Preventing Falls in Elderly: Effective Strategies for Care Environment

This document discusses the importance of preventing falls in the elderly within a care environment and provides effective strategies to promote positive patient outcome. It includes a literature review of scholarly articles on fall prevention.

Running head: NURSING ASSIGNMENT
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Name of the Student:
Name of the University:
Author Note:

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Research topic: Preventing falls in elderly within a care environment so as to foster care
for the elderly
Background:
According to a report published by Australian Institute of Health and Welfare (2019),
older people constitute a considerable proportion of the Australian population base.
According to the epidemiological data published by the Australian Institute of Health and
Welfare (2019) in the year 2017, 1 in every 7 people were aged 65 years and older. Further, it
is expected that by the end of the year 2097, approximately 25% of the Australian population
would comprise of old age patients. The report published by El-Bendary et al. (2013),
revealed that falls were a major cause of harm to the older people which added to the burden
related to healthcare and medical expenses. As per the report published by Uusi-Rasi et al.
(2015), a total of 41% of the hospitalization rate is attributed to falls among the elderly. In
addition to this, the report also mentioned that the incidence of fall was highest within the
care facility (Pfortmueller et al. 2014). This suggests that there is a need to adapt effective fall
prevention strategies so as to acquire positive care outcome among the elderly.
Research Rationale:
The rationale for conducting the research can be explained as the alarming rise of
hospitalization rate among the elderly on account of fall related accidents. In addition to this,
the research would subsequently help in reducing the rate of recurrent hospitalization and at
the same time also alleviate the patients from the financial stress elicited by the medical
expense of the disease burden.
Research Hypothesis:

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The research hypothesis for the research study can be stated as “Does the adaption of
effective fall prevention strategies within a healthcare setting, help in preventing falls among
the elderly and help in providing effective care to the patients?”
Research Objectives:
In order to conduct a research aligned to the research hypothesis, there is a need to set
specific, measurable, achievable, relevant and time-bound research objectives (Neuman &
Robson, 2014). Clearly, the research objectives for this research study would comprise of the
following:
Specific Adapt and implement fall prevention
strategies within the care environment and
promote health literacy among patients and
their family members during discharge to
reduce episodes of falls
Measurable Implement and ensure compliance with the
fall prevention strategies in order to reduce
rate of recurrent hospitalization
Achievable Reduce rate of recurrent hospitalization on
account of accidents related to fall
Relevant Make use of the scholarly evidence based in
order to figure out effective prevention
strategies
Time-bound The specific objectives are expected to be
accomplished within a time period of 6
months

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Referral of other discipline closely connected to research activity:
According to El-Khoury et al. (2013), advancing age leads to deterioration of muscle
strength as well as bone strength. As stated by Ungar et al. (2013), advancing age triggers a
number of health issues such as osteoporosis and osteoarthritis. These factors account for the
major reason, why the mobilising ability of the old age patients is impaired. In addition to
this, another research study conducted by Pfortmueller et al. (2014), stated that advancing age
and neurological dysfunction causes problems with auditory perceptions. It should be noted
in this context that problems with auditory perceptions leads to problems with the
maintenance of proper body posture and this accounts for a major reason that leads to falls
and accidents related to falls (Ungar et al. 2013). Falls lead to injuries and fractures which
limits the ability of the old age patients to perform activities of daily living (Pfortmueller et
al. 2014). In this regard, it should be mentioned that referral to an occupation therapist
could prove to be effective for the patients. The rationale for the referral can be explained as
educating the patients with appropriate exercise techniques and assisting patients with
strategies to address activities of daily living such as cooking, showering and dressing.
Search Strategy:
It is important to note here that in order to develop an understanding about the best
practice guidelines for fostering fall prevention strategies within a care environment, it is
important to conduct a rigorous search on the electronic databases. The electronic databases
where the search was conducted included Google Scholar and PubMed. The search was
carried out using proper exclusion and inclusion criteria and with the use of relevant key
terms. This helped in retrieving a number of relevant research papers that were closely
aligned to the research hypothesis and the devised SMART objectives.

