Deacreasing toileting related falls

However, it is important to note that this paper is intended for accustomed readers who can clearly understand that critical issues surrounding the subject matter. After a comprehensive analysis of 25 journal articles, a number of noticeable themes and subthemes were identified and will be widely discussed in this paper. The following are the key themes that were identified from the 25 articles. I. Guiding theory II. Description of the intervention strategies without supportive evidence or cases studies of affected patients were excluded. In order to ensure that the literary works included are authentic, systematic screening was carried out. Moreover, 15 US acute and older patient care facilities were identified. Only a small fraction showed a showed insufficient data to compare the rate of toileting falls.

The strategies of implementation were adequately documented and discussed. This doesn’t include toileting falls that occur prior to, or after the patient has been admitted to the hospital. Approximately 800000-150000 patients in the United States healthcare systems are normally involved in toileting-related falls (Lee, Lee, & Khang, 2013). According to Hicks, (2015) the AHRQ approximates that about two-thirds of the toileting-related falls can be prevented. Based on a research on 1300 patients in medical care center, it was identified that the neurology and medical units are associated with the highest number of toileting falls (Lee & Khang, 2013). The study identified that about 6. During the period of the study, 547 falls occurred, where 60% of them were within medical units (n=63), 23% on patients within medical-surgical units (n=8) and 18.

6% were on patients within the surgical units (n=10). About 50% of the falls that were captured in the study were attributed to toileting engagements (n=247), which is a critical area that needs addressing from the nurses (Volz & Swaim, 2013). Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Introduction (to the Chapter) and Background (to the Problem) This section describes the overall topic to be investigated, outlines the approach taken for the literature review, and defines the evolution of the problem based on the gap or need defined in the literature from its origination to its current form. 2 1 Need to rewrite this section. This provides a framework that can address toileting-related falls. A framework can be described as the attributes of organizing, incorporating resources, and relevant personnel.

A procedure is what is done while either delivering or getting care, which also includes actions of the patient. According to Milos, et. al (2014), quality assessment starts with Donabedian’s fundamental tenets of structural process and outcomes. The manner in which various stressors interrelate can have a huge impact on whether or not the line of defense has been broken, and therefore, a patient would be at risk of fall-related injuries. Compensating for a change in setting can, sequentially, encourage and maintain wellbeing (Volz, & Swaim, 2013). Neumann’s Systems Model can be utilized to expose the risk of falls. A set of stressors might interrelate to break the physique’s line of defense, the risks of falling upsurges with the blending of other risk elements.

Fawcett, (2013) supports this idea by pointing out that a higher number of stressors increase the risks for falls. (2012) indicate that lack of gates and handrails, or ramps and lack of anti-slippery materials is toilets pose significant safety hazards that increase the risks of falling. Hill, Etherton-Beer, & Haines, (2013) add that unfamiliar surrounding can make most patients confused, thus making them more exposed to sharp corners which carry a lot of risk on injury-related falls. Even though wheelchairs are commonly used to ensure total safety of patients, results from Hanger, Wills, & Wilkinson, (2014) indicate that such mechanisms usually cause falls as patients try to move out of a wheelchair. Medication Prescriptions are another fundamental subtheme to this subject matter. Drugs which can influence diverse psychosomatic effects on a patient, also play a huge role to toilet-related falls.

Manual muscle testing procedures highlight the weak parts of the body, and therefore, helps nurses to have prior knowledge about the needs of the patient (Zhao & Kim, 2015). Muscle testing procedure that has the greatest impact in highlighting weakness in the patients include hip adduction, hip flexion, and knee extension. Manual muscle testing can be easily conducted in the presence of a nurse and a practitioner during the follow-up visitation. Psychosocial risk factors It is vital to note that psychological and social aspects sometimes work together to increase the risks of falls. Such factors are usually known as psychosocial factors (Godlock, Christiansen, & Feider, 2016). The theories or models(s) guide the clinical questions and justify what is being measured (variables) as well as how those variables are related.

2 1 This section identifies and describes the theories or models to be used as the foundation for the project. 2 1 This section identifies and describes the seminal source for each theory or model. 2 1 This section discusses how the clinical question(s) align with the respective theories or models. 2 1 This section illustrates how the project fits within other evidence-based on the theory or model. 9 days in hospitals. Such compacted acuteness puts huge responsibilities on clinicians to ensure that the patients are safe. Therefore, findings from long–term prevention strategies in care facilities might not be applicable to acute care settings. Similarly, findings by Kolla, et. al, (2013) show that where hospital admissions are longer might not generalize to US care facilities. A recent review by the CDC offers limited evidence for acute care settings.

