Reducing Elderly Falls in Nursing

Introduction

The elderly due to their illness as well as deteriorated physical health condition such as heart diseases, poor vision, vertigo attack and others are unable to have proper strength to move alone and balance their body making them be at risk of experiencing falls (Giordano et al. 2016). The nurses are entrusted to offer care to these elderly individuals but due to their lack of proper response in managing the patients the elderly experiences unnecessary falls (Cartagena et al. 2017). Thus, in this change proposal, the way nurse responses are to be changed for reducing falls among the elderly is to be discussed. For those working on related topics, seeking nursing dissertation help can be beneficial in addressing these complex issues effectively.

The change mentioned in justified because with improvement in nurse’s response towards the needs and management of the elderly individuals they would be able to implement effective precaution and modification in their care to reduce risk of falls. In order to mention the way the change is to be made, Kotter’s 8-step model of change is to be used. The way tools such as PSDA cycle, 5 Why’s and Fishbone diagram in supporting the mentioned change is to be discussed. Further, the leadership required in making the change and impact of the change in quality of care is to be analysed. Lastly, the way the proposed change is to be communicated is to be suggested.

Background

The Public Health England reported that falls in hospital among the elderly patients the most commonly reported patient safety issue in the UK. In 2015-16, 190,000 cases of falls among the elderly who are above the age of 65 due to improper nurse response are reported in the acute hospitals as well as mental health trusts settings in and around England and Wales to the NHS (NHS, 2017; GOV, 2019). Moreover, it is been reported that impact of falls experienced by the elderly due to inactive nurse response resulted in serious injuries such as head injury, hip injury (more than 3000 each year) and others which are resulting the elderly to experience disability and in intense cases uncertain death (GOV, 2015).

The inpatient falls among the elderly has led more than £24,000 to be spent for their care. It is mentioned that nearly £204 million is spent in acute settings and £105 million in mental health trusts additionally for treatment of falls among the patients. Nearly, 86-87% of this amount is spent on the treatment of elderly inpatients falls, in turn, increasing the healthcare cost (NHS, 2017). The figures indicate that change in nurse response in reduction of falls among the elderly inpatient in England and Wales is required as their lack of proper response and support is making the elderly inpatient experience increased finances to be spent for their treatment. In addition, the change is required as the fall issues are making elderly inpatient experience severe health issues such as head injury, hip fractures and others. Therefore, to create better health environment and reduce addition of unnecessary healthcare cost for the elderly inpatient the mentioned change is needed at the local level.

Implementing the Change

Critically analysing and explaining the chosen change management model

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The change management model chosen for implementing the change is Kotter’s 8-step change management model which includes eight steps (Small et al. 2016). In the sense of urgency stage, the people to be involved in making the change are to be inspired to accept and work to make the change (Fourman et al. 2016). Thus, this stage indicates that nurses in the hospital are to be inspired to make change in their response. This is to be done by mentioning the way their current response is creating fall issues along with hindrances for elderly inpatients and the way change in their current response will resolve it as well as improve elderly patient’s health, care quality and their care satisfaction. However, lack of sense of urgency is going to make individuals avoid considering that a change is required in turn blocking the implementation of change (Kuo and Chen, 2019).

In building guiding team stage, the right individuals from the setting where the change is to be made are to be selected from all levels to form a team so that proper skills and people required to make the change are present (Mount and Anderson, 2015). This stage indicates that the hospital management requires selecting registered nurses and officials from all levels to form a team who will act together by sharing their skills and ideas to determine the way to achieve the change in nurse response for reducing falls among elderly inpatient. The lack of inclusion of right individuals in making the change led to the development of hindered vision and strategies which leads to unsuccessful change (Mørk et al. 2018). In vision development stage, the team framed are to establish a proper vision and strategies to be followed for making the change (Henry et al. 2017). This informs that different strategies such as respond to light calls and alarms immediately by nurses, maintaining call light viewing within reach of nurses, keeping possession within patient reach of bed by nurses, providing support to patients in need, monitor patient movement, demonstrating the way of using call light and bells by nurses and others along with vision that is providing quality care to elderly are to be developed at the stage. The inability to develop proper vision for change makes others unable to understand way to make the changes leading failure to make change (Romeyke et al. 2016).

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In communication stage, the vision and strategies are to be informed in details to the individuals who are involved in making the change (Odor, 2018). This means that all nurses who are involved in care of elderly care are to be informed of the strategies and vision developed that they are to follow in making change in their current services so that reduction of falls among the elderly inpatient can be achieved. However, inability to communicate concerning individuals related with the change creates barrier in making the change as individuals do not have information on way they are to improve for making the change successful (Kenny et al. 2017). In empowering action stage, the management and the team involved in making the change are to determine and remove any obstacles to be faced in making the change, need feedback to be received and support from leaders in making the change (Orr and Davenport, 2015). This stage informs that to make the change in response of nurses to reduce falls among elderly inpatients the team involved in making the change are to identify obstacles to be experienced in making the change an remove them to ensure success.

