Expert answer:While the implementation plan prepares students to

Expert answer:While the implementation plan prepares students to apply their research to the problem or issue they have identified for their capstone change proposal project, the literature review enables students to map out and move into the active planning and development stages of the project.A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence. Students will use the information from the earlier PICOT Statement Paper and Literature Evaluation Table assignments to develop a 750-1,000 word review that includes the following sections:Title pageIntroduction sectionA comparison of research questionsA comparison of sample populationsA comparison of the limitations of the studyA conclusion section, incorporating recommendations for further researchPrepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
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While the implementation plan prepares students to apply their research to the problem or issue they
have identified for their capstone change proposal project, the literature review enables students to
map out and move into the active planning and development stages of the project.
A literature review analyzes how current research supports the PICOT, as well as identifies what is
known and what is not known in the evidence. Students will use the information from the earlier PICOT
Statement Paper and Literature Evaluation Table assignments to develop a 750-1,000 word review that
includes the following sections:
1.
2.
3.
4.
5.
6.
Title page
Introduction section
A comparison of research questions
A comparison of sample populations
A comparison of the limitations of the study
A conclusion section, incorporating recommendations for further research
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the
Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become
familiar with the expectations for successful completion.
Literature Review
2
1
Less than
Unsatisfactory
Satisfactory
0.00%
75.00%
80.0 %Content
10.0
An
An
%Introduction introduction is introduction is
not present.
present, but it
does not relate
to the body of
the paper.
3
Satisfactory
79.00%
An
introduction is
present, and it
relates to the
body of the
paper. There is
nothing in the
introduction to
entice the
reader to
continue
reading.
4
Good
89.00%
An
introduction is
present, and it
relates to the
body of the
paper.
Information
presented in
the
introduction
provides
incentive for
the reader to
continue
reading.
20.0
No comparison A comparison A cursory
A moderately
%Comparison of research
of research
though valid thorough and
of Research
questions is
questions is
comparison of valid
Questions
presented.
presented, but research
comparison of
it is not valid.
research
5
Excellent
100.00%
An
introduction is
present, and it
relates to the
body of the
paper.
Information
presented in
the
introduction is
intriguing and
encourages the
reader to
continue
reading.
A reflective
and insightful
comparison of
research
questions is
presented.
A cursory
though valid
comparison of
sample
populations is
presented.
questions is
questions is
presented.
presented.
20.0
No comparison A comparison
A moderately A reflective
%Comparison of sample
of sample
thorough and and insightful
of Sample
populations is populations is
valid
comparison of
Populations
presented.
presented, but
comparison of sample
it is not valid.
sample
populations is
populations is presented.
presented.
20.0
No comparison A comparison A cursory
A moderately A reflective
%Comparison of the
of the
though valid thorough and and insightful
of the
limitations of limitations of comparison of valid
comparison of
Limitations of the study is
the study is
the limitations comparison of the limitations
the Study
presented.
presented, but of the study is the limitations of the study is
it is not valid. presented.
of the study is presented.
presented.
10.0
No conclusion A conclusion A conclusion A conclusion A conclusion
%Conclusion and
and
and
and
and
and
recommendatio recommendatio recommendatio recommendatio recommendatio
Recommendatio ns for further ns for further ns for further ns for further ns for further
ns for Further research are
research are
research are
research are
research are
Research
presented.
presented, but valid, but they valid and
reflective and
they are not
are cursory.
moderately
insightful.
valid.
thorough.
15.0
%Organization
and
Effectiveness
5.0 %Thesis
Paper lacks any Thesis is
Thesis is
Thesis is clear Thesis is
Development discernible
insufficiently apparent and and forecasts comprehensive
and Purpose
overall purpose developed or appropriate to the
and contains
or organizing vague. Purpose purpose.
development of the essence of
claim.
is not clear.
the paper.
the paper.