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Resource Links:
Karlsson, M. K., Magnusson, H., von Schewelov, T., & Rosengren, B. E. (2013). Prevention
of falls in the elderly—a review. Osteoporosis international, 24(3), 747-762. Retrieved from:
https://www.ncbi.nlm.nih.gov/pubmed/23296743
Miake-Lye, I. M., Hempel, S., Ganz, D. A., & Shekelle, P. G. (2013). Inpatient fall
prevention programs as a patient safety strategy: a systematic review. Annals of internal
medicine, 158(5_Part_2), 390-396. Retrieved from:
https://www.ncbi.nlm.nih.gov/pubmed/23460095
Methodology:
In order to conduct the research study, the research methodology that would be
adapted would comprise of conducting a literature review of the available scholarly
literatures. As stated by Neuman and Robson (2014), conducting an elaborate review of the
existing scholarly literatures helps in developing an understanding about the best practice
strategies that has been implemented in order to acquire positive outcome. The review of the
literature would be conducted by scanning the electronic databases and by using relevant key
terms. After conducting a thorough review of the literatures, a systematic review would be
conducted of the recruited scholarly literatures. The rationale for the choice of the methods
can be explained as better feasibility of addressing the research topic within a stipulated
period of time. In addition to this, building on the evidence base would also equip the
researcher with an elaborate idea about the research developments and accordingly help the
researcher in identifying existing research gaps which needs to be bridged in order to promote
positive patient outcome.
Data Collection and evaluation process:

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A research study conducted by Karlsson et al. (2013), mentioned that the frequency of
fall and fall related accidents among the older adults increased with the advancing age. Falls
result in soft tissue injuries as well as pain, functional impairment and decreased quality of
life among the senior adults. Karlsson et al. (2013) conducted a review of the randomized
control trials that have successfully implemented fall prevention strategies in order to reduce
the incidences of fall among the elderly in a healthcare setting. The researchers typically
identified that regular physical training program for the elderly as well as modification of the
high-risk environment helped in promoting an effective patient outcome. In addition to this,
increased consumption of vitamin D supplements and using anti-slip shoe devices while
walking on tiled floors also helped in the reduction of the episodes of fall. As stated by
Miake-Lye et al. (2013), the rate of falls within acute care units ranges in between 1 to 9
patients per 1000 bed days. The researchers concluded on the basis of an exhaustive
systematic review that the use of multicomponent interventions could help in the reduction of
fall episodes among the old age patients (Miake-Lye et al.,2013). The multicomponent
intervention strategies made use of components such as conducting risk assessment for the
patients, imparting health literacy to the care professionals as well as the patients and
teaching patients about bedside signs, wristband alerts in order to ensure prevention from
falls (Miake-Lye et al., 2013). In addition to the researchers also stressed upon the
appropriate footwear recommendation, medication review as well as offering supervision
with toileting and washing in order to reduce the incidences of fall among the acute care unit
(Miake-Lye et al., 2013). The research study indicated that the implementation of the
recommended strategies within a healthcare setting helped in reducing the episodes of fall
among the elderly. Barker et al. (2016), conducted a randomised control trial across six
Australian hospitals in order to test the effectiveness of a 6 PACK program to reduce the
incidences of fall within the hospital setting. The 6 PACK program was basically a support

