Wait a second!
More handpicked essays just for you.
More handpicked essays just for you.
Evidence based practice critique
Evidence based practice critique
Evidence based practice critique
Don’t take our word for it - see why 10 million students trust us with their essay needs.
Recommended: Evidence based practice critique
1. Scope and purpose of the clinical practice guideline - What are the scope and purpose of this document? What are the objectives, questions, and target population (patients, consumers, students, and so forth)? In other words, who are the recipients of the services outlined in the document?
This document’s purpose is to assist nurses to identify elderly patients at risk for falls and to implement interventions to prevent or decrease the number of falls and fall related injuries (RNAO, 2005). The target population are elderly adults in acute or long-term care. The recommendations are to help practitioners and patients make effective healthcare decisions, support nurses by giving educational recommendations, and to guide organizations in providing an environment receptive to quality nursing care and ongoing evaluation of guideline implementation and outcomes. These guidelines stress and interdisciplinary approach with ongoing communication and take patient preferences into consideration.
2. Stakeholder involvement - What professions are represented in the committee that developed the guideline? Have members of the target population been consulted in the development of the document? What conflicts of interest are possible?
For this practice guideline, the original development panel of six members included; a Chief Nursing Officer, Charge Nurse, Clinical Nurse Specialist, Clinical Practice Facilitator, a Professor from a School of Nursing, and an Education Coordinator. The revision panel members included; a Chief of Nursing & Professional Practice, an Assistant Lecturer from York University, a Clinical Nurse Specialist, Clinical Practice Facilitator, a Nursing Professional Development Educator, an Internist/Geriatrici...
... middle of paper ...
...ementation and suggested team-based problem solving and solid communication plans as solutions to these problems. Measuring for outcome improvement after implementation would be fairly easy as most long-term care facilities maintain fall reports and statistics for dates, times, locations, causative factors and injuries. This information can be compared from prior to implementation at various levels post intervention.
APA reference:
Pexton, C. (2010). Overcoming the barriers to change in healthcare system. Retrieved from http://www.isixsigma.com/implementation/change-management-implementation/overcoming-barriers-change-healthcare-system/
Registered Nurses’ Association of Ontario (RNAO). (2005). Prevention of falls and fall injuries in the older adult. Retrieved from http://rnao.ca/sites/rnao-ca/files/Prevention_of_Falls_and_Fall_Injuries_in_the_Older_Adult.pdf
Peel, N. M., Travers, C., Bell, R. R., & Smith, K. (2010). Evaluation of a health service delivery intervention to promote falls prevention in older people across the care continuum. Journal Of Evaluation In Clinical Practice, 16(6), 1254-1261. doi:10.1111/j.1365-2753.2009.01307.x
Introduction The College of Nurses of Ontario (CNO) is the governing body of all registered nurses in Ontario and is regulated. The CNO provides expectations and guidelines to follow, which need to be met by each Registered Practical Nurse (RPN) individually. As a nursing student, I am taught about the CNO and the importance of referring back to the guidelines while caring for patients. While gaining experience in the nursing field through my clinical settings, I have realized as a nursing student there are areas I need further development in. In this paper, I will address two of my learning needs and my goals for each.
Falls in nursing homes residents are associated with morbidity, mortality, and healthcare costs. The centers for Medicare and Medicaid indicate falls as the quality indicator. (Leland, Gozalo, Teno, Mor, 2012). Factors such as new environment, medication, cognition, and non-compliance contribute to falls. A significant number of falls occur from wheelchairs. (Willy, 2013). Newly admitted residents to long-term care facilities are confused with the change. The new environment and the new unfamiliar faces increase the level of anxiety. Pain may also contribute to falls. In order to take tailor made preventative measures, fall risk factors for each resident should be evaluated periodically. Tools scoring risk factors can be utilized.