The creation of short-term wins is to set small aims to make the change gradually (Small et al. 2016). This indicates that nurses are to be provided small goals to be achieved in making change in their response and care towards elderly inpatients so that gradually the reduction of fall can be achieved. In consolidating gains stage, improvements in strategies to accomplish the change are to be made based on the result of short-term wins (Grad and Mallet, 2018). This means the change team are to implement and encourage others to mention change in strategies required to successfully implement the change. In implementation of change stage, the change is to be established and continuous monitoring is required to ensure the changed activities are followed (Small et al. 2016). This indicates the change team are to monitor nurse responses to ensure they are following change in their services being asked properly to reduce falls among the elderly.

Discussing tools to be used for supporting chosen change management

The tools to be used for making the change in nurse response to reduce falls among the elderly inpatient include 5 why’s, PDSA cycle and Fishbone diagram.

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), lack of immediate response by the nurses to call alarms and lights used by the patients makes them experience falls. This is because the patients even after using the call lights or alarms when perceives that the help they required is not to be provided by nurses they personally tries to execute it making them prone to experience falls by losing balance t stand as a result of their health issue.

In the study of Haines et al. (2015), it is mentioned that nurses being forgetful to lock bed position lower to the ground makes the elderly experience falls. In addition, lack of education among nurses 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), lack of proper communication by nurses with the patients regarding the way the elderly individuals are to use call bells or lights for help makes them prone to fall. 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), lack of proper monitoring of elderly inpatients to check on their 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 Lack of presence of belonging within the range of beds elderly inpatients makes them try to leave their beds and move (Card, 2017) Why Lack of education among nurses to reduce falls (Haines et al. 2015) Why Lack of proper communication by nurses with the patients regarding the way the elderly individuals are to use call bells or lights (Shumba and Abraham, 2017) Why Lack of proper monitoring of elderly inpatients to check on their needs (Clancy and Mahler, 2016) Why Nurses being forgetful to lock bed position lower to the ground (Kim et al. 2015)

The PDSA cycle indicates plan, do, study and act. In the planning stage, the process and objectives need to make the desired change for the problem is determined (Bollegala et al. 2016). Thus, in this stage, the change in responses of nurses required to lower falls among elderly inpatient is to be determined. The plan for making the change in response of nurses includes maintaining call light viewing within nurses’ reach, demonstrate patients they way they are to use call lights and alarms, patient monitoring, reminding elderly to ask for help while in need, installation of fall signs for risky patients, immediate approach to patients on alarm by the nurses, manage and ensure proper locking of bed brakes, provide well-fitting footwear, maintain essential needs of the patient within their reach and others.

In the Do phase, the planned objectives are implemented (Parker et al. 2018). This means nurses are to follow the plan in making change of their response to elderly patients so that reduction in falls can be achieved. In the study phase, the implemented plan is to be checked and reviewed to understand the change to be made further to implement the change in a better way (Mazzocato et al. 2016). Thus, in this stage feedback from the nurses and monitoring of nurse’s changed response is to be made to identify the further change required to successfully reduce fall of elderly inpatient fir long-term. In the act stage, the people involved in making the change is to act according to the feedback and data received for adjusting the action of nurses responses to ensure success in reducing falls. The benefit of using the PDSA cycle is that it helps to establish change through continuous improvement (Reed and Card, 2016). This indicates that changes in nurse's responses can be continuously done according to change in needs and demands of elderly inpatient to ensure reduction of fall among them for longer-term. The limitation of using PDSA cycle is that it is not proactive (Ho et al. 2017). This means that the implemented change actions can be understood after it has been implemented but not before its actual implementation making elderly to face negative issues of health while making the change if the mentioned plan for change is not effective.

Justifying and explaining leadership approach to be used

Transformational Leadership is to be used in making the determined change. The transformation leadership is the approach in which the leaders inspire, encourage and motivates the employees and other staffs in the organisation to inform ways making change and creating which will help in the growth and success of the organisation (Fischer, 2016). As commented by Olvera et al. (2017), transformational leadership helps to allow immediate dealing with challenging situation by quickly formulating vision. This is because in this approach leaders are aware of challenges being faced and have the key intention to make growth by inspiring others to look for areas to be improved to resolve the challenges making them quickly develop vision for change. Therefore, this approach is to be used so that leaders in the hospital can quickly develop vision regarding which areas of nurse response are to be improved or changed so that reduction of fall among elderly inpatient can be achieved. As commented by Choi et al. (2016), transformational leadership leads to promote inspiration and motivation among employees to make change. Thus, use of this leadership is going to lead nurses enthusiastically make change in their responses to reduce falls among elderly without creating barrier to accept change as the transformation leaders have the power to stimulate the minds of the employees to consider that change is for good. As argued by Lavoie‐Tremblay et al. (2016), transformation leaders can make wrong decision for change. This is because they are in sole authority and confidence to make change thus taking abrupt decision without effective thinking would act detrimentally. Thus, the leaders in making change in nurse response for reduction of fall are to avoid taking abrupt decision or develop strategies for change and rather think properly and then implement it make change.

