Review of literature

REVIEW OF LITERATURE 15

The following is an analysis and appraisal of the 15 articles inorder 1.

Colon-Emeric, C. S., McConnell, E., Pinheiro, S.O., Corazzini, K., Porter, K., Earp, K. M., &amp … Anderson, R.A. (2013). CONNECT for Better Fall Prevention in Nursing Homes:Results from a Pilot Intervention Study. JournalOf The American Geriatrics Society,61(12),2150-2159 10p. doi:10.1111/jgs.12550

This is an article which focuses on the improvementof staff connection, communication and problem solving to see theeffect this would have on the implementation of a falls reductioneducation program. The study uses a group of nurses in a nursing hometo try and see the implementation of the education program withoutthe improvement of nursing staff connection, communication andproblem solving. According to the article, the nursing staff whoseconnection, communication and problem solving skills were improvedshowed that they enhanced the implementation of falls reductioneducation program. The article also asserts that the nurses who weretrained on connection, problem solving and communication offeredbetter and quality care.

The article has presented immense evidence and thedata collection method proves its conclusions to be prudent. Theresearch uses a control group and this helps in adding credence tothe research. The conclusions in the article are based on theevidence and the data that has been collected. The research used 497participants who provided credible results. The falls per bed peryear in situations where there was no intervention did not change.The results were 2.61 at baseline and 2.64 at the end of theintervention. However, there was a 12% reduction of falls from 2.34to 2.06 falls per bed per year.

Teresi, J. A., Ramirez, M., Remler, D., Ellis, J.,Boratgis, G., Silver, S., &amp … Dichter, E. (2013). Comparativeeffectiveness of implementing evidence-based education and bestpractices in nursing homes: Effects on falls, quality-of-life andsocietal costs. InternationalJournal of Nursing Studies, 50(4),448-463 16p. doi:10.1016/j.ijnurstu.2011.07.003.

This is a research study that focused on assessingthe effects of application of evidence-based practices and educationprograms on patient falls and the cost of health. It was found outthat the application of these evidence-based nursing practices andeducation programs reduces the cost and reduces patient falls.

The research used the experimental quasi designwhere there were three groups with each having 15 nursing homes. Datawas collected, analyzed and results published. It is clear that thethree groups recorded a reduction in falls. It is clear that theresearch has gathered sufficient evidence for the conclusions. Thefalls recorded were between 5 and 12 per year in the nursing homes.

Berry, S., Zhang, Y., Lipsitz, L., Mittleman, M.,Solomon, D., &amp Kiel, D. (2011). Antidepressant prescriptions: anacute window for falls in the nursing home. JournalsOf Gerontology Series A: Biological Sciences &amp Medical Sciences,66A(10), 1124-1130 7p.

This is a study which ought to find out the effectsof antidepressants on the risk of falling in a nursing home. Theresearch sought to also find out whether antidepressants have anacute effect or their effect is slow and progressive. The resultsfound out that the introduction of a new prescription such as anantidepressant increases the likelihood of a fall. It is essential tonote that even an increase in the dosage of an antidepressant canalso increase the risk of a fall.

The study used 1181 participants and this is a clearindication that the results that were arrived at were not by chance.The use of a control group during the study gives credence to theconclusions arrived at by the researchers. The evidence collected wasimmense and the participants were of the right age and gender tocarry out the study. The effect on falls with non SSRI change within2 days was an odds ratio of 4.7, 95% and confidence interval of1.3-16.2.

Leland, N. E., Gozalo, P., Teno, J., &ampMor, V.(2012). Falls in Newly Admitted Nursing Home Residents: A NationalStudy. Journal of The AmericanGeriatrics Society, 60(5),939-945 7p. doi:10.1111/j.1532-5415.2012.03931.x

This is a research which sought to find out the relationship betweenthe likelihood of a fall and the organizational characteristics in anursing home. The researchers looked at the various aspects of thenursing home such as the funding, presence of special care unit,number of beds and the facilities in the nursing home. It was foundout that the nursing homes with certified nursing assistantsexperienced fewer falls than the nursing homes without the certifiednursing assistant staff (odds ratio = 0.97, 95%confidence interval = 0.95-0.99).