Thesis is
Thesis
descriptive and statement
reflective of
makes the
the arguments purpose of the
and appropriate paper clear.
to the purpose.
5.0 %Argument Statement of Sufficient
Argument is Argument
Clear and
Logic and
purpose is not justification of orderly, but
shows logical convincing
Construction justified by the claims is
may have a few progressions. argument that
conclusion.
lacking.
inconsistencies. Techniques of presents a
The conclusion Argument
The argument argumentation persuasive
does not
lacks consistent presents
are evident.
claim in a
support the
unity. There minimal
There is a
distinctive and
claim made.
Argument is
incoherent and
uses
noncredible
sources.
are obvious
flaws in the
logic. Some
sources have
questionable
credibility.
justification of smooth
compelling
claims.
progression of manner. All
Argument
claims from
sources are
logically, but introduction to authoritative.
not thoroughly, conclusion.
supports the
Most sources
purpose.
are
Sources used authoritative.
are credible.
Introduction
and conclusion
bracket the
thesis.
5.0
Surface errors Frequent and Some
Prose is largely Writer is
%Mechanics of are pervasive repetitive
mechanical
free of
clearly in
Writing
enough that
mechanical
errors or typos mechanical
command of
(includes
they impede errors distract are present, but errors,
standard,
spelling,
communication the reader.
they are not
although a few written,
punctuation,
of meaning.
Inconsistencies overly
may be present. academic
grammar,
Inappropriate in language
distracting to A variety of
English.
language use) word choice or choice
the reader.
sentence
sentence
(register),
Correct
structures and
construction is sentence
sentence
effective
used.
structure, or
structure and figures of
word choice audiencespeech are
are present.
appropriate
used.
language are
used.
5.0 %Format
2.0 %Paper
Template is not Template is
Template is
Template is
All format
Format (use of used
used, but some used, and
fully used;
elements are
appropriate
appropriately elements are formatting is There are
correct.
style for the
or
missing or
correct,
virtually no
major and
documentation mistaken; lack although some errors in
assignment)
format is rarely of control with minor errors formatting
followed
formatting is may be present. style.
correctly.
apparent.
3.0
Sources are not Documentation Sources are
Sources are
Sources are
%Documentati documented. of sources is documented, as documented, as completely and
on of Sources
inconsistent or appropriate to appropriate to correctly
(citations,
incorrect, as
assignment and assignment and documented, as
footnotes,
appropriate to style, although style, and
appropriate to
references,
assignment and some
format is
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style, with
formatting
mostly correct. style, and
etc., as
numerous
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format is free
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assignment and
style)
100 %Total
Weightage
formatting
errors.
Running head: HOSPITAL FALLS: AN ONGOING PROBLEM
Hospital Falls: An Ongoing Problem
Grand Canyon University – NRS 490
November 26, 2017
1
HOSPITAL FALLS: AN ONGOING PROBLEM
2
Hospital Falls: An Ongoing Problem
Inpatient hospital falls especially in elderly patients can impact not only the quality of
care provided but can have a substantial financial burden to the organization (Hoffman,
Neumann, Golgert, & Von Renteln-Kruse, 2015). Healthcare providers must be aggressive in
adhering utilizing tools and resources prevent falls and ensure patient safety.
The Medical Telemetry unit has an average of four days stay for patients are admitted for
multiple co-morbidities but all require cardiac monitoring (Hoffman et al., 2015). Examples
include congestive heart failure (CHF), dialysis, irregular heart rhythms, altered mental status,
and strokes to name a few. Many present with acute problems secondary to chronic conditions
such as CHF exacerbation, altered mental status due to drugs, toxins, or infections. The
population serves about 90% Caucasians and about 43% are age 60 and above (Office of
Statewide Health and Planning Development [OSHPD], 2015). Staffing ratio is 1:4 and a
multidisciplinary team approach is used in caring for patients.
