University Reflection: Fall Management and Healthcare Analysis

This assignment is a reflection on a fall management incident in a healthcare setting, analyzed using the 5Rs model (Reporting, Responding, Relating, Reasoning, and Reconstructing). The student reflects on a case where an elderly patient fell from a gurney due to an unsecured wheel, leading t...Read More

Running head: REFLECTION ON HEALTH-RELATED ISSUE
REFLECTION ON FALL MANAGEMENT
Name of the Student:
Name of the University:
Author Note:

1REFLECTION ON FALL MANAGEMENT
From the perspective of the person closest to them (partner, parent, child,
etc.)
Reflection on the incidence of fall that has changed the life of a daughter.
For this reflection, I will use the 5R’s model of reporting. According to Simpson (2017), 5R’s
model of reflection helps in building personnel narrative.
The first element of the 5R’s model is reporting. As per the article from
Patientsafetyinstitute.ca. (2020) Anne is the daughter of the patient. The patient was a
mother, and her name was Berth. Her age was 84 and was severely ill with swelling in her
face along with her abdomen. Besides, previously she has a record of heart problem. She was
taken to hospital by Anne and waited for a longer period and needed to perform an x-ray of
her lungs. Berth condition was not right and therefore, Anne has asked to perform x-ray with
the support if gurney. Anne accompanied her mother and stayed until she slept. However,
after she left the hospital, Berth had undergone another x-ray, and there was no apparent
reason. During the procedure of x-ray, Berth felled from the gurney, and therefore,
paramedics have transferred Berth into the emergency department. Anne got a call regarding
the fall and injury, and she returned to the hospital. Later, she was informed that the wheel of
gurney was not locked and that is the reason for the fall. After the incidence, Anne went back
to home and collected all the documents from the initial days and had a meeting with patient
concern manager along with the manager of diagnostic imaging. The managers have
promised Anne that they would follow-up. However, Berth passed away, and Anne was
called after several weeks for a meeting. In the meeting, she was informed about the Velcro
strips were not aligned properly. However, there was no answer to a wheel of gurney of not
being locked. Anne thought of taking legal action, then her mother would not want such
activity, and therefore, she dropped the situation.

2REFLECTION ON FALL MANAGEMENT
One beautiful day, after nine-month of Berth’s death, Anne saw the news about the
conference on patient safety. She went and then she found every justified answer to her
questions. The second element of 5R’s model is responding. Anne did not want any other
patient to suffer like her mother, and therefore, she got involved in volunteer and became the
advocate for patient safety. Patient safety measures would reduce adverse events (World
Health Organization, 2017). In this way, Anne carried her mother legacy by helping other
patients in assuring safety and measures. My response would be Anne has come up with a
much healthier attitude and supporting safety and reducing the pain of patients and their
family. According to Gilasi et al. (2015), the fall can result in severe complication in older
adults. I have observed that the health-related issue can occur at any point in time, and it is
not right to simply sit back and grieve. Instead, one should come up with a much broader
attitude, just like Anne.
The third element of 5R’s model is relating. In this case, Berth felled from the gurney
and immediately shifted to emergency care. As per my knowledge, the fall management
results in adverse events and increases the risks of complications. Berth already had
cardiovascular disease. All measures need to be taken on an urgent basis, and in this case,
also she moved to the emergency department and provided with all the essential requirement.
The fourth element of 5R’s model is reasoning. According to my understanding, the
health outcome of Berth has reduced to the fall. The condition of Berth was already poor with
failure of heart and kidneys, and also the falls have made the situation more badly. The
significant factor is enhancing fall management. The paramedic or nursing professionals must
provide regular care to such patient who is in extreme pain and illness.
The last element of 5R’s model is reconstructing. With the details discussion, I can
conclude that unwitnessed falls or any such falls as in this case should be addressed and must

3REFLECTION ON FALL MANAGEMENT
not ignore. The senior leaders and senior management of the hospital or healthcare
organisation should take necessary steps in falls management. This case gives an addition to
the evidence-based approach. The first step is removing all the hazardous element and
checking all the equipment before using special equipment (Ambrose, Cruz & Paul, 2015).
The fall can occur for multiple reasons and can adversely affect the health outcome of the
patients. Therefore, proper medication, assisting patients with various complications and
reducing the negligence behaviour of healthcare professionals (Iyioha, 2016). According to
Hamm et al. (2016), the action plan must be formulating effective fall prevention measures
such as active monitoring for reducing such adverse events that often leads to complication or
deaths just like Berth.

4REFLECTION ON FALL MANAGEMENT
References
Ambrose, A. F., Cruz, L., & Paul, G. (2015). Falls and fractures: a systematic approach to
screening and prevention. Maturitas, 82(1), 85-93.
Gilasi, H. R., Soori, H., Yazdani, S., & Tenjani, P. T. (2015). Prevention of fall and related
injuries in home-dwelling elderly. Safety Promotion and Injury Prevention, 2(3), 161-
172.
Hamm, J., Money, A. G., Atwal, A., & Paraskevopoulos, I. (2016). Fall prevention
intervention technologies: A conceptual framework and survey of the state of the
art. Journal of biomedical informatics, 59, 319-345.
Iyioha, I. O. (2016). Medical Negligence. In Comparative Health Law and Policy (pp. 65-
94). Routledge.
Patientsafetyinstitute.ca. (2020). A fall changed Anne’s life forever. Retrieved 11 March
2020, from https://www.patientsafetyinstitute.ca/en/toolsResources/Member-Videos-
and-Stories/Pages/A-fall-changed-Anne%E2%80%99s-life-forever.aspx
Simpson, A. (2017). A Framework for Reflection (pp. 1-3). auburn.edu. Retrieved from
http://wp.auburn.edu/writing/wp-content/uploads/A-Framework-for-Reflection.pdf
World Health Organization. (2017). Patient safety: making health care safer (No.
WHO/HIS/SDS/2017.11). World Health Organization.