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Evidence Based Nursing Practice

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The evidence-based care for the elderly people fall, has provided instances that the elderly people (65+ years) within the primary care clinic have shown the repeated history of falls or fall-related health-care causing the multifactorial risk assessment along with facing the interventions (Moquin, 2018). For example, from the researched evidence within the primary care clinics i.e. Pacific Northwest, has shown 116 patients with the average mean age were 79 ± 8 years; 68% were female, and 10% were non-white, have experienced falls over 12 months in the index fall. On accessing the situation closely, there have been fall risk factors such as 24% (for home safety) to experiencing the 78% (for vitamin D) (Tazuma, et al, 2017). From the evidence-based intervention, it is important to identify the risk factors 73% of the time experienced on an average. Two risk factors that have been experienced are the infrequently: medications (21%) and home safety (24%) depending on the clinical care settings in the aged care home. The other reasons are the slippery falls and experiencing the lack of care (Robinson, 2017).

Access:

In the elderly settings, the fall and injury prevention has been identified as the challenge and should be provided with the continuum care. Elderly people often experience unintentional falls, due to the lack of control over oneself, feeling unattended when experiencing the routine care and issues faced are the likely causes. LoBiondo-Wood (2017) mentions, approximately there are 32 percent of elderly patients who have experienced falls every year due to the lack of the gross motor skills and fall reflects more of the females experiencing the falls then the males belonging to the age group. Within the fall-related injuries, the rate of accidental death has been approximately 41 fall deaths per 100,000 people every year (Algoso, 2016). Within the studies, the evidence shows from the cohort studies, that the consequence of the fall is the likely reason for the injury and mortality rates rise that cause more death cases in the males (aged 85 and above) in comparison to same age group females (Birks, 2017). Above the 65 years of age, since the period of the 2003 year and above, approximately 38 per 100,000 population have experienced accidental deaths in female, that has been an emerging problem (Annear, 2016).

Falls have been one of the prevalent reasons, causing the unintentional injury-related deaths along with experiencing the non-fatal injuries in elderly people aged 65 years and older. Due to the elderly experiencing the falls, they experience the predispose to injury, even attaining loss of independence, decreased mobility, prolog period in the hospitalization, facing the nursing home placement, and even the early death (1–3). Doyle (2018) mentions in his literature, that every year, there have been prominent accidental falls causing two million emergency department (ED) visits (1), there have been fall-related injury care costs that account for $30 billion annually (4). subsequent rates of fall-related ED visits along with hospitalizations are increasing and there have been larger older adults in the population that are experiencing the epidemic of falls. It is important to adopt a strategy for the rate of falls prevention and experiencing the injuries causing the public health issue.

 Budden (2017) mentions that the falls have been experienced high in the community-dwelling older adults showcasing factors such as the multifactorial approach to assess and integrate the modifiable risk factors approach for the effective intervention for individuals experiencing the history of falls. Subsequently, there have been the routine health-care practice, and evidence shows, there has been the low translation of fall-prevention evidence shown during the practice was limited, having the fall-focused physical examinations along with experiencing the treatment plans as identified in the third of medical records of patients that have experienced the sustained falls. The importance of the quality of falls evaluation along with experiencing the management in primary care has remained sub-optimal. Huisman‐de Waal (2018) provides evidences in his literature, that the elderly age patient needs the support from the physical therapist or a physician along with the practicing nurse that can note the fall risk assessment and identify it from the screening tool

Appraise:

Due to the evidence-based appropriate resources, it is acknowledged, that the likeliness of the falls and the prevention can be controlled through the coordinated multidisciplinary approach. Additionally, effective communication can help to achieve effective client control and can control the likeliness to fall. Through the coordinated approaches and with the rightful communication between the health professionals and patients, the screening tools and the assessment tools for the patient personal preferences and needs can be identified. For example, if the person is experiencing dementia, the greater risk and also suffer from the recurrent falls, due to the low mobility, balance and feeling lower muscle weakness along with attaining the lower memory and unable to find out their way (Bourke-Matas, 2020). The quality of evidence has been observed in the intended individual competencies for the nurse to take adequate steps in falling and preventing falls.

The prevention strategies of the nurses are done through the knowledge, skills, attitudes, and judgment and by taking adequate steps from the education team to take the highest degree of evidence in prevention (Annear, 2016). The nurse's approach to preventing elderly people fall is to understand increasing rigor, bringing in the quality, including the reliability of the evidence through the different types as designed through study designs. The nurses should include support practice and understand the multimodal, interdisciplinary prevention programs through which the elderly fall assessment instruments can be mapped and considering the rate of effects on the elderly due to falls efficacy, fear of falling, or actual fall rate (Algoso, 2016). The other prevention methods are to check the floor slip resistance test, checking the unevenness of the floors, and even placing the warning signs on the slippery/wet floors.

