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Literature Review

Literature Review

(Literature Review)

Introduction

Falls are common in older adults, leading to serious injuries, including fractures and head injuries, and death in worst-case scenarios. Falls are also associated with disability and significant morbidity and mortality among older adults. Old age leads to overall poor physical and mental or cognitive status, which makes older adults prone to falls that cause physical injury and, in some instances, fear and psychological trauma. Statistically, a third of older adults experience at least one fall annually, while 10% fall multiple times yearly (Lloyd, 2021). Medical conditions increase the risk of falls, jeopardizing an older adult’s independence, and associated socioeconomic and personal consequences. Falls can occur at home or in any healthcare setting, including nursing homes. Hospitals are responsible for adopting interventions to minimize or prevent falls in older adults. Many interventions are adopted to prevent falls, including improving the environment and the terrain to make walking easy, providing non-slippery footwear, patient education, adequate lighting, installing handrails in hallways and bathrooms, and raising the bed to a comfortable height. This paper focuses on the role fall prevention interventions in reducing the risk factors of falls and associated effects among older adults. The primary themes addressed are; effects of falls on older adults, risk factors most frequently associated with falls in elderly patients, and impact of fall prevention programs on number of falls experienced by elderly patients. (Literature Review)

Literature Review

PICOT Question

Among older patients, do fall prevention interventions reduce the risk factors of falls and associated effects compared with no intervention? (Literature Review)

 

Primary Themes

Effects of Falls on Older Adults

Falls among older adults are one of the most prevalent and dangerous issues causing disabilities, physical injury, and cognitive impairment. Falls are directly correlated with mortality, morbidity, and decreased functionality. Falls are widespread among the elderly, kids, and athletes. Studies have indicated that a higher tendency to fall and, thus, a higher risk of injury is connected with medical comorbidities in the elderly (Appeadu & Bordoni, 2022). Falls are also linked to socioeconomic and personal effects, including direct and indirect healthcare costs such as paying for fall-related injury treatment and financial loss from the patient’s or the caregiver’s work absence to attend to the injury or impaired functionality. According to Appeadu and Bordoni (2022), the US incurs over $31 billion, which could rise to 74 billion by 2030, associated with falls among older adults 65 years and over. Conclusively, falls impact the patient and the healthcare system in multiple ways, including increasing healthcare costs, contributing to medical conditions, financial loss, and impaired functionality. Therefore, it is critical to prevent falls and reduce the risk of falls for hospitalized patients to promote their quality of care.

Falls lead to different injuries, including minor and major fractures and head injuries. Approximately 30%-50% are minor, 10% major injuries, and 1% hip fractures, with the last one increasing post-fall morbidity and mortality risk. Approximately 20% lead to serious injuries, including fractures in other body parts or head injuries. Studies have shown that, annually, fall-related injuries lead to over 800,000 hospitalizations, with 300,000 requiring hip fracture treatment (Vaishya & Vaish, 2020). Falls are estimated to be the leading cause of traumatic brain injury and associated deaths among older people aged 65 years and above. Repeated falls increase the risk of severe injury, hospitalization, and death because of frail body structures (Vaishya & Vaish, 2020). About half of the falls lead to an injury, with major ones including head injuries and fractures. Frailty rather than age determines the severity of an injury and associated consequences. In conclusion, falls cause different types of injuries that can lead to morbidity, disability, loss of function, and mortality among older adults. Therefore, preventing falls and their associated injuries is critical to promote patient safety and experience during their hospital stay. (Literature Review)

Literature Review

Risk Factors Most Frequently Associated with Falls in Older Patients

Inpatient falls, and fall-related injuries can be caused by various factors, including physical or cognitive impairments, environmental hazards, inadequate staff supervision, and age-related, such as hearing and vision impairment, vibration sensation and proprioceptive reduction, altered gait, and declining positional control. Age-related factors and changes do not cause falls directly but significantly contribute to most falls. Research shows that falls in older adults are also associated with physical diseases, medication side effects, cognitive deterioration, and environmental hazards (Vaishya & Vaish, 2020). According to Vaishya and Vaish (2020), environmental factors increase the risk of falling and can occur independently or interact with other factors, especially when postural control and mobility are needed, like walking on slippery and uneven surfaces. Maintaining balance becomes a problem as people age because of an impaired nervous system, which makes recovering balance challenging (Cuevas-Trisan, 2019). Furthermore, older age causes muscle weaknesses that make balancing and positioning difficult, leading to increased fall risk. Also, inadequate staffing or insufficient staff supervision can mean potential fall risks are not identified and addressed quickly enough (Vaishya & Vaish, 2020). In conclusion, inpatient falls, and fall-related injuries can be caused by a variety of factors, including physical or cognitive impairments, environmental hazards, and inadequate staff supervision. It is important to identify these potential causes to reduce the risk of falls and fall-related injuries. (Literature Review)

