They have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. At the conclusion of this project, the student will be able to apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.

Students will develop a 1,250-1,500 word paper that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:

  1. Background
  2. Problem statement
  3. Purpose of the change proposal
  4. PICOT
  5. Literature search strategy employed
  6. Evaluation of the literature
  7. Applicable change or nursing theory utilized
  8. Proposed implementation plan with outcome measures
  9. Identification of potential barriers to plan implementation, and a discussion of how these could be overcome
  10. Appendix section, if tables, graphs, surveys, educational materials, etc. are created

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.


Literature Evaluation Table

Student Name: Yavaunee Jackson

Change Topic (2-3 sentences):

Falls is a national issue, with many interventions in place the statics related to falls has not indefinitely decreased. Through research and fall prevention efforts and studies on present efforts and potential interventions; I plan to understand how to implement changes in the hospital setting and to better equip and educate nursing staff on assessment of fall prevention.

Criteria Article 1 Article 2 Article 3 Article 4
Author, Journal (Peer-Reviewed), and

Permalink or Working Link to Access Article

Radecki, Bethany Reynolds, Staci Kara, Areeba

APPLIED NURSING RESEARCH ; OCT 2018, 43 p114-p119, 6p.


Huey-Ming Tzeng1

Huey-Ming Tzeng1


Votruba, Lisbeth1,2 (NURSE) Graham, Bridget3 (NURSE) Wisinski, Jeana4 (NURSE) Syed, Ayesha5 (NURSE)

Nursing Economic$. Jul/Aug2016, Vol. 34 Issue 4, p185-189. 5p. 1 Chart.


Cangany, Martha

Clinical Educator, Post-Surgical Unit, Orthopedic/Neuroscience Unit, and Liaison, Carmel Inpatient Unit, Franciscan Health, Indianapolis, IN


MEDSURG Nursing (MEDSURG NURS), Nov/Dec2018; 27(6): 379-382. (4p


Article Title and Year Published Inpatient fall prevention from the patient’s perspective: A qualitative study*(2018)

A Multihospital Survey on Effective Interventions to Prevent Hospital Falls in Adults. (Dec 2017) Video Monitoring to Reduce Falls And Patient Companion Costs For Adult Inpatients.

(Jul/Aug 2019)

Preventing Falls: Is No Toileting Alone the Answer?

(NOV/DEC 2018

Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study Falls are one of the most common adverse events in hospitals and can lead to preventable patient harm, increased length of stay, and increased healthcare costs. There is a need to understand fall risk and prevention from the patients’ perspectives; however, research in this area is limited.

Aim: The aim of this study was to describe the patient’s perspective of fall prevention in an acute care setting to aid in the design of patient centered strategies