Problem, Issue, Suggestion, Initiative, or Education Need
For every 1000 bed occupied, 3-20 falls will occur (Haines, Lee, O’Connell, McDermott,
& Hoffmann, 2012). Many factors contribute to patient falls particularly chronic conditions and
medications. For example, a patient on Lasix may try to jump out of bed to the bathroom, a
dialysis patient is confused due to elevated toxin levels, and stroke patients on heparin drips
are at higher risk for bleeds and falls if there are deficits from the stroke. A substantial
contributing factor to this is that elderly patients a weak bone structure as a result of age hence
their general weakness, often resulting to falling while in the hospital (Thomas & Mackintosh,
2016).
HOSPITAL FALLS: AN ONGOING PROBLEM
3
Many falls occur during shift change when nurses are pre-occupied with report. It is
recommended that fall risk is assessed at the beginning of every shift and interventions are
implemented immediately (call light at bedside, mobility aids within reach, beds locked and at
lowest position, and alarms on as necessary). Nurses should perform handoff at the bedside to
ensure that IV lines and meds are evaluated, patient is involved in their plan of care, and to
ensure that patient is safe and both staff member should sign off. Education should be
continuous to staff and to patients the importance of adhering to the plans discussed.
Impact on Work Environment, Quality of Care, and Patient Outcomes
The repercussions of patient falls not only affects patient outcomes, but the hospital work
environment and quality of care provided. Looking at the effects of falls on patient outcomes,
hospital falls have been an impeding factor to quick recovery of patients in hospitals. In this
regard, patients who are victims of falls often end up being injured contributing to their health
problems as well as their social and psychological well-being (Oliveira, Hammerschmidt,
Schoeller, Girandi, & de Paula, 2016).
This prolongs their recovery time hence elongating their stay in the hospital. Shifting
gears to quality of care, hospital falls are a subtracting factor to quality of care given to patients
in hospitals. Hospital falls are a pointer of lack of safety for inpatients. This significantly affects
the reputation of hospitals with high number of falls (Babine et al., 2016). The effects of hospital
falls on work environment are centered on the compromise of patient safety during their stay in
the hospital. A work environment is rendered unsafe for patients having in mind that there is a
high potential for patients to fall (Tzeng, Hu, & Yin, 2016).
HOSPITAL FALLS: AN ONGOING PROBLEM
4
Implications to Nursing
Poorly implemented programs, failure to follow recommendations, and quality of
delivery of fall risk programs can explain why falls continue to occur (Morello et al.,
2017). Studies show that fall programs are effective if carried out as it should. A study of the 6PACK falls program includes assessing patients daily using fall risk scales, placing a “Falls
Alert” sign outside the door, and at least one of the 6-PACK recommended strategy: a) assisting
patients to bathroom, b) bed at lowest level, c) mobility aids within reach, d) planned toileting,
and e) using bed/chair alarms (Morello et al., 2017).
Conclusion
Preventive measures that are based on evidence-based practice are implemented to ensure
the safety of patients during their stay. It is up to the organization as a whole to collaborate to
ensure that programs are adhered to. Nurses musts be consistent with shift assessments and
required interventions, handoff should be at the bedside, and management should provide
resources and support to ensure that interventions are not missed due to overwhelming
workload.
HOSPITAL FALLS: AN ONGOING PROBLEM
5
References
Araújo, J., Fernandes, A., Moura, L., Santos, M., Ferreira, M., & Vitor, A. (2017, May).
Validation of nursing outcome content fall prevention behavior in a hospital environment.
Revista da Rede de Enfermagem do Nordeste, 18(3), 337-344.
http://dx.doi.org/10.15253/2175-6783.2017000300008
Babine, R., Hyrkas, K., Bachand, D., Chapman, J., Fuller, V., Honess, C., & Wierman, H. (2016,
May/June). Falls in a tertiary care hospital – Association with delirium: A replication
study. The Academy of Psychosomatic Medicine, 57, 273-282. Retrieved from
http://eds.a.ebscohost.com.lopes.idm.oclc.org
Haines, T., Lee, D., O’Connell, B., McDermott, F., & Hoffmann, T. (2012). Why do hospitalized
older patients take risks that may lead to falls? Health Expectations, 18, 233-249.