Miake-Lye, et. al. hypothesizes that the confluence of an effective preventative strategy to device preventative measures into clinical practices, the selected intervention mechanisms, the type of monitoring approaches utilized is the observance of protocols, and the least level of care intensity offered within a certain assessment groups would help in determining the success of a prevention program. Hill, et. The sample comprised patients with more than 60 years who had been admitted to various care medical institutions within the United States. The findings were evaluated by a random valuation model that simply assessed the general fall risks. The outcomes showed that anemias, mental illness, and various treatment are some of the most fundamental fall risk factors. Understanding these indicators can help nursing practitioners to implement better strategies in a various care setting and device the most applicable strategies, and in the long run mitigate toileting-falls.

Another study carried out by Hill, et. When a gait assessment, proactive toileting, and patient education were used during the intervention process, toileting falls decreased by 23% while injury related falls went down by 38%. Understanding the predictors of toileting falls provides a suitable approach for tackling the problem to its totality. In an effort to understand the most significant factors that lead to toileting falls, this literature review will try to explore the following questions: What are the primary predictors of toileting associated falls? What are the common predictors of toileting and bed falls? What are the major predictors of toileting bedside and bathroom toileting falls? In 5 of the literature materials that were analyzed, toileting encompasses all types of engagements that enables a patient to fulfill elimination needs.

This includes getting out of the bed, walking and getting into the bathroom, sit-to-stand/ stand-to-sit movements that a patient has to undertake in order to successfully eliminate waste from the body. Finding a way back to the bed and also getting onto the bed. Falls, are normally analyzed as a physical indication of hidden morbidity issues. All the 25 literature materials for this study indicate that patients shy away from asking for assistance since they are afraid that independence will be struck off and that their movement will have to be limited. Choi, & Boyle, (2013) view the restriction of movement is a major factor makes patients to avoid asking for assistance. The Primary question that is explored in this review is; what are the available options that can be used in conjunction with multifactorial fall elimination and follow-up? What are the most important elements that should be included? Could there be a least-optimal mix that can be effective in helping to tackle toileting falls? All the chosen literature materials indicate that toileting falls don’t depend on just one factor.

Rather, falls are based on either intrinsic or extrinsic factors. One proposed solution to prevent this type of hospital-related falls is to consider a multifaceted intervention and assessment approach. This is an approach where the delivery of care is designed specifically in accordance with the patient assessments to a specific target. The multifaceted approach has proven to lessen fall incidences as well as the related injuries. Weber, & Kelley, (2013) demonstrated this by using targeted interventions, created based on the patient assessment. The findings showed that the number of falls with injuries reduced by 57% from the earlier 35%. This was based on research on 42. 7% oncology, 28% orthopedic, and neurology patients. All the patients who were analyzed had previously experienced a toileting fall. Fischer also found out that toileting falls increased the Length of Stay (LOS) by an average of 7 days (Barker et al.

The average cost for an inpatient client is 10000-15000, while the average ICU cost ranges at around $26,000. For instance, 86% of nurses believe that implementation of the bed alarm is an effective tool when a patient is in need of toileting assistance (Choi, & Boyle, 2013). On the other hand, 50% of patients seem to believe that they would take care of their toileting needs and don’t view the bed alarm as an effective tool. 2013 hospital fall audits indicate that 40% of patients were involved in toileting falls, and this indicates the need for intensive toileting awareness creation on the patient. The issue of toileting arises out of the numerous fluids that are pumped into the patient’s body. 90% of patients who have been admitted have an IV bag that they have to carry around wherever they go.

More than half of the journal articles used did not utilize validate the scales and as an alternative developed the different tool, for which there was no reporting of psychometric data. It is important to note that the specificity of some of the best-known tools is still limited. Therefore, it can be concluded that it might not be optimal for the identification of high-risk individuals in order to prevent toileting related risks (DuPree, Fritz-Campiz, & Musheno, 2014). Due to the multiple risk factors of ambulation to and from the bathroom has been identified and previous studies show that proactive toileting, toileting reduces patient falls, a proactive toileting regimen carried out by PCA would be analyzed. The literature review also shows the need for proper education describing the various risk factors, as well as the consequences of falls, would be integrated into the toileting regimen.

Fawcett, (2013) argues that hiring PCA’s would make it possible to have a single nurse who understands how to properly disseminate information to patients. Secondly, it would ensure that there is a professional who understands how to and tests for muscle weakness and note patients who are in greatest need of toileting assistance. Safety in the healthcare system has been researched by many scholars, but the perceptions of nurses on the implementation of safety measures have been less researched. The main objective of this study was to examine the fundamental predictors of various forms of falls with the goal of toileting-related falls occurring in acute care settings. This review has answered a number of fundamental questions: what are the fundamental predictors of toileting-related falls? What are the solutions towards a reduced toileting-related falls? What is the significance of preventative strategies? What are the fundamental predictors of bedside and toilet-related falls? According to the literature, toileting can be described as all the activities that are intended at addressing the elimination needs which includes how to get out of bed, walking from assigned rooms to the lavatory, getting into the restroom, movements in the toilet and getting back to bed (DuPree, Fritz-Campiz, & Musheno, 2014).