A multihospital, cross-sectional design explored the underlying grouping structure of the nurse perceived effectiveness items of preventive interventions in acute hospital settings. Twenty-one highly effective interventions to prevent fall injuries were identified. The specific aim of this study was to evaluate the effectiveness of remote video monitoring with a dedicated tele sitter in order to reduce falls, as well as to reduce patient companion usage in the inpatient adult population What affects do integrating a “fall bundle” have on patient safety and does utilizing a “no bathroom alone” policy help to decrease the amount of falls?
Design (Type of Quantitative, or Type of Qualitative) A qualitative study was designed to describe the patient’s perspective of their own fall risk and of the fall prevention interventions implemented by nursing staff. The study was reviewed and approved by the local Institutional Review Board (protocol #1407636143). All adult patients admitted to one of the three study units during the intervention stage were eligible to be selected for video monitoring with NURSING ECONOMIC$/July-August 2016/Vol. 34/No. 4 187 the exception of those meeting exclusion criteria. Patients with behavioral restraints and those at risk for harm to self or others were excluded from the stud This study was compromised of taking a nursing unit with a high fall risk and slowly over 3 years integrating a fall bundle into the fall prevention program. Using these methods to assess if there would be a decrease in fall related to specific interventions. Nurses on the unit where educated comprehensively on new interventions.
Setting/Sample The study was conducted in a large, urban, tertiary care, academic health center in the Midwest. The facility has been designated as a Magnet Hospital for excellence in nursing services and high-quality clinical outcomes for patients. Participants were selected from non-intensive care inpatient units. The facility screens all inpatients for fall risk on admission and every shift. In addition to universal fall risk prevention measures, additional interventions are matched to patient specific etiology to mitigate fall risk. Interviews took place over a period of seven weeks starting October 2014. Data collection was interrupted for a period of five months due to personal leave and was completed in March 2016. Design. An exploratory, cross-sectional study was conducted at five nonprofit health systems located in the Midwest region of the United States from July 2011 through February 2012. It included 68 critical care, step-down, and noncritical acute care units for adult inpatients. Unit types included medical, surgical, combined medical-surgical, telemetry, oncology, orthopedics, cardiac, behavioral, women’s health/delivery, rehabilitation, and geriatric units (Tzeng & Yin, 2013). This study was approved by each health system’s institutional review board (IRB). Each IRB waived documentation of consent. This research study took place in a 350-bed urban, not for-profit, Magnet ®-designated hospital. The intervention took place in three inpatient, adult units including a critical care/intermediate unit, a neuroscience unit, and a senior adult unit. Approval was obtained from the institutional review board to conduct the research with a waiver of consent. Consent for video monitoring was included in the organization’s general consent for treatment. 43-bed post-surgical unit in a not-for-profit healthcare setting in the midwestern United States
Methods: Intervention/Instruments . Interviews were audiotaped and conducted in the patient’s private room using a standardized open-ended interview approach (Turner, 2010). The interview guide was developed by the investigators with input from local and national experts in fall prevention. The guide was designed to elicit patient awareness/perceptions of fall risk and prevention interventions. Interviews were transcribed verbatim and checked for accuracy The survey tool used in this study, The Injurious Fall Risk Factors and Fall Prevention Interventions Survey, was developed by the authors (Tzeng & Yin, 2013). Its development was based on previous studies and guidelines related to fall prevention (American Geriatrics Society and British Geriatrics Society Panel on Prevention of Falls in Older Persons, 2011; Currie, 2008; GrayMiceli, 2008; Shever et al., 2011; Titler, Shever, Kanak, Picone, & Qin, 2011; Tzeng & Yin, 2008a, 2008b). Authors sought input from 11 clinical or content