Nursing Interventions to Prevent Elderly Falls

Introduction

The elderly patients are often prone to risk of falls because their deteriorated physical health condition like heart diseases, vertigo attack, blurred vision and others makes them incapable for having the strength to move without support (Giordano et al. 2016). In this case, the nurses have the duty to ensure safe care and assistance is provided to the elderly patients so that they are avoided to fall. However, in many cases the irresponsibility and lack of proper care by the nurses making them responsible for making elderly patients face the risk of falls (Cartagena et al. 2017). Therefore, in this proposal, explanation regardiung the way nurses are to response towards the elderly patients in lowering their chances of falls is to be mentioned. The mentioned change is essential and justified because the improvement to be created by the nurses in response to fulfilling and managing needs of the elderly would lead to modify care approach and implement prior care activities in lowering the risk of falls among elderly. The Kotter’s 8-step Change Model is to be implemented in explaining the change and the PDSA Cycle, Fishbone diagram and 5 Why’s are to be used to support the establishment of the change. The leadership style to be implemented in making the change and the way facts of change are to be informed to others is to be recommended.

Background

In the UK, the report published by the Public Health England (PHE) mentions that elderly patients are vulnerable to maximum falls in the hospital during care compared to patients of another age group. This is evident in 2015-16 nearly 190,000 cases are reported regarding falls in hospital and they were among the patients who were aged 65 years and above. The cause highlighted was irresponsible care delivery by the nurses (NHS, 2017; GOV, 2019). As a result of falls among the elderly, various serious injuries like hip injury, head injury and others which are more than 300 per year are reported making elderly patients face complicated health condition (GOV, 2015). The falls among the patients in the hospital has led the NHS to spend nearly £24,000 and more finances to deliver care regarding it. In the acute settings, expenditure of £204 million and in mental health trusts expenditure of £105 million is reported to treat impact of falls on the health of the elderly patients. This indicates that 86-87% of healthcare costs are used for the elderly patients to treat the health impact caused as a result of falls which is leading the healthcare costs to be increased (NHS, 2017). These figures inform that nurses are to create change in their response towards lowering falls for the elderly in England Wales so that effective support and management is implemented for resolving extra cost spent by the NHS and improve the health condition of elderly. The change is also required so that health issues created among the elderly as a result of falls can be avoided.

Change Implementation

Critical analysis and explanation of the selected change management model

The Kotter’s 8-step Change Model is selected for implementation of implementing change in this proposal and it contains eight key steps to be followed (Small et al. 2016). At the stage of sense of urgency, the individuals included in the change are needed to be motivated in accepting the altered activities being proposed (Fourman et al. 2016). Thus, in this stage, the nurses are to be motivated to understand the change in reducing falls is required by providing them statistical and factual evidence regarding present response and impact of falls among the elderly patients. The sense of urgency being lacked is able to lead people consider no alteration in the current course of services is required in turn creating hindrance to initiate the establishment of the change (Kuo and Chen, 2019). At the stage of building guided team, the selection of the proper participants for the change is to be determined at each level of the organisation to determine effective skills and workforce needed for making the change to be available (Mount and Anderson, 2015). According to the stage, the management professionals in the hospital need to select specific registered nurses as well as officials from different level in the organisation to act as a team where they are going to share their knowledge and skills along with ideas to implement the proposed change of lowering fall incidences of elderly patients. The inability to select right individuals for making the change leads to hindered implementation of the change as a result of improper execution of activities by improper people (Mørk et al. 2018). In the stage of creating vision, all the members in the team to make the change are required to develop proper vision for establishing the change (Henry et al. 2017). This indicates that nurses are required to have information about the way to response immediately to light alarms and calls, marinating viewing of proper call lighting within their reach, maintaining possession of the patients within their reach from bed, demonstrate patients regarding the way to use call lights in alarming nurses and other vision required for delivering quality care to lower the falls among the elderly. The lack of efficiency to develop proper vision makes team members making the change unable to determine the direction and strategies to be followed in making the change (Romeyke et al. 2016). At the stage of communication, the developed vision is to be interacted to all in detailed manner (Odor, 2018). This mentions that nurses in the change are to be informed of the strategies and directions to follow to create altering in their present services so that incidences of falls can be reduced among the individuals who are elderly. However, lack of communication creates barriers to establish the change because the team making the change do not valid information regarding the way alteration in services is to be made to make the change successful (Kenny et al. 2017). In the stage of empowering action, the management and the team are to work together so that any probable obstacles in making the change can be identified and removed to make the members making the change successful in achieving the goal (Orr and Davenport, 2015). This mentions that leaders of the change are to access feedback from the individual involved in making the change regarding the obstacles they are facing so that appropriated action can be taken to resolve it to make the individual empowered in taking action towards successful change.

