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Clinical Problem and Current Research


The main stakeholder groups that are important for the future change project include patients older than 65 years, their closest family, the nursing staff of the healthcare institution, and the hospital’s administration. The primary stakeholders are patients and the staff since they will be directly engaged in project implementation and will experience the immediate effects of it (Lund Jepsen & Eskerod, 2013).

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Patients’ families and administration are secondary stakeholders since the outcomes will either positively or negatively affect them after program introduction. In addition, medical, as well as a general society, can also be considered stakeholders since their interest will be reflected in the academic and professional progression of nursing care. However, the main roles will belong to senior patients and their care providers since the results obtained and their further applicability will depend on them and their efforts.

To involve the diverse stakeholder groups in the project, it is crucial to explain clearly and vividly the potential positive effect of the proposed intervention if they provide their consent to participate in it (Lund Jepsen & Eskerod, 2013).

Apart from that, it is essential to dwell on the health-related outcomes they can achieve. For instance, it can be stated that patients will improve the quality of their health by reinforcing their balance and muscle tone, which will ensure that the risk of falls and fall-related injuries is minimized. In terms of nurses, they should be made aware of the fact that by educating their patients on correct exercising they will improve the quality of care provided, ensure the continuity of it, and will contribute to decreasing the potential expenditures for the institution (Lund Jepsen & Eskerod, 2013).

It is crucial to identify the needs of stakeholders in support of the intervention since it will help the researcher to motivate them to participate in it. It can be assumed that when people comprehend the meaning and usefulness of implementing certain measures, they will be more likely to accept them even if they experience some inconveniences.

Cost-Benefit Analysis

The resources required for the project implementation include expenditures to educate staff on the chosen intervention program. In addition, different handout materials will be needed to provide them to patients as illustrational and instructional tools. Since there are multiple intervention programs regarding fall prevention in elderly patients that have proved effective, it will be essential to choose the most appropriate one, which will allow meeting the aims of the future project and will fit in the budget. Since the particular program will be selected in the future, it is possible to provide a cost-benefit analysis based on the evidence that already exists.

According to Carande-Kulis, Stevens, Florence, Beattie, and Arias (2015), almost 30% of falls in elderly patients results in trauma, which affects the quality of care and raises hospital’s expenditures. The Otago Exercise Program is one of the programs aimed at improving the strength and balance of patients older than 65 years. The intervention cost per person is approximately 312 USD while the net benefit per participant is approximately 122 USD. In addition, the incremental cost per fall prevented is 1303 USD (Carande-Kulis et al., 2015). The return on investment that stakeholders can expect is almost 36% per each dollar. Therefore, it can be stated that the benefits will be much greater than expenditures.

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Clinical Problem and Current Research

The clinical issue that will be the focus of the change project falls in elderly patients (including fall-related injuries). According to statistics, one in every four senior patients falls. It leads to traumas and evidence that falls are very common in the clinical setting (Saxon, Etten, & Perkins, 2014). They affect the quality of care provided to patients, resulting in poorer nursing outcomes, and increase the costs for healthcare institutions.

Therefore, immediate interventions are needed to resolve this problem (Saxon et al., 2014). According to the latest research, the most effective programs to address falls in senior patients are A Matter of Balance, Otago Exercise Program, Tai Chi, and some other approaches (Carande-Kulis et al., 2015).

They have the potential to prevent falls in more than 30% of patients; however, the costs for each program are different. This evidence will be considered when implementing the intervention in the chosen clinical setting and will guide the researcher to choose the most appropriate method. Nevertheless, the particular approach will be chosen when the primary aspects such as the number of patients and nurses willing to participate, and the available budget are clear. The future cost-benefit analysis will also be calculated when all the details have been refined.

Gaps in Research

One of the gaps that exist in the current research is the problem of transmitting evidence into practice. Also, the efficiency of the programs discussed above in minimizing traumas has not been studied exhaustively (Li et al., 2016).

In addition, it is unclear whether the patient’s culture or socioeconomic factors have any influence on the final results. It is likely that the selected setting will be different from the ones discussed in the existing research, which might lead to poorer outcomes and unconvincing evidence. Therefore, it is necessary to consider these aspects when carrying out the change project in the chosen clinical setting and keep track of these factors if it turns out that they significantly affect program implementation. It can be assumed that it will be possible to regard these gaps as possible limitations.


Carande-Kulis, V., Stevens, J. A., Florence, C. S., Beattie, B. L., & Arias, I. (2015). A cost-benefit analysis of three older adult falls prevention interventions. Journal of Safety Research, 52, 65-70.

Li, F., Eckstrom, E., Harmer, P., Fitzgerald, K., Voit, J., & Cameron, K. A. (2016). Exercise and fall prevention: Narrowing the research‐to‐practice gap and enhancing integration of clinical and community practice. Journal of the American Geriatrics Society, 64(2), 425-431.

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Lund Jepsen, A., & Eskerod, P. (2013). Project stakeholder management. Farnham, UK: Gower Publishing.

Saxon, S. V., Etten, M. J., & Perkins, E. A. (2014). Physical change and aging: A guide for the helping professions (6th ed.). New York, NY: Springer.

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