Retrieved from http://eds.a.ebscohost.com.lopes.idm.oclc.org
Hoffman, V., Neumann, L., Golgert, S., & Von Renteln-Kruse, W. (2015, November 10). Proactive fall-risk management is mandatory to sustain in hospital-fall prevention in older
patients – Validation of the Lucas fall-risk screening in 2, 337 patients. Journal of
Nutrition Health and Aging, 19, 1012-1018. Retrieved from
http://eds.a.ebscohost.com.lopes.idm.oclc.org
Morello, R., Barker, A., Ayton, D., Landgren, F., Kamar, J., Hill, K., … Stoelwinder, J. (2017).
Implementation fidelity of a nurse-led falls prevention program in acute hospitals during
the 6-PACK trial. BMC Health Services Research, 17(383).
http://dx.doi.org/10.1186/s12913-017-2315-z
Office of Statewide Health and Planning Development. (2015). Hospital discharge summary
report. Retrieved from http://gis.oshpd.ca.gov/atlas/topics/use/inpatient#charts
HOSPITAL FALLS: AN ONGOING PROBLEM
Oliveira, D. M., Hammerschmidt, K. S., Schoeller, S. D., Girandi, J. B., & de Paula, N. F.
(2016). Assessment instrument for falls among the hospitalized elderly (Hospital AIFE):
Nurse analyzing vulnerability and mobility. Journal of Nursing, 4065-4074.
http://dx.doi.org/10.5205/reuol.9881-87554-1-EDSM1011201631
Thomas, S., & Mackintosh, S. (2016, June). Improvement of physical therapist assessment of
risk of falls in the hospital and discharge handover through an intervention to modify
clinical behavior. Physical Therapy, 96(6), 764-773. Retrieved from
http://eds.a.ebscohost.com.lopes.idm.oclc.org
Tzeng, H., Hu, H., & Yin, C. (2016, July-August). Understanding inpatient injurious fall rates
using Medicare’s hospital compare data. MedSurg Nursing, 25(4), 255-269. Retrieved
from http://eds.a.ebscohost.com.lopes.idm.oclc.org
6
Literature Evaluation Table
Student Name:
Change Topic: Hospital falls for older adults, their characteristics and appropriate interventions. Factors that contribute to
the risk of falls in hospitals.
Criteria
Author, Journal
(Peer-Reviewed),
and
Permalink or
Working Link to
Access Article
Article Title and
Year Published
Article 1
Article 2
Article 3
Article 4
Haines, T., Lee, D.,
O’Connell, B.,
McDermott, F., &
Hoffmann, T.).
Health Expectations,
18(2), 233-249.
http://dx.doi.org/10.1
111/hex.12026
Why do hospitalized
older adults take
risks that may lead to
falls?
Lim, S., & Yam, S.
International E-Journal
Of Science, Medicine &
Education, 10(3), 14-23.
http://eds.b.ebscohost.co
m.lopes.idm.oclc.org
Guerreiro, M., & Jose, H.
Journal Of Nursing UFPE
On Line, 7(1):96-103.
http://dx.doi.org/10.5205/reo
l.3049-24704-1
LE.0701201314
The level of knowledge
and competency in the
use of the Morse Fall
Scale as an assessment
tool in the prevention of
patient falls.
Nursing Program for
prevention of falls
Midori, A., Angela,
M., Fernandez, M., &
Vituri, D. Journal Of
Nursing UFPE On
Line, 10(11):4720-6
http://dx.doi.org/10.52
05/reuol.8200-718303-SM.1006sup201602
Risk of bed falls in
adult patients and
prevention measures.