The development of short-term wins involves setting small aims for gradually executing the change (Small et al. 2016). This mentions in making changes nurses initially are to be provided small goals so that they can gradually improve their skills to finally reduce chances of falls among the elderly. In the stage of consolidated gain, on the basis of results of short-term wins strategies of change are to be improved who are to be considered in making the change (Grad and Mallet, 2018). This indicates that team members involved in the change are to be encouraged to evaluate the current strategies for determining the alteration required in them for success of the proposed change. At the implementation stage, the establishment of change is to done and continuous monitoring is to be made to ensure the changed activities are actively followed (Small et al. 2016). Thus, the change team at this stage are to monitor the responses for the provided change strategies in fall management to determine they are appropriately abided for long-term care.

Discussion of tools to be implemented for supporting the change management

The PDSA Cycle, 5 Why’s and Fishbone Diagram are the tools to be implemented for making the change of reducing falls of elderly people in care by the nurses.

The Five Whys is a nature of interrogative technique which is implemented for exploring cause effect relationship for a certain issue. In order to implement 5 Why’s, the key problem is to be discussed and then 5 reasons are to be identified that are leading to cause the problem (Card, 2017). This is because understand and determining the why would help to understand the changes to be implemented to achieve success. Thus, according to the technique five key reasons or whys that is leading to cause current nurse responses led elderly inpatients face risk of fall is to be identified. As mentioned by Álvarez Barbosa et al. (2016), lack of presence of belonging within the range of beds elderly inpatients makes them try to leave their beds and move. This makes prone to fall as due to their health issue and aging they are unable to maintain proper muscle coordination to balance their body while moving making them experience fall. As argued by Lannering et al. (2016), placing things away from the reach of bed of the elderly pateints makes them try to leve the beds and move. This is because the patients tries to access the things on their own even though they are not able to stand properly with balance as they need the things for immediate use. Moreover, even after using the call lights or alarms when patients perceives that the help they required would not to be provided by nurses they personally tries move from bed to execute it making them prone to experience falls by losing balance to stand as a result of their health issue (Lannering et al. 2016).

In the study of Haines et al. (2015), forgtfulness of nurses to lock the level of the bed lower to the floor for fall prone patients leads nurses increases chances of falls for the elderly. In addition, nurses lacking knolwdege to reduce falls also makes them fail to prevent falls (Kim et al. 2015). This is because proper support is unable to be provided by nurses to elderly inpatients for ensuring protection of them from fall during movement. As criticised by Shumba and Abraham (2017), inability of the nurses to inform and educate fall prone pateints regardiung the way to use call lights results in fall incidences among them. This is because patients while need for assistance to move are unable call for help from nurses making them to move on their own beyond their efficiency making them prone to fall. As asserted by Clancy and Mahler (2016), improper monitoring of elderly inpatients for determining thir needs leads the elderly experience risk of falls. This is because patient could not rely on availability of nurses making them to execute own tasks leading them be at risk of falls due to lack of support and balance for moving.