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program assisted by nursing professionals and included a fall risk tool with six individualized
nursing intervention strategies. The interventions included supervision of the patients in the
bathroom, ensuring that the walking aids of the patients are within reach, use of a proper
toilet regimen, use of a bed-chair alarm and a low-low bed (Barker et al., 2016). The results
of the study showed positive results in fall prevention among the older adults. Further, Sahota
et al. (2014), mentioned that the use of sensor technology could help in reducing the
incidences of fall among healthcare setting. The researchers tested the effectiveness of using
pressure sensors in bed and chair using radio pagers in a group of older adults and compared
the result with a control group that were not supplied with pressure sensors (Sahota et al.,
2014). The results showed a lower incidence of fall among the patients equipped with
pressure sensors, however, the overall findings revealed that the use of pressure sensors as a
single intervention was not sufficient to reduce the rate of fall among the elderly.
Data Analysis:
On the basis of the exhaustive review of scholarly literatures, it can be mentioned that
episodes of fall among elderly and fall related accidents is a cause of major concern.
Typically the high rate of fall and fall related accidents leads to poor health outcome, limits
the ability to perform activities of daily living and at the same time also deteriorates the
quality of living of the older adults (Karsson et al., 2013). Typically one of the research study
showed that the use of fall prevention intervention programs could help in reducing the
episodes of fall among the patients admitted at the acute care unit (Barker et al., 2016).
Further, one of the research study also showed that the use of pressure sensors on the bed and
chairs could help in reducing the episode of falls, however, the individualised use of the
pressure sensor was not sufficient to reduce the instances of fall among the old age patients.
On the other hand, two of the research studies stressed upon the fact that appropriate
incorporation of risk assessment scale along with imparting health literacy helped in reducing

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the rate of falls within a healthcare setting and also helped in acquiring positive patient
outcome (Karlsson et al., 2013; Miake-Lye et al., 2013).
Measuring relevance of findings:
Upon closely analysing and evaluating the findings of the scholarly literatures, it can
be mentioned that imparting patient education and conducting an effective risk assessment
could help in reducing the incidence rate of falls among the elderly within a healthcare
environment. In addition to this, it is also important to maintain a safe care environment in
order to promote positive patient outcome and reduce incidences of fall.
Summary:
Hence, to summarize, it can be mentioned that on the basis of the review of scholarly
literatures, conducting a risk assessment of the care environment is important to reinforce fall
prevention strategies (Barker et al., 2016). In addition to this, the review of the scholarly
literatures also helped in estimating that imparting patient education and maintenance of a
secure care environment could help in achieving positive outcome and at the same time also
help in reducing the incidences of fall (Ungar et al., 2013).
Prioritising retrieved findings:
Therefore, on the basis of the literature review, the research priority can be identified
as conducting a risk assessment of the care environment. In addition to this, the second care
priority can be identified as the need to educate the patients and teach them effective
strategies so as to reduce the risk of encountering a fall or a related accident.
Implementation within workplace:
In order to address the research objectives of reducing hospital re-admission rate and
curtailing medical expense related to accidents and injuries related to falls, nurses would

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conduct a risk assessment so as to secure the care environment and reduce the risks related to
fall. In addition to this, at the time of patient discharge, nurses would educate the patient as
well as the family members of the patient about intervention strategies so as to reduce
occurrences of fall within home environment and ensure convenience with addressing
activities of daily living.
Critical reflection:
On reflecting upon the findings of the scholarly literatures, I strongly feel that
conducting a mandatory risk assessment of the environment could help in securing the
environment. This could reduce the episodes of fall. Further, imparting patient education and
teaching self-management strategies to the old age patients could help in reducing falls and at
the same time also help in reducing the rate of hospital admission and curtailing medical
expense related to fall and accidents.
Recommendation:
Advanced research on the use of protective gear and inclusion of pressure sensors on
the wheel chair or walker used by old age patients could prove to be useful and help in
reducing falls among the elderly.
Conclusion:
Hence, to conclude, it can be mentioned that conducting a risk assessment and
imparting health literacy to the patient as well as the family members at the time of discharge
could help in reducing episodes of fall and at the same time help in promoting positive patient
outcome.

