Preventing Patient Falls : Evidence Based Practice & Applied Nursing Research

Providing the best care to each patient starts with providing the proper amount of staff members to each unit. Looking at the needs of different units not only allows administration to see areas for improvement, but also areas that are being handled correctly. Utilizing the indicators provided by The Joint Commission, 4 East, a pediatric medical/surgical floor, has a high rate of falls and nosocomial pressure ulcers that appears to be related to the increase overtime nurses have been working for that floor (Nightingale, 2010). Research has shown increases in adverse events have been related to nurses working over 40 hours a week (Bae, 2012).

Major studies in the last three decades have confirmed an association between the registered nurse to patient ratio and adverse patient outcomes such as mortality, morbidity, length of stay, failure to rescue (Hunt 19). For example, bed sores or patient falls, are considered an adverse outcome because it is a complication that occurred after the patient was admitted to a healthcare facility, Nonetheless, the key to

Omission of nursing care, such as failure to reposition patients, missing medications, and not responding to call lights, is usually unrecognized yet poses a threat to patient safety. Missed nursing care refers to any aspect of required patient care that is omitted or significantly delayed (Dabney & Kalisch, 2015). The more patients a nurse is providing care for correlates with more missed nursing care. This could result in failure to rescue, inadequate nutritional intake, and decreased mobility. Additionally, more missed care was reported by patients who also reported experiencing skin breakdown, medication errors, new infections, and other adverse events during hospitalization (Dabney & Kalisch, 2015). Patients are more likely to receive the wrong medication or medication too late with lower nurse staffing levels (MN

Keywords: Clinical Supervision Patient Safety Quality of Care Nurses Risk of Fall Morse Fall Scale

Nurse staffing and how it relates to the quality of patient care has been an important issue in the field of nursing for quite some time. This topic has been particularly popular recently due to the fact that there is an increasing age among those who make up the Baby Boomer era in the United States. There will be a greater need for nurse staffing to increase to help accommodate the higher demand of care. Although nursing is “the top occupation in terms of job growth,” there are still nursing shortages among various hospitals across America today. The shortage in nurses heavily weighs on the overall quality of care that each individual patient receives during their hospital stay (Rosseter, 2014).

This work has significance because staff and patient education can help prevent falls. Specific interventions decrease falls. Nurses have a responsibility to their patients and their facility to be competent and confident in their abilities to do all that they can to prevent falls. Facilities have the responsibility to provide the tools and the training that is required to carry out fall prevention

Within the staffing effectiveness report, most data collected indicated a downward linear trend. This downward trend is a positive outcome. However, 4E has an upward linear trend which needs to be improved. The linear trend of nursing hours compared to the number of falls and pressure ulcers indicate an increase in nursing hours do not guarantee drop in falls or pressure ulcers. The performance trends show a gradual increase in the number of falls and pressure ulcers. A closer look is needed to identify reasons for the correlation between greater nursing hours and increased falls. This may be due to a need for increase in nursing staff and limiting the number of hours the nurse can work

Significance: Because nursing is the largest health care profession and nurses provide most of the patient care, and as an acute nurse, I can relate to how unsafe nurse staffing/low nurse-to-patient ratios can have negative impact on patient satisfaction and outcome, can lead to medical and/or medication errors and nurse burnout. It can also bring about anxiety and frustration, which can also clouds the nurses’ critical thinking. Most patients might not know the work load on a particular nurse and can assume that her nurse is just not efficient. Doctors also can become very impatient with their nurses because orders are not being followed through that can delay treatments to their patients. There is also delays in attending to call lights resulting in very unhappy patients who needed help.

A fall can make wide spread consequences on the health service or can be affected seriously by the increased health care utilization. Among the fallers approximately 30% of falls result in physical injury leading to extensive hospitalization with significant hospital expenses (Tzeng & Yin 2010). Preventive care phases can support health services to regulate the spare expenditure to a greater extend. A fall in hospital consequently affects the nursing staff, which lead to impaired job satisfaction, additional work load and startling time consume. As the front line of care, nurses can prevent falls and reduce fall injury rates in acute care unit with available resources (Dykes et al. 2013). This literature review aims to assess the efficiency of planned interventions to reduce the incidence of falls in acute medical units. The discussions of the main findings of the review as well as the recommendations for further research are revealed to conclude this study.

In recent years, the healthcare industry has seen a significant decline in the quality of patient care it provides. This has been the result of reduced staffing levels, overworked nurses, and an extremely high nurse to patient ratio. The importance of nurse staffing in hospital settings is an issue of great controversy. Too much staff results in costs that are too great for the facility to bear, but too little staffing results in patient care that is greatly hindered. Moreover, the shaky economy has led to widespread budget cuts; this, combined with the financial pressures associated with Medicare and private insurance companies have forced facilities to make due with fewer

Tzeng and Yin (2008) state that nurses assume the responsibility and are liable when a patient falls in their care. Nurses spend the most time with patients at their bedside; however, nurses don’t have any

The broad research problem leading to this study is the belief that nursing shortage in facilities leads to patient safety issues. The review of available literature on this topic shows strong evidence that lower nurse staffing levels in hospitals are associated with worse patient outcomes. Some of these outcomes include very high patient to nurse ratio, fatigue for nurses leading to costly medical mistakes, social environment, nursing staff attrition from the most affected facilities. The study specifically attempts to find a way to understand how nurse

The article “Improving Nursing Care: Examining Errors of Omission” is a cross-sectional, descriptive, nonexperimental study that examines the relationship between nursing care and missed care and the effects it has on the quality of patient care. The setting for the study takes place at three acute care hospitals in central New York. (medsurg nursing, 2017)

The study that was done shows that there is a significant inverse relationship between nurse staffing and the number of patients who sustain falls or pressure ulcers while hospitalized. The findings have proven that the more nursing staff on during a shift, the less falls and pressure ulcers occurred (He, Staggs, Bergquist-Beringer, & Dunton, 2016).

The first quantitative study analyzed was conducted by Dabney and Kalisch in 2015 and surveyed 729 patients. The purpose of the study was to continue researching for any correlation between patient outcomes and nurse staffing. They analyzed patient reports of missed nursing care and determined if there was a relationship between patient reports and the nurse staffing levels. The design and sample include data that was obtained in the study of patient reports of missed nursing care and compared it to the level of nurse staffing. The sample was made up of 729 patients on 20 units in 2 hospitals. The 20 units consisted of 12 medical units with 420 participants, 6 surgical units with 255 participants, and 2 rehabilitation