(2012)
(2013)
(2016)
© 2015. Grand Canyon University. All Rights Reserved.
(2016)
Research
Questions
(Qualitative)/Hypot
hesis
(Quantitative), and
Purposes/Aim of
Study
Design (Type of
Quantitative, or
Type of
Qualitative)
Setting/Sample
Methods:
Intervention/Instru
ments
Analysis
This study was
purposed to understand
the reasons at to why
older adults often take
risks that may easily
result to falls in the
hospital setting and in
the transition period
prior to being
discharged.
Qualitative research
16 older adult patients
who were admitted, 8
informal inpatient
caregivers, and 33
medical professionals
were recruited from
Southern
Health hospital.
Unearthed various
fueling factors that
contribute
to risk taking behavior
that may cause falls.
Interviews as well as
focus groups were
implemented for the
generation of
How conversant are nurses
with Morse Fall Scale used
as an assessment tool in
preventing patient falls.
How competent are nurses
in the use of Morse Fall
Scale which is as an
assessment tool in
preventing patient falls?
Are nurses knowledgeable
in the use of Morse Fall
Scale scores in the
planning of interventions.
Descriptive research
This study was purposed
towards the prevention of
hospital falls for elderly person
admitted in the Equipe de
Cuidados Continuados
Integrados
(ECCI).
Assessment of the
adequacy existing
between evaluation of
the falls risk in older
adult patients and the
relevant
prevention measures
adopted.
Descriptive analyses and crosssectional study, with also a
quantitative approach
Descriptive, crosssectional study with a
quantitative
approach
The study sample
comprised of 1,408
patients who were from
public university
hospital.
80 nurses were selected
using a Raosoft
calculator.
The sample included 53 people
who were 65 years of age and
older
Data was analyzed using
SPSS software.
Descriptive statistics
Analyzed various
variables.
100 respondents scored
correctly in fall risk.
However, only 4
The measurement scale was
used to collect data.
Morse Scale was used
for data collection and
evaluation of fall
prevention strategies.
This study was conducted in
compliance to
MS Excel 2010 was
used to tabulate data,
while SPSS Program
© 2017. Grand Canyon University. All Rights Reserved.
Key Findings
qualitative data.
Interviews
were conducted on
patients who had spent
2 weeks in hospital and
also those who had
spent 3 months.
Scored correctly in the
total score of the Morse
Fall Scale.
Helsinki’s declaration. This
dictates standards followed for
ethics in international research.
The research
culminated in
findings which
brought about several
classifications of
patients’ risk taking
when engaging in
behavior that would
easily result in a fall.
These classifications
are enforced,
deliberate and aware,
deliberate and
unaware. In addition
to this, the fuelling
motives that
influence risk taking
behavior were
classified as risk
compensation ability,
the intention of
asking for assistance,
the inner drive of the
older patients to
gauge their physical
strength,
miscommunication
The results obtained
evidenced that nurses
had moderate
knowledge and
competency in relating
and implementing the
Morse Fall Scale.
Results evidenced that 86.8%
of the study sample population
shows risk of falling. 49.1% of
those with the risk have a low
risk while
37.7% showed high risk. It is
only 13.2% who were declared
as without the risk of falling.
© 2017. Grand Canyon University. All Rights Reserved.
was used for statistical
analyses. In addition to
this, descriptive
analyses and the chisquare test were
conducted, considering
a p-value of <0.05. 60 years and older patients demonstrated high risk of falls (33.9%). These patients identified as having high risk had been connected to venous devices (90.1%). Others were those who had a history of falling (59.9%) and those who had a disoriented mind (34.0%). In addition to this, prevention measures were found to be adequate in 91.0%. and misunderstandings between all parties involved i.e. older patients, informal caregivers and also the attending medical caregivers. Recommendations Health professionals and caregivers ough ... Purchase answer to see full attachment

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