Exam 1
- In experimental studies, the subjects receive treatment and are observed, and a control group is used to verify the effect of the intervention performed on the experimental group. On the other hand, in non -experimental studies, the subjects are not subjected to any process of treatment. In this study, the subjects have not received any treatment at all and data is collected from archived secondary sources. Additionally, experiments usually have both dependent and independent variables. Finally, experiments involve randomization of the sample population into groups which are later to be subjected to specifically defined treatment. This is a non-experimental design. The data that the study used was basically from archived sources.
- The general objective of this study was to find out the rate of use of call light to alert nurses in the clinical areas and the average time of response by nurses to the call light usually affect the rates of fall by patients and their susceptibility to injury from such falls in areas of acute care in hospitals. The study thus intended to find out how nurses responsiveness to call light affected the frequency or rate of fall injuries in patients.
The problem statement of this study was that there was a dearth of literature on the connection between these two variables, suggesting insufficient study on the same topic. This study therefore sought out to fill this gap in knowledge.
- Accidental falls for patients being nursed in the inpatient departments in the hospital makes the highest incidence of accidental falls. Inpatient falls result from accidental trips, slips or fall when nurses are not available to assist them. This is in essence is due to delayed response to call lights. It has been found that such falls have the potential of making the patients stay for a long time in the hospital, lead to injuries and compromise the independence of a patient. When they need help, for example with medication and bathroom needs, normally they may call the nurses verbally or in most cases, use call lights when the nurses are not in close proximity to seek their attention.
Patients use the call light to summon the nurse to provide them with information or to assist them. It is the expectation of the patient that the cue for help through the call light will alert the nurse who will then come to assist them. Nurses though, have been documented to view the call lights merely as interruptions and noise, disrupting them from doing their normal tasks. This disparity between the patient and the nurse regarding the use of call lights is regarded to be at the core of the safety of the patient especially when nurses do not respond and they resort to attempt activities which jeopardize their safety. This problem emanating from the use of call lights may also be significant in affecting the relationship and communication between the nurse and the patient. It has been suggested that 3 components are related to the use of call lights. First is response to the call light, second is responding to the patient need which necessitated the use of call light. Third is the effort by the nurse to follow through with the request made by the patient. Patients often feel frustrated with call lights which go unanswered. It is important that nurse perceive call lights as way in which the patients assess the sensitivity of the nurses and the hospital to the patient needs.
According to the Joint Commission( 2005), the causes of falls can be categorized as either intrinsic or extrinsic. Intrinsic causes include factors such as unstable gait, low vision, muscular or skeletal disorders or state of the mind or acute and chronic comorbidities. The extrinsic factors include may include factors related to medication, rails, height of bed, slipperiness of the floor, lighting and the absence of support equipment in the toilets and the bathtubs. More vulnerable are the patients who come for the first time with acute, serious conditions or who have just been through treatment, surgery or some other procedure( Reiling, 2006). According to Hignett and Masud ( 2006) senile patients who are 80 years old or more are vulnerable to intrinsic causes while those who are between 65 and 70 years are more likely to experience falls from intrinsic causes. The research previously conducted have identified that there is dearth of research on the assessment of the programs and recommendations on this issue( ibid). Secondly, research has also identified that there is no potential for reproducibility of the recommended interventions in different environments. Third is that the cost effectiveness of the interventions is in question (Oliver et al 2007). A study conducted by Tzeng and Yin ( 2008a) identified that according to the perspectives of the nurses and the nurse attendants factors leading to lack of use of call lights included inability to identify the priorities of the patients, misconception on why the call lights are being used by the patients and the challenge of implementing timed observations. Solutions to solve the problems arising from the extrinsic factors that may lead to falls from the viewpoint of the nurses include improvement of teamwork and division of work among the nurses and patient attendants with regard to call light response and making rounds to find out how the patient situations are (Tzeng and Yin, 2008b).
