Fall Reduction by Patient Education and Physical Therapy

Plan Presentation

The presented project can be summarized in the following PICOT question: In senior hospitalized patients, what is the effectiveness of increased patient education and participation with regular exercise/physical therapy versus current hospital fall prevention programs with limited exercise/physical therapy in promoting balance and stability thus minimizing falls and fall-related injuries in senior patients within three months? The first step in the project is designing a program of patient education and exercise/physical therapy. The strategy to be applied to this step is based on evidence-based practice, i.e. the program should comply with the available information on fall prevention programs and their implementation in various facilities (Spoelstra, Given, & Given 2012). The next step is measuring baseline falls and fall-related injuries rates in a given facility. The strategy applied to this step is the framework of research in health care; the researcher must be unbiased and committed to documenting the existing situation fully and accurately.

The third step is conducting the intervention. This step should comply with two major fall prevention strategies: education about fall-related risk factors and exercise programs (DiBardino, Cohen, & Didwania, 2012). Also, it should be ensured that the intervention is conducted correctly so that the results are reliable, valid, and generalizable; for this, patients should be divided into two groups (intervention and control) randomly, and the second group should not be affected by the intervention. The final step is evaluation; after three months, the researcher will be able to compare the results of the intervention to the fall rate in the control group and the baseline rate. The key stakeholders in the presented project are patients (the control group included), health care providers who will implement the project (including the researcher), and the facility administrators who will provide necessary resources for the implementation stage, e.g. premises and equipment for patient education sessions and exercise/physical therapy.

Communication Strategies

In developing communication strategies, it is important to recognize the stakeholders (see Plan Presentation) and to plan how communications among them should be carried out. First, the researcher should contact the facility administration and health care providers to explain the necessity to conduct the proposed intervention. The strategy to be employed in this communication is facility-centeredness: the researcher should not explain the general importance of fall prevention programs but should refer to particular fall rates in the given facility. Further, evidence should be presented that fall prevention interventions similar to the proposed one have been successful in other facilities, and this is confirmed by scholarly studies (DiBardino et al., 2012). A plan should be demonstrated so that the facility’s decision-makers can see that the researcher has developed every step of the intervention and strengthened the research design with relevant academic literature.

In communicating with the health care providers who will participate in the implementation of the project, the researcher should regard them as fellow researchers. According to Smith (2013), nursing care providers may adopt many roles in their practice, e.g. act as administrators and facilitators, and in the proposed project, they should be encouraged to act as researchers instead of mere performers of project implementation instructions. This is expected to increase their involvement in the study and improve the quality of intervention they will provide.

Finally, communications with patients should be carried out according to the strategy of overcoming “barriers to patients’ willingness to actively engage in their care” (Berger, Flickinger, Pfoh, Martinez, & Dy, 2013, p. 548). The purpose of the intervention, the procedures and activities included in its implementation, and the expected outcomes should be clearly explained to the patients who agree to participate. It should be recognized that the intervention can be hard for some targets, which is why the researcher and the health care providers should communicate with the participants in a comforting and encouraging manner.

Educational Requirements

Mitchell (2013) claims that “staff education and training [is] a pivotal part of the change process” (p. 37); in fact, one of the theories of change in nursing practice is the normative re-educative theory that implies the change of behaviors through the provision of certain information. In the proposed project, training and education will play a significant role. First of all, the health care providers who will be involved in the intervention need to be trained according to the pre-designed program of patient education and participation and exercise/physical therapy. In this regard, the requirement is that the researchers who will act as educators are not only provided with educational materials but also equipped with relevant knowledge on how patient education and exercise/physical therapy can be delivered effectively. This training will be provided by the researcher as the author of the intervention program and project plan. The evaluation will be conducted upon the completion of the training and before the beginning of the intervention (part of the implementation stage); the health care providers will need to demonstrate their ability to hold educational sessions with patients and to understand the rationale behind the intervention.

Concerning the exercise/physical therapy part of the intervention, the researcher’s experience may be insufficient in terms of training health care professionals, which is why an external expert can be invited to teach the intervention providers to conduct appropriate physical activity sessions. The expert should be proficient in fall prevention exercise programs. A requirement for this aspect of training is that differences among patients are explained, i.e. what physical activities are more recommended for certain groups of patients and not recommended to some other groups. During the evaluation, health care providers will be expected to demonstrate their ability to carry out exercise/physical therapy sessions and differentiate among patient needs for particular types of exercise.