Impact of Fall Prevention Programs on Number of Falls Experienced by Older Patients

Falls prevention programs are implemented to reduce the risk of falls and fall-related injuries among hospitalized patients, especially older patients. There are many fall prevention programs, including patient education, hourly rounding, and medication management. Other interventions include reorganizing the Falls Committee, flagging high-risk patients, improving fall reports, increasing falls scrutiny, reorganizing leadership systems, standardizing fall prevention equipment, adapting to new hospital buildings, investigating root causes, and helping nurses think critically regarding risk. Additionally, falls prevention interventions can include alarms, fall risk identification, sitters, intentional rounding, patient education, physical restraints, environmental modifications, and non-slip socks. Studies indicate that fall prevention programs have varying effectiveness, but using several interventions at once increases the efficacy of fall prevention efforts. Based on research, patient education, medication management, and hourly rounding generate consistent fall prevention results and reduce risk factors associated with falls among older adults (Daniels, 2016; Mant et al., 2016; Goldsack, 2015; Walsh et al., 2018; LeLaurin & Shorr, 2019). In conclusion, there are many interventions to prevent fall risk, but with varying effectiveness. A nurse’s role is to conduct evidence-based research on various interventions and select the one with more benefits to the particular patient population. (Literature Review)

The following fall prevention interventions or programs are reviewed for their effectiveness in preventing risk factors of falls and associated effects among older adults:

Patient Education

Patient education helps influence patients towards the desired behavior and produces knowledge, attitude, and skills changes required to promote health and improve patient outcomes. Fall prevention education includes strategies such as increasing awareness of slippery surfaces, using equipment installed in hallways to aid walking, communicating with providers, and taking caution about medications that increase the risk of falling. Studies indicate that incorporating patient education into other fall prevention strategies helps reduce fall risks. Heng et al. (2020) explored the effectiveness of patient education in preventing falls among older adults. Findings indicate that direct face-to-face patient education, educational materials like handouts, pamphlets, brochures, hospital policies, procedures, and systems can help reduce falls and associated injuries. Fall prevention programs incorporating patient education reduce the risk of falling because patients are empowered and more aware of themselves and their surroundings. Heng et al. (2021) also explored patient education’s impact on fall rate and found that consistent, patient-centered education and small interactive groups helped prevent falls among hospitalized patients. Conclusively, patient education programs are effective in helping reduce the risk of falling among older adults, and studies recommend incorporating patient education into other fall prevention programs to increase effectiveness. (Literature Review)

Medication Management

Medication management includes strategies that engage patients and healthcare providers to establish a comprehensive, complete, and accurate medication list to help manage potential adverse events, side effects, and what to avoid to reduce the risk of complications. Hospitalized patients, particularly older adults, are under several medications, which increases the risk of medication-induced falls. Medication side effects that increase the risk of falling are often ignored when planning for fall prevention. Fall-risk-increasing drugs should be considered a significant risk factor during fall risk assessment in healthcare settings. About 47% of active substances used by inpatients increase the risk of falling because most affect the nervous and cardiovascular systems (Michalcova et al., 2020). Research shows that medication management can minimize side effects and interactions that contribute to falls. Michalcova et al. (2020) suggest adopting medication management programs such as preliminary categorizing fall-risk-increasing drugs (FRIDs) based on adverse drug effects to reduce fall risk. In support, Ming et al. (2021) report medication review as an effective approach to managing adverse drug reactions and enhancing drug safety among older patients to prevent falls and fall-related injuries among older adults. Medication review also helped reduce the severity of injuries and fall-related fractures (Ming et al.,2021). In conclusion, there are different medication management programs, including risk categorization of drugs according to their adverse effects and medication review of drugs that can help prevent medication-induced falls. Therefore, hospitals should increase awareness of medication-induced falls by adopting medication management programs to prevent falls and fall-related injuries. (Literature Review)