- According to Culley(2008)hourly nursing rounds have been existent for quite some time. However, lately they have been used more to reduce the noise and interruptions caused by use of call lights in ways that are not necessary. Documented ways to reduce call light use include hourly rounds and patient service partner program( Gersh, 1996). Meade et al(2006), studying on the most recurring use of the call lights, identified the top reasons for patients use of call lights to include bedpans, bathroom assistance, help with intravenous line or pumps. Hourly rounds was identified to reduce fall rates.
- The study framework was Donabedian’s model. This is a model that examines the quality of care in health systems. It is components are structure, process and outcomes. In the case of this study, the indicators of the outcome are the injurious fall rates and the total fall rates. These outcome parameters are related to such process variables as the quality of nursing care and safe hospital stay as measures through the use of call light response rate by the nursing staff.
- The major objective of the research was to determine the relationship between the use of call lights initiated by either family or patients and the response time to the call lights and the rates of falls and resultant injuries from the falls.
The study question was, ‘‘what are the correlations between the use rate of call lights by patients and their relatives and the response time to call lights by nurses and the rate of occurrence of falls and the resultant injuries?’’
The hypothesis of the study was ‘the call light use rate and the response time by the nurses to the call light contribute to the total fall and resultant injuries from falls.’
7. The independent variables are the factors which cause the presumed effect while the dependent variable is the independent effect. It is the independent variable that is manipulated to cause the desired effect on the dependent variable. In this study, there are three variables.
a. The use of call rate lights by the patients and relatives
b. response time to call lights by the nurses
c. rate of occurrence of falls and injurious falls
In this study, the three variables are the important study elements. The first two variables, i.e. the rate of use of call lights by the patients and relatives and the response time by the nurses are the two factors which are interventions to find out their effect on the rate of occurrence of falls. Therefore the effect in this case is the rate of occurrence of falls and injurious falls. It is therefore the dependent variable.
8. The study design for this particular research study was exploratory research design. The study used data collected from Michigan University hospital. The time period when this study was conducted was between February 5th 2007 and June 29th of 2008. This is the time when the archived data was retrieved for data collection. The data that was collected was in lieu of the use of call lights by patients, the mean time response by the nurse, the mean fall rate and the level of patient satisfaction of the patients in four ward units.
9. There was no manipulation of the independent variable in this study. This is due to the fact that the study was a non- experimental research study. The data used was derived from secondary data from the files in the hospital database. Therefore there was no treatment of the subjects at all.
10. The data sought was with regard to inpatients who had been admitted in the Michigan University hospital. Their data according to the criteria already described was used.
11. Regarding sample and the sampling technique, the sample was a total of 288 patient data. This information was drawn from four inpatient units. 87 beds were in two medical wards and 111 beds were in two other wards one surgical and the other being used as combined ward for both medical and surgical cases. Within one week, a total of 288 individual patient data were collected.
12. The method of data collection in this study is secondary data collection method. The technique used is data archiving of the information already contained in the databases. In this technique, the information sought is collected from the data sources that are available. It is a convenient sampling method because the researcher has chosen one facility where he will conduct his study based on convenience.
13. There were no data collection instruments being administered in this study.
14. No data collection instruments are reported to have been used in this study.
The results of this study were as follows. One way ANOVA and Tukey difference tests revealed statistically significant findings for the mean values on call light use rate through all the wards - the surgical, medical, and combined wards. The values for the mean for call light use rates were between 3Æ60–6Æ08 counts for every patient day. At the same time, regarding the call light response time, there as a statistically significant difference between the mean values obtained with data from the surgical and medical units and mean time ranged between 3 min 2Æ86 seconds to 3 mins 30Æ72 seconds. There was a significant statistical difference in the mean differences between the combined and the surgical units.
