The Theoretical Framework Research Paper

The Theoretical Framework Research Paper

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The Theoretical Framework: Patient Falls

The foundation for all nursing actions is nursing theory. To put it another way, they justify any actions done to avert or treat any health conditions. Grand theories, mid-range theories, as well as practical theories can all be used in nursing (Wayne, 2023)The Theoretical Framework Research Paper. Nursing theories serve the purpose of directing practice by providing the conceptual framework necessary to describe and justify it. It is feasible to link the efforts made to avoid accidental falls among elderly patients to a theoretical framework that supports the precise conceptual framework for implementation. This is the purpose of this paper.

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The Two Theories Selected, Process and Logic in Selection

The two nursing theories that have been chosen here to guide the reasoning and interventions about the prevention of patient falls are:

1. The theory of Human Caring by Jean Watson (Alharbi & Baker, 2020), and
2. The Self-Care Deficit Theory (SCDT) by Dorothea Orem (Borji et al., 2017).

Examining the current healthcare problem and the required solutions was a step in the process of choosing the aforementioned two theories. To effectively prevent accidental falls especially among the elderly, the main preoccupation will be rehabilitation and education where feasible.

The nurse’s responsibility is to provide considerate treatment in a healing setting. The nurse’s responsibility also extends to treating the elderly who lack access to evidence-based treatment. The selection of these two middle range nursing theories was properly logical (Risjord, 2018). The theory of human caring supports the requirement for compassionate, all-encompassing nursing care, which the aged and frail require (Guirguis-Blake et al., 2018)The Theoretical Framework Research Paper. On the other hand, the SCDT serves as the cornerstone for offering assistance to those who are unable to look after themselves. In this case, these are the elderly patients with comorbidities and possible neurodegenerative disorders (dementia) who have a deficit of self-care.

The Way Each Theory/ Model Applies to the Individual Project

1. The Theory of Human Caring

Ten carative elements form the foundation of Jean Watson’s Human Caring theory. These are the guiding principles for translating theory into reality in fall prevention. They consist of:

• Divinity and faith in miracles.
• Creating a culture where decisions are made using evidence only.
• Keeping the big image in mind (i.e. physical, psychological, spiritual, cultural, and emotional) (Providence, 2023)The Theoretical Framework Research Paper.

The elderly patient population, particularly those over the age of 65, frequently experiences accidental patient falls. Many older people find themselves susceptible to falls due to aging and the natural decline in bodily functions that goes along with it, which causes avoidable morbidity and mortality. In actuality, falls account for the majority of injuries among this group (Kenny et al., 2017). According to the theory of Human Caring, these elderly persons at risk therefore need empathetic, compassionate, and loving care to prevent falls.

1. The Self-Care Deficit Theory (SCDT)

In this project, the elderly patients at risk of accidental falls have a self-care deficit. This is due to the fact that they are frail and suffer from several comorbid physical conditions already. These include diabetes, hypertension, heart disease, and osteoarthritis amongst others. These conditions as well as the effects of the medications used to manage them render this population demographic susceptible to falls and hence have a self-care deficit. As a matter of fact, this is also the same population demographic affected by neurocognitive disorders such as Alzheimer’s disease (APA, 2022)The Theoretical Framework Research Paper. These NCDs cause dementia and hence spatial disorientation, confusion, memory loss, language problems, and learning deficits. These further tremendously widen the self-care deficit.

The Framework Guiding the Study

The study’s framework is founded on some fundamental ideas that will guide the interventions. The concepts come from the two theories mentioned above. These guiding principles are:

• That the subjects are unable to assist themselves because of their cognitive impairment.
• That the subjects require love, compassion, empathy, selflessness, and an enabling and conducive healing atmosphere in order to be rehabilitated back to health.
• That they also require assistance in making the most of whatever functionalities they still possess so that they can live a secure and healthy life.

Assumptions of the Framework

• The problem of falls can be solved by intentional nursing rounds every hour, intelligent bedside alarms, and staff training. (AHRQ, 2018; Gavaller et al., 2019; Guirguis-Blake et al., 2018 ; Kenny et al., 2017)The Theoretical Framework Research Paper.
• Non-pharmacotherapeutic measures (playing games, jigsaw puzzles, art and craft) will supplement the three interventions above to manage cognitive impairment.