area experts on the initial version of the survey tool The intervention phase of this prospective, descriptive study took place over a 9-month period. During the intervention phase, a dedicated tele sitter was added to the central monitoring unit (CMU) 24/7 to observe up to 12 patients at high risk for falls in three adult inpatient units as an alternative to using a patient companion. The tele sitter workstation was located in the CMU, at a workstation adjacent to the hospital’s two current cardiac monitor technicians (CMTs). During previous construct The initial intervention was the use of a fall bundle (yellow blanket, yellow socks, yellow armband, yellow magnet to be placed outside the door) for all patients scoring 51 or greater on the MFS. This fall bundle included visual cues to identify a patient as high risk for falling, and to increase awareness and communication among caregivers who interact with patients
Analysis Transcript analysis was guided by constant comparative methods (Kolb, 2012). During open coding, the team, which consisted of a CNS and a physician, read all transcripts repeatedly to gain a general understanding of the data. The team individually analyzed the transcripts for emerging themes. Together, the team iteratively refined the themes to reflect meanings in the data. Data were processed using SPSS 19.0 statistical software for Windows (SPSS Inc., Chicago, IL). Data from completed or partially completed surveys were included in the analysis; missing values in the partially completed surveys were kept as missing. Authors conceptualized information collected in the “Effectiveness” column captured nurses’ levels of agreement between their prior knowledge and their perceptions of the effectiveness of specific interventions. Agreement between prior knowledge and perceptions could be established through observation and clinical experience. Because nurses’ agreement precedes their know-how (e.g., knowing how to implement fall prevention interventions), exploratory factor analysis was completed on the items in the “Effectiveness” column. The skewness and kurtosis values of effectiveness intervention items on a 5-point scale were acceptable; absolute skewness values for all items were less than 2.00 and absolute kurtosis values were less than 2.42. Therefore, these items were treated as continuous variables . Baseline data were collected in the 9 months prior to the intervention phase of this study on the three study units. The baseline data included falls per discharge and the number of 1:1 patient companion hours per month. A fall was defined as an unplanned descent to the floor with or without injury. During the 9 months of the intervention phase while video monitoring was in progress, data on falls per discharge and 1:1 patient companion hours continued to be collected. In addition, the tele sitters kept paper logs recording the patients monitored, admission date, time to video monitoring, discharge date, and reason(s) the patient was monitored. They also logged their interventions, which included verbal redirections via microphone to the patients and calls to care providers on their personal communication dev Throughout this multi-year project as interventions were added gradually to nurses’ toolkit for fall prevention and safety, a steady decline in the number of falls occurred. Within 3 years, the unit consistently met and exceeded the National Database for Nursing Quality Indicators (NDNQI) benchmark for similar units (see Figure 1). Falls declined from 4.45 to 1.53 falls per 1,000 patient days (approximately 70% decrease). Falls with serious injury declined as well; for the year ending this inquiry, they remained at zero. The most drastic reduction in falls occurred after implementation of a no toileting alone program in 2013 for patients in the first 24 hours after a surgical procedure. This intervention was followed by implementation of the same program for all patients who were at high risk for falling
Key Findings previous investigations focusing on patients’ perceptions of their own fall risk have found that patients do not perceive their risk accurately (Shuman et al., 2016; Sonnad, Mascioli, Cunningham, & Goldsack, 2014). Twibell, Siela, Sproat, and Coers (2015) found more than half of the patients who were considered at risk of falling as assessed by nursing did not believe that they were likely to fall. Contradictory to this, in our sample, most patients were aware that they were identified as a fall risk.

