-Book: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences.
Maeda, N., Urabe, Y., Murakami, M., Itotani, K. and Kato, J., (2015). Discriminant analysis for a predictor of falls in stroke patients by using the Berg Balance Scale. Singapore medical journal, 56(5), p.280.
Melnyk, B.M., Gallagher?Ford, L., Long, L.E. and Fineout?Overholt, E., (2014). The establishment of evidence?based practice competencies for practicing registered nurses and advanced practice nurses in real?world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence?Based Nursing, 11(1), pp.5-15.
Sadeghi?Bazargani, H., Tabrizi, J.S., and Azami?Aghdash, S., (2014). Barriers to evidence?based medicine: a systematic review. Journal of evaluation in clinical practice, 20(6), pp.793-802.
Schmidt, N.A. and Brown, J.M., 2014. Evidence-based practice for nurses. Jones & Bartlett Publishers.
Walsh, M.E., Horgan, N.F., Walsh, Accounting., and Galvin, R., (2016). A systematic review of risk prediction models for falls after stroke. J Epidemiol Community Health, pp.ch-2015.
Watabe, T., Suzuki, H., Konuki, Y., Aoki, K., Nagashima, J. and Sako, R., (2018). Beneficial falls in stroke patients: evaluation using a mixed method design. Topics in stroke rehabilitation, 25(2), pp.137-144.
Williams, B., Perillo, S. and Brown, T., (2015). What are the factors of organizational culture in health care settings that act as barriers to the implementation of evidence-based practice? A scoping review. Nurse education today, 35(2), pp.e34-e41.
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