In terms of Pearson correlation analysis, with high rate in use of call light, there was a corresponding length in the time of response from the nurses in the medical unit. With all the data points, when the call response rate was much higher, there was however, a decrease in the fall rates. For the combined unit( medical and surgical) with increase in the response time of the call lights there was however a lower injurious fall rate. With high average call light response rate, there was subsequent lower fall rate. With the medical unit, high average call light response rate was associated with lower fall rates. For the combined unit (medical and surgical), high call light rate of use resulted into lower injurious fall rate.
15. Descriptive statistics is science of describing quantitatively the major features of a research study( Mann, 1995). The study used both univariate and bivariate analysis. The use of mean in determining the average response rate is evidence of univariate analysis. The use of bivariate analysis is evident when the researcher uses Pearsons and Spearman’s rho. Because Pearsons correlates have been described above, the Spearmans rho will be described here. With high call light use rate, there was a longer call light response time.. there was a correlation coefficient of 0Æ55 (p < 0Æ01 when all data points were used. With all data points, there was a lower injurious fall rate with high call light use rate. With long call light response time, there was however lower fall rate. With the data from the medical unit, high call light response time was associated with lower fall rate. For the combined unit, injurious fall rate was lower with high use of call light use rate.
16. the statistics used to answer the hypothesis and the research question was , ‘’there as a statistically significant difference between the mean values obtained with data from the surgical and medical units and mean time ranged between 3 min 2Æ86 seconds to 3 mins 30Æ72 seconds. There was a significant statistical difference in the mean differences between the combined and the surgical units.’’
17. The results of this study were statistically significant. The statistical analysis through ANOVA showed statistical significance of the findings. For example, the mean call light response time obtained from the data obtained from the surgical unit and the surgical and medical units showed a range between 3 min 2Æ86 seconds to 3 mins 30Æ72 seconds. Also for the fall rates, there was a statistical significance in the mean differences between the data obtained from the surgical unit and that obtained from the combined unit. There was statistical significance for all the parameters studied.
18. The study found that there was statistically significant evidence that the use of call lights, the average time for nurses response affected the rate of occurrence injurious falls. This was in tandem with the hypothesis.
19. One study limitation was the fact that this study utilized data only from one hospital. The data from other hospitals could have provided data which can be used more broadly. Another limitation is the single minded focus of the researcher on the data regarding patient call light response time by nurses. However, issues like staffing or the patient nurse ratio have the potential of contributing to delays in nurses response and therefore such confounding issues should be put in perspective, which the researcher did not.
20. Having pointed out that the study relied on data from only one facility, it is therefore imperative to conclude that the results from this data can only have limited generalizability to the hospital where the study was conducted.
References
Curley C, McEachern JE & Speroff T (1998) A firm trial of interdisciplinary rounds on the
inpatient medical wards: an intervention designed using continuous quality improvement. Medical Care 36(8 Suppl), AS4–AS12.
Gersch P (1996) Initiating a patient service partner program. Nursing Management 27, 46–50.
Hignett S & Masud T (2006) A review of environmental hazards associated with in-patient falls.
Ergonomics 49, 605–616.
Joint Commission (2005) Defining the problem of falls. In Reducing the Risk of Falls in Your
Health Care Organization (Smith IJ, ed.). Joint Commission, Oakbrook Terrace, IL, pp. 13–27.
Mann, Prem S. (1995). Introductory Statistics (2nd ed.). Wiley
Oliver D, Connelly JB, Victor CR, Shaw FE, Whitehead A, Genc Y, Vanoli A, Martin FC &
Gosney MA (2007) Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses. BMJ 334, 82.
Reiling J (2006) Safe design of healthcare facilities. Quality and Safety in Health Care 15(Suppl.
1), i34– i40.
Tzeng HM & Yin CY (2008a) The extrinsic risk factors for inpatient falls in hospital patient
rooms. Journal
of Nursing Care Quality 23, 234–242.
Tzeng HM & Yin CY (2008b) Nurses’ solutions to prevent inpatient falls in hospital patient
rooms. Nursing Economics 26, 179–187.
