Response to FNU Student Essay
Re: Topic 3 DQ 1 The qualitative article,” Exploring Older Adult ED Fall Patients’ Understanding of Their Fall” which is a qualitative study by Shankar et al. explored about the falls of elderly people. The problem was that elderly patients more than 65 years are more prone to falls. Therefore, understanding the older patients’ perspectives about their fall, fall risk factors, and attitude toward emergency department fall prevention interventions helps to formulate methods to prevent falls. Semi-structured interviews were applied for the research. The strength of this article is that it helps to understand the older people’s perspective to fall which helps to formulate necessary intervention to prevent fall. The weakness is that it does not emphasis on the fall prevention strategy. Also, patients exhibited a variety of receptiveness to ED interventions directed at narrowing falls but contributed limited information (Shankar et al, 2017). The qualitative article, “Implementing exercise programs to prevent falls: systematic descriptive review” which is a qualitative study by Shier et. al explored about the interventions that helped the elderly patients to prevent falls by implementing exercise programs. The United States Preventive Services Task Force suggests an exercise to prevent falls in patients aged more than 65 years at more fall risk. However, little is known about how best to execute exercise programs in regular care when a patient’s crucial for exercise is identified inside the healthcare system. Study design was a randomized controlled trial (RCT).The strength of the article is that primary care providers could recognize people at risk and encourage support since most elder populations frequently visit, and ask about exercise from, their physicians. The weakness is that Flourishing programs encompassed expense for exercise sessions, which is a weekly class coupled with exercises at home cost less than $2 per participant per week, while regular individual sessions require more than $100 per participant per week (Shier et al,2016). The qualitative article,” Factors influencing the implementation of fall-prevention programmes: a systematic review and synthesis of qualitative studies” by Goodwin et.al, identify, what factors serve as barriers and facilitators to the successful implementation of fall-prevention programmes. 5010 articles identified through database searching, 19 were included in the review. The results show that the implementation of fall-prevention programmes is complex and multifactorial. The strength of the study was that it helps to identify what factors, serve as barriers to the successful implementation of fall-prevention programmes. The weakness is that it identified that implementation of fall-prevention programmes are very complex(Goodwin et.al ,2012). The quantitative article “Modified Timed Up and Go Test for Tendency to Fall and Balance Assessment in Elderly Patients with Gait Instability” by Soto-Varela et.al uses a cross-sectional study and data collection, conducted in a tertiary university hospital, for a population aged 65 years or older with gait instability. The study performed modified TUG Test. It proved that time is the parameter that corresponds most robustly with falls. The strength of the article is that it helps to identify and assess the elderly patient who is with gait instability. The weakness is that there is no intervention to prevent falls (Soto-Varela et.al, 2020). The quantitative article,“Integrating Emergency Care with Population Health Screening for Fall Risks in the Emergency Department: A Novel Nursing-Driven Program” by Huded et.al used statistical analysis. TUGT is a commonly used falls screening tool, to identify seniors at high fall risk and prompt interventions through a geriatric nurse liaison model. Patients with abnormal TUGT results could then be referred to physical therapy (PT), social work or home health as determined by the GNL. The strength of the article is that it helps to identify the patients who are at fall risk through fall risk screening with the TUGT. The weakness is that there is no intervention to prevent falls (Huded et.al,2015). The quantitative article, “Prevalence of falls among elderly participants of a health promotion group and comparison of balance tests to detect risk of falls” is a qualitative study by Carvalhoa et.al is a cross-sectional study with an observational approach. This study is to verify the incidence of falls in a group of elderly patients and detect which balance test is the most appropriate for the studied sample. The study observed a high prevalence of falls in a group of elderly patients participating in a health promotion group. The strength of the study is that it helps to detect the balance test which is most appropriate for the elderly population. The TUG was the test that presented the best sensitivity for the studied sample. The weakness of the study was that a recent systematic review shows that the use of the TUG is limited in elderly living in the community, and that it must not be used as the sole instrument in the identification of individuals under risk of falls (Carvalhoa et.al ,2017). Reference: Carvalhoa et.al (2017).Prevalence of falls among elderly participants of a health promotion group and comparison of balance tests to detect risk of falls Fisioterapia em Movimento, Vol 30, P. 519-525. Retrieved from: https://doi.org/10.1590/1980-5918.030.003.ao10 Goodwin et.al (2012). Factors influencing the implementation of fall-prevention programmes: a systematic review and synthesis of qualitative studies. Implementation Science, 7, Article number: 91.Retrieved from: https://doi.org/10.1186/1748-5908-7-91 Huded et.al (2015). Integrating Emergency Care with Population Health Screening for Fall Risks in the Emergency Department: A Novel Nursing-Driven Program. Retrieved from: https://escholarship.org/uc/item/4rg7c7rh Shier et al (2016). Implementing exercise programs to prevent falls: systematic descriptive review. Injury Epidemiology, volume 3, Article number: 16. Retrieved from: https://link.springer.com/article/10.1186/s40621-016-0081-8#citeas Shankar et al (2017). Exploring Older Adult ED Fall Patients’ Understanding of Their Fall: A Qualitative Study. Geriatric orthopaedic surgery & rehabilitation, P. 231–237. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755844/ Soto-Varela et.al (2020). Modified Timed Up and Go Test for Tendency to Fall and Balance Assessment in Elderly Patients with Gait Instability. Retrieved from: https://www.frontiersin.org/articles/10.3389/fneur.2020.00543/full
Reading through your post, it is apparent that you gave it a lot of thought. You have summarized six articles well enough for someone to understand what they are about and the methodology that was used. You have also pointed out with clarity what the strengths and weaknesses of the articles are. The concise nature of the information in each articles summary deserves to be commended. What is also commendable is the fact that there is only one running theme that unites all the articles you have summarized. This is the fact that the clinical issue or problem that all these articles address is accidental falls in hospitalized elderly patients aged 65 years and above. It must be said that this is an important clinical practice problem that is also a quality improvement issue. Accidental falls are preventable, and it is for this reason that the Centers for Disease Control and Prevention or CDC stopped reimbursing for services provided to fall victims (Bouldin et al., 2013).Response to FNU Student Essay. This cost now falls on the facility in which the patient suffered the fall. They must shoulder this cost because if they do not, there is a real risk of having to face litigation for the Tort of Negligence (which covers civil negligence) in a court of law (Walter, 2011). The remedy for this is damages which translate to huge financial settlements.
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It is also notable that in your post that the six studies are a mixture of qualitative and quantitative studies. This is good in the sense that you realized that evaluation of evidence requires both approaches/ methods. The only confusing bit is that when it comes to the last article in your post, you start by stating that it is a quantitative study but at the end write that it is a qualitative study. It may be a typographical error, but certainly it brings about some degree of confusion in an otherwise great post. Lastly, the inclusion of systematic reviews is phenomenal. This is because systematic reviews and meta-analyses provide the highest level of evidence for interventions used in evidence-based practice or EBP.
Bouldin, E.D., Andresen, E.M., Dunton, N.E., Simon, M., Waters, T.M., Liu, M…. & Shorr, R.I. (2013). Falls among adult patients hospitalized in the United States: Prevalence and trends. Journal of Patient Safety, 9(1), 13–17. https://doi.org/10.1097/PTS.0b013e3182699b64
Walker, R. (2011). Elements of negligence and malpractice. The Nurse Practitioner, 36(5), 9–11. https://doi.org/10.1097/01.npr.0000396597.73019.45
Response to FNU Student Essay