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Research topic: Bridging communication barriers between patient and care professionals
to improve care outcome
Background:
Nursing professionals are expected to build a strong therapeutic relationship with the
patients. As per the standard 2 of the NSQHS standard, nursing professionals are expected to
practice person-centred care and deliver effective and culturally safe care interventions
(Safetyandquality.gov.au, 2019). In addition to this, care professionals must also
communicate effectively with the patient and include the patient as well as the family
members of the patient in the decision making process so as to acquire positive patient
outcome (Rosstad et al., 2013). However, it should be noted that statistical figures retrieved
from research studies mention that a considerable 21% of the Indigenous population base is
unable to access healthcare services on account of communication barriers (Ferguson et al.,
2013).
Research Rationale:
On the basis of the background information, it can be mentioned that maintenance of
effective communication could help in improving access to healthcare facilities for the
indigenous as well as the culturally diverse proportion of the Australian population and help
in promoting effective care delivery.
Research Hypothesis:
Therefore, the research hypothesis for this research study can be mentioned as, “What
are the evidence based strategies that could help in improving the communication barrier
between the patient and the care professionals so as to improve the quality of patient
outcome?”

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Research Objectives (SMART):
It is extremely important to devise appropriate research objectives that are critically
aligned to the research hypothesis. The specific, measurable, achievable, realistic and time-
bound objectives for the research study can be enlisted as under:
Specific To adapt evidence based effective
communication strategies in order to
address the effective communication
barriers existing between patients of diverse
cultural beliefs and care professionals
Measurable To educate and train care professionals to
communicate effectively with the patients
and the family members so as to render
effective care
Achievable To enhance the level of patient satisfaction
and improve care outcome
Realistic To make use of evidence based strategies in
order to improve the quality of effective
communication between the patient and the
care professionals
Time-bound To conduct a week long training course of
the care professionals to improve the quality
of communication and effectively address
the existing communication barriers

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Referral of other discipline closely connected to research activity:
According to Levesque et al. (2013), the quality of communication between care
professionals and the patient is largely determined by a number of factors. It should be
critically noted in this context that research studies suggest that involuntary cultivation of a
discriminatory attitude on the part of the care professionals could lead to poor care outcome
(Kitson et al., 2013). While dealing with patients belonging to diverse cultural beliefs, it is
integral for care professionals to maintain an effective body language and empathetic gesture
so as to practice in an anti-discriminatory manner. Further, it is also important to adapt
measures so as to critically consider the cultural and ethnic preferences of the patient and
deliver effective care. In this case, the other discipline that is closely connected to the
research study includes a psychological counsellor. The psychological counsellor could help
with the explanation of the proper body language and gesture that could help in minimising
communication barrier and promote effective care to the patients.
Search Strategy:
A through search would be conducted on the electronic databases in order to retrieve
relevant research papers that are critically aligned to the research hypothesis and the
articulated SMART objective. The relevant research papers would be retrieved by conducting
a thorough search on the electronic databases of Google Scholar and PubMed. The papers
would be searched on the basis of specific exclusion and inclusion criteria as well as specific
key terms. The key terms that would be used to conduct the search would include phrases that
are aligned to the research hypothesis.
Resource Links:
Marcus, C. (2014). Strategies for improving the quality of verbal patient and family
education: a review of the literature and creation of the EDUCATE model. Health

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Psychology and Behavioral Medicine: An Open Access Journal, 2(1), 482-495. Retrieved
from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4346059/
Meuter, R. F., Gallois, C., Segalowitz, N. S., Ryder, A. G., & Hocking, J. (2015).
Overcoming language barriers in healthcare: a protocol for investigating safe and effective
communication when patients or clinicians use a second language. BMC health services
research, 15(1), 371. Retrieved from:
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-1024-8
Methodology:
The methodology that would be used in order to conduct the research study would
typically comprise of conducting a literature review of the available scholarly journals that
talk about addressing communication barriers between patient and care professionals. In
addition to this, after conducting the review of literatures, a systematic review would be
conducted so as to clearly identify relevant evidence based strategies that could help in
effectively addressing the communication barrier between the patient and the care
professionals.
Data Collection and evaluation process:
According to Boykins and Anita (2014), effective communication between care
professionals and patient is integral for the promotion of patient-centred care. The researchers
in this research paper have critically focused on the importance of effective education
programs and faculty support at the undergraduate as well as the post graduate level in order
to equip professionals with the means to communicate effectively with the patients. In
addition to this, the research study also mentions that the use of effective communication
tools could help in dealing with communication barriers that obstruct the smooth flow of
communication between the patients and the care professionals. In support of the findings,

