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Prevention of Falls for Elderly Patients
Fall prevention is an important healthcare issue in the United States. Fall prevention is a critical issue if one considers the aging population in this country. Effective fall prevention strategies are established after a scientific inquiry revealed current practices and the reason why the elderly are prone to fall from their beds. The proponent of this study suggested a data-collecting scheme that lasted four weeks. A research team was deployed to observe nurses while doing rounds. The team observed how nurses behaved and interacted with their patients during nursing rounds. After four weeks, the proponent of this study discovered the importance of correctly implementing nursing rounds protocol, the use of the call light system, and the need to monitor the side effects of medication.
Background
One of the most important equipment in the hospital in relation to fall prevention is the call light system. The earlier design consists of a cord that when a patient pulls it, an electric signal is sent to the nurses station and alerts the nurses that a patient requires assistance. However, in most modern hospitals, it is a hand-held button device (Carter 251). When the patient pushes the button on the device, it signals to the nurse outside the room that he or she needs help.
Although the call light system is an effective communication tool, it is also prone to abuse. Whereas some patients want to maintain their independence, there are also patients with a different outlook and felt entitled to be treated with much deference and respect. With this type of patients, the call light button is an added burden to the nursing staff. The solution to this problem is not to remove the call light system from every room. A better solution, however, is to develop an effective nurse rounding protocol.
A well-developed nurse rounding protocol provides the necessary guidelines on the frequency of nursing rounds during a 24-hour cycle (Mauk 14). At the same time, an effective rounding protocol provides the necessary steps and requirements to be fulfilled every time a nurse is in the room. By creating a predictable routine geared towards improving the safety and comfort of the patients, nurses are then able to curb the incessant use of the call light system significantly. But more importantly, it can also lead to a substantial reduction in the incidence of patient falls (Weinberg 30).
Methods
Four weeks later, data collected formed the basis for the discussion on how to reduce the incidence of patient falls. The research team was able to accomplish this by securing permission from hospital administrators that they want to observe nurses doing their rounds and how the nursing staff interacted with their patients while fulfilling the requirements of their respective nurse rounding protocol.
Members of the research team made sure their presence does not disrupt the and hinder healthcare services in the said hospital. Patient and nurse interaction was accomplished with the use of discreet methods, and the members of the research team acted as if they were nurses in training.
After four weeks, the members of the research team saw a gradual pattern emerged from the regular nursing rounds. Nurses were diligent in assessing patient levels using a pain assessment scale. They assisted in giving medication when needed. They offered toilet assistance. The nurses assessed the patients position while in bed, and they also assessed if patients need to adjust their position if they believe that they are not comfortable. They made sure that the call light was within reach. They made sure that the telephone was within reach. They positioned the bedside table next to the bed. They also made sure that the TV remote was within easy reach. The nurses made sure that the Kleenex box and water was within reach. Finally, before they left the room, they followed a strict protocol, asking the patient if they needed anything. The nurses made it clear that while they were still in the room, it is their pleasure to assist the patients. They also conveyed a reassuring message that it is prudent to maximize the time that they are in the room. Before leaving the patient, the nurse told them that after two hours, another nurse would come back and check on them.
Members of the research team discovered later on that the emerging pattern was actually the rounding protocol that every nurse must follow. Hospital management made sure that there was a system in place to reduce the incidence of patient falls.
Discussion
Insights gleaned from the analysis of available data pointed to the importance of strict adherence to the rounding protocol. At the same time, the protocol is balanced by the efficient and prudent use of the call light. Fall prevention is indeed possible if the nursing staff is able to share the workload. The workload is shared if two things can happen if nursing rounds and the effective management of the call light system intersect.
Strict adherence to the rounding protocol reduces the incidence of patient falls because it limits the need of the patient to move in order to get something far away from the bed. Most of the patients in the hospital are unable to assess their capability to get up from the bed and get items that they needed. For example, a patient tried to get up to go to the bathroom, but because of his weakened state fell immediately to the ground, and he was injured in the process.