Hourly Rounding

Hourly rounding includes nurses and unlicensed assistive personnel conducting scheduled patient visits to perform interventions specific to or tailored to a particular hospitalized patient. Hourly rounding includes activities like nourishment, pain management, helping with elimination needs, range of motion, proper positioning, helping patients with applicable musculoskeletal needs, and room observation to ensure proper and adequate lighting, call bell and phone are within reach, medical equipment is functioning as expected, and walking areas or hallways are clutter-free (Shepard, 2015). Studies indicate that hourly rounding generates consistent fall prevention results and reduces risk factors contributing to falls and associated effects among older adults (Daniels, 2016; Mant et al., 2016; Goldsack, 2015; Walsh et al., 2018; LeLaurin & Shorr, 2019). According to Daniels (2016), purposeful and timely hourly rounding is effective in helping meet patient needs consistently, ensuring patient safety, lowering preventable events, and proactively addressing patient problems. Mant et al. (2016) also found that implementing hourly rounding effectively prevents fall-related incidents among older patients in acute care settings. Goldsack (2015) further supports this after finding in a pilot test that fall rate was considerably lower, at 1.3 falls/1,000 patient days after implementing hourly rounding during the test period. Furthermore, Walsh et al. (2018) found that when nurses began addressing fall risk during hourly rounds, the fall rate significantly declined, implying hourly rounds’ effectiveness in reducing fall risk among inpatients. Consistently, Manges et al. (2020) found that hourly rounding improved care quality, patient satisfaction, and patient empowerment and helped decrease patient fall rates. In conclusion, hourly rounding is an effective approach to preventing falls among older patients. Therefore, hospitals and nurse leadership should implement intentional and purposeful hourly rounding to reduce risk factors contributing to falls in older adults and associated effects such as disability, loss of independence, and increased healthcare costs due to injury treatment. (Literature Review)

Others Interventions

Besides patient education, medication management, and hourly rounding, other fall prevention interventions can be adopted to help reduce the risk of falling among older adults. These interventions include reorganizing the Falls Committee, flagging high-risk patients, improving fall reports, increasing falls scrutiny, reorganizing leadership systems, standardizing fall prevention equipment, adapting to the new hospital building, investigating root causes, educating patients, and helping nurses think critically regarding risk in reducing patient falls. Walsh et al. (2018) found that implementing these interventions incrementally reduced the fall rate from 3.07 to 2.22 per 1000 patient days and injury rate from 0.77 to 0.65 per 1000 patient days. LeLaurin & Shorr (2019) investigated the effectiveness of alarms, fall risk identification, sitters, intentional rounding, patient education, physical restraints, environmental modifications, and non-slip socks and found that these interventions, coupled with intentional rounding, enhanced patient satisfaction and minimized patient harm. However, these studies indicate that other interventions have moderate effects on fall prevention, associated injuries, morbidity, and mortality and should not be implemented as stand-alone interventions. In conclusion, multiple fall prevention programs are implemented in hospitals, but research shows most fall prevention programs have moderate effects on fall prevention. Therefore, hospitals should consider adopting various interventions to increase the effectiveness of fall prevention efforts in healthcare settings. (Literature Review)

Conclusion

Patient falls are a significant problem in US hospitals, especially among older adults at increased risk of falling due to age-related factors, environmental factors, medical conditions, and frail bodies. Falls lead to injuries and contribute considerably to subsequent morbidity and mortality among hospitalized patients. Many interventions currently used to prevent falls indicate moderate benefits and unknown sustainability. Reviewed articles provide consistent results showing patient education, medication management, and hourly rounding as effective in reducing the risk of patient falls and associated effects, promoting patient safety, and improving patient experience, outcome, and satisfaction. (Literature Review)

References

Appeadu, M. K., & Bordoni, B. (2022). Falls and fall prevention in the elderly. In StatPearls [Internet]. StatPearls Publishing.

Cuevas-Trisan, R. (2019). Balance problems and fall risks in the elderly. Clinics in geriatric medicine35(2), 173-183.