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Mirza et al. (2014) stated that the use of patient centred communication tools that builds upon
the domains of establishing a therapeutic connection, exploring and integration of the
patient’s perspective, demonstration of empathy, collaborating with patient and imparting
patient education could help in minimising communication barriers. Further, Meuter et al.
(2015) mentioned that miscommunication within the healthcare sector could lead to fatal
health outcomes. Specifically in the context of a rise in the number of migrant patients and
employment of a large number of foreign nurses, the most, the problem related to
communication barrier is unavoidable (McCathy et al., 2013). The findings of the study
typically pointed out that communication barriers led to the emergence of confusion and
psychological distress among the patients that led to poor care outcome. Another researcher
Marcus (2013), mentioned that the use of audio or video or a combination of both the
technologies to educate the patient about the progress of the treatment and the expected
health outcome could help in acquiring positive patient outcome. The overall findings of the
research study mentioned that the use of the audio and visual educational tool to impart
health literacy to the patient as well as the family members of the patient helped in
minimising language barriers and promoted positive patient outcome. Also, the research
conducted by O’Hagan et al. (2013) mentioned that the choice of effective communication
techniques based upon the cultural and ethnic background of the patients helped in achieving
higher level of patient satisfaction.
Data Analysis:
Upon critically analysing the findings of the research studies included in the literature
review, it can be said that effective care delivery is dependent upon the adaption of a patient-
centred care approach. In addition to this, the research studies also mentioned that the use of
effective communication tools could help in addressing the existing communication barrier
between the patient as well as the care professionals (Van Rosse et al., 2016; Betancourt et

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al., 2016). In addition to this, it was also evaluated that the use of communication aids such as
imparting patient education by virtue of audio as well as video tools helped in addressing
communication barriers and elevating the level of patient satisfaction (Pharmacy, 2019). At
the same time, it also helped in improving the overall care outcome for the patients (Meuter
et al., 2015).
Measuring relevance of findings:
It should be noted in this context that the scholarly literatures reviewed are all relevant
and are closely linked to the research hypothesis. In this context, it should further be noted
that the research findings of Marcus (2013), is extremely relevant and it presents a vivid
discussion on the use of effective strategies that could help in improving the quality of
communication between the patient as well as the care professionals. In addition to this, the
research study conducted by Boykins et al. (2014) also emphasised upon the use of
communication tools to improve the quality of services offered to patients belonging to
diverse cultural origin.
Summary:
Therefore, to summarize the findings of the research studies included in the review of
literatures, it can be mentioned that effective communication is extremely important in order
to offer quality in terms of care delivery (Marcus, 2014). In addition to this, it is also
important for the care professionals to pay attention to specific cultural and religious or
spiritual needs of the patient and collaborate with the patients as well as the family members
in the decision making process to render positive care outcome (Davis Boykins, 2014).
Further, care professionals must also make use of effective communication tools such as
audio and visual aid in order to minimise communication barrier and effectively
communicate with the patients.