Why

The placement of the belonging of patients far away from the beds leads many elderly to leave their bed without support (Card, 2017)

Why

Less knowledge among nurses regarding the ways to use for preventing falls (Haines et al. 2015)

Why

Lack of information delivery to patients by the nurses in proper way regarding the way call lights are to be used (Shumba and Abraham, 2017)

Why

Improper monitoring and determination of the needs of the elderly patients (Clancy and Mahler, 2016)

Why

Forgetfulness of nurses in lacking beds near floor posituion for rthe fall prone elderly pateints (Kim et al. 2015)

Fishbone Diagram provides visualisation of cause and effect relationship regarding the raised problem (Gartlehner et al. 2017). The Fishbone Diagram is to be used in this case to determine the causes which is leading to the increased fall incidences so that the nurses understand what steps are to be taken to resolve the problem.

The PDSA Cycle refers to Planning, Doing, Studying and Acting to making the change needed. At the planning stage, objectives, as well as processes needed for the desired changes, is to be identified (Bollegala et al. 2016). This indicates nurses and officials at the stage are to develop plan in lowering falls among the elderly patients. The plan as developed included that belonging of patients are to be kept near their bed, call lights viewing by nurses are to be improved, beds are to be lowered at floor level, patients are to be monitored, fall sign installation for elderly fall prone patients, bed brakes application, well-fitting footwear allocation, management of significant needs of patients and others. In the Doing phase, the objectives for change are applied (Parker et al. 2018). This indicates that nurses required following the developed plan to improve their services accordingly so that reduction in falls for the elderly is achieved. In the studying phase, it is duty of the individuals making change to evaluate and examine the impact of their implemented plan for change (Mazzocato et al. 2016). This indicates nurses are to gather feedback from patients as well as monitor health environment to determine the extent of success the implemented change plan has brought in reducing elderly falls. In the action stage, the nurses are required to change the plan for reduction of elderly falls based on the received feedback for long-term quality care and support for the patients. The PDSA cycle has the benefit of helping establishment of change in continuous manner (Reed and Card, 2016). This means that changes towards elderly care by the nurses can be executed in continuous manner according to the changing demands and needs to ensure the fall risk of the elderly remains lower. The limitation to use the PDSA cycle is that it does not allow the change to be made in proactive manner (Ho et al. 2017). This indicates that the change actions impact can be understood after it has been established and not prior of its actual implementation to lower negative health issues to be faced by the elderly if the changed plan is not successful.

Explanation and Justification of Leadership Approach implemented

In order to make the change proposed, the Transformation Leadership approach is o be used. As asserted by Fischer (2016), transformation leadership is the process where the leaders encourage, inspires and motivates their subordinates and staffs to work with increased zeal to create better productivity. The transformational leadership assist to allow development of quick vision to deal with challenging situation with immediate effect (Olvera et al. 2017). This is because transformational leaders are well aware of challenges to be faced and the way they are to be resolved so that the employees are able to be inspired to work effectively in making the intended change. Therefore, according to this leadership, the leaders involved in making the change are to develop vision regarding the way nurses are to be influenced in lowering elderly falls. As asserted by Choi et al. (2016), transformation leaders motivate employees to create change. Therefore, implication of the leadership would help nurses to enthusiastically make change to lower number of falls of elderly patients without creating barriers. This is because transformation leaders have the efficiency to stimulate the employee’s minds for accepting any change. As criticised by Lavoie‐Tremblay et al. (2016), transformational leaders have the ability to make wrong decision. This is evident as transformational leaders have sole confidence and authority in making the change which intends them at times to take abrupt decision neglecting effective thinking for acting properly. Therefore, the transformation in making the change successful in reducing falls of elderly patients are to execute critical and logical thinking for implementing change.

