NUR2300 Evidence Based Nursing Practice

Haines, T. P., Lee, D. C. A., O’connell, B., McDermott, F., & Hoffmann, T. (2015). Why do hospitalized older adults take risks that may lead to falls?. Health expectations, 18(2), 233-249.

Introduction

One of the prominent health issues that is faced by the elderly population is falls. This is mainly faced by the age group of 65 and above, where 20% of older population are in need of medical attention because of their prevalent condition. Therefore this area of healthcare needs researches to be conducted in order to determine the risk factors including then intrinsic and the extrinsic risk factors (Lee et al., 2013). In reference to this, the paper selected for the study presents a research on the identification of these intrinsic and the extrinsic risk factors. This article was published in the journal Health expectations in the year 2015 in the 18^th volume of the journal which had been co-authored by six authors. The title of the journal projects a direct and clear question, which addresses the risk factors that might result in falls. The abstract of the article is structured in an organised way that includes the objective along with the design, setting and the participants. It also includes the main variables studies along with main outcome measures, the results, the discussion and conclusion. The background of the study shows that the behaviour of hospitalized older adults can contribute to falls that leads to the adverse event that occurs during or after hospitalization. The objective shows clearly that it is important to understand that why the older adults take risk that end up in falls. The design of study selected is qualitative research where the hospital patients are chosen as participants along with the informal caregivers and the health professionals involved. From the result it was clear that the process of risk taking were of different type which in conclusion revealed that there was an existence of tension between taking risks which was part of rehabilitation and its effect on chances of falling (Haines et al., 2015).

Literature review

 Most of the times, risk has been defined as an act where implementation of goal-directed options are provided. It has been seen that the conduction of the research is based on the understanding of then utility theory. A study showed that this can be further classified into those which can explain the differences existing between people who get involved in taking risks and those that do not (Hill et al., 2014). Additionally those who explain the differences that is present in between the situations which play a role in promoting risks by considering most of the people. The situations that bring about risk aversion and those which are involved in explaining both types of differences are also part of the classification. Data from previous researches show that older hospital inpatients involve in the identification of the factors which are associated with higher self-perceived risk of falling (Mihaljcic et al., 2014). This involves the conceptually long with the probability of an outcome of fall during hospitalization. In addition to this, there is a higher self-perceived risk related to injury in cases where fall were to occur. Some studies also highlighted the regression models that are related to older ages and individuals having better cognitive function who were independently associated with the reduced risks of fall (Belita, Ford & Kirkpatrick, 2013). Some studies also argued that hat inpatients who are the older adults have a tendency regarding approapriate impression of the probability of risk of fall during the stay in hospital. However there is also a tendency to underestimate the injury rates related with falls (Morello et al., 2015).

Methodology

The particular study utilised a qualitative research approach in addition to the phenomenological, constructivist approach which was exploratory and descriptive in nature. Data collection was conducted through face to face interviews in addition to the telephone based interviews in addition with the focus group interviews. Semi-structured schedules of interviews were used along with the open-ended questions in order to collect data. The investigators had designed the interview questions. Using TH and DAL the questions were refined for the analysis of data. The participants of the study were segregated into three groups that involved the older adult group who were aged 65 and above. These individuals were admitted to the in- patient medical wards, the rehabilitation or the evaluation of the geriatrics and management wards. The inclusion criteria for choosing the participants involved English speaking individuals which sound mental condition.  Next was the care giver group, who were part of the family and the healthcare professional group, who were involved in providing care to the inpatient and to patients during the post-discharge periods. The recruitment was conducted from the tertiary hospitals in addition to community-based rehabilitation programs and rehabilitation hospital situated in the Southern Health healthcare network. In order to analyse the data obtained, a framework analysis approach was implemented. This was done in order to apply a thematic framework so that data could be separated. The index and apply codes to the data was done to group codes into categories along with linking to the appropriate part of the thematic framework. The sample size considered for this study included 36 hospitalized older adults along with 36 health professionals and 24 family caregivers.

Ethics consideration

The ethical consideration that was taken into account for the study involved receiving of approval from the Southern Health Human Research Ethics Committee and Monash University Research Ethics Committee. In order to recruit suitable participants, posters of advertisement was posted on the wards, hence it included voluntary participation and no one was forced to be a part of this study. The study involved condition of interviews, therefore consent was collected from the participants before the focus groups or interviews were conducted (El-Khoury, Cassou, Charles & Dargent-Molina, 2013).

Significant results

After the analysis of the collected data, the results were segregated into three broad themes classifying the concept of risk. The three identified themes were enforced, along with voluntary and the final being uninformed. The results revealed that the primary factors that were identified as being responsible for influencing the risk taking behaviour included the ability of the older adults to compensate, followed by the willingness of the older adults requiring help. Additionally the factors involved the desire of the older adult to test their boundaries in terms of physical abilities. There is also a factor of communication failure that occurs between and among the older adults and the informal care givers and health professionals with delayed provision of help (Ambrose et al., 2013). The conceptual framework showed that the aspect of environment was related to getting assistance from other and different environment. In a similar way the aspect of task was related to different environment as well as the difficulty of the task. However regarding the aspect of the older adults, there is inclusion of the factors like active consideration, awareness of self and the ability, the awareness of the demand of the task, which in turn is related to the sub factors of cognitive decline, sensory loss, risk compensation, denial, and ability to perform the task that is in turn related to health (Hawley-Hague et al., 2014).