Daniels J. F. (2016). Purposeful and timely nursing rounds: a best practice implementation project. JBI database of systematic reviews and implementation reports, 14(1), 248–267. https://doi.org/10.11124/jbisrir-2016-2537

Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly rounding and patient falls: what factors boost success?. Nursing45(2), 25–30. https://doi.org/10.1097/01.NURSE.0000459798.79840.95

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital falls prevention with patient education: a scoping review. BMC geriatrics20(1), 140. https://doi.org/10.1186/s12877-020-01515-w

Heng, H., Slade, S. C., Jazayeri, D., Jones, C., Hill, A. M., Kiegaldie, D., Shorr, R. I., & Morris, M. E. (2021). Patient Perspectives on Hospital Falls Prevention Education. Frontiers in public health9, 592440. https://doi.org/10.3389/fpubh.2021.592440

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing Falls in Hospitalized Patients: State of the Science. Clinics in geriatric medicine35(2), 273–283. https://doi.org/10.1016/j.cger.2019.01.007

Lloyd, S. L. (2021). Hourly rounding to reduce patient falls – A quality improvement project. University of Texas.

Manges, M. E., Zuver, M. C., Mack, K., & Abraham, S. P. (2020). hourly rounding and medical-surgical patient falls: A review of the literature. International Journal of Science and Research Methodology.

Mant, T., Dunning, T., & Hutchinson, A. (2016). The clinical effectiveness of hourly rounding on fall-related incidents involving adult patients in an acute care setting: a systematic review. JBI Evidence Synthesis10(56), 1-12.

Michalcova, J., Vasut, K., Airaksinen, M., & Bielakova, K. (2020). Inclusion of medication-related fall risk in fall risk assessment tool in geriatric care units. BMC geriatrics20(1), 1-11.

Ming, Y., Zecevic, A. A., Hunter, S. W., Miao, W., & Tirona, R. G. (2021). Medication Review in Preventing Older Adults’ Fall-Related Injury: a Systematic Review & Meta-Analysis. Canadian geriatrics journal : CGJ24(3), 237–250. https://doi.org/10.5770/cgj.24.478

Shepard, L. H. (2015). Stop going in circles! Break the barriers to hourly rounding. Nursing management44(2), 13-15.

Vaishya, R., & Vaish, A. (2020). Falls in Older Adults are Serious. Indian journal of orthopaedics54(1), 69–74. https://doi.org/10.1007/s43465-019-00037-x

Walsh, C. M., Liang, L. J., Grogan, T., Coles, C., McNair, N., & Nuckols, T. K. (2018). Temporal Trends in Fall Rates with the Implementation of a Multifaceted Fall Prevention Program: Persistence Pays Off. Joint Commission journal on quality and patient safety44(2), 75–83. https://doi.org/10.1016/j.jcjq.2017.08.009

 
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Literature Review 5

Literature Review 5

(Literature Review 5)

Literature Review 5

Introduction

Falls are common in older adults, leading to serious injuries, including fractures and head injuries, and death in worst-case scenarios. Falls are also associated with disability and significant morbidity and mortality among older adults. Old age leads to overall poor physical and mental or cognitive status, which makes older adults prone to falls that cause physical injury and, in some instances, fear and psychological trauma. Statistically, a third of older adults experience at least one fall annually, while 10% fall multiple times yearly (Lloyd, 2021). Medical conditions increase the risk of falls, jeopardizing an older adult’s independence, and associated socioeconomic and personal consequences. Falls can occur at home or in any healthcare setting, including nursing homes. Hospitals are responsible for adopting interventions to minimize or prevent falls in older adults. Many interventions are adopted to prevent falls, including improving the environment and the terrain to make walking easy, providing non-slippery footwear, patient education, adequate lighting, installing handrails in hallways and bathrooms, and raising the bed to a comfortable height. This paper focuses on the role of hourly rounding in reducing the risk of falls among older adults. The paper explores literature offering evidence on the effectiveness of hourly rounding in preventing falls. (Literature Review 5)

Background

Falls among older adults are one of the most prevalent and dangerous issues causing disabilities, physical injury, and cognitive impairment. Falls are directly correlated with mortality, morbidity, and decreased functionality. Falls are widespread among the elderly, kids, and athletes. Studies have indicated that a higher tendency to fall and, thus, a higher risk of injury is connected with medical comorbidities in the elderly (Appeadu & Bordoni, 2022). Falls are also linked to socioeconomic and personal effects, including direct and indirect healthcare costs such as paying for fall-related injury treatment and financial loss from the patient’s or the caregiver’s work absence to attend to the injury or impaired functionality. According to Appeadu & Bordoni (2022), the US incurs over $31 billion, which could rise to 74 billion by 2030, associated with falls among older adults 65 years and over. Conclusively, falls impact the patient and the healthcare system in multiple ways, including increasing healthcare costs, contributing to medical conditions, financial loss, and impaired functionality. Therefore, it is critical to prevent falls and reduce the risk of falls for hospitalized patients to promote their quality of care.

