The University of Texas at Arlington Fall Prevention in Elderly Paper

The University of Texas at Arlington Fall Prevention in Elderly Paper The University of Texas at Arlington Fall Prevention in Elderly Paper NU 390 INDIVIDUAL RESEARCH PAPER ASSIGNMENT In this assignment you will formulate a research problem/question, conduct a literature review, find research articles that help to explain and support your problem. This paper will be the beginnings of a research paper, but you will not carry out the research. You will basically be writing the introduction of a research paper. 1. This paper should be approximately four to five pages double spaced, excluding the title and reference page. The University of Texas at Arlington Fall Prevention in Elderly Paper 2. Limit your variables to two, one independent and one dependent variable. 3.Do not write an abstract. 4. Make sure you have a title. See text for writing a good title. 5. Use APA style. 6. Do not use any quotations in this paper. All your citations must be paraphrased not quoted. Points will be deducted for quoting. Introduce your research problem and state the importance of doing the study. In this section you introduce the reader to the problem, give data that supports the importance of exploring the problem and why this would be significant to nursing knowledge. This should be one to two paragraphs. Make sure that you support all of this with citations from the literature. 10 points Define the concepts or variables to be studied. Give definitions of the variables that you are exploring. These should come from nursing literature, not Webster’s dictionary. Make sure you cite the literature that helps you to define the concepts 15 points Write a review of the literature. Review several research articles that are relevant to your problem. (At least 3 articles must be used). Make sure you cite properly. 20 points Write a purpose statement for your research study Must be well- developed stating your problem. This should be in your own words and needs no citation. 20 Points Write a research question and an hypothesis In your own words, no citation. 5 points Identify your research design Include your research design and methods to be used. Provide sampling information for your study population 20 points APA format Paper must be of professional quality in terms of spelling, grammar, sentence structure 10 points falls_in_ltcf.pdf use_of_it_in_fall_prevention.pdf fall_prevention_in_elderly_in__ltcf.pdf ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS THEMATIC EDITION: GOOD PRACTICES: FUNDAMENTALS OF CARE IN GERONTOLOGICAL NURSING RESEARCH Falls in long-term care institutions for elderly people: protocol validation Queda nas Instituições de Longa Permanência para Idosos: validação de protocolo Caída en Residencias Geriátricas: validación de protocolo Cristina Rosa Soares Lavareda BaixinhoI, Maria dos Anjos Coelho Rodrigues DixeII, Maria Adriana Pereira HenriquesI I Escola Superior de Enfermagem de Lisboa, Nursing Research & Development Unit. Lisbon, Portugal. II Instituto Politécnico de Leiria, School of Health, Health Investigation Unit. Leiria, Portugal. How to cite this paper: Baixinho CRSL, Dixe MACR, Henriques MAP. Falls in long-term care institutions for elderly people: protocol validation. Rev Bras Enferm [Internet]. 2017; 70(4):740-6. [Thematic Edition “Good Practices: Fundamentals of care in Gerontological Nursing”] DOI: http://dx.doi.org/10.1590/0034-7167-2017-0109 Submission: 02-15-2017 Acceptance: 04-02-2017 ABSTRACT Objectives: To validate the content of a fall management risk protocol in long-term institutions for elderly people. Methods: Methodological, quanti-qualitative study using the Delphi technique. The tool, based on the literature, was sent electronically to obtain consensus among the 14 experts that meet the defined inclusion criteria. Results: The 27 indicators of the protocol are organized in three dimensions: prepare for the institutionalization (IRA=.88); manage the risk of falls throughout the institutionalization (IRA=.9); and lead the communication and formation (IRA=1), with a CVI=.91. Two rounds were performed to get a consensus superior to 80% in every item. Conclusion: The values obtained in the reliability test (>0.8) show that the protocol can be used to meet the intended goal. The next step is the clinic validation of the protocol with residents of long-term care institutions for elderly people. Descriptors: Accidental Falls; Aged; Accident Prevention; Nursing; Institutionalization. RESUMO Objetivos: Validar o conteúdo de um protocolo para a gestão do risco de queda em Instituições de Longa Permanência para Idosos. Método: Estudo metodológico, de abordagem quantiqualitativa, utilizando a técnica de Delphi. O instrumento, construído com base na literatura, foi enviado por via electrónica, para obter consenso entre os 14 peritos que respeitam os critérios de inclusão definidos. Resultados: Os 27 indicadores do protocolo estão organizados em três dimensões: Preparar a Institucionalização (IRA=,88); Gerir o Risco de Queda ao longo da Institucionalização (IRA=,9) e Liderar a comunicação e formação (IRA=1), com um CVI=,91. Foram efetuadas duas rodadas para se obter consenso superior a 80% em todos os itens. Conclusão: Os valores obtidos no teste de fidedignidade (>0,8) atestam que o protocolo pode ser utilizado para atingir o fim que se pretende. A próxima etapa é a validação clínica do protocolo com idosos residentes em Instituições de Longa Permanência para Idosos. Descritores: Acidentes por Quedas; Idosos; Prevenção de Acidentes; Enfermagem; Institucionalização. RESUMEN