The research has gathered enormous evidence and data that isrelevant for this study. 230 newly admitted patients in a nursinghome were observed over a period of one year. It is essential to notethat this was an enough period to determine the relationship betweenfalls and the organizational characteristics of the nursing home.

Burland, E., Martens, P., Brownell, M., Doupe, M.,&amp Fuchs, D. (2013). The evaluation of a fall management programin a nursing home population. TheGerontologist, 53(5), 828-838. doi:10.1093/geront/gns197

This study was done in Manitoba, Canada and it sought to find outwhether nursing home fall management programs were effective inreducing injurious falls. According to the article, it is clear thatthe application of the programs reduces injurious falls, as well asthe falls that result in hospitalization. The falls that lead tohospitalization reduced by 0.036–0.021 perperson-year [ppy] p= .043. residents under the program also recorded fewer injuriousfalls of 0.596–0.746 ppy p= .02.

The evidence in the study is enormous. It is evident from thearticle that data was collected for a period of 5 years from 2003 to2008 and this is a testament that the results are not by chance. Theuse of control groups also indicated that the results were originaland genuine.

Magaziner, J., Miller, R., &amp Resnick, B.(2007). Intervening to prevent falls and fractures in nursing homes:are we putting the cart before the horse? Journalof the American Geriatrics Society,55(3),464-466 3p. doi:10.1111/j.1532-5415.2007.01088.x

The journal entry contains four articles which are seeking to findinterventions in nursing homes that would reduce the falls especiallythe ones resulting in injuries and deaths according to theinformation herein it is evident that most of the falls occur innursing homes as opposed to within the community. This implies thatthere are some personal and or nursing home characteristics thatcontribute to the falls. According to this research, it is evidentthat 12% of falls result in serious injuries where 4% result infractures.

The four articles have gathered sufficient information over theyears in order to propose the various intervention measures such asuse of bed rails and bed alarms. Considering that the four articlesare proposing similar intervention measures, it is clear that theevidence is sufficient and the conclusions made are indeed truthful.The researchers relied on 2711 residents for the data and evidence.

Rubenstein, L. Z. (2006). Falls in older people:epidemiology, risk factors and strategies for prevention. Age&amp Ageing, 35ii37-ii41.doi:10.1093/ageing/afl084

This article asserts that falls are extremely commonand they are one of the leading causes for morbidity, injuries andmortality. They are common among the elderly people and they are theleading cause for their admission in nursing homes. The risk factorsmentioned in the article are muscle weakness, medication andenvironmental factors. Falls occur in 13% of the population and 40%in people older than 65 years. Environmental factors were figured outas the major causes of falls constituting 31% followed by weaknessesat 17%.

The article has relied on immense data in order toarrive at conclusions and to propose various intervention measures.The research has identified risk reduction measures as the bestintervention programs to reduce falls.

Parikh, S., Avorn, J., &amp Solomon, D. (2009).Pharmacological management of osteoporosis in nursing homepopulations: a systematic review. Journalof the American Geriatrics Society,57(2),327-334 8p. doi:10.1111/j.1532-5415.2008.02119.x

The article asserts that there are numerous falls innursing homes as compared to the people dwelling in the community.The study sought to find out the effects of osteoporosis medicationon falls. Some mineral such as calcium and vitamin were found toreduce the risk of fractures during falls

The research relied on literature since 1974regarding the use of osteoporosis medication. This providedsufficient data and evidence regarding their use in reducing fallsand or reducing the effects of the falls. It is essential to notethat the research did not rely on any research design but data wasgathered using any appropriate method. Research indicated that 9-25%of the hospitals used the medication.

Anderson, R. A., Corazzini, K., Porter, K., Daily,K., McDaniel Jr, R. R., &amp Colón-Emeric, C. (2012). CONNECT forquality: protocol of a cluster randomized controlled trial toimprove fall prevention in nursing homes. ImplementationScience, 7(1),11-11 1p.