Falls lead to different injuries, including minor and major fractures and head injuries. Approximately 30%-50% are minor, 10% major injuries, and 1% hip fractures, with the last one increasing post-fall morbidity and mortality risk. Approximately 20% lead to serious injuries, including fractures in other body parts or head injuries. Studies have shown that, annually, fall-related injuries lead to over 800,000 hospitalizations, with 300,000 requiring hip fracture treatment (Vaishya & Vaish, 2020). Falls are estimated to be the leading cause of traumatic brain injury and associated deaths among older people aged 65 years and above. Repeated falls increase the risk of severe injury, hospitalization, and death because of frail body structures (Vaishya & Vaish, 2020). About half of the falls lead to an injury, with major ones including head injuries and fractures. Frailty rather than age determines the severity of an injury and associated consequences. In conclusion, falls cause different types of injuries that can lead to morbidity, disability, loss of function, and mortality among older adults. Therefore, preventing falls and their associated injuries is critical to promote patient safety and experience during their hospital stay. (Literature Review 5)

PICOT Question

Among older patients, does patient education and hourly rounding reduce the risk of falls compared with normal nursing care?

Factors Most Frequently Associated with Falls in Elderly Patients

Inpatient falls, and fall-related injuries can be caused by various factors, including physical or cognitive impairments, environmental hazards, inadequate staff supervision, and age-related, such as hearing and vision impairment, vibration sensation and proprioceptive reduction, altered gait, and declining positional control. Age-related factors and changes do not cause falls directly but significantly contribute to most falls. Research shows that falls in older adults are also associated with physical diseases, medication side effects, cognitive deterioration, and environmental hazards (Vaishya & Vaish, 2020). According to Vaishya and Vaish (2020), environmental factors increase the risk of falling and can occur independently or interact with other factors, especially when postural control and mobility are needed, like walking on slippery and uneven surfaces. Maintaining balance becomes a problem as people age because of an impaired nervous system, which makes recovering balance challenging (Cuevas-Trisan, 2019). Furthermore, older age causes muscle weaknesses that make balancing and positioning difficult, leading to increased fall risk. Also, inadequate staffing or insufficient staff supervision can mean potential fall risks are not identified and addressed quickly enough (Vaishya & Vaish, 2020). In conclusion, inpatient falls, and fall-related injuries can be caused by a variety of factors, including physical or cognitive impairments, environmental hazards, and inadequate staff supervision. It is important to identify these potential causes to reduce the risk of falls and fall-related injuries. (Literature Review 5)

Impact of Fall Prevention Programs on Number of Falls Experienced by Elderly Patients

