Dealing with elderly patients in various nursing scenarios can be challenging in a number of ways. One of the biggest risks to these patients is falls, as these can lead to a number of different health issues, including fractures and psychological distress (Campbell, 2016). As such, much research has been conducted with the aim of understanding what can be done to prevent these falls. Hourly rounding by nurses working with elderly patients is one area of interest, as it has been shown to significantly reduce the incidence of falls in nursing units (Campbell, 2016). The purpose of this paper is to explore the work of Johnson (2015) on assessing the effects of an hourly rounding program on the incidence of falls in a Trauma Unit in Northern California on the incidence of falls.
Article Analysis
Research Question
The main research question for this study was whether the implementation of the LEAF program (a previously validated approach to reducing falls which includes the implementation of hourly rounding) had a positive impact on the number of falls in this Trauma Unit. The study aimed to assess whether the rates of falls can be reduced simply by introducing a scheme that is specifically targeted at giving patients more access to nursing staff on a regular basis. Another research question was focused on understanding what nurses felt about the LEAF program and how the staff members dealt with the challenges of implementing it.
Research Design
This study had a mixed-method design. The quantitative data was gathered by measuring the pre- and post-intervention rates of falls. This is a quasi-experimental approach as there is a control and an intervention group, but these have not been manipulated by the researcher. The quantitative information was gathered based on a questionnaire delivered to nursing staff about how they felt about the LEAF program.
Sample Selection
The study was focused on one Trauma Unit in Northern California. To measure the incidence of falls, the sample included all patients in this unit who had suffered a “sudden, uncontrolled, unintentional, downward displacement of the body to the ground or other object” (Johnson, 2015, p45). Patients who experienced falls as a result of trauma or in transit were not included in statistical data. For the questionnaire part of the research, nurses were asked to participate based on convenience sampling. A total of 51 nurses out of the 68 working on the unit responded to the study.
Data Collection
The data was collected by assessing the rates of falls on the unit from before the intervention and compared against the rate of falls after the implementation of the LEAF program. These were then noted as a figure representing the number of falls per 1,000 patient days. The data for the qualitative section of the research was collected using an internet survey, which was then advertised to all of the nurses working on the trauma unit. This was then stored electronically and a correlational statistical analysis was conducted in order to assess for trends in the responses.
Limitations
There were a number of limitations in this study. The first was that the sample size for both portions of the research was small, and the population was fairly homogenous in terms of race, age, and gender. This makes it difficult to assess whether there are any significant results that can be applied to the LEAF program in other areas and whether the results can be generalized to other units