Objetivos: Validar el contenido de un protocolo para gestión de riesgo de caídas en Residencias Geriátricas. Método: Estudio metodológico, de abordaje cualicuantitativo, utilizando técnica de Delphi. El instrumento elaborado con base en la literatura fue enviado por vía electrónica para obtener consenso entre los 14 peritos que observan los criterios de inclusión definidos. Resultados: Los 27 indicadores del protocolo están organizados en tres dimensiones: Preparar la Institucionalización (IRA=,88); Gerenciar el Riesgo de Caída durante la institucionalización (IRA=,9); y Liderar la comunicación y formación (IRA=1), con un CVI=,91. Fueron efectuadas dos rondas para obtener consenso superior al 80% en todos los ítems. Conclusión: Los valores obtenidos en el test de fidelidad (>0,8) certifican que el protocolo puede utilizarse para alcanzar el fin pretendido. La siguiente etapa será la validación clínica del protocolo con ancianos que moren en Residencias Geriátricas. Descriptores: Accidentes por Caídas; Ancianos; Prevención de Accidentes; Enfermería; Institucionalización. CORRESPONDING AUTHOR http://dx.doi.org/10.1590/0034-7167-2017-0109 Cristina Lavareda Baixinho Email: [email protected] Rev Bras Enferm [Internet]. 2017 jul-ago;70(4):740-6. 740 Baixinho CRSL, Dixe MACR, Henriques MAP. INTRODUCTION Falls are a recurrent problem for older people and a matter of concern in long-term care (LTC) institutions for the elderly(1-3), where their incidence varies between 34% and 67%(4). They are a common cause of institutionalization and affect the independent residents of LTC facilities(5). The incidence of fall-related injuries is higher in institutionalized elderly(6) than in older people that live at home, which makes this type of accident an important cause of morbidity and mortality in institutionalized elderly(3). It is estimated that falls originate from 6,000 to 9,000 hospital admissions in this population every year, with an average length of stay of 12 to 20 days(7). Controlling this problem is difficult because the risk of fall is complex and multifactorial. However, in a rapidly aging population, the need emerged for the transfer of knowledge as a proactive and systematic measure to prevent falls. This effort must integrate policies, prevention, and practice(8), with a multiprofessional approach. The authors emphasize that prevention may have several formats, but must involve different professionals(7). Both in the level of healthcare policy definition and in direct care of the elderly, nurses are the most qualified and suitable professionals to identify and categorize risk and to plan, implement, and evaluate prevention programs(4), playing a key role in the assurance of quality of care in LTC units(4). In the interface between the appointment and the analysis of research results for this public healthcare issue, the need arises to outline and validate an intervention protocol for fall management risk in LTC institutions that allows nurses to use tools and interventions in clinical practice based on investigation, and assess the results of nursing care. Research has been useful to identify single and multiple sets of interventions that effectively decrease the prevalence of falls and associated injuries, but there is no intervention protocol for nursing clinical practice dedicated to LTC institutions that allows a systemic approach to maintain the safety of the elderly. Therefore, the goal of the present study is to evaluate the content of a fall management risk protocol in LTC institutions. METHODS Ethical aspects This study is part of an investigation into risk management of falls in equipment for the elderly and has the approval of the Ethics Committee of the Catholic University of Portugal. Prior contact was necessary to obtain the authorization of the professionals to join the team, and the referral to the instrument by the participants assumes the will to participate in the research. For this reason, signature of the free and informed consent form was not required. Type of study Fall risk management in LTC facilities is a complex process that implies keeping the elderly safe throughout the entire period of institutionalization. To validate a fall risk management protocol for LTC units, a set of indicators was sent to a group of Falls in long-term care institutions for elderly people: protocol validation experts whose assignment was the evaluation of its pertinence and contribution to solve this serious public healthcare issue. This methodological, quanti-qualitative study was conducted from February 2015 to July 2016 and the Delphi technique was used to obtain consensus among the experts regarding the propositions submitted to analysis. The methodological choice was state of the art and the goal of the study. This technique allowed access to geographically distant people, the production of a profusion of high quality and high specificity ideas, the possibility of individual thinking, and the integration and synergy of ideas among experts, without the drawbacks of face-to-face meetings(9). Sample The intentional sample consisted of 14 experts that met the predefined inclusion criteria: to have more than five years of experience, with published research in the area of risk and/or prevention of falls in the elderly. The University of Texas at Arlington Fall Prevention in Elderly Paper The researchers opted for a heterogeneous sample, advocated by some authors to assure the validity of the results, given that multidisciplinarity provides a more valid predictive consensus(10). Protocol The indicators submitted for evaluation by the examining board