Discussion

From the study it can be seen that there are a number of factors that are responsible in influencing the risk taking behaviour of the hospitalised older adults. As a framework has been implemented in order to understand the risk taking behaviours, it has been seen that the incorporation of the roles of the others do not assume a choice that is rational within the framework (Cadore et al., 2013). It showed that there is an existence of tension between the taking of risk which is part of the rehabilitation program and its effect on the chances of falling. There was also evidences that the health professionals along with the caregivers played an important role in the mitigation of unnecessary risk taking. Additionally some of the older adults showed more chances of taking risk in comparison to other by the virtue of their attitudes. The research findings showed that the qualitative research approach was appropriate for this study. The one to one trial education of the patient was based on the model of health belief which aims to modify the high risk activities which were performed in the hospital ward (Gschwind et al., 2013). This was able to successfully demonstrate that falls can be reduced for the older adults who are cognitively intact in the hospital setting. The goals could be set in order to modify the activities which were performed.

Recommendations

The study was conducted within one geographic region and multiple hospitals within one health service therefore the research needs to be conducted in a way that it can be applied broadly. The suggestions for the study also involve that the interpretations of this study should focus on the background experiences along with the investigator’s perspectives that may have influenced them in this task. There is also a need of highlighting the factors that is expressed by health professionals. There is also an impact on the capability of the staff of hospital to give assistance that are beyond their control (Haines et al., 2015).

References

Ambrose, A. F., Paul, G., & Hausdorff, J. M. (2013). Risk factors for falls among older adults: a review of the literature. Maturitas, 75(1), 51-61.

Belita, L., Ford, P., & Kirkpatrick, H. (2013). The development of an Assessment and Intervention Falls Guide for older hospitalized adults with cardiac conditions. European Journal of Cardiovascular Nursing, 12(3), 302-309.

Cadore, E. L., Rodríguez-Mañas, L., Sinclair, A., & Izquierdo, M. (2013). Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation research, 16(2), 105-114.

Carroll, D. L., Dykes, P. C., & Hurley, A. C. (2010). Patients’ perspectives of falling while in an acute care hospital and suggestions for prevention. Applied Nursing Research, 23(4), 238-241.

El-Khoury, F., Cassou, B., Charles, M. A., & Dargent-Molina, P. (2013). The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMj, 347, f6234.

Gschwind, Y. J., Kressig, R. W., Lacroix, A., Muehlbauer, T., Pfenninger, B., & Granacher, U. (2013). A best practice fall prevention exercise program to improve balance, strength/power, and psychosocial health in older adults: study protocol for a randomized controlled trial. BMC geriatrics, 13(1), 105.

Haines, T. P., Lee, D. C. A., O’connell, B., McDermott, F., & Hoffmann, T. (2015). Why do hospitalized older adults take risks that may lead to falls?. Health expectations, 18(2), 233-249.

Hawley-Hague, H., Boulton, E., Hall, A., Pfeiffer, K., & Todd, C. (2014). Older adults’ perceptions of technologies aimed at falls prevention, detection or monitoring: a systematic review. International journal of medical informatics, 83(6), 416-426.

Hill, A. M., Waldron, N., Etherton-Beer, C., McPhail, S. M., Ingram, K., Flicker, L., & Haines, T. P. (2014). A stepped-wedge cluster randomised controlled trial for evaluating rates of falls among inpatients in aged care rehabilitation units receiving tailored multimedia education in addition to usual care: a trial protocol. BMJ open, 4(1), e004195.

Lee, D. C. A., McDermott, F., Hoffmann, T., & Haines, T. P. (2013). ‘They will tell me if there is a problem’: limited discussion between health professionals, older adults and their caregivers on falls prevention during and after hospitalization. Health education research, 28(6), 1051-1066.

Mihaljcic, T., Haines, T. P., Ponsford, J. L., & Stolwyk, R. J. (2014). Development of a new self-awareness of falls risk measure (SAFRM). Archives of gerontology and geriatrics, 59(2), 249-256.

Miller, P. A., Sinding, C., Griffith, L. E., Shannon, H. S., & Raina, P. (2016). Seniors’ narratives of asking (and not asking) for help after a fall: implications for identity. Ageing & Society, 36(2), 240-258.

Morello, R., Barker, A., Watts, J., Haines, T., Zavarsek, S., Hill, K., … & Stoelwinder, J. (2015). The extra resource burden of in-hospital falls: a cost of falls study. Medical journal of Australia, 203(9), 367-e1