Key Components of the Framework

• Education and training of staff in risk identification and management.
• Hourly purposeful nursing rounds.
• Using bedside alarms.
• Ensuring a safe environment such as not leaving wet floors.
• Rehabilitating the cognitively impaired.

How Each Element of the Phenomenon Applies to the Framework and the Rationale for the Sample Selection Criteria

Physical comorbidities: This element will be taken care of by ensuring that the comorbidities that the patient has are well managed. For instance, the blood sugar for diabetics should be within euglycemic levels at all times. Hypoglycemia will predispose the patient to accidental falls. Likewise, a very high blood pressure reading may give headaches and lead to seizures that will definitely cause a fall (Hammer & McPhee, 2018)The Theoretical Framework Research Paper.

Hourly rounding: This will involve the nurses taking turns to move around evaluating the situation of the elderly patients every hour. In doing so, they have the chance to correct any abnormality they see that may cause a fall.

Alarms: In the event that a patient at risk attempts to leave their bed, this alarm will sound and alert the nurses to the impending fall.

Training: The nurses and nurse assistants will undergo training on risk identification and what to do in the event that a patient at risk is identified.

A national survey is not practical due to expense considerations, which is the justification for the sample selection. Thus, random sampling will be used to choose a representative group.

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Analysis and Critique of Pertinent Research

Research using this framework has as the independent variable the fact of being elderly and above the age of 65 years; while the dependent variable is the occurrence of an accidental fall. This is quite in order and follows standard practice. However, a number of confounding variables must also be controlled if valid and reliable results are to be obtained The Theoretical Framework Research Paper.

References

Agency for Healthcare Research and Quality [AHRQ] (2018). Preventing falls in hospitals. https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/index.html

American Psychological Association [APA] (2022). Diagnostic and Statistical Manual of Mental Disorders-Text Revision (DSM-5-TR), 5^th ed. Author.

Gavaller, M., Gavaller, M., & Oh, H. (2019). Impact of bed alarm removal and implementation of hourly rounding to reduce falls. Journal of the American Medical Directors Association, 20(3), B19. https://doi.org/10.1016/j.jamda.2019.01.080

Guirguis-Blake, J., Michael, Y., Perdue, L., Coppola, E., & Beil, T. (2018). Interventions to prevent falls in older adults. JAMA, 319(16), 1705. https://doi.org/10.1001/jama.2017.21962

Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8^th ed. McGraw-Hill Education.

Kenny, R., Romero-Ortuno, R., & Kumar, P. (2017). Falls in older adults. Medicine, 45(1), 28-33. https://doi.org/10.1016/j.mpmed.2016.10.007

Project Aims, Desires, and Outcomes: Patient Falls

Everyone agrees that hospital patient accidents involving slips occur frequently among elderly patients. Their weakness, age-associated physiologic decline, and condition of having numerous comorbid chronic diseases as well as neurodegenerative illnesses all contribute to this. Interventions based on evidence are necessary to stop these accidents because this is a problem with healthcare quality that needs to be improved. According to the Agency for Healthcare Research and Quality (AHRQ, 2018), Gavaller et al. (2019)The Theoretical Framework Research Paper, and Guirguis-Blake et al. (2018); some of these evidence-based strategies for reducing falls among the elderly are hourly nursing rounds, bed alarms, and staff training. This paper looks at the aims, the desires, and the outcomes of a project to reduce patient falls among the elderly in a residential rehabilitation center.

Project Benefits

This project will have tangible benefits in terms of cost, time, and quality. Elderly fall victims will incur significant financial or income losses for the organization involved, in addition to the costs associated with morbidity and mortality for the patients. This is due to a policy adopted by the Centers for Medicare and Medicaid Services (CMS) in 2008 that prohibits payment for services provided to individuals who suffer accidental accidents in healthcare facilities (Fehlberg et al., 2017). As a result, the organization will lose this source of income and will be responsible for paying the patient’s bill. In addition, the patient may file a lawsuit against the healthcare provider for negligence in a court of law. If the suit is successful, more funds will be lost by paying for damages awarded. Looking at all this, preventing falls will confer a lot of benefits in terms of cost to the organization.