Falls prevention programs are implemented to reduce the risk of falls and fall-related injuries among hospitalized patients, especially older patients. There are many fall prevention programs, including reorganizing the Falls Committee, flagging high-risk patients, improving fall reports, increasing falls scrutiny, adopting hourly nursing rounds, reorganizing leadership systems, standardizing fall prevention equipment, adapting to new hospital buildings, investigating root causes, educating patients, and helping nurses think critically regarding risk. Additionally, falls prevention interventions can include alarms, fall risk identification, sitters, intentional rounding, patient education, physical restraints, environmental modifications, and non-slip socks. Studies indicate that fall prevention programs have varying effectiveness, but using several interventions at once increases the efficacy of fall prevention efforts. Based on research, hourly rounding generates consistent fall prevention results and reduces risk factors associated with falls among older adults. According to Daniels (2016), purposeful and timely hourly rounding is one of the effective nursing interventions to meet patient needs consistently, ensuring patient safety, lowering preventable events, and proactively addressing patient problems. According to the Institute for Healthcare Improvement (IHI), hourly rounding is the best approach to prevent and minimize call lights and fall injuries, increasing care quality and patient satisfaction. The study recommends increasing nurse knowledge on purposeful hourly rounding and facilitating infrastructure to ensure consistency with this intervention. Mant et al. (2016) also found that implementing hourly rounding effectively prevents fall-related incidents among older patients in acute care settings. Goldsack (2015) found that the effectiveness of hourly rounding in preventing patient falls depends on multiple factors, such as staff training, interdisciplinary teams, and leadership. Goldsack (2015) found that the unit that engaged staff and leadership in the project achieved a 3.9 falls/1000 patient days, with the pilot period fall rate being considerably lower, at 1.3 falls/1,000 patient days. In the second unit, the fall rate was 2.6 falls per 1000 patient days and 2.5 falls per 1000 patient days during the pilot period. These findings indicate that adopting an interdisciplinary team that includes leadership and unit champions can enhance the effectiveness of a patient-centered proactive hourly rounding program, leading to significant fall rate reduction. Therefore, leadership and front-line staff should be actively involved in developing and implementing hourly rounding programs. Walsh et al. (2018) explored the effectiveness of reorganizing the Falls Committee, flagging high-risk patients, improving fall reports, increasing falls scrutiny, adopting hourly nursing rounds, reorganizing leadership systems, standardizing fall prevention equipment, adapting to the new hospital building, investigating root causes, educating patients, and helping nurses think critically regarding risk in reducing patient falls. These interventions reduced the fall rate from 3.07 to 2.22 per 1000 patient days and injury reduction from 0.77 to 0.65 per 1000 patient days. When nurses began addressing fall risk during hourly rounds, the fall rate significantly declined, implying hourly rounds’ effectiveness in reducing the fall risk among inpatients. Heng et al. (2020) explored the effectiveness of patient education in preventing falls among older adults. Findings indicate that direct face-to-face patient education, educational materials like handouts, pamphlets, brochures, hospital policies, procedures, and systems can help reduce falls and associated injuries. Fall prevention programs incorporating patient education reduce the risk of falling because patients are empowered and more aware of themselves and their surroundings. Heng et al. (2021) also explored patient education’s impact on fall rate and found that consistent, patient-centered education and small interactive groups helped prevent falls among hospitalized patients. LeLaurin & Shorr (2019) investigated the effectiveness of alarms, fall risk identification, sitters, intentional rounding, patient education, physical restraints, environmental modifications, and non-slip socks. LeLaurin & Shorr (2019) found that intentional rounding enhances patient satisfaction and minimizes patient harm. It is a proactive method that helps meet patient needs, involving bedside checks and schedule intervals, typically one hour during the day and after two hours during the night. However, inadequate education, workload, lack of staff adherence, competing priorities, and poor documentation can be barriers to intentional hourly rounding. Consistently, Manges et al. (2020) found that hourly rounding improved care quality, patient satisfaction, and patient empowerment and helped decrease patient fall rates. In conclusion, multiple fall prevention programs are implemented in hospitals, but research shows most fall prevention programs have moderate effects on fall prevention. However, hourly rounding and patient education significantly reduce the risk of falls and associated injuries. Therefore, hospitals should consider adopting purposeful and intentional hourly rounding and patient education to prevent falls among older patients. Falls prevention patient education can be incorporated during hourly rounding to increase the effectiveness of fall prevention efforts. (Literature Review 5)

Impact of Medication Management on Fall Prevention in Elderly Patients

Hospitalized patients, particularly older adults, are under several medications, which increases the risk of medication-induced falls. Medication side effects that increase the risk of falling are often ignored, and fall-risk-increasing drugs should be considered a significant risk factor during fall risk assessment in healthcare settings. Research shows that about 47% of active substances used by inpatients increase the risk of falling because most affect the nervous and cardiovascular systems (Michalcova et al., 2020). The findings recommend adopting medication management programs such as preliminary categorizing fall-risk-increasing drugs (FRIDs) based on adverse drug effects to reduce fall risk. Ming et al. (2021) report medication review as an effective approach to managing adverse drug reactions and enhancing drug safety among older patients. According to Ming et al. (2021), medication review effectively prevents falls and fall-related injuries among older adults. Medication review also helped reduce the severity of injuries and fall-related fractures. In conclusion, there are different medication management programs, including risk categorization of drugs according to their adverse effects and medication review of drugs that can help prevent medication-induced falls. Therefore, hospitals should increase awareness of medication-induced falls and adopt medication management programs to prevent falls and fall-related injuries. (Literature Review 5)

