Clinical Nursing Practice Problem
Despite the advancements in medical equipment and nursing education, falls are still among the primary causes of physical injuries for older patients. There are forecasts predicting an increase of falls in the future, resulting in more substantial expenditures in healthcare (Bergen, Stevens, and Burns, 2016). The severity of the issue is exacerbated by the fact that the majority of patients that were subject to falls are deprived of the ability to live an independent life.
The number of older adults who reported such an incident was 29 million in 2014, and one-third of those had to ask for medical assistance (Bergen et al., 2016). However, the majority of the adults who fall do not go to their medical service provider and do not discuss the issue with a professional (Carande-Kulis et al., 2015). Such an attitude creates challenges both for the subjects and the health providers because no intervention can be applied to reduce the number of falls. Therefore, fall prevention stays as a priority area for both research and evidence-based practice.
Clinical Nursing PICOT Question
In patients older than 65, what is the effect of screening for fall risks and recommending Vitamin D and physical exercises on fall prevention compared with the absence of intervention within two years?
Define PICOT Elements
- P- (patient population/patients of interest): Elder patients who are 65 or more years old
- I- (Intervention): Screening patients for fall risks and the prescription of Vitamin D and exercises in appropriate circumstances
- C- (Comparison): Absence of intervention, as it usually happens when patients do not discuss their falls with health professionals
- O- (Measurable outcome): Reduction of falls
- T- (Time frame in months): 24 months
Evidence Retrieval Process and Summary
Callis, N. (2016). Falls prevention: Identification of predictive fall risk factors. Applied Nursing Research, 29, 53–58.
To understand how falls can be prevented by screening for risk factors, health professionals must learn what these risk factors are and what makes them predictive. Callis (2016) provides a comprehensive literature review on all available evidence about risk factors and assessment. The author also provides a risk assessment tool that is based on common risks found in the majority of scientific papers.
Uusi-Rasi, K., Patil, R., Karinkanta, S., Kannus, P., Tokola, K., Lamberg-Allardt, C., & Sievänen, H. (2015). Exercise and vitamin D in fall prevention among older women: a randomized clinical trial. JAMA Internal Medicine, 175(5), 703–711.
Uusi-Rasi et al. (2016) conducted a randomized control trial to study the benefits of exercises and Vitamin D in terms of reduction of the number of falls. Because the PICOT question is directly related to the potential effects of VItamin D and physical activities, the research by Uusi-Rasi (2016) plays a significant role in answering the question.
Implications of the Evidence
Callis (2016) identified eleven risk factors that are not currently part of any risk assessment tool. This fact shows that contemporary interventions are not comprehensive because they lack essential details. The author states that there is a need for a systematic process of evaluating patients for risks (Callis, 2016). There is a strong connection between the number of falls and the use of particular pharmaceuticals at hospitals (Callis, 2016). Using the study results as the foundation, health professionals may develop comprehensive assessment tools that will help identify people at risk and apply preventive interventions.
The randomized control trial by Uusi-Rasi et al. (2015) attempted to determine the efficacy of recommending Vitamin D and physical exercises to elderly patients. This vitamin, along with activities, is a part of an intervention strategy that is applied toward the patients who often fall. The study results, however, showed that this approach does not lead to significant improvements (Uusi-Rasi et al., 2015). The rate of fall stayed almost the same in all groups (Uusi-Rasi et al., 2015). This knowledge should be used to revise the current intervention strategies and encourage further research in developing new methods of fall prevention.
References
Bergen, G., Stevens, M. R., Burns, E.R. (2016). Falls and fall injuries among adults aged ≥65 years – United States, 2014. Morbidity and Mortality Weekly Report, 65(37), 993-998.
Callis, N. (2016). Falls prevention: Identification of predictive fall risk factors. Applied Nursing Research, 29, 53–58. Web.
Carande-Kulis, V., Stevens, J. A., Florence, C. S., Beattie, B. L., & Arias, I. (2015). A cost-benefit analysis of three older adult fall prevention interventions. Journal of Safety Research, 52, 65-70.
Uusi-Rasi, K., Patil, R., Karinkanta, S., Kannus, P., Tokola, K., Lamberg-Allardt, C., & Sievänen, H. (2015). Exercise and vitamin D in fall prevention among older women: a randomized clinical trial. JAMA Internal Medicine, 175(5), 703–711.