Introduction
Falls and fall-related injuries are critical issues in the contemporary healthcare setting. They can occur at any stage of health care provision and in any setting notwithstanding the efforts contributed by the staff for their prevention. Nevertheless, falls can happen due to several reasons including negligence, insufficient care, or lack of competence in employees. It is worthy of mentioning that much research has been carried out to investigate the reasons for falls as well as to promote preventive practices in general; however, little is known about the incidence rate and preventive measure for patients with mental illnesses or disorders. Thus, the project aims to conduct empirical research on the issue of falls in senior patients suffering from psychiatric health conditions.
Literature Review
According to Bunn et al. (2014), particularly mental health conditions can adversely affect the wellbeing of patients and cause falls due to the possible agitation. The researchers have conducted a comprehensive overview of different preventive measures to evaluate their efficiency in eliminating falls and injuries in older patients. The results have revealed that none of the strategies were equally effective, but the most efficient approaches were staff and patient education and sensory stimulation of patients to mitigate agitation.
The study conducted by Wesson et al. (2013) dwelled upon the effectiveness of exercising for patients suffering from dementia. It turned out that regular physical activity does not have any significant influence on the rate of falls or related injuries because only a small number of patients have been able to succeed in boosting their strength and balance. However, the research proved the significance of nursing supervision.
Sakamoto et al. (2012) have proposed a new intervention for fall prevention. The research team investigated the efficiency of lavender olfactory stimulation in abating agitation. The patients with mental disorders wore special lavender patches close to their necks, which resulted in a decrease in falls. The patients felt less anxious and nervous, that is why their motor activity was calmer.
The research carried out by Faes et al. (2011) was designed to compare the efficiency of two different care approaches. In particular, they have evaluated the efficiency of fall prevention initiative and regular geriatric care. Interestingly enough, the study revealed the inefficiency of the first program compared to the usual geriatric care. The team was able to conclude that developing the fall prevention principles within the limits of regular care would be more feasible and efficient rather than expanding the scope of nursing practice.
Quigley, Barnett, and Friedman (2014) have researched whether different healthcare institutions place a higher emphasis on the prevention of injuries or the prophylaxis of the falls. The study has revealed that almost all of the organizations concentrate on the prevention of falls and educate their nurses to supervise mentally unstable patients with higher caution. This approach has been proven effective.
Methodology and Design
Because the research topic has not been covered sufficiently yet, it is necessary to conduct a qualitative study. It would be possible to observe the phenomenon, to accumulate facts about it, and to establish the relationship between the factors (Ellis, 2013). To answer the research questions, it will be helpful to conduct participant observation.
In particular, the specific group of patients (elderly people suffering from psychiatric health conditions) will be monitored in the healthcare environment, and guided by the researcher to answer the following study questions:
- What are the intrinsic risk factors that influence the incidence of hospital falls and fall-related injuries within psychiatric inpatient units caring for the elderly?
- What are the extrinsic risk factors that influence the incidence of hospital falls and fall-related injuries within psychiatric inpatient units caring for the elderly?
- Which fall prevention processes could be implemented in these units to enhance the quality of care and minimize hospital-associated costs?
Direct observation will be carried out to obtain the most reliable information, while an indirect investigation will be conducted to expand the scope of the research (Ellis, 2013). Thus, the combination of the two methods will allow generating the empirical statements and obtaining the essential information about the sample group. To ensure that the empirical research project addresses the research questions, such criteria as progressiveness, the presence of focus, and a systematic approach would be applied during the implementation phase.
The important aspect of the design is record-keeping. It would be necessary to document all the crucial information related to internal and external causes of falls and injuries in senior patients suffering from mental illnesses. Also, the preventive measures applied in the healthcare institution should be investigated. In that matter, it could be useful to discuss the approaches with nurses engaged in inpatient care. However, there are ethical issues to be considered. During the participant observation, no names, personal or sensitive information would be collected or disclosed further. To avoid weak validity and reliability of the research results, the triangulation method would be used (Ellis, 2013). It would enable eliminating subjectivity when gathering evidence and finalizing the outcomes.
Sampling
In terms of the current research project, the sampling-for-meaning approach would be applied. It should be noted that the size would depend on the particular healthcare institution. The convenience sampling technique would be acceptable because the research is aimed at investigating the phenomenon in a fixed social setting (Ellis, 2013). This way the number of participants observed would enable determining general tendencies.
Tools
The tools needed for research implementation include:
- Interviewing tools;
- Participant observation tools;
- Technical tools.
It will be crucial to record all the data gathered during interviews with nurses. Both full and partial transcriptions could be made by the setting and the relevance of information. It will allow determining similar patterns within the entire study context. Further on, a research journal would help take notes regarding the participants (Ellis, 2013). This would be particularly important in terms of objectivity. In the case of miscommunication or biases, it would be possible to justify the solutions or results by relying on the records.
Flow Map
The current research will be implemented following the sequence displayed in Figure 1.
In this flow, each new stage emerges from the previous one to ensure the adequate progression of the study (Ellis, 2013). In the beginning, it is important to make the research question as precise as possible. After that, the study can be conducted within the limits of the research objectives. When the data is collected, the general patterns would be determined, and the results would be presented for further dissemination.
References
Bunn, F., Dickinson, A., Simpson, C., Narayanan, V., Humphrey, D., Griffiths, C.,…Victor, C. (2014). Preventing falls among older people with mental health problems: A systematic review. BMC Nursing, 13(4), 1-15.
Ellis, P. (2013). Understanding research for nursing students. Thousand Oaks, CA: Learning Matters.
Faes, M., Reelick, M., Melis, R., Borm, G., Esselink, R., & Olde Rikkert, G. (2011). Multifactorial fall prevention for pairs of frail community-dwelling older fallers and their informal caregivers: A dead end for complex interventions in the frailest fallers. JAMDA, 12, 451-458.
Quigley, P. A., Barnett, S. D., & Friedman, Y. (2014). Reducing falls and fall-related injuries in mental health: A 1-year multihospital falls collaborative. Journal of Nursing Care Quality, 29(1), 51-59.
Sakamoto, Y., Ebihara, S., Ebihara, T., Tomita, N., Toba, K., Freeman, S.,…Kohzuki, M. (2012). Fall prevention using olfactory stimulation with lavender odor in elderly nursing home residents: A randomized controlled trial. Journal of the American Geriatrics Society, 60(6), 1005-1011.
Wesson, J., Clemson, L., Brodaty, H., Lord, S., Taylor, M., Gitlin, L., & Close, J. (2013). A feasibility study and pilot randomised trial of a tailored prevention program to reduce falls in older people with mild dementia. BMC Geriatrics, 13(89), 1-12.