Patient falls in inpatient settings
This paper will focus on the following components of the study, data collection and measurement, expected outcomes of the study, implementation of change, and evaluation of the impact of the change.
Data collection and measurement
Data will be collected via a semi structured interview. The study participants will be asked to provide demographic data such as gender, age, working experience, and level of education. The questions contained in the interview guide will be designed to acquire information related to the organizational system, attitudinal and other factors that prevent the successful adoption of evidence-based fall prevention practices by nurses. The interview questions will be framed in a way that they will facilitate the identification of change barriers at the individual professional, innovation, patient, social, and organizational, political and economic levels (Koh et al, 2008). Questions pertaining to the factors that facilitate change in the practice will also be incorporated. Each interview will last for half an hour. The participants will be given ample opportunity to explain their perceptions on the topic. The researcher will take handwritten notes during the interview. The interviews will also be recorded on tape.
After collection, the data will be analyzed via qualitative content analysis using NVIVO 10 software for thematic analysis. The tapes will be transcribed verbatim and a pseudonym assigned to each participant. The transcripts and the hand written notes will then be analyzed via multiple readings. Using the NVIVO 10 software and by reading the statements made by the participants, the researcher will interpret the emerging themes and carry out simple coding. The simple coding will be followed by a more advanced form of coding. The latter will be achieved via iterative and continuous immersion into the collected data. Qualitative thematic analysis will be used as the analytic tool because it enables the exploration of meanings, patterns, and themes that emerge from text (Hsieh & Shannon, 2005).
Expected outcomes of the study
The proposed study is hoped to facilitate the identification of the various organizational, professional-related, patient-related, innovation, societal, economic, and political factors that hinder the effective implementation of fall prevention strategies by nurses in these nursing homes. Identification of these local barriers to change will enable the development and adoption of implementation strategies customized to local situations or those that can overcome local barriers to change (Koh et al., 2008).
Implementation of change
Implementation of the identified changes will be done using the change model developed by Kurt Lewin in 1951. This change theory consists of three steps that are, unfreezing, movement and refreezing respectively. The first stage will entail creating discontent amongst nurses with the status quo. This will be accomplished by for instance, engaging the nurses in identifying the number and adverse consequences of the preventable patient falls that have occurred in their institutions so far. This will raise awareness on the need for change in the five nursing homes (Marquis & Huston, 2009, p. 168). In the movement stage, the customized fall prevention strategies will be implemented. The change will be implemented gradually to allow all those involved in the change process to become fully assimilated. At this point, the researcher who is also the change agent will ensure that the forces for the change exceed those against the change.
In the refreezing stage, the researcher will help integrate the change into the status quo. To do this, the change agent will reinforce and support the individual adaptive efforts of the nurses (Marquis & Huston, 2009, p. 168).
Evaluation of change
After the change has been implemented, evaluation of its success will be done. The evaluation will assess process and outcome measures. Process measures will assess the provision of patient care using evidence-based fall prevention strategies. The outcomes to be assessed, on the other hand, include measures such as the incidence of patient falls in the five hospitals (Hughes, 2008). The findings of outcome and process measures will be compared with the pre-implementation rates in each hospital to determine the impact of the change program. Comparisons will also be made across the five hospitals. External benchmarking against those of best performing hospitals will also be done.
Conclusion
In summary thus, data collection will be done via interviews which will be guided by a semi structured interview transcript. The information collected from the interviews will be subjected to qualitative analysis. The study is expected to facilitate the identification of organizational, patient-related, nurse-related amongst other factors that act as barriers to the successful utilization of evidence-based fall prevention practices by nurses. These findings will be used to plan and implement change targeted at overcoming these barriers. The 3-step Lewin change theory will be used to implement the identified change. The impact of the change will be measured as the difference in the pre-and-post change in process and outcome measures.
References
Hsieh, H.F., & Shannon, S.E. (2005). Three approaches to qualitative content analysis.
Qualitative health research, 15(9), 1277-1288.
Hughes, R.G. (2008). Tools and strategies for quality improvement and patient safety. In R.G.
Hughes (ed.), Patient safety and quality: An evidence-based handbook for nurses.
Rockville, MD: Agency for Healthcare Research and Quality (US).
Koh, S. S. L., Manias, E., Hutchinson, A.M., Donath, S., & Johnston, L. (2008). Nurses’
perceived barriers to the implementation of a fall prevention clinical practice guideline in
Singapore hospitals. BMC Health Services Research, 8, 105.
Marquis, B. L., & Huston, C. J. (2009). Leadership roles and management functions in nursing:
Theory and application (6th ed.). Philadelphia, PA: Wolters Kluwer Health/ Lippincott
Williams & Wilkins.