This article proposes that there needs to be a goodinteraction between staff in a nursing home if the qualityimprovement programs to reduce falls have to be implementedeffectively. The research applies the CONNECT model to enhanceinteraction amongst staff in a nursing home. The research found thatthere are 1.5 falls per bed per year of which 40 were recurrentfalls.

The research relied on experimental design to gatherdata and evidence hence the research leads to credible results. Theresearchers used a control group which does not participate inCONNECT but participate in the quality improvement program. Thisshows that the researches are determined to find out whethereffective interaction among the employees improves their knowledgeand implementation of the programs. The results are positive and theresearchers conclude that indeed good relations among the employeesresult in the improvement of the intervention programs

Capezuti, E., Taylor, J., Brown, H., Strothers HS,3.,&ampOuslander, J. (2007). Challenges to implementing anAPN-facilitated falls management program in long-term care. AppliedNursing Research, 20(1),2-9 8p.

According to this article, there are variouschallenges that affect the successful implementation of fallsreduction programs. The removal of consultants and the advancepractice nurses are some of the factors influencing theimplementation of the programs. The advance practice nurses offereffective nursing assessment of the programs and also assist inmaking decisions.

The article has relied on empirical evidence to reach intoconclusions. The researchers relied on literature and also interviewsto gather data and information regarding the factors affecting theimplementation of falls reduction programs.

Neyens, J., Dijcks, B., van Haastregt, J., deWitte, L., van den Heuvel, W., Crebolder, H., &amp Schols, J.(n.d). The development of a multidisciplinary fall risk evaluationtool for demented nursing home patients in the Netherlands. BmcPublic Health, 6.

This is a research study that sought to develop amultidisciplinary risk assessment tool for demented patients who areat risk of falling. The article asserts that demented patients are ata greater risk of falling and therefore there needs to be anintervention plan that will address the risk factors. The authorshave asserted that it is important to consider every patientindependently in order to develop tailor made solutions to theproblems.

The evidence gathered in the development of the riskassessment tool was from previous scientific research. The authors ofthe article also relied heavily on expert opinions regarding the riskfactors of falls in nursing homes and the best intervention measures.This information together with the data from the scientific studieswas used as evidence in order to arrive at conclusions.

Breimaier, H. E., Halfens, R. G., &ampLohrmann,C. (2015). Effectiveness of multifaceted and tailored strategies toimplement a fall-prevention guideline into acute care nursing practice: a before-and-after, mixed-method study using aparticipatory action researchapproach. BMC Nursing,14(1),1-12. doi:10.1186/s12912-015-0064-z.

This is a study thatsought to find out how evidence based practice programs areimplemented in acute care hospitals. The researchers havehypothesized that the time investment, as well as the effectivenessof the multifaceted and tailor made strategies of implementation havenot been tested and therefore they seek to test them in this study.

The research relied onparticipatory action design to gather data. All the graduate andassistant nurses participated in the research and therefore thefindings were not by chance. The study was conducted in the hospitaldepartment of an Australian university. Questionnaires, interviewsand discussions were used to gather data for the study.

Sakamoto, Y., Ebihara, S., Ebihara, T., Tomita,N., Toba, K., Freeman, S., &amp … Kohzuki, M. (2012). FallPrevention Using Olfactory Stimulation with Lavender Odor in ElderlyNursing Home Residents: A Randomized Controlled Trial…[corrected][published erratum appears in J AM GERIATR SOC2012 Nov 60(11): 2193]. Journal OfThe American Geriatrics Society,60(6),1005-1011 7p. doi:10.1111/j.1532-5415.2012.03977.x

This is a researchstudy that sought to find out the effects of Lavender olfactorystimulation on patient falls in a nursing home. Previous research hasshown that the lavender olfactory stimulation reduces patient falls.These research also found the same results and therefore proven itshypothesis. The lavender group had 26 falls while the placebo grouphad 36 falls. The incidence rate in the lavender group was 1.04 whilethat in the placebo group was 1.4 per person per year.