Conclusion

Patient falls are a significant problem in US hospitals, especially among older adults at increased risk of falling due to age-related factors, environmental factors, medical conditions, and frail bodies. Falls lead to injuries and contribute considerably to subsequent morbidity and mortality among hospitalized patients. Many interventions currently used to prevent falls indicate moderate benefits and unknown sustainability. Reviewed articles provide consistent results showing patient education and hourly rounding as effective in reducing the risk of patient falls, promoting patient safety, and improving patient experience, outcome, and satisfaction. (Literature Review 5)

References

Appeadu, M. K., & Bordoni, B. (2022). Falls and fall prevention in the elderly. In StatPearls [Internet]. StatPearls Publishing.

Cuevas-Trisan, R. (2019). Balance problems and fall risks in the elderly. Clinics in geriatric medicine35(2), 173-183.

Daniels J. F. (2016). Purposeful and timely nursing rounds: a best practice implementation project. JBI database of systematic reviews and implementation reports, 14(1), 248–267. https://doi.org/10.11124/jbisrir-2016-2537

Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly rounding and patient falls: what factors boost success?. Nursing45(2), 25–30. https://doi.org/10.1097/01.NURSE.0000459798.79840.95

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital falls prevention with patient education: a scoping review. BMC geriatrics20(1), 140. https://doi.org/10.1186/s12877-020-01515-w

Heng, H., Slade, S. C., Jazayeri, D., Jones, C., Hill, A. M., Kiegaldie, D., Shorr, R. I., & Morris, M. E. (2021). Patient Perspectives on Hospital Falls Prevention Education. Frontiers in public health9, 592440. https://doi.org/10.3389/fpubh.2021.592440

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing Falls in Hospitalized Patients: State of the Science. Clinics in geriatric medicine35(2), 273–283. https://doi.org/10.1016/j.cger.2019.01.007

Lloyd, S. L. (2021). Hourly rounding to reduce patient falls – A quality improvement project. University of Texas.

Manges, M. E., Zuver, M. C., Mack, K., & Abraham, S. P. (2020). hourly rounding and medical-surgical patient falls: A review of the literature. International Journal of Science and Research Methodology.

Mant, T., Dunning, T., & Hutchinson, A. (2016). The clinical effectiveness of hourly rounding on fall-related incidents involving adult patients in an acute care setting: a systematic review. JBI Evidence Synthesis10(56), 1-12.

Michalcova, J., Vasut, K., Airaksinen, M., & Bielakova, K. (2020). Inclusion of medication-related fall risk in fall risk assessment tool in geriatric care units. BMC geriatrics20(1), 1-11.

Ming, Y., Zecevic, A. A., Hunter, S. W., Miao, W., & Tirona, R. G. (2021). Medication Review in Preventing Older Adults’ Fall-Related Injury: a Systematic Review & Meta-Analysis. Canadian geriatrics journal : CGJ24(3), 237–250. https://doi.org/10.5770/cgj.24.478

Vaishya, R., & Vaish, A. (2020). Falls in Older Adults are Serious. Indian journal of orthopaedics54(1), 69–74. https://doi.org/10.1007/s43465-019-00037-x

Walsh, C. M., Liang, L. J., Grogan, T., Coles, C., McNair, N., & Nuckols, T. K. (2018). Temporal Trends in Fall Rates with the Implementation of a Multifaceted Fall Prevention Program: Persistence Pays Off. Joint Commission journal on quality and patient safety44(2), 75–83. https://doi.org/10.1016/j.jcjq.2017.08.009

(Literature Review 5)

 
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Literature Review4

Literature Review4

(Literature Review4)

Prior to beginning work on this assignment, read the Ryder, Ban, & Chentsova-Dutton (2011) “Towards a Cultural-Clinical Psychology,” American Psychological Association (2014) “Guidelines for Prevention in Psychology,” Hage, et al. (2007) “Walking the Talk: Implementing the Prevention Guidelines and Transforming the Profession of Psychology,” and Rivera-Mosquera, et al. (2007) “Prevention Activities in Professional Psychology: A Reaction to the Prevention Guidelines” articles.

Clinical and counseling psychology is a dynamic field that is constantly evolving and striving toward better treatment options and modalities. In this literature review, you will explore and integrate psychological research into a literature review, addressing current trends in three major areas of clinical and counseling psychology: assessment, clinical work, and prevention.