Definition and discussion of the effect of change on individuals

The effect of the proposed change that is response from nurses in lowering incidence of risk of falls among the elderly patients would help the hospitals improve their image of delivering quality care to the aged people, in turn, attracting more aged individuals to access services from them. As asserted by Hurren (2016), hospitals that are unable to reduce or avoid fall risk of adult patients are avoided by the aged people and family members to access healthcare. This is because such healthcare environment is considered to be unsafe and intends to create deteriorated health conditions for the elderly rather than recovering them from negative health issues. In relation to this, the improvement of the nurses response in reducing fall risk among elderly patients within hospitals would make people trust such environment to access care. This is because such healthcare environment ensures better care of the patients as well as improve health conditions, in turn, promoting a positive reputation and image of the hospitals. As criticised by Hoffman et al. (2017), increased healthcare cost is faced by the NHS due to elderly falls as complex injury are faced by the patients. Thus, the change proposed would impact to avoid complex injuries due to fall among elderly in turn leading the NHS to save finances to be used more productively in offering improved care for complex condition in adults and elderly people.

Discussion of ways to examine change

The change proposed that is increasing nurses response in avoiding falls among the elderly patients is to be examined and evaluated through survey of before as well as after health scenario of change implementation for elderly patients in healthcare settings, monitoring activities of nurses and accessing feedback from patients. The survey is important as it is cost-effective way of determining and analysing the extent of the impact of any change (Zhu et al. 2015). According to the proposed measure, before and after survey of change implementation is going to inform to what extent falls has been reduced among elderly in turn mentioning extent of effectiveness of the change. As commented by Lipsitz et al. (2016), monitoring activities of nurses would help to determine the way they are executing the care services This, in turn, would help in the change to examine whether or not and to what extent the nurses are following new strategies suggested in the change to response in caring for adults for reducing or avoiding falls. As argued by Zhao et al. (2018), feedback from patients informs their satisfaction as well as extended needs for care. Thus, accessing feedback from patients in the change would help to determine whether or not the patients are happy with the change as well as the additional needs that are to be fulfilled so that proper safety from falls is ensured.

Discussion and evaluation of change proposal in enhancing the care quality for elderly patients

In the proposal for change, it has been mentioned that call light viewing within their reach of nurses, patient would be demonstrated ways they are to use call lights and alarms, patient monitoring and others will be done. The maintaining of call light and alarm viewing within reach of nurses and educating the elderly inpatients to use them will help the patients to ask for help without trying to personally move avoid falls. In addition, nurses would understand which particular patients need their assistance immediately without being in front of the individual (Kangas et al. 2015). Thus, implementation of the change proposal would help nurses to provide immediate help to elderly for moving, in turn, avoiding risk of falls as patients would not try to personally move beyond their capability as they know they can rely on nurses to help them. As mentioned by Carande-Kulis et al. (2015), posting fall sign on patient bed would make the patient avoid falls. This helps in improving quality of care as injury and fractures due to fall can be avoided because nurses would be able frequently checking on the patient to ensure the individual moves with their support due to the alert sign. The proposed change is effective to lower fall among elderly because it suggested the way management of essential needs in reducing falls to be established for the patients. This is evident as it mentioned belongings of patients to be kept within their reach and by side of bed, in turn, helping to limit mobility of patients away from the bed where they may fall due to lack of balance out of health issues. The patient monitoring helps nurses to be alert regarding the needs and demands in care of patients, in turn, making the nurses able to provide those services so that least movement away from the bed without assistance can be avoided for the elderly patients (Mikolaizak et al. 2017). The low bed position near the floor and locking of bed at low level for elderly patients helps to reduce chances of injury from fall making the change proposal to be effective in lowering adverse impact of fall on the service users.

Suggestion of communicating proposed change

The change proposed regarding nurses response improvement for lowering falls among elderly patients is to be communicated to different nursing professionals through fall prevention informative weeks and programs. This is because healthcare prevention programs and weeks inform professionals in details regarding the skills and knowledge to be followed for offering improved healthcare (Choi et al. 2017). Therefore, through fall prevention weeks and programs, the nursing professionals can be made aware regarding the way care responses are to be changed and altered so that effective reduction in falls among the elderly patients is achieved. The change proposed would also be able to be communicated through training and education of nurses. This is an appropriate step as it would allow the nurses to develop new skills and expertise in managing their care activities in such an improved way so the fall reduction among the elderly is effectively achieved. In addition, the fall reduction ways suggested in change proposal are to be informed to nurses through leaflets and posters so that they are able to use the documented data to implement in practice in successful manner.