Despite a lack of evidence supporting the effectiveness of bed and chair alarms to prevent falls, they are often used in fall prevention programs (Hempel et al., 2013; Sahota et al., 2014). Our patients identified the alarms as part of the fall prevention plan, but most viewed the alarm as a useful alert for nurses when a patient was out of bed rather than a reminder to wait for help

Twenty-one highly effective interventions to prevent fall injuries were identified. Ten were related to improving patients’ surrounding environment, and four of these environment modification-related interventions focused on patient pathways. Eleven were related to increasing RN staff vigilance, and four of these vigilance-related interventions focused on providing assistive devices or appropriate footwear. The 21 highly effective preventive interventions were not ranked as having the most frequently used interventions in practice. This difference suggests the need to address priorities of resource allocation as related to making effective interventions to prevent fall injuries feasible and available to nursing staff (e.g., timely housekeeping in patient rooms, storing sufficient and free-assistive devices in the units for patient use). The number of falls decreased significantly from 85 to 53 (p< 0.0001, 95% CI) comparing 9 months of baseline data to 9 months of intervention data on the three units. Table 1 demonstrates the overall decrease of patient falls including all adult inpatients on the three study units; those who were video monitored and those who were not. This represented a 35% decrease in falls. Of the 828 patients selected for video monitoring, 13 (1.6%) experienced a fall. During the same time period there were 40 falls (1.7%) among the 4,213 adult patients admitted who were not selected for video monitoring. Patient companion hours decreased 10% from an average of 1,930 hours per month to an average of 1,735 hours per month during the study period. The average length of time for Throughout this multi-year project as interventions were added gradually to nurses’ toolkit for fall prevention and safety, a steady decline in the number of falls occurred. Within 3 years, the unit consistently met and exceeded the National Database for Nursing Quality Indicators (NDNQI) benchmark for similar units (see Figure 1). Falls declined from 4.45 to 1.53 falls per 1,000 patient days (approximately 70% decrease). Falls with serious injury declined as well; for the year ending this inquiry, they remained at zero. The most drastic reduction in falls occurred after implementation of a no toileting alone program in 2013 for patients in the first 24 hours after a surgical procedure. This intervention was followed by implementation of the same program for all patients who were at high risk for falling
Recommendations More research is needed to develop and validate an inpatient self-assessment tool that may help the patient recognize both their overt and covert risk factors and become a more active and accepting participant in the plan. For future research, additional data collection and analysis (e.g., one-way ANOVA, multiple regression analyses with binary predictors) is needed to explore differences in RN staff perspectives on effectiveness and frequency of use of fall injury preventive interventions across, but not limited to, rural and urban areas, health systems and hospitals, and specialties and acuity levels of units (e.g., long-term care and skilled nursing home facilities). Differences in perspectives across nursing staff and nurse managers/executives, and nursing providers and other types of providers (e.g., physicians, physical therapists, occupational therapists, nutritionists, pharmacists) also warrant investigation. Findings of these additional analyses may help nurse executives and researchers identify essential interventions relevant to characteristics of settings beyond ones included in universal fall precautions. Universal fall precautions are meant to keep the patient environment safe regardless of fall risks and hospital areas. For example, maintaining a call light within reach is one of the keys (Agency for Healthcare Re This study suggests the use of remote video monitoring is a safe tool for fall prevention. While there was a decrease in 1:1 sitter usage, there was no corollary increase in falls. In fact, falls decreased 35%. . An area for further study is accurate criteria for selecting the most appropriate patients for video monitoring. Implications for further study could also include investigating the most appropriate length of shift for a tele sitter and the most effective telesitter-topatient ratio. Results of this project affirmed the need to assure patient safety during toileting. Nursing staff should acknowledge the importance of patient safety related to toileting when patients are of high risk for falling and remain with these patients while toileting. They also should discuss the rationale for this strategy with patients
Explanation of How the Article Supports EBP/Capstone Project This article takes into account the patient’s perspective on falls and risk they identify in themselves and how even with education from staff patients still have little understand on the proper use of bed alarms, and things out in place as fall precautions. It also takes into account patient thoughts on what makes them not adhere to fall precautions and how they view interventions placed by staff and how useful they think they are. This article based off a study of nurses and current fall prevention methods and their effectiveness is essential because it uses the perspective of healthcare workers that are on the frontlines of patient care. I also scrutinizing current practices and allows for new ideas to be formulated about old practices and opening doors for new interventions. Video Monitoring is a fairly new intervention In the prevention of patient falls. I think it is relevant as it looks into the implications and differing risk associated with patient fall, the implementation of video monitoring on some units could help with cost needing to pull less staff for 1:1 sitters for patient safety thus increasing the amount of staff available on shift to properly assist patients. Also have one person watch multiple individuals on constant and recorded video allows for education and quicker response times. This study focused on nursing staff lead interventions and assessment of fall risk patients. With the implementation of a “fall bundle”, technology and the no bathroom alone policy supports the finding that toileting Is a high risk activity for patients.
Criteria Article 5 Article 6 Article 7 Article 8
Author, Journal (Peer-Reviewed), and

Permalink or Working Link to Access Article

Ji Hyun ParkJung Tae Son

Journal of Korean Academy of Fundamentals of Nursing


Enishi, T.1 tetsuya-e@umin.org Yamasaki, N.Matsumoto, A.Higuchi, T.Takeuchi, M.Kashima, M.Yoshioka, S.Nakamura, M.Nakano, S.2


Gygax Spicer, Joan


Julie David Maria Ojeda James O. Adefisoye Winifred Pardo

Nursing & Health Sciences Research Journal, Vol 1, Iss 1, Pp 7-18 (2018)

Library & Knowledge Services and Nursing & Health Sciences Research Departments, 2018.


Publisher Information:

Article Title and Year Published Structural Analysis of Variables related to Fall Prevention Behavior of Registered Nurses in Small-to-Medium Sized Hospitals.


Annals of Physical & Rehabilitation Medicine. (2018) The Got-A-Minute Campaign to Reduce Patient Falls with Injury in an Acute Care Setting.