Safety, Ethics, Scope of Practice, and Regulations

Several areas of the facility operation and health care providers’ work need to be considered to ensure that the plan will stay in compliance. First, patients’ safety needs to be guaranteed; for this, the researchers must create learning and physical activity environments in which the senior patients’ health risks (primarily associated with frailty-related injuries) are reduced. Second, ethical principles should be followed; for example, Mubashir, Shao, and Seed (2013) stress that the principle of autonomy, i.e. the recognized patients’ ability to make independent decisions, should be considered in the implementation of fall prevention programs. The patients’ participation should be voluntary and informed. In case a patient wants to stop receiving the intervention, he or she should be excluded from the intervention group. Also, the program should be designed according to the principles of beneficence and nonmaleficence, i.e. it should be ensured that the patients’ health or treatment plans are not undermined by the intervention.

Third, the intervention should be aligned with the scope of practice of those health care providers who will implement the project plan. It should be ensured that the educational materials provided to the patients do not contain information that nurses may not be authorized to provide because it is part of physicians’ competence; an example of such information may be medication plans. Also, it should be stressed that patient education sessions and exercise/physical activity sessions are not designed by the providers but based on academic literature and evidence-based practice, which is why the provision of the intervention is not beyond the scope of practice. Finally, it should be ensured that the intervention program complies with any external and internal regulations the facility may have. For this, the researcher should consult the facility’s administration and, if needed, adjust the project plan to any requirements the administration will provide.

Support from Literature Review

As has been demonstrated, the change project implementation plan relies on relevant academic literature; moreover, the planned activities are aligned with the literature review conducted previously, and nursing theories are identified as related to the PICOT question. First of all, it was confirmed by Stenhagen, Ekstrom, Nordell, and Elmstahl (2014) that frequent falling among senior patients can cause a variety of negative effects on patients’ health, which justifies the need for the presented project. Further, a study by Aizen and Zlotver (2013) shows that risk-prediction tools are not effective for reducing the fall rate, which is why practical interventions are required, and the presented project provides required practical interventions. Concerning the regular exercise/physical therapy, several confirmations of its effectiveness had been found in the relevant literature, including articles by Patel and Pachpute (2015) and by Yoo, Chung, and Lee (2013). Also, Haines et al. (2013) confirm that patient education can be effective in fall prevention programs.

Conclusion

The presented project suggests researching the effectiveness of patient education and physical therapy for reducing the number of falls among senior inpatients. Stages of the project have been identified and planned; strategies have been designed to ensure effective communications among the researchers, health care providers, facility administrators, and patients. Intervention providers will require certain education and training before the implementation, and the goal has been set to provide them with effective instructional methods instead of merely supplying them with educational materials to be passed on to the patients. Possible complications and risks associated with safety, ethics, scope of practice, and regulations have been identified, and solutions have been planned. Finally, it has been shown that the planned project’s goals and activities comply with the findings and recommendations from nursing researchers and theorists.

References

Aizen, E., & Zlotver, E. (2013). Prediction of falls in rehabilitation and acute care geriatric setting. Journal of Clinical Gerontology and Geriatrics, 4(2), 457-461.

Berger, Z., Flickinger, T. E., Pfoh, E., Martinez, K. A., & Dy, S. M. (2013). Promoting engagement by patients and families to reduce adverse events in acute care settings: A systematic review. BMJ Quality & Safety, 23(1), 548-555.

DiBardino, D., Cohen, E. R., & Didwania, A. (2012). Meta-analysis: Multidisciplinary fall prevention strategies in the acute care inpatient population. Journal of Hospital Medicine, 7(6), 497-503.

Haines, T. P., Hill, A. M., Hill, K. D., Brauer, S. G., Hoffmann, T., Etherton-Beer, C., & McPhail, S. M. (2013). Cost effectiveness of patient education for the prevention of falls in hospital: Economic evaluation from a randomized controlled trial. BMC Medicine, 11(135), 1-12.

Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management, 20(1), 32-37.

Mubashir, M., Shao, L., & Seed, L. (2013). A survey on fall detection: Principles and approaches. Neurocomputing, 100(1), 144-152.

Patel, N. N., & Pachpute, S. (2015). The effects of Otago exercise program for fall prevention in elderly people. International Journal of Physiotherapy, 2(4), 633-639.

Smith, N. J. (2013). Professional doctorates and nursing practice contribution: A systematic literature search and descriptive synthesis. Journal of Nursing Management, 21(2), 314-326.

Spoelstra, S. L., Given, B. A., & Given, C. W. (2012). Fall prevention in hospitals: An integrative review. Clinical Nursing Research, 21(1), 92-112.

Stenhagen, M., Ekstrom, H., Nordell, E., & Elmstahl, S. (2014). Accidental falls, health-related quality of life and life satisfaction: A prospective study of the general elderly population. Archives of Gerontology and Geriatrics, 58(1), 95-100.

Yoo, H., Chung, E., & Lee, B. H. (2013). The effects of augmented reality-based Otago exercise on balance, gait, and falls efficacy of elderly women. Journal of Physical Therapy Science, 25(7), 797-801.