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Prioritising retrieved findings:
Therefore, on the basis of elaborate literature review, the priority goals would
comprise of educating care professionals about the need to maintain a smooth flow of
communication with the patients. In addition to this, equipping care professionals with
appropriate communication tools so as to maintain effective communication with the patients
can also be considered as a priority.
Implementation within workplace:
Therefore, on the basis of the findings collected from the evidence base, it can be
mentioned that nursing professionals must possess a sound knowledge about the concept of
effective communication. In addition to this, care professionals must also possess a sound
knowledge about the NSQHS standard 2 so that they are able to build a strong therapeutic
relationship with the client and at the same time the nurses must also be able to display the 6
Cs of caring while caring for the patients. Therefore, the above mentioned learning objectives
would be imparted to the care professionals by conducting a training workshop where the
attributes of effective communication and safe care delivery would be taught to the nursing
professionals.
Critical reflection:
As per (), reflection forms an integral aspect of the nursing profession as it equips care
professionals to conduct a self-assessment and identify the existing strengths as well as
weaknesses that need to improved so as to enhance the scope of practice. In this respect, I
strongly feel that conducting a training workshop would help in educating care professionals
about the importance of communicate effectively with the patients. In addition to this, the
training workshop would also help nurses to identify areas of ineffective communication with
patients and assist them with proper knowledge to take note of the cultural as well as the

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ethnic preferences of the patient. Further, it would also equip care professionals about
effective communication tools such as audio and visual technology devises which could be
used in order to impart health literacy to the patient and the family members of the patient
who belong to a different linguistic or cultural background. This would help in minimising
communication carrier and would help in promoting positive patient outcome.
Recommendation:
Although, the research studies retrieved from the evidence base has helped in identify
existing communication barriers and has also offered intervention strategies to deal with the
communication barriers, there is a substantial lack of research studies that shed light on
refreshment or additional courses that could help professionals in improving their skill set of
communication and help in communicating with patients belonging to diverse culture
conveniently.
Conclusion:
Therefore, to conclude, it can be mentioned that effective communication is integral
to foster positive patient outcome. Nursing professionals while caring for patients belonging
to diverse cultural background find it difficult to communicate effectively with the patients.
This subsequently leads to poor patient outcome and also leads to a compromise with the
quality of care provided to the patients. Training programs that offer conceptual knowledge
about the NSQHS standard and at the same time help in identifying instances of ineffective
communication could help professionals in avoiding such instances and ensuring a smooth
flow of communication. Further, the training programs could also help in equipping
professionals with proper communication tools which could help in making the process of
communication much easier.

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References:
Australian Institute of Health and Welfare (2019). Home - Australian Institute of Health and
Welfare. [online] Australian Institute of Health and Welfare. Available at:
https://www.aihw.gov.au/ [Accessed 22 Apr. 2019].
Barker, A. L., Morello, R. T., Wolfe, R., Brand, C. A., Haines, T. P., Hill, K. D., ... &
Sherrington, C. (2016). 6-PACK programme to decrease fall injuries in acute
hospitals: cluster randomised controlled trial. bmj, 352, h6781.
Betancourt, J. R., Green, A. R., Carrillo, J. E., & Owusu Ananeh-Firempong, I. I. (2016).
Defining cultural competence: a practical framework for addressing racial/ethnic
disparities in health and health care. Public health reports.
Davis Boykins, A. (2014). Core communication competencies in patient-centered
care. ABNF Journal, 25(2).
El-Bendary, N., Tan, Q., Pivot, F. C., & Lam, A. (2013). FALL DETECTION AND
PREVENTION FOR THE ELDERLY: A REVIEW OF TRENDS AND
CHALLENGES. International Journal on Smart Sensing & Intelligent Systems, 6(3).
El-Khoury, F., Cassou, B., Charles, M. A., & Dargent-Molina, P. (2013). The effect of fall
prevention exercise programmes on fall induced injuries in community dwelling older
adults: systematic review and meta-analysis of randomised controlled
trials. BMj, 347, f6234.
Ferguson, L. M., Ward, H., Card, S., Sheppard, S., & McMurtry, J. (2013). Putting the
‘patient’back into patient-centred care: An education perspective. Nurse Education in
Practice, 13(4), 283-287.