Conclusion

The discussion mentions that changes in response by the nurses to lower chances of falls among the elderly patients are needed as nurses being the key carers are able to deliver proper care to reduce the injury faced by elderly out of falls. This, in turn, leads the nurses acting to ensure better health and safety to the patients. The change is also significant to lower extra cost faced by the NHS in treatment of injury of the elderly patients due to fall. The Kotter's 8-step Change Model along with PDSA Cycle, Fishbone digram and 5 Why's is followed to determine the causes of the falls and develop a clear plan for change. The transformation leadership approach is used in the change implementation because it would assist in better communication of change principles making nurses and medical staffs to understand the way services are to be provided and alteration to be made to ensure success of the change. The survey of change implementation, monitoring activities of nurses and feedback of patients is to be accessed for measuring the effect of proposed changes. The fall prevention programs, fall prevention training and education are to provided to nurses in success of the change.

References

Álvarez Barbosa, F., del Pozo‐Cruz, B., del Pozo‐Cruz, J., Alfonso‐Rosa, R.M., Sanudo Corrales, B. and Rogers, M.E., 2016. Factors associated with the risk of falls of nursing home residents aged 80 or older. Rehabilitation nursing, 41(1), pp.16-25.

Bollegala, N., Patel, K., Mosko, J.D., Bernstein, M., Brahmania, M., Liu, L., Steinhart, A.H., Silver, S.S., Bell, C.M., Nguyen, G.C. and Weizman, A.V., 2016. Quality improvement primer series: the plan-do-study-act cycle and data display. Clinical Gastroenterology and Hepatology, 14(9), pp.1230-1233.

Carande-Kulis, V., Stevens, J.A., Florence, C.S., Beattie, B.L. and Arias, I., 2015. A cost–benefit analysis of three older adult fall prevention interventions. Journal of safety research, 52, pp.65-70.

Cartagena, L.J., Kang, A., Munnangi, S., Jordan, A., Nweze, I.C., Sasthakonar, V., Boutin, A. and Angus, L.G., 2017. Risk factors associated with in-hospital mortality in elderly patients admitted to a regional trauma center after sustaining a fall. Aging clinical and experimental research, 29(3), pp.427-433.

Choi, S.L., Goh, C.F., Adam, M.B.H. and Tan, O.K., 2016. Transformational leadership, empowerment, and job satisfaction: the mediating role of employee empowerment. Human resources for health, 14(1), p.73.

Choi, S.D., Guo, L., Kang, D. and Xiong, S., 2017. Exergame technology and interactive interventions for elderly fall prevention: a systematic literature review. Applied ergonomics, 65, pp.570-581.

Fourman, J., Umberger, G., Byrn, S. and Clase, K., 2016. Pharmaceutical Organizational Change: Redefining Regulatory Science Learning. BAOJ Pharm Sci, 2, p.022.

Gartlehner, G., Schultes, M.T., Titscher, V., Morgan, L.C., Bobashev, G.V., Williams, P. and West, S.L., 2017. User testing of an adaptation of fishbone diagrams to depict results of systematic reviews. BMC medical research methodology, 17(1), p.169.

Giordano, A., Bonometti, G.P., Vanoglio, F., Paneroni, M., Bernocchi, P., Comini, L. and Giordano, A., 2016. Feasibility and cost-effectiveness of a multidisciplinary home-telehealth intervention programme to reduce falls among elderly discharged from hospital: study protocol for a randomized controlled trial. BMC geriatrics, 16(1), p.209.

Grad, R. and Mallet, L., 2018. Improving Communications Between Hospitals and Community Providers: The Role of a Pharmacy Discharge Letter. The Canadian Journal of Hospital Pharmacy, 51(1). pp.241-278.

Henry, L.S., Hansson, M.C., Haughton, V.C., Waite, A.L., Bowers, M., Siegrist, V. and Thompson, E.J., 2017. Application of Kotter’s theory of change to achieve baby-friendly designation. Nursing for women's health, 21(5), pp.372-382.