In your review, include the following headings, and address the required content.

Assessment
Support this section with information from the Ryder et al. (2011) article “Towards a Cultural-Clinical Psychology” and at least one additional peer-reviewed article from the Ashford University Library.

  • Compare the assessments currently in use by clinical and counseling psychologists.
  • Explain the trend towards cultural-clinical psychology and the suitability of clinical assessments with diverse clients.

Clinical work
Support this section using a minimum of three peer-reviewed articles from the Ashford University Library. The recommended articles for this week may be useful in generating your response.

  • Compare and contrast technical eclecticism, assimilative integration and theoretical integration.
  • Provide a historical context and identify the major theorists for each perspective.
  • Assess the trends in psychotherapy integration.
  • List three pros and cons for each perspective, sharing which perspective most closely aligns with your own.
  • Analyze the major trends in psychology and explain the connection between evidenced-based practices and psychotherapy integration.

Prevention
Review the “Guidelines for Prevention in Psychology” (American Psychological Association, 2014), and support this section with information from the Hage, et al. (2007) “Walking the Talk: Implementing the Prevention Guidelines and Transforming the Profession of Psychology,” and Rivera-Mosquera, et al. (2007) “Prevention Activities in Professional Psychology: A Reaction to the Prevention Guidelines” articles.

  • Describe general prevention strategies implemented by clinical and counseling psychologists at the micro, meso, exo, and macro levels.

The Literature Review

  • Must be 7 to 10 double-spaced pages in length (not including title and references pages) and formatted according to APA style as outlined in the Ashford Writing Center (Links to an external site.)Links to an external site..
  • Must include a separate title page with the following:
    • Title of paper
    • Student’s name
    • Course name and number
    • Instructor’s name
    • Date submitted
  • Must use at least seven peer-reviewed sources in addition to the course text.
  • Must document all sources in APA style as outlined in the Ashford Writing Center.
  • Must include a separate references page that is formatted according to APA style as outline
 
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Literature Review & Methods Section

Final Project: Introduction, Literature Review, and Methods Section

(Literature Review & Methods Section)

An Example.

Introduction:

The introduction of this final project provides an overview of the topic, highlighting its significance and relevance in the field. It begins by presenting the main research question or objective, followed by a brief discussion of the broader context in which this study is situated. Key terms and concepts are defined to ensure clarity, and the overall structure of the project is outlined to guide the reader through the subsequent sections.

Literature Review:

The literature review critically examines existing research and scholarship related to the topic. It synthesizes findings from various studies, identifying key themes, debates, and gaps in the current literature. By reviewing relevant literature, this section establishes the theoretical framework and informs the research methodology. It also helps to justify the significance of the study and its potential contributions to the field.

Methods Section:

The methods section details the specific approach and procedures employed in conducting the research. It outlines the research design, data collection methods, and data analysis techniques. This section explains how the research question will be addressed and how the study aims to achieve its objectives. Clarity and transparency in describing the methods are essential for ensuring the rigor and replicability of the research findings. The methods section also discusses any ethical considerations and limitations of the study.

(Literature Review & Methods Section)

In this assignment you will update the methods section for your research paper and add your introduction and literature review.

The introduction and literature review should address your research question: why it is important, and how prior research does or does not support your hypothesis, as well as providing a background on what we know about this topic.

Please refer to the material on the components of a research paper provided in Module 1 as you work on this document.

Your methods section, in addition to covering the subheadings of participants, instruments, and procedure, must include a fourth subheading called ethical issues and note any ethical issues that need to be considered, as well as how they would be handled.

Be sure to include a title/cover page and a reference page formatted in APA style.

Submit your response to the Submissions Area by the due date assigned. Your response should be at least four pages, double spaced, long. All written assignments and responses should follow APA rules for attributing sources. Confirm the latest edition number with your instructor.

Assignment 2 Grading CriteriaMaximum PointsWith clarity and good writing style and grammar, you presented your proposed methods section for your research paper.

  • participants (15 points)
  • instruments (15 points)
  • procedure (15 points)
  • ethical issues and how they would be handled (20 points)

65You submitted an introduction and literature review that included a research question, a statement regarding the importance of the research topic, background information and a review of the literature regarding the topic, and a proposed hypotheses.20You wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources; and displayed accurate spelling, grammar, and punctuation.15Total:100

 
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