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Karlsson, M. K., Magnusson, H., von Schewelov, T., & Rosengren, B. E. (2013). Prevention
of falls in the elderly—a review. Osteoporosis international, 24(3), 747-762.
Kitson, A., Marshall, A., Bassett, K., & Zeitz, K. (2013). What are the core elements of
patient‐centred care? A narrative review and synthesis of the literature from health
policy, medicine and nursing. Journal of advanced nursing, 69(1), 4-15.
Levesque, J. F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care:
conceptualising access at the interface of health systems and
populations. International journal for equity in health, 12(1), 18.
Marcus, C. (2014). Strategies for improving the quality of verbal patient and family
education: a review of the literature and creation of the EDUCATE model. Health
Psychology and Behavioral Medicine: An Open Access Journal, 2(1), 482-495.
McCarthy, J., Cassidy, I., Graham, M. M., & Tuohy, D. (2013). Conversations through
barriers of language and interpretation. British journal of nursing, 22(6), 335-339.
Meuter, R. F., Gallois, C., Segalowitz, N. S., Ryder, A. G., & Hocking, J. (2015).
Overcoming language barriers in healthcare: a protocol for investigating safe and
effective communication when patients or clinicians use a second language. BMC
health services research, 15(1), 371.
Miake-Lye, I. M., Hempel, S., Ganz, D. A., & Shekelle, P. G. (2013). Inpatient fall
prevention programs as a patient safety strategy: a systematic review. Annals of
internal medicine, 158(5_Part_2), 390-396.
Mirza, M., Luna, R., Mathews, B., Hasnain, R., Hebert, E., Niebauer, A., & Mishra, U. D.
(2014). Barriers to healthcare access among refugees with disabilities and chronic

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health conditions resettled in the US Midwest. Journal of immigrant and minority
health, 16(4), 733-742.
Neuman, W. L., & Robson, K. (2014). Basics of social research. Toronto: Pearson Canada.
Pfortmueller, C. A., Lindner, G., & Exadaktylos, A. K. (2014). Reducing fall risk in the
elderly: risk factors and fall prevention, a systematic review. Minerva Med, 105(4),
275-81.
Pharmacy, S. (2019). Patient-Centered Communication Tools (PaCT). [online] Stlcop.edu.
Available at: https://stlcop.edu/health-literacy/pact.html [Accessed 22 Apr. 2019].
Pulvirenti, M., McMillan, J., & Lawn, S. (2014). Empowerment, patient centred care and
self‐management. Health Expectations, 17(3), 303-310.
Richards, T., Coulter, A., & Wicks, P. (2015). Time to deliver patient centred care.
Røsstad, T., Garåsen, H., Steinsbekk, A., Sletvold, O., & Grimsmo, A. (2013). Development
of a patient-centred care pathway across healthcare providers: a qualitative
study. BMC health services research, 13(1), 121.
Safetyandquality.gov.au (2019). [online] Safetyandquality.gov.au. Available at:
https://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-
Standards-Sept-2012.pdf [Accessed 18 Apr. 2019].
Sahota, O., Drummond, A., Kendrick, D., Grainge, M. J., Vass, C., Sach, T., ... & Avis, M.
(2013). REFINE (REducing Falls in In-patieNt Elderly) using bed and bedside chair
pressure sensors linked to radio-pagers in acute hospital care: a randomised controlled
trial. Age and ageing, 43(2), 247-253.

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Ungar, A., Rafanelli, M., Iacomelli, I., Brunetti, M. A., Ceccofiglio, A., Tesi, F., &
Marchionni, N. (2013). Fall prevention in the elderly. Clinical Cases in mineral and
bone metabolism, 10(2), 91.
Uusi-Rasi, K., Patil, R., Karinkanta, S., Kannus, P., Tokola, K., Lamberg-Allardt, C., &
Sievänen, H. (2015). Exercise and vitamin D in fall prevention among older women: a
randomized clinical trial. JAMA internal medicine, 175(5), 703-711.
van Rosse, F., de Bruijne, M., Suurmond, J., Essink-Bot, M. L., & Wagner, C. (2016).
Language barriers and patient safety risks in hospital care. A mixed methods
study. International journal of nursing studies, 54, 45-53.