The other benefits of this project are in terms of time and quality. By saving the elderly residents from accidental falls, they will recover fast and their rehabilitation will be shorter. This means that their stay at the facility will be shorter and so they will save time and money. Lastly, because these interventions by this project are evidence-based, they bring assured quality and improvement in the services offered. The Theoretical Framework Research Paper

Goals and Objectives

This project has goals and objectives that are agreed upon by all stakeholders. These are:

3. To reduce the fall rate among the elderly in the nursing home to below the federal average rate of falls of 3.44 falls per 1,000 patient stays (Venema et al., 2019) within six months.
4. To cut the number of malpractice or professional negligence lawsuits by 90% with regard to accidental patient falls by the end of one year.

• To conduct bi-annual staff training focusing on nurses and nurse assistants in risk assessment and application of effective falls prevention measures.

1. To reduce the length of hospital stay and readmission rates for at least half of the elderly residents by the end of six months.

Considered Variables

A number of variables will be considered. Some will be under the control of the project manager, while others will not. Examples of these are the budget, time, and resources. This project aims to implement this change concerning accidental falls within the whole organization. For this reason, it has been allocated its own budget but this may not be sufficient due to paucity of fiscal resources. The project manager partly has control over the budget in that he or she controls the spending. However, they do not have control over contingent expenses that may arise.

The other variable over which the project manager has part control is time. They control the project schedule so that it may be completed on time. However, contingencies may arise to prolong the project beyond the expected completion date. These contingencies have to be dealt with before the project can proceed so that objectives are achieved as desired. The last is resources. These include fiscal, human, and material resources and the project manager also only has part control over them. As every manager knows, resources are always finite and so they must always be used carefully. In this case, these will include money for expenses and wages, trainers, supervisors, and equipment such as alarms The Theoretical Framework Research Paper.

Gathering Data and Contribution to Social Change

The data for this project will be gathered from the electronic health record (EHR) dashboard. This data will almost exclusively be quantitative in nature. This means the method that will be used to analyze it will be quantitative in nature too. The project will contribute immensely to the community in terms of social change. When falls occur, they impact not only the patient but also their families. This impact is financial, emotional, psychological, and social. Preventing falls therefore saves families within the community agony and anxiety. This is what the social change this project brings looks like.

Desired Outcomes

The project purpose is to reduce the rate of falls and improve the quality of life of the elderly residents of the rehabilitation center. The focus is on their physical and psychological well-being and the viewpoint of the project is an overall improvement in the quality of care. The expected accomplishments are lower fall rates, lower readmissions, and lower number of days stayed. The timeline for accomplishing this project is six months The Theoretical Framework Research Paper.

 References

Agency for Healthcare Research and Quality [AHRQ] (2018). Preventing falls in hospitals. https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/index.html

Fehlberg, E.A., Lucero, R.J., Weaver, M.T., McDaniel, A.M., Chandler, M., Richey, P.A., Mion, L.C., & Shorr, R. I. (2017). Impact of the CMS no-pay policy on hospital-acquired fall prevention related practice patterns. Innovation in Aging, 1(3), 1-7. http://dx.doi.org/10.1093/geroni/igx036

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Gavaller, M., Gavaller, M., & Oh, H. (2019). Impact of bed alarm removal and implementation of hourly rounding to reduce falls. Journal of the American Medical Directors Association, 20(3), B19. https://doi.org/10.1016/j.jamda.2019.01.080

Guirguis-Blake, J., Michael, Y., Perdue, L., Coppola, E., & Beil, T. (2018). Interventions to prevent falls in older adults. JAMA, 319(16), 1705. https://doi.org/10.1001/jama.2017.21962

Venema, D.M., Skinner, A.M., Nailon, R., Conley, D., High, R., & Jones, K.J. (2019). Patient and system factors associated with unassisted and injurious falls in hospitals: An observational study. BMC Geriatrics, 19(348), 1-10. https://doi.org/10.1186/s12877-019-1368-8 The Theoretical Framework Research Paper