In this assignment you will introduce your clinical topic for your project. You will submit a paper as part of this assignment that will cover the following components:
- Introduction – Describe the clinical topic. Include a narrative statement of the clinical problem, including setting and population. Provide rationale as to why this clinical problem is important in a clinical setting.
- Background and Significance – Describe background and significance of the clinical problem. Clearly and logically argue for the need to explore this clinical problem. State the significance of the clinical problem in terms of incidence and prevalence, morbidity and mortality, cost, etc. Support with citations.
- PICO/PICOT Statement – Pose an answerable question in PICOT format. Briefly describe each component to include Population; Intervention (or harm/exposure); Comparison (only if applicable); Outcome; and Timing (only if applicable).
- Key Stakeholders – Identify the key stakeholders who can most affect, or who will be most affected by, the project, actions, objectives, or change and who can influence the success of the translation work. Discuss which of the four roles each stakeholder may play in your action planning and translation work. The possible roles are: Responsibility, Approval, Consult, Inform
Your scholarly paper must follow APA format. Include a cover page and headings per 7th edition APA guidelines. The paper will be approximately 3-4 pages in length and employ APA format (double-spaced with Times New Roman 12-point font).
Use the JHNEBP Appendix B-Question Development and Appendix C-Stakeholder Analysis Tools to gather the information needed for this assignment.
Please refer to the rubric for grading criteria.
One of the most prevalent clinical problems in long-term care settings is falling. This is because, in most long-term care facilities, elderly people with different illnesses, including dementia and Alzheimer’s, are attended to. Falls are the leading causes of non-fatal and fatal injuries among elderly patients. For the patients in long-term care(LTC) facilities, the repercussions of falls usually are greater than only physical injuries with such repercussions including significant fear of falling again, functional decline, reduced quality of life, and feelings of low self-esteem, helplessness, social isolation and even depression (Cameron et al., 2018). Reduction of falls is one of the most important quality improvement projects that leaders in LTC facilities can spearhead to significantly improve the quality of care in such facilities and to improve the outcomes of patients. Preventing falls in LTC facilities can also help to save on resources, including both human resources and financial resources that are normally utilized to attend to patients that have experienced falls.
Background and Significance
Falls are a significant hazard in LTC facilities and are responsible for adverse outcomes among elderly patients who are normally treated in such facilities. The consequences of falls can therefore range from bruises, and major trauma, including internal fractures and bleeding, especially on the hip and even brain injuries (Dyer et al., 2018). Severe injuries that are fall-related are life-threatening, with an estimated 30,000 elderly individuals succumbing to fall related complications ever year (Cameron et al., 2018). According to the CDC, nearly 50 to 75% of patients in long-term care facilities fall, with many incidents going without being reported highlighting that the falling percentage among residents in long-term care facilities is significantly higher (CDC, 2021). According to Dyer et al. (2018), a single resident in a LTC facility will fall more than once every year, with fall rates among residents of LTC facilities being more than double that of elderly people who live in communities. Only 20 to 30% of residents in long-term care facilities who fall suffer from moderate to severe injuries such as laceration, head trauma and hip fracture (Dyer et al., 2018). According to the CDC, the medical costs associated with injuries related to falls totalled an estimated $50 billion dollars by 2021. On average, the cost of care for fall injuries is $30,000(CDC, 2021). Over the coming decades, the cost of treating fall-related injuries is expected to rise significantly because the U.S. population is ageing, and the number of falls is expected to increase significantly. The direct costs of treating fall injuries relate to services like physical therapist visits, nursing home care, doctor visits, medical equipment, and prescription drugs. On the other hand, fall-related injuries contribute to indirect costs such as loss of time from household duties or work, loss of independence among elderly patients and reduced quality of life (Cameron et al., 2018).
Considering the negative consequences of falls among residents in LTC facilities, which include physical injuries, mental issues such as depression, anxiety, social isolation, helplessness, and low self-esteem, reduced quality of life and high financial costs both in lost productivity and treatment, there is a significant need for nurse leaders in LTC facilities to adopt quality improvement projects targeting fall reduction. Fall reduction quality improvement projects can therefore help LTC facilities to improve the health outcome of residents, boost the quality of care and save resources.
Considering the clinical problem of high rates of falls in LTC facilities and the negative impacts that falls have on the health of residents, it is vital to formulate evidence-based practices that can help resolve this issue. One of the most effective ways of formulating evidence-based practices is through a picot statement. A picot question can therefore help to evaluate the effectiveness of interventions to reduce falls in LTC facilities. The ideal picot question related to the quality improvement project would be: Among residents in a long-term care facility(P), how will the involvement of nurse leaders in fall reduction programs(I) compared to not involving nurse leaders(C) help in reducing fall rates(O) for a period of one year(T)?
The population of focus would be residents in long-term care facilities who mainly include elderly patients over the age of 65. Past scholarly data has indicated that the elderly patients in long-term care facilities are at high risk of falls, with their average fall rates being more than double that of senior citizens who live in communities. On the other hand, the ideal intervention to reduce falls in long-term care facilities would be the involvement of nurse leaders in various fall reduction programs. Nurse leaders can therefore play a significant role in the implementation and coordination of various fall reduction activities in long-term care facilities, including spearheading fall risk assessment activities and providing staff training on fall reduction. A comparison group would include not involving nurse leaders in fall prevention programs implemented in long-term care facilities. The ideal outcome for the improvement project would be a reduction in falls, while the ideal period to evaluate outcomes would be one year.
The key stakeholders that would be significantly affected and who would have a significant effect on the quality improvement project to reduce falls in long-term care units would include nurse leaders, healthcare practitioners including nurses and nursing assistants, patients and executive management in the healthcare facility (Baris & Seren Intepeler, 2018). The central role of the executive management in a long-term care facility would be to approve and provide funding for any fall reduction programs that are suggested by the nurse leaders. On the other hand, the primary role of nurse leaders would be to consult nurses and nursing assistants so as to draw up effective fall reduction programs in a long term care facility. Nurse leaders would also play the informing role by updating the executive management on the progress of various fall prevention programs in a long-term care facility. On the other hand, the central role of healthcare practitioners, including nurses and nursing assistants, would be to assume the responsibility of implementing fall reduction programs in collaboration with patients. Healthcare practitioners would also inform nurse leaders of the progress of already implemented fall prevention programs (Baris & Seren Intepeler, 2018). Finally, the primary role of patients in a long-term care facility would be to follow the guidance of nurses and nursing assistants so as to avoid falls.
Baris, V. K., & Seren Intepeler, S. (2018). Views of key stakeholders on the causes of patient falls and prevention interventions: A qualitative study using the international classification of functioning, disability and health. Journal of Clinical Nursing, 28(3–4), 615–628. https://doi.org/10.1111/jocn.14656
Cameron, E. J., Bowles, S. K., Marshall, E. G., & Andrew, M. K. (2018). Falls and long-term care: a report from the care by design observational cohort study. BMC Family Practice, 19(1). https://doi.org/10.1186/s12875-018-0741-6
CDC. (2021). Older Adult Falls. CDC.Gov. Retrieved January 28, 2022, from https://www.cdc.gov/falls/index.html
Dyer, S. M., Panagoda, C. E., Murray, G. R., Hill, K. D., Cumming, R. G., & Kerse, N. (2018). Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd005465.pub4