The research used 145 participants and divided them into two groupswith one being the control group and which received placebo. Thenumber of participants was sufficient to provide credible results.

Broe, K., Chen, T., Weinberg, J.,Bischoff-Ferrari, H., Holick, M., &amp Kiel, D. (2007). A higherdose of vitamin D reduces the risk of falls in nursing homeresidents: a randomized, multiple-dose study. JournalOf The American Geriatrics Society,55(2), 234-239 6p. doi:10.1111/j.1532-5415.2007.01048.x

This study sought to find out the effects of vitaminD supplements on the reduction of falls in a nursing home. It wasfound out that there is little or no difference in rates of falls forpatients using vitamin D supplements and those not using thesupplements. According to the findings of the research, there were44% falls in the placebo group, 58% in the 200 IU group, 60% (15/25)in the 400 IU group, 60% (15/25) in the 600 IU group, and 20% in the800 IU group.

The study relied on two groups of patients with onereceiving placebo over a period of five months. The other groupreceived the four categories of vitamin D (200 IU, 400 IU, 600 IU, or800 IU). The vitamin D 800IU was the only one that reduced fall ratesin the nursing home. The other categories recorded almost similarrates with the placebo group.

Kobayashi, N., &amp Sugai, Y. (2006). Witnessedand un-witnessed falls among the elderly with dementia in Japanesenursing homes. Japan Journal of Nursing Science, 3(1), 31-41 11p.

This research sought to describe the falls among theelderly with dementia whether witnessed or not. According to theresearch, it is essential to note that the cognitive level of theelderly patients and the shifts of the professional caregiverscontribute to the huge number of the un-witnessed falls in a nursinghome. The witnessed falls constitute only 14% of all the falls in anursing home.

The researchers relied upon over 276 study reports in Japan toarrive at conclusions. The researchers also used descriptivestatistics to find out when a fall occurred. It is clear that theresearchers relied upon a huge body of research and therefore thefindings and conclusions are credible.

Giles, C. Et al. (2006). Can volunteer companionsprevent falls among inpatients? A feasibility study using a pre-postcomparative design. BMC Geriatrics.Retrieved from: http://bmcgeriatr.biomedcentral.com/articles/10.1186/1471-2318-6-11

This article focuses on researching on the effectsof introducing volunteers to accompany patients who are at a risk offalling. According to the authors who carried out the research, whenelderly patients who are at risk of falling are accompanied byvolunteers, they hardly fall. It is therefore recommended thatnursing homes for the elderly should consider having volunteers tolook after the patients who are at risk of falling.

Volunteers were introduced and the worked for 2345hours to find out the effect on falls that they would have on highrisk patients. The rates of falls were measured per 1000 of occupiedbed days. The data was collected between February to March 2002 andFebruary to March 2003. The research found out that there were 14.5falls per 1000 occupied bed days at the baseline while there were15.5 falls per 1000 OBD during the implementation period. It isessential to note that the 2345 hours that the volunteers gave areworth over $57,000. This research provided credible results since theperiod of study was long and the volunteers dedicated immense time tothe services.

References

Anderson, R. A., Corazzini, K., Porter, K., Daily,K., McDaniel Jr, R. R., &amp Colón-Emeric, C. (2012). CONNECT forquality: protocol of a cluster randomized controlled trial to improve fall prevention in nursing homes. ImplementationScience, 7(1),11-11 1p.

Berry, S., Zhang, Y., Lipsitz, L., Mittleman, M.,Solomon, D., &amp Kiel, D. (2011). Antidepressant prescriptions: anacute window for falls in the nursing home. JournalsOf Gerontology Series A: Biological Sciences &amp Medical Sciences,66A(10),1124-1130 7p.