117), the volume of work (-0. 03), and work-related demands (-0. The researcher concluded that patients would be exposed to a much safer environment if the nurses were provided with a lighter workload. It was also observed that nurses tend to over-exhaust themselves in an effort to ensure that the healthcare system is safe. In the process, they end up ignoring some of the critical factors that ensure that the healthcare system is void of hazards (Godlock, Christiansen, & Feider, 2016). ANA elaborate Staff Mix as the number of registered hours subjected to nursing compared to the total number of nursing care hours and this included unlicensed personnel RNs and LPN’s. Total Nursing Care Hours per Patient Day is elaborated as the productive number of hours that a nursing staff gets to work.

The continuous decrease in the number of nurses worldwide has led the Bureau of Labour and Statistics to approximate that there will be a vacancy of about 1. 3 million nurses by 2020. The Institute of Medicine identified that the working environment of nurses is filled with numerous threats towards the patient’s overall safety (Rowan & Veneman, 2017). 001, n=439), step-down units (-0. 0527, p<0. 01, n=393), and medical-surgical sections (-0. 0286, n=317). When a patient was exposed to more than 10 hours of nurse care, the aspect of staffing and toileting falls decreased significantly. Other measures include alternative patient management strategies such as alarm devices, spacious bathrooms and walking aids, provision of physical assistance for patients with high risks while they are trying difficult maneuvers in the toilet. A number of fall prevention strategies have been proposed but most of them have not to be tested properly.

Fawcett, (2013) analyzed and provided a detailed review of the method that can be used to prevent such incidents concluded that there is insufficient evidence that evidence-based guidelines are effective in preventing falls. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Review of the Literature This section provides a broad, balanced overview of the existing literature related to the project topic. It identifies themes, trends, and conflicts in evidence-based research methodology, design, and findings. Uses this information to justify the design. 2 1 This section argues the appropriateness of the practice improvement project’s instruments, measures, and/or approaches used to collect data. 2 1 This section discusses topics related to the practice improvement project topic and may include (a) studies relating the variables (quantitative) or exploring related phenomena (qualitative), (b) evidence-based studies on related factors associated with the topic, (c) Relates the literature back to the DPI-project topic and the practice problem.

d) studies on the instruments used to collect data, and (e) studies on the broad population for the project. Set of topics discussed in the Review of Literature demonstrates a comprehensive understanding of the broad area in which the topic exists. Thus, such states have passed legislation that dictates the most suitable staffing of nurses based on the number of patients who are in any medical facility. However, most nurses continue to be overworked environment due to lack of goodwill from the related hospital's managerial teams to curb the issue of toileting falls (DiBardino, Cohen, & Didwania, 2012). The primary objective of this literature review was to explore different literal works in an effort to create an understanding of measures that are being taken, or the frameworks that have been developed so as to create a safer environment for the patients.

Different frameworks have been considered such as the Donabedian Framework which helps to outline the processes and outcomes of any undertaking. Patient-related falling is an issue that faces many health institutions in the world. 2 1 This section synthesizes the information from all of the prior sections in the Review of Literature and uses it to define the key strategic points for the project. This section summarizes the gaps and needs in the background and introduction and describes how it informs the problem statement. This section identifies the theories or models and describes how they inform the clinical questions. This section uses the literature to justify the design, variables or phenomena, data collection instruments or sources, and answer the clinical questions on your selected intervention protocol, clinical setting, and patient population.

be evaluated. Barker, A. L. , Morello, R. T. , Wolfe, R. D. , Andresen, E. M. , Dunton, N. E. Choi, J. , & Boyle, D. K. RN workgroup job satisfaction and patient falls in acute care hospital units.  Journal of Nursing Administration, 43(11), 586-591. Journal of nursing care quality, 29(2), 99-102. Fawcett, J. Thoughts about conceptual models, theories, and literature reviews. Nursing science quarterly, 26(3), 285-288. Godlock, G. C. , Wills, K. L. , & Wilkinson, T. Classification of falls in stroke rehabilitation–not all falls are the same. , & Haines, T. P. Tailored education for older patients to facilitate engagement in falls prevention strategies after hospital discharge—a pilot randomized controlled trial. PloS one, 8(5), e63450. Hill, A. , Mansukhani, M. P. , & Morgenthaler, T. I. Zolpidem is independently associated with increased risk of inpatient falls.