In another example, a patient was distracted because she was looking for the TV remote. Most of the elderly patients were not accustomed to long-term hospital care and never used to asking for help from others.
After going over the data, the research team realized that there was a greater incidence of patient falls if their needs were not addressed properly. Research data also shows that the call light can be effectively integrated into the nurse rounding protocol. It has proven its effectiveness whenever patients needed to go to the bathroom. The team also realized that a high incidence of patients falls occurred in the bathroom (Morse 10). In addition, a call light system is an efficient tool when alerting nurses to an emergency situation.
The research team also realized that aside from establishing clear guidelines on how to use the call light system and how to maintain strict nurse rounding protocols, the critical part is not the presence of well-defined rules but the interplay between different factors within the hospital. For example, if patients abuse the sue of the call light system, the nurses that were assigned to these patients are forced to go back and forth from the nursing station to each of the individual rooms. Thus, a high burnout rate forces the nurses to shirk from their duties. When this happens, the strict rounding protocol can never be enforced properly.
Members of the research team realized that when the needs of the patients were properly addressed, they do not need to move around or compelled to leave their beds. For example, the simple issue with regards to trash bins, TV remote, tissue, and food can be addressed when nurses are doing the rounds. It is, therefore, important to look into the interpersonal skills of the nurses. The nursing staff must not only learn the value of patience, but they must also develop the necessary skills to interact with their patients.
If the nursing staff are unable to communicate properly what they intend to do, then, the patients will never realize the main reason why they have to express what they feel and what they want the nurses to do for them. Hospital management must never assume that nurses under their employ have mastered the art of communication. Seminars and workshops must be conducted for skill and knowledge transfer.
Hospital management should not lament the lack of resources to increase the efficiency of their nursing staff. They must develop creative solutions to address their manpower needs. For instance, they must find out how to leverage cutting-edge technology to increase output without necessarily investing inexpensive tools and equipment. A good example is the use of web videos. Hospital management can hire an instructor or a seasoned registered nurse who understands the value of interpersonal communication. The said expert will then provide a series of lectures. But aside from teaching the current batch of employees, management must invest in capturing the live teaching sessions with a digital camera.
Information from these teaching sessions forms part of the instruction materials of the said healthcare facility. Furthermore, the video that was the result of the numerous teaching sessions can be converted into a digital file and uploaded through popular video-sharing websites like YouTube. If there is downtime and the nurses have nothing else to do, they must be instructed to watch these demonstration videos in order to sharpen their skills.
Conclusion
An aging population is manifested by the sudden increase in the number of elderly patients in hospital care. One aspect of elderly patient care is the high incidence of patient falls. Healthcare cost becomes more complicated and more expensive when patients fall from their beds and get injured in the process. A well-developed nurse rounding protocol combined with appropriate tools and equipment can significantly reduce the incidence of patient falls. However, hospital management must play an important role. Management must be the first to see the critical interplay between strict adherence to a rounding protocol, the call light system, and the nurses ability to communicate with the patients.
It is only through the integration of technology into the rounding protocol combined with effective communication skills that nurses are able to address the needs of the patients before they leave the room. By doing so, the patients are no longer distracted and compelled to get up from their beds to get something that is beyond their reach. Improvements in the system will not happen overnight. Management must invest in skill and knowledge transfer activities. However, they can reduce the cost while at the same time, enhance the delivery of service by leveraging technology into their various human resource management programs. Members of the research team are seeking funding to continue the study in another hospital setting.
Works Cited
Carter, Pamela Lippincotts Textbook for Nursing Assistants: A Humanistic Approach to Caregiving. PA: Lippincott Williams and Wilkins, 2005. Print.
Mauk, Kristen. (2006). Gerontological Nursing: Competencies for Care. MA: Jones and Bartlett Publishers, 2006. Print.
Morse, Janice. Preventing Patient Falls. CA: Sage Publications, Inc., 1997. Print.
Weinberg, Dana. Code Green: Money-Driven Hospitals and the Dismantling of Nursing. New York: Cornell University Press, 2003. Print.
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