An Exploration of the Association of Patient Characteristics and Pharmacological Treatments to Inpatient Falls among Patients At-risk for Falling during Hospitalization


Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study How does the fall prevention behaviors of nurses affect patient falls? Falls are one of the major causes of mortality and morbidity in older adults, which needs a practical fall risk assessment tool to predict future falls. Recent researches suggested various functional tests produce more power than a single test in many aspects. So, we aimed to determine whether combined functional tests could increase predictive ability of future falls, especially recurrent-falls, which may result in stronger adverse impacts. How does skills and knowledge of nursing staff and patient population affect falls? Which fall prevention practices should be used? How should a standardized assessment of fall risk factors be conducted? How should staff assess and manage patients after a fall? The focus was falls with minor or greater injury.

H: Implementing a bundle based off evidence based best practice will decrease the number of falls

The purpose of this study was to describe and compare patient characteristics and pharmacological treatments between patients who fell and patients who did not fall, among a sample of patients deemed to be at-risk for falling during hospitalization. Additionally, the study aimed to identify independent predictors of falls among patients at-risk for falls during hospitalization.
Design (Type of Quantitative, or Type of Qualitative) Qualitative Retrospective qualitative study A qualitative study of three hospitals implementing falls prevention programs described the real-world journey (Ireland, Kirkpatrick, Boblin, & Robertson, 2013) Observational cross-sectional study
Setting/Sample Participants were 382 nurses from 13 hospitals who responded to the structured self-reported questionnaire. The research model was based on previous study of fall prevention, theory of planned behavior, and the health belief model Retrospective study carried out with stroke hospitalized patients. Thirty-four stroke patients who fell and 34 stroke patients who did not fall during their hospital stay underwent structured medical examinations to identify factors associated with fall. The control subjects were matched for age, height, body weight, body mass index (BMI), and primary diagnosis. Potential variables related to fall risk factors were collected from medical records. A conditional logistic regression was performed to calculate odds ratios using SPSS. Clinical data were collected from January to December 2016. “An unexpected displacement of the body to a lower level than the initial The setting was a medical-surgical unit with average daily census of 35 patients in a safety-net hospital. A safety-net hospital provides a significant level of care to low-income, uninsured, and vulnerable populations (National Association of Public Hospitals and Health Systems, n. d  A convenience sample of all patients with a Morse Fall Scale of >45 over a 1-year period, was extracted from electronic medical records.
Methods: Intervention/Instruments Structured questionnaire This was a prospective cohort study (N = 875) among residents of Hangu area of Tianjin, China, who were ≥ 60 years old. Falls were ascertained after one year. Meanwhile, sociodemographic information, medical history and physical performance data were also collected. The Timed Up and Go Test (TUGT), walking speed (WS) and grip strength (GS) are more recommended as tests targeting on balance, mobility and muscle strength by many studies. Therefore, we selected these three tests to clarity our hypothesis. The research team naming themselves the “stumble stoppers” which was an interprofessional team of nurses, pharmacy personnel, and a physical therapist reviewed evidence-based practice (EBP) recommendations in the literature. A 5- year review (2008-2012) of EBSCOhost to search English-language peer-reviewed journals for studies with the search terms nursing, adult, patient fall, and hospital identified over 150 articles. Team members realized they did not have the skills to evaluate the studies. Following Stevens’ (2012) recommendations, they focused on evidence summaries, including systematic reviews and other forms that integrated all research on a given topic into a single, meaningful whole.

They started by personalizing the data of patients who had already fallen rather than giving statistics where nurses seemed to disassociate from their day to day work. They let nurse read these patients stories reflect, had one on one meetings. Discussion was had on current fall prevention efforts and practices, and interventions where added to put into practice, commitment letters were signed to the nurses and their patients to increase the use of fall prevention practices. These practices included conducting patients centered rounds, debriefing patients and family after a fall ad being transparent fall data in the form of a fall board.