originated from a literature review and the results of research on this subject in LTC institutions. The analysis of interventions with emphasis on fall prevention, as well as good quality interventions that do not stress this aspect and the theoretical framework of Meleis’s Theory of Transitions allowed categorization of the indicators, at first, into three aspects: prepare for the institutionalization; manage the risk of falls throughout the institutionalization; and lead the communication and formation. A previous contact was established to explain the goal of the study and avoid the abstention of the participants. The questionnaire was designed and sent through Google Drive®. The experts were asked to give their opinion about the indicators; scores of ?1, 0, and 1 point were given to a non-pertinent indicator (“I do not have an opinion”) and a pertinent indicator, respectively. A pretest to evaluate the readability of the items was carried out with five experts that did not belong to the definitive examining board(9). Two rounds of evaluation(9-10) were conducted to get a consensus higher than 80% in all of the answers. After the referral of the instrument in the first round, the propositions were analyzed with descriptive statistical tools and suggestions for alterations/rewriting of the items were considered. The level of consensus and the suggestions were integrated according to the chosen theoretical framework. The participants gave feedback on the answers, and the indicators that obtained a consensus lower than 80% were reformulated between rounds, following the reformulation suggestions of the examining board. In the second round, the items that reached the previously stipulated 80% consensus(9-10) were excluded. New questions were not introduced in the questionnaire because the analysis of the answers to the open-ended questions in the first round did not point to any new queries. Rev Bras Enferm [Internet]. 2017 jul-ago;70(4):740-6. 741 Baixinho CRSL, Dixe MACR, Henriques MAP. Falls in long-term care institutions for elderly people: protocol validation Analysis of the results For validation of the protocol content, the Content Validity Index was applied to each item (CVII) and to the whole document (CVI). Also, the Interrater Agreement (IRA) was used to evaluate the reliability or the inter-rater reliability. To calculate the CVI for individual items and the entire protocol, the number of participants that gave a score of 3 or 4 in a Likert scale was divided by the number of participants that judged the item or the instrument(11). IRA was obtained by dividing the number of items with a consensus higher than 80% among the experts by the total number of items in each dimension(11). SPSS version 21 software performed the statistical treatment of the data. The suggestions given by the experts were analyzed within the theoretical framework and introduced in the second round. RESULTS The sample, consisting of 14 female experts, was heterogeneous regarding the professional formation of the members, although all of them had experience in researching and publishing about falls in the elderly. Regarding professional experience, there were eight nurses, one medical doctor, two physical educators, one psychologist, and two physical therapists. Eight were Portuguese and six were Brazilian. Chart 1 shows the dimensions and their indicators, submitted for evaluation by the examining board. Chart 1 – Expert agreement (first round of the evaluation) regarding the items of a fall risk management protocol, Lisbon, Portugal, 2016 Dimensions of the fall risk management protocol for LTC institutions* CVII** IRA*** CVI**** Preparing the institutionalization 1 Meets the elderly and their family before the admittance to a LTC unit*. 0.86 2 Applies an assessment scale for fall risk. 0.93 3 Applies a scale to evaluate the elderly’s practices and behaviors regarding the fall risk management. 0.86 4 Describes rules of good practice. 0.93 5 Tells the fall prevalence rate in the LTC institution*. 0.71 6 Contracts the commitment of the family in the elderly person’s safety. 0.86 7 Informs the elderly person of the need to report every fall episode. 0.93 8 Formalizes the care continuity with the family nurse. The University of Texas at Arlington Fall Prevention in Elderly Paper 0.79 9 Hands written information about the criteria for clothes/shoes to bring to the institution. 1.0 0.77 Managing the fall risk throughout the institutionalization 10 Evaluates the individual fall risk with a risk assessment tool. 1.0 11 Controls the environment and equipment. 1.0 12 Manages the daily activities of the elderly. 0.93 13 Manages the care given by different professionals. 0.93 14 Determines the task delegation mechanisms to other professionals. 0.79 15 Evaluates the practices and behaviors of the professionals regarding fall risk management. 1.0 16 Evaluates the practices and behaviors of the elderly regarding fall risk management. 0.86 17 Selects safe supporting products for the execution of daily activities. 0.86 18 Monitors the fall episodes. 0.93 19 Implements strategies to control fall consequences and prevent the decrease of functionality in the post-fall period. 0.91 0.9 1.0 Leading communication and formation 20 Decides as a team the preventive measures to be implemented. 1.0 21 Tells the family the individual fall risk factors of the elderly person. 1.0 22 Tells the family the implemented measures. 0.86 23 Evaluates the impact of the implemented preventive measures. 1.0 24 Communicates and reports the fall episodes. 0.93 25 Runs epidemiological studies. 