Ho, E., Principi, E., Cordon, C., Amenudzie, Y., Kotwa, K., Holt, S. and MacPhee, M., 2017. The synergy tool: Making important quality gains within one healthcare organization. Administrative Sciences, 7(3), p.32.

Hoffman, G.J., Hays, R.D., Shapiro, M.F., Wallace, S.P. and Ettner, S.L., 2017. The costs of fall‐related injuries among older adults: Annual per‐faller, service component, and patient out‐of‐pocket costs. Health services research, 52(5), pp.1794-1816.

Hurren, E.T., 2016. “Deliver Me From This Indignity!”: Cottage Hospitals, Localism and NHS Healthcare in Central England, 1948-1978. Family & Community History, 19(2), pp.129-151.

Kim, M.H., Jeon, H.W. and Chon, M.Y., 2015. Study on the knowledge and attitudes of falls and awareness of fall risk factors among nursing students. Indian Journal of Science and Technology, 8, p.74.

Lavoie‐Tremblay, M., Fernet, C., Lavigne, G.L. and Austin, S., 2016. Transformational and abusive leadership practices: impacts on novice nurses, quality of care and intention to leave. Journal of advanced nursing, 72(3), pp.582-592.

Lipsitz, L.A., Tchalla, A.E., Iloputaife, I., Gagnon, M., Dole, K., Su, Z.Z. and Klickstein, L., 2016. Evaluation of an automated falls detection device in nursing home residents. Journal of the American Geriatrics Society, 64(2), pp.365-368.

Mazzocato, P., Stenfors-Hayes, T., von Thiele Schwarz, U., Hasson, H. and Nyström, M.E., 2016. Kaizen practice in healthcare: a qualitative analysis of hospital employees' suggestions for improvement. BMJ open, 6(7), p.e012256.

Mikolaizak, A.S., Lord, S.R., Tiedemann, A., Simpson, P., Caplan, G.A., Bendall, J., Howard, K., Webster, L., Payne, N., Hamilton, S. and Lo, J., 2017. A multidisciplinary intervention to prevent subsequent falls and health service use following fall-related paramedic care: a randomised controlled trial. Age and ageing, 46(2), pp.200-207.

Mount, A. and Anderson, I., 2015. Driving change—not just a walk in the park: the role of the nurse champion in sustained change. Nurse Leader, 13(4), pp.36-38.

Olvera, J., Llorens, S., Acosta, H. and Salanova, M., 2017. Transformational leadership and horizontal trust as antecedents of team performance in the healthcare context. anales de psicología, 33(2), pp.365-375.

Parker, S.G., Downes, T., Godfrey, M., Matthews, R. and Martin, F.C., 2018. Age and Ageing to introduce a new category of paper: healthcare improvement science. Age and ageing, 48(2), pp.178-184.

Romeyke, T., Nöhammer, E. and Stummer, H., 2016. Lessons from change management theory for the implementation of clinical pathways. Int J Care Pathways, 2(9), pp.43-47.

Small, A., Gist, D., Souza, D., Dalton, J., Magny-Normilus, C. and David, D., 2016. Using Kotter's change model for implementing bedside handoff: a quality improvement project. Journal of nursing care quality, 31(4), pp.304-309.

Zhao, T., Pi, H.Y., Ku, H.A., Pan, L. and Gong, Z.Y., 2018. Establishment and application effect of fall prevention and control information system in elderly community. Zhongguo ying yong sheng li xue za zhi= Zhongguo yingyong shenglixue zazhi= Chinese journal of applied physiology, 34(2), pp.182-186.

Zhu, L., Zhou, P., Pan, A., Guo, J., Sun, W., Wang, L., Chen, X. and Liu, Z., 2015, August. A survey of fall detection algorithm for elderly health monitoring. In 2015 IEEE Fifth International Conference on Big Data and Cloud Computing (pp. 270-274). IEEE.