The National Patient Safety Goal (NPSG) for falls in long term care facilities is to identify which patients are at risk for falling and to take action to prevent falls for these residents. (NPSG.09.02.01). There are five elements of performance for NPSG: 1. Assess the risk for falls, 2. Implement interventions to reduce falls based on the resident’s assessed risk, 3. Educate staff on the fall reduction program in time frames determined by the organization, 4. Educate the resident and, as needed, the family on any individualized fall reduction strategies, and 5. Evaluate the effectiveness of all fall reduction activities, including assessment,
Fatigue, decreased mobility and impaired balance from the rheumatoid and osteoarthritis pain also increases the risk of falls (Stanmore et al., 2013). Age related changes such as sarcopenia causes muscle tone and strength to decrease, especially in the lower limbs and as a result, balance and gait become impaired (Culross, 2008). These factors significantly influence the risk of falls and also affect the ability to carry out daily activities therefore, with a physiotherapists assistance, the nurse could introduce a personalised exercise regime to enhance muscle tone and strength (Culross, 2008). According to Neuberger et al (1997), exercise lessens fatigue and improves muscle tone and balance in older people. Recommending an exercise programme for Mrs Jones that incorporates strength training exercises and aerobics, could potentially improve muscle tone and strength and as a result improve mobility, balance and lessen the risk of falls (Bird, Pittaway, Cuisick, Rattray & Ahuja, 2013). The nurse could also suggest safety precautions such as advising Mrs Jones to use a mobility aid (Gooberman-Hill & Ebrahim,
Fall can lead to serious injuries and death which, increase the health care cost. Hence prevention of fall is an important public health issue in the hospital for patient safety. We had many falls incidents reported in our unit every month. Therefore, it is essential to implement prevention strategies through multidimensional approach by interdisciplinary team. Through the proposed fall management program, we can reduce fall rate drastically.
Development of The Evidence Based Geriatric Nursing Protocols for Best Practice Guideline originated with the goal of providing strategies that would allow nursing to monitor and support family caregivers (Agency for Healthcare Research and Quality, n.d.). Evidence selection and collection occurred utilizing the PICO question methodology to hand search primary and secondary relevant published literature, in addition to electronic database searches. The data was then analyzed via a meta-analysis of the published materials garnered from the search in addition to a systematic review of the evidence. From the preceding analysis of the evidence, major recommendations arose for
Association, A. N. (2010). Nursing Scope and Standards of Practice. (2nd ed.) Maryland: American Nurses Association. Retrieved January 20, 2014 from http://media.wix.com/ugd/8c99f2_4fde86431966e34f2e03bbb137edfee3.pdf
When taking steps to analyze and apply intervention strategies for falls, we must examine the factors that cause these occurrences. There are numerous reasons that falls occur, such as intrinsic and or extrinsic risk factors. Intrinsic risk factors for falls may be due to changes that are part of the normal aging process and acute or chronic conditions. According to Zheng, Pan and Hua et al. (2013), about 35-45 percent of individuals who are usually older than 65 years and other 50 percent of the elderly individuals report cases of fall every year. Extrinsic factors are those related to physical environment such as lack of grab bars, poor condition of floor surfaces, inadequate or improper use of assistive devices (Currie). Patient falls is not an easy thing to eliminate. With many clinical challenges, there’s no easy answer to the challenges posed by patient falls; howe...
Barker, A. M. (Ed.). (2009). Advanced practice nursing Essential knowledge for the profession. Sudbury, MA: Jones and Bartlett.
Assessing the reason for the falls would be the first step in the plan. Is there any repetition of the reason behind the fall (Olrich, Kalman, & Nigolian, 2012)? For instance, is there frequent falls at a certain time of the day such as during shift change? Also it may be helpful to know if the fall was related to tethers such as IV poles or Foley catheters. It may also be a good idea to look at the type of patient who fell, is the patient reported to be confused at the time of the fall? Is there any history of dementia reported for the patient that fell? Once all the information is gathered then the pertinent information could be categorized into groups that would help to decipher the best plan of action to prevent falls. The plan would need to be written and approved by the nursing managers and may be put into place by the clinical leaders that are involved with the unit. Although each unit is different some of the ways to prevent falls are similar in all units in the hospital and a team should be formed that would use the inf...
Dougherty, L. & Lister, s. (2006) ‘The Royal Marsden Hospital manual of Clinical Nursing Procedures: Communication 6th Edition Oxford: Blackwell Publishing Ltd
Taylor, C. R., Lillis, C., LeMone, P., & Lynn, P. (2011). Fundamentals of nursing: The art and science of nursing care (7th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Potter, P. A., & Perry, A. G. (2009). Fundamentals of nursing (Seventh ed.). St. Louis, Mo.: Mosby Elsevier.
Balancing between professional and personal life is stressing and one will always offer more time to either of the two. For this reason, most choose to send the elderly to nursing homes and other assisted living facilities. In these institutions, the elderly are well taken care of by a team of professionals and they even get to socialize with others. However, even in these facilities falls can occur and it is the obligation of