Elyssa Ion Group 1
- Identification of the Problem
On our unit, we are seeing a frustrating trend of falls, specifically when residents try to get up on their own to use the bathroom or reach for things like their glasses or water. As nurses, we know that fall prevention is squarely within our scope of practice and is a major indicator of how safe our unit really is.
From my perspective as an MDS nurse, I see how these falls are not just physical injuries. They trigger a cascade of administrative requirements, specifically in Section J of the MDS (Minimum Data Set) assessment. This section requires us to meticulously document every fall and any resulting injuries for federal reporting, which adds a significant documentation burden to the nursing staff. More importantly, these events can lead to a decline in ADLs and negatively impact our facilitys Quality Measures, hurting our residents’ quality of life and their sense of independence.
- Summary and Evaluation of the Primary Research Article
APA Reference: Amaechi, A. (2024). Implementing hourly rounding in reducing the rate of falls among older adults in long-term care facilities (DNP Project). Sacred Heart University.
To address this, I found a recent study by Amaechi (2024) that looked at how a structured hourly rounding protocol, specifically using the 4 Ps of Pain, Potty, Placement, and Positioning, could cut down fall rates. This was a primary research project conducted in a long-term care facility where staff were trained to proactively check on residents every hour. The results were impressive; they saw a 27.8% drop in falls in just 30 days (Amaechi, 2024).
When I was searching for this, I used the FSW library databases with keywords like “hourly rounding” and “long-term care.” I made sure to look for original data because, as Polit and Beck (2021) point out, appraising original research is the best way to ensure we are using the most reliable evidence for our patients. One specific strength of Amaechi’s (2024) background section is how it uses very recent data to show that reactive tools, like bed alarms, just are not enough on their own. Polit and Beck (2021) mention that a good literature review should provide a solid “state of the science,” and this article does exactly that by proving we need to move toward proactive behaviors rather than just relying on technology.
- Application to Nursing Practice
I believe we could easily bring the 4 Ps protocol to our unit. If our team, both RNs and CNAs, is physically in the room every hour checking on pain and toileting, we catch those residents before they decide to try and get out of bed alone. The biggest benefit is obviously fewer injuries, but it also makes the unit quieter because there are fewer call lights and alarms going off. Of course, the challenge is always staffing. We are all busy, and adding one more thing to the to-do list can feel overwhelming. To make this work, we would need to follow the advice of Polit and Beck (2021) and make sure the intervention is actually feasible. Maybe we can simplify the charting so it is just a quick click in the EHR rather than a separate paper log. The study showed that residents often do not want to “bother” us, so if we are already there, that barrier disappears (Amaechi, 2024).
- Supporting Literature (Secondary Research)
APA Reference: Ojo, E. O., & Thiamwong, L. (2022). Effects of nurse-led fall prevention programs for older adults: A systematic review. Pacific Rim International Journal of Nursing Research, 26(3), 417431.
I also looked at a systematic review by Ojo and Thiamwong (2022). While my first article gave us a close look at one facility, this review looked at the bigger picture. Polit and Beck (2021) place systematic reviews at the very top of the evidence hierarchy, and this one confirms that nurse-led, multifactorial programs are the most effective way to keep our seniors safe. It really reinforces that the hourly rounding approach in the Amaechi (2024) study is the right path for us to take.
- Use of Course Textbook
Using the Polit and Beck (2021) textbook has helped me understand that Evidence-Based Practice is not just about finding a random article; it is about the “systematic use of the best available evidence” to make clinical decisions. For this discussion, I focused on the “appraisal” phase of the research process. According to Polit and Beck (2021), nursing research must be scrutinized for its “clinical significance,” meaning, does this study actually matter at the bedside? By evaluating Amaechis (2024) study, I learned how to look past just the summary and actually analyze the “Methods” and “Background” to see if the intervention is grounded in logic and high-quality prior evidence. This process ensures that when we propose a policy change on our unit, we are doing so based on proven data rather than just tradition or habit.
- References
Amaechi, A. (2024). Implementing hourly rounding in reducing the rate of falls among older adults in long-term care facilities (DNP Project). Sacred Heart University.
Ojo, E. O., & Thiamwong, L. (2022). Effects of nurse-led fall prevention programs for older adults: A systematic review. Pacific Rim International Journal of Nursing Research, 26(3), 417431.
Polit, D. F., & Beck, C. T. (2021). Essentials of nursing research: Appraising evidence for nursing practice (10th ed.). Wolters Kluwer.