Breimaier, H. E., Halfens, R. G., &ampLohrmann, C.(2015). Effectiveness of multifaceted and tailored strategies toimplement a fall-prevention guideline into acute care nursing practice: a before-and-after, mixed-method study using aparticipatory action research approach. BMCNursing, 14(1),1-12. doi:10.1186/s12912-015-0064-z

Broe, K., Chen, T., Weinberg, J., Bischoff-Ferrari,H., Holick, M., &amp Kiel, D. (2007). A higher dose of vitamin Dreduces the risk of falls in nursing home residents: a randomized, multiple-dose study. Journal Of TheAmerican Geriatrics Society, 55(2),234-239 6p. doi:10.1111/j.1532-5415.2007.01048.x

Burland, E., Martens, P., Brownell, M., Doupe, M., &ampFuchs, D. (2013). The evaluation of a fall management program in anursing home population. The Gerontologist,53(5), 828-838. doi:10.1093/geront/gns197

Capezuti, E., Taylor, J., Brown, H., Strothers HS,3.,&ampOuslander, J. (2007). Challenges to implementing anAPN-facilitated falls management program in long-term care. Applied Nursing Research, 20(1),2-9 8p.

Colon-Emeric, C. S., McConnell, E., Pinheiro, S. O.,Corazzini, K., Porter, K., Earp, K. M., &amp … Anderson, R. A.(2013). CONNECT for Better Fall Prevention in Nursing Homes: Resultsfrom a Pilot Intervention Study. Journal OfThe American Geriatrics Society, 61(12),2150-2159 10p. doi:10.1111/jgs.12550

Kobayashi, N., &ampSugai, Y. (2006). Witnessed andunwitnessed falls among the elderly with dementia in Japanesenursing homes. Japan Journal Of NursingScience, 3(1),31-41 11p.

Leland, N. E., Gozalo, P., Teno, J., &ampMor, V.(2012). Falls in Newly Admitted Nursing Home Residents: A NationalStudy. Journal Of The American GeriatricsSociety, 60(5),939- 945 7p. doi:10.1111/j.1532-5415.2012.03931.x

Magaziner, J., Miller, R., &amp Resnick, B. (2007).Intervening to prevent falls and fractures in nursing homes: are weputting the cart before the horse?.JournalOf The American Geriatrics Society,55(3), 464-4663p. doi:10.1111/j.1532-5415.2007.01088.x

Neyens, J., Dijcks, B., van Haastregt, J., de Witte,L., van den Heuvel, W., Crebolder, H., &amp Schols, J. (n.d). Thedevelopment of a multidisciplinary fall risk evaluation tool for demented nursing home patients in the Netherlands. BmcPublic Health, 6

Parikh, S., Avorn, J., &amp Solomon, D. (2009).Pharmacological management of osteoporosis in nursing homepopulations: a systematic review. JournalOf The American Geriatrics Society,57(2), 327-3348p. doi:10.1111/j.1532-5415.2008.02119.x

Rubenstein, L. Z. (2006). Falls in older people:epidemiology, risk factors and strategies for prevention. Age&amp Ageing, 35ii37-ii41.doi:10.1093/ageing/afl084

Sakamoto, Y., Ebihara, S., Ebihara, T., Tomita, N.,Toba, K., Freeman, S., &amp … Kohzuki, M. (2012). Fall PreventionUsing Olfactory Stimulation with Lavender Odor in Elderly NursingHome Residents: A Randomized Controlled Trial…[corrected][published erratum appears in J AM GERIATR SOC 2012 Nov 60(11): 2193]. JournalOf The American Geriatrics Society,60(6), 1005-10117p. doi:10.1111/j.1532- 5415.2012.03977.x

Teresi, J. A., Ramirez, M., Remler, D., Ellis, J.,Boratgis, G., Silver, S., &amp … Dichter, E. (2013). Comparativeeffectiveness of implementing evidence-based education and bestpractices in nursing homes: Effects on falls, quality-of-life andsocietal costs. International Journal OfNursing Studies, 50(4),448-463 16p. doi:10.1016/j.ijnurstu.2011.07.003