Descriptive statistics of demographic characteristics and medication classes were generated to compare those who fell to those who did not fall. To examine significant predictors of falls, logistic regression (univariate and multivariable) were employed
Analysis The modified model generally showed higher levels than recommended level of model fit indices and acceptable explanation. Of 17 hypothetical paths, 14 were supported. Predicting variables explained 51.6% of fall prevention behavior. The mean age was 67.1 years; 58.6% were women. According to ROC area, the cutoff point of TUGT, GS and WS of falls is 10.31 s, 0.3742 kg/kg and 0.9467 m/s, respectively. Therefore we defined good performance on the tests as “+”, and poor performance as “− ” with the cutoff point.

A simple tool using TUGT, GS and WS has better predictive power on future falls. Based on this result, individuals who show poor ability in TUGT and WS but have good grip strength ought to be more concerned about the high-risk of future falls, especially the likelihood of recurrent-falls.

At the start of year 1, the patient injury fall rate was 1.21/1,000 patient days. At year 2, the patient injury fall rate was 0.66/1,000 patient days; the patient injury fall rate at year 3 was 0.15/1,000 patient days. To examine significant predictors of falls, logistic regression (univariate and multivariable) were employed
Key Findings The fall prevention behavior of nurses showed a direct influence of fall prevention expectations, fall prevent threats, perceived behavioral control for fall prevention, and intention to prevent falls and an indirect of influence of patient safety culture, attitude toward fall prevention, and the subjective norm. Nutrition status, evaluated with modified fall score at admission, was significantly associated with fall risk (odds ratio = 3.11, 95% CI: 1.18–9.94). There were no statistically significant differences in the other candidate factors (e.g. sarcopenia, activities of daily living, and rehabilitation intervention) between the two groups. The Got-A-Minute Campaign was effective in facilitating accountability for practice. The change has been sustained for 36 months, and many of the practices are now routine care for patients on the project unit. Patient falls and fall prevention remain complex phenomena for every acute care setting The sample consisted of 4,978 valid patient records. White non-Hispanics constituted 60% of the falls group but only 24% of the non-falls group. A larger proportion of those who fell received antiemetics or insulin compared to those who did not fall. Univariate regression analysis found that race and 39 medication classes were independently associated with falls. Multivariable regression analysis showed that race and 11 medication classes were associated with the odds of falling.
Recommendations  Findings show a need to identify a range of barrier factors to increase the benefits of fall prevention behavior and enhance the perceived control of fall prevention so that nurses will be able to promote fall prevention behavior in hospitals. Also, it is critical to increase awareness of patient safety culture among nurses. Our findings demonstrated that nutrition status was associated with fall risk in stroke hospitalized patients. Further studies are needed to reveal that nutritional intervention can contribute to falls prevention in stroke patients The Got-A-Minute Campaign has proven successful. Keeping the core team of Stumble Stoppers together was difficult as time passed. Implementing and sustaining changes in practice takes time and compensating for turnover and replacement of core team members was a challenge. Although the Stumble Stoppers understood the fall prevention program was not time-limited, the continuous effort required to support and sustain the initiative was not appreciated fully until 36 months into the initiative White patients were more likely to fall than patients of other races. New associations were found between the odds of falling and antiprotozoal, diagnostic agents, and gastrointestinal agents. Prospective studies are needed to determine the predictive accuracy of these factors. Bedside practitioners should understand the mechanism and onset of action of medications so that individualized safety precautions may be implemented. By including classes of medications as part of fall-risk assessment, patient safety may be optimized, and falls avoided in this high-risk population.
Explanation of How the Article Supports EBP/Capstone Nurse behavior can be a direct barrier to patient safety efforts. An unwillingness to adapt to new efforts for patients safety. Identifying behaviors that enhance patient safety is important so that awareness and education on the critical need for diligent patient safety efforts. Through this study researchers looked at stroke patients who fell post hospital stay. I currently work on a Neurology unit where we see many stroke patients. Falls in this area can be very high as patients have limitations secondary to disease process and cognitive shortcomings as well that make it difficult to keep them safe with current fall prevention efforts.

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