0.93 26 Registers the fall episodes in a national platform. 0.86 27 Sets up the multidisciplinary team. 1.0 1.0 Notes: *Long-term care; **Content Validity Index, applied to the items of the protocol; ***Interrater Agreement, applied to the protocol dimensions; ****Content Validity Index of the protocol Rev Bras Enferm [Internet]. 2017 jul-ago;70(4):740-6. 742 Baixinho CRSL, Dixe MACR, Henriques MAP. Falls in long-term care institutions for elderly people: protocol validation After the referral of the form to the experts and an analysis of the answers, it was noticed that items 5, 8, and 14 did not attain a consensus higher than 80%. Also, the reformulation suggestions given by the examining board were considered, and the items changed and resent. Regarding item 5, an expert (E) expressed her concern about the communication of fall prevalence to the elderly person and how it would influence the fear of falls, especially in individuals that had already had an episode, and whether this information would impact the fear of a new fall episode or its occurrence in the first days of institutionalization. The expert (E7) therefore disagreed on its pertinence. Another participant, who stated not to have an opinion, argued that the low literacy of the elderly and their families could hinder their understanding of this information and create anxiety about the chosen LTC unit (E11). As for item 8, an expert stated not to have an opinion and two considered that the item was not pertinent. A participant that considered this item pertinent suggested its reformulation because not all of the population have a family nurse (E14). Analysis of item 14 revealed a suggestion to make it clear that the nurse has to determine the task delegation mechanisms to hands-on healthcare professionals, instead of those with higher professional autonomy and a superior academic degree (E3). After the rewrite, the changed items looked like this: (5) tells the family the fall prevalence rate in the LTC institution; (8) assures the care continuity, asking the primary care nurse for information; and (14) determines the task delegation mechanisms to hands-on professionals. At the end of the second round, these items obtained a consensus of 93%, 93%, and 86%, respectively. The University of Texas at Arlington Fall Prevention in Elderly Paper Chart 2 exhibits the results after the second round of evaluation by the examining board. Chart 2 – Expert agreement (second round, final version) regarding the items of a fall risk management protocol, Lisbon, Portugal, 2016 Dimensions of the fall risk management protocol for LTC institutions* CVII* IRA** CVI*** Preparing the institutionalization 1 Meets the elderly person and their family before the admittance to a LTC unit*. 0.86 2 Applies an assessment scale for fall risk. 0.93 3 Applies a scale to evaluate the elderly person’s practices and behaviors regarding the fall risk management. 0.86 4 Describes rules of good practice. 0.93 5 Tells the family the fall prevalence rate in the LTC institution*. 0.93 6 Contracts the commitment of the family in the elderly person’s safety. 0.86 7 Informs the elderly person of the need to report every fall episode. 0.93 8 Assures the care continuity, asking the primary care nurse for information. 0.93 9 Provides written information about the criteria for clothes/shoes to bring to the institution. 1 1 Managing the fall risk throughout the institutionalization 10 Evaluates the individual fall risk with a risk assessment tool. 1 11 Controls the environment and equipment. 1 12 Manages the daily activities of the elderly. 0.93 13 Manages the care given by different professionals. 0.93 14 Determines the task delegation mechanisms to hands-on professionals. 0.86 15 Evaluates the practices and behaviors of the professionals regarding fall risk management. 1 16 Evaluates the practices and behaviors of the elderly person regarding fall risk management. 0.86 17 Selects safe supporting products for the execution of daily activities. 0.86 18 Monitors the fall episodes. 0.93 19 Implements strategies to control fall consequences and prevent the decrease of functionality in the post-fall period. 0.93 1 1 Leading communication and formation 20 Decides as a team the preventive measures to be implemented. 1 21 Tells the family the individual fall risk factors of the elderly. 1 22 Tells the family the implemented measures. 23 Evaluates the impact of the implemented preventive measures. 0.86 1 24 Communicates and reports the fall episodes. 0.93 25 Runs epidemiological studies. 0.93 26 Registers the fall episodes in a national platform. 0.86 27 Sets up the multidisciplinary team. 1 1 Notes: *Long-term care; **Content Validity Index, applied to the items of the protocol; ***Interrater Agreement, applied to the protocol dimensions; ****Content Validity Index of the protocol Rev Bras Enferm [Internet]. 2017 jul-ago;70(4):740-6. 743 Baixinho CRSL, Dixe MACR, Henriques MAP. DISCUSSION One of the greatest, if not the greatest, challenge in nursing as a science and a profession is the integration of research results and practice, aiming the development of the subject and a more efficient professional intervention. This contributes to the improvement of health care to the population and decreases the costs related to disease treatment/incapacity, rehabilitation, and complications associated with the processes of health/disease, promoting different transitions(12). Falls in the elderly are a typical example of the need to in … Purchase answer to see full attachment Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service . Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10