Apply:

To prevent elderly people fall, the rate of the effectiveness, cost-benefit, including the cost-effectiveness of home safety can prevent falls. As identified from the practice-change, having a primary-care-based intervention framework that can focus on providing the quality of care for elderly patients. The specific target to improve the care, provision of the safety evaluations has to be increased, along with including the physical or occupational therapists for the better services. Through the emergency medical service (EMS) providers can provide the extensive services and the well-developed EMS program can acquire the program and others to ascertain the long-term viability and provide a solution like the modifications in the low-cost, high-return intervention that could fall injuries. Birks (2017) mentions to include the mandatory safety assessment and modifications to provide the health insurance benefit for the elder patients that provide swift care at the low minimal health-care costs.

The barriers and intervention plans involve checking over the falls to ascertain the seizure medication, to use orthopedic diagnosis, and subsequently to provide the physical/occupational therapy ordered. The identified four categories such as including the alert attendants that can provide a better check over the gross motor skills of the quickly providing medication and through the assisted devices to walk around and to take the steady steps. The steps like to check the elderly patient alertness, to determine the has mentioned that it is also important that there would be the elderly patient attendant that could check timely and also proactively take accurate steps to prevent falls (Annear, 2016). An attendant has to continuously check the floor and to note the cracks, placing the wet signs and even some caution signs.

Assess:

The importance of the successful intervention can be noted by appropriately having a plan, to provide the strategy to take care and even placing the required intervention that can help to overcome the falls. For the nurses to timely access to the situation and to provide adequate necessary ways to intervene and overcome the fall and injury prevention can be observed to be a care continuum plans (Budden, 2017). As described, from the lens of the fall of an elderly patient can be noted that can be analyzed with the monthly rate of falling. The importance of effective intervention can be accessed for the multifactorial falls risk assessment and through the management program (Annear, 2016). The intervention can be to provide an assistance within the premises, staff in handy to check the patient condition and the mobility comfort, in order to provide the quick support and better condition. Team of professional experts with the better coordinated care can provide a quick resolution in preventing and setting barriers for the elderly falls.

References for Evidence Based Nursing Practice 

Algoso, M., Peters, K., Ramjan, L., & East, L. (2016). Exploring undergraduate nursing students' perceptions of working in aged care settings: A review of the literature. Nurse Education Today36, 275-280.

Annear, M., Walker, K., Lucas, P., Lo, A., & Robinson, A. (2016). Interprofessional education in aged-care facilities: Tensions and opportunities among undergraduate health student cohorts. Journal of Interprofessional Care30(5), 627-635.

Birks, M., Bagley, T., Park, T., Burkot, C., & Mills, J. (2017). The impact of clinical placement model on learning in nursing: A descriptive exploratory study. Australian Journal of Advanced Nursing, The34(3), 16.

Bourke-Matas, E., Maloney, S., Jepson, M., & Bowles, K. A. (2020). Evidence-based practice conversations with clinical supervisors during paramedic placements: An exploratory study of students??? perceptions. Journal of Contemporary Medical Education10(4), 123-130.

Budden, L. M., Birks, M., Cant, R., Bagley, T., & Park, T. (2017). Australian nursing students’ experience of bullying and/or harassment during clinical placement. Collegian24(2), 125-133.

Doyle, K., Sainsbury, K., Cleary, S., Parkinson, L., Vindigni, D., McGrath, I., & Cruickshank, M. (2017). Happy to help/happy to be here: Identifying components of successful clinical placements for undergraduate nursing students. Nurse education today49, 27-32.

Huisman‐de Waal, G., Feo, R., Vermeulen, H., & Heinen, M. (2018). Students’ perspectives on basic nursing care education. Journal of clinical nursing27(11-12), 2450-2459.

Lea, E., Mason, R., Eccleston, C., & Robinson, A. (2016). Aspects of nursing student placements associated with the perceived likelihood of working in residential aged care. Journal of Clinical Nursing25(5-6), 715-724.

Loffler, H., Barnett, K., Corlis, M., Howard, S., & Van Emden, J. (2018). Student participation at Helping Hand Aged Care: taking clinical placement to the next level. Journal of Research in Nursing23(2-3), 290-305.

Moquin, H., Seneviratne, C., & Venturato, L. (2018). From apprehension to advocacy: a qualitative study of the undergraduate nursing student experience in a clinical placement in residential aged care. BMC nursing17(1), 1-11.

Robinson, A., See, C., Lea, E., Bramble, M., Andrews, S., Marlow, A., ... & McInerney, F. (2017). Wicking teaching aged care facilities program: innovative practice. Dementia16(5), 673-681.

Tazuma, S., Unno, M., Igarashi, Y., Inui, K., Uchiyama, K., Kai, M., ... & Ryozawa, S. (2017). Evidence-based clinical practice guidelines for cholelithiasis 2016. Journal of gastroenterology52(3), 276-300.

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