Discussing and defining the impact of change on the individuals

The impact of reduction of change in response of nurses to reduce falls among the elderly inpatients is going to help the hospitals improve their name in the healthcare field which in turn would promote growth of their business. As mentioned by Hurren (2016), hospitals in which patients are prone to experience falls and deteriorated healthcare are avoided to be accessed by public and it creates a negative image of them in the industry. This is because lack of safety to patients from falls makes the patients, as well as their family member, fear that worst health condition is to be faced from such hospitals which would further deteriorate patient’s health rather than improving it. In this context, improving nurse responses to reduce falls would express better image of the hospitals in the industry as well as attract patients as trusted and effective care is ensured which in turn would make them have trust from the public. The public would consider the hospital to be frequently availed for healthcare out of trust, in turn, promoting expansion of their business. As argued by Hoffman et al. (2017), falls in elderly inpatients creates additional healthcare cost and further deteriorated health of patients from the injury. Thus, changing nurse response to reduce falls among elderly patients would promote prevention of unnecessary injury, in turn, cutting additional cost of healthcare making patients spend fewer amounts for care and treatment.

Discussing the way change is to be evaluated

The measures to be used for evaluating the change management of nurse response for reduction of falls among the elderly inpatients include survey of before and after assessment of settings, gaining feedback from patients and monitoring the care response way of nurses. The survey of before and after assessment of setting is effective to evaluate the change because it assists to compare data before and after implementation of the change for determining whether or not the change has been effectiveness (Zhu et al. 2015). This means if there is reduction of falls in elderly inpatients after the change than before then it the change can be evaluated as successful. The monitoring of nurses activities helps to understand the way they are executing their responsibilities (Lipsitz et al. 2016). Thus, monitoring the nurse response after implementation of the change strategies will help to evaluate to what extent the nurses have improved in their responses as well as further actions to be taken to holistically implement the change in a more effective way. The feedback from the patients and their family members informs to what extent they are satisfied with the current care and they also highlight gaps present in care (Zhao et al. 2018). Thus, feedback from the elderly inpatient is to be taken to evaluate the success of the change because it will inform whether or not change in care responses have been actually made for them due to which they are facing less risk of falls as well safety in the hospital.

Discussing and evaluating the way change proposal is going to enhance the care quality for service users

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 change proposal would be effective to reduce falls in elderly as it proposes management of essential needs within reach of patients. This would make the patients execute limited movement in turn avoiding falls by walking. The proposal mentions nurses to execute monitoring of the patients. The monitoring of patients leads nurses remain alert as well as provide requirement by the patients in their beds in turn limiting their unnecessary movement which could make them experience risk of fall by losing balance (Mikolaizak et al. 2017). Thus, the change proposal is effective to enhance quality of care for elderly inpatients by limiting their movement to ensure safety from falls. The locking of bed brakes and managing lower bed position as proposed in the change proposal will enhance quality of care for elderly inpatient by making them be near the floor while trying to stand or get things in turn avoiding injury due to fall from heights.

Suggesting ways for communicating the proposed change

The proposed change can be communicated to the nurses through development of fall prevention program and weeks. This is because in fall prevention programs and weeks the nurses and health professionals are informed about different ways and techniques through which falls among the elderly inpatient can be avoided (Choi et al. 2017). Thus, in through these programs the proposed change in the proposal is to be communicated to nurses to make them create change in their way of response to ensure patient safety. The proposed change can also be communicated through education and training for the nurses. This is because in this way the nurses are to be directly informed regarding the way each aspect of the change proposal plan is to be implemented in their current response so that they can be able to successfully reduce falls among the elderly inpatients. In addition, use of intranet facility, as well as poster and leaflets, are to be used to roll out and communicate the proposed change to the nurses. This is because it would make them have documented information regarding the way change in their response is to be made to reduce fall risk among elderly inpatients.

Conclusion

The above discussion informs that change in nurse response to reduce fall among elderly inpatient is required because nurses are their main carers and therefore they are to help the patients to ensure them safety. Moreover, the change is required as it is creating additional treatment cost for patient as well as deteriorating their health due to injury experienced from falls. The Kotter’s 8-step model of change will be followed to make the change and PDSA cycle along with 5 Whys and Fishbone diagram is used to mention the way proposed change is to be made successful. The transformational leadership approach is being taken because it helps to communicate the vision of change immediately and create success for change through motivated employees. The monitoring of nurses, survey and patient feedback is to be used as measures to evaluate the change. The training and education, fall prevention programs, leaflets and intranet facility are to be used for communicating the change.

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