Roles of Nurses in Minimizing Hospital Based Falls: A Critical Analysis

The assignment undertakes a critical analysis of the roles played by nurses in minimizing the incidences of hospital based falls. The success of these programs is greatly dependent on the multifactorial interventions put in place in different levels of the institution.

Sandhya Neupane Khadka student Id: 2196209 Assignment 4: Investigate clinical
governance issue
Background
The assignment undertakes a critical analysis of the roles played by nurses in minimizing the
incidences of hospital based falls. About 30% of the 700,000 patient falls that occur on a yearly
basis could be prevented (Chaboyer 2015 p.1286). Similarly, the longer stays that result from
such incidences increase the patient care costs by over 60% resulting from unplanned intracranial
harms, fractures and dislocations. The results of the analysis indicate 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. Further, the scholars
reveal that the success of these programs is greatly dependent on the multifactorial interventions
put in place in different levels of the institution. However, poor collaboration between nurses and
other healthcare practitioners hinders effective flow of information and therefore, the
effectiveness of the initiatives set to minimize falls.
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Sandhya Neupane Khadka student Id: 2196209 Assignment 4: Investigate clinical
governance issue
Introduction
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
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Sandhya Neupane Khadka student Id: 2196209 Assignment 4: Investigate clinical
governance issue
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.
Critique of Literature
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.
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.
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Sandhya Neupane Khadka student Id: 2196209 Assignment 4: Investigate clinical
governance issue
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
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Sandhya Neupane Khadka student Id: 2196209 Assignment 4: Investigate clinical
governance issue
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.
Findings
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.
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Sandhya Neupane Khadka student Id: 2196209 Assignment 4: Investigate clinical
governance issue
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.
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Sandhya Neupane Khadka student Id: 2196209Assignment 4: Investigate clinical governance issue
Summary of Literature
Author/s
(year)
Country
Aims Sample/ setting Design/
methods
Main findings Strengths and limitations of the paper
Article
1
Colón-
Emeric,
C.S.,
Corazzini,
K.,
McConnell,
E.S., Pan,
W., Toles,
M., Hall, R.,
Cary, M.P.,
Batchelor-
Murphy, M.,
To investigate the
effectiveness of a complexity
science–based staff training
intervention
(CONNECT) in fostering staff
interactions as a way of
minimizing falls.
24 nursing holes
located
within100miles
of Duke
University.
Cluster-
randomized
trial
.
 Falls in hospital settings can
be reduced through adoption
of methods aimed at
improving connections, flow
of information, and
application of cognitive
diversity.
.
Strength: Inclusion of patients from
diverse populations increased the
validity and reliability of the study.
Limitation: A small sample size (N =
24) limited the ability of the study to
foster generalizations.
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Sandhya Neupane Khadka student Id: 2196209Assignment 4: Investigate clinical governance issue
Yap, T.,
Anderson,
A.L. and
Burd, A.,
(2017)
Country:
USA
Article
2
Dykes, P.C.,
Duckworth,
M.,
Cunningham
, S., Dubois,
S., Driscoll,
M.,
Feliciano,
Z., Ferrazzi,
M., Fevrin,
To categorize the factors that
act as facilitators and barriers
to effective implementation of
fall prevention initiatives in
residential care facilities.
Articles included
for the systematic
review (n = 8)
Systematic
review
 17 facilitators and 27 barriers
to effective implementation
of fall prevention programs
in healthcare settings were
identified.
 Social and organizational
factors have the greatest
influence on the efficacy of
these factors.
Strength: Quality of the systematic
review was enhanced through
application of a systematic search
strategy conducted in line with the
Center for
Reviews and Dissemination Handbook.
Limitations: The use of strict inclusion
and exclusion frameworks limited the
efficacy of the study in including
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Sandhya Neupane Khadka student Id: 2196209Assignment 4: Investigate clinical governance issue
F.E., Lyons,
S., Lindros,
M.E. and
Monahan,
A., (2017)
Country:
Belgium
 Communication and facility
equipment availability were
the most cited factors.
relevant data.
Article
3
Vlaeyen, E.,
Stas, J.,
Leysens, G.,
Van der Elst,
E., Janssens,
E., Dejaeger,
E., ... &
Milisen
(2017)
To pilot test the efficacy of
Tailoring Interventions for
Patient Safety toolkit in
preventing hospital based falls.
4 hospitals Pilot
Testing
 Patient education led to a
substantive decrease in the
number of hospital based
falls.
Limitations: Small sample size
hindered the effectiveness of the results
to foster generalizations.
Strength: Reliability and validity
ensured by the researchers move to
adopt 1,000 patient-days in 2015 and
1,000 patient-days from January through
June 2016
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Sandhya Neupane Khadka student Id: 2196209Assignment 4: Investigate clinical governance issue
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.
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Sandhya Neupane Khadka student Id: 2196209Assignment 4: Investigate clinical governance issue
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.
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Sandhya Neupane Khadka student Id: 2196209Assignment 4: Investigate clinical governance issue
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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NURS2006 Assignment 2 Marking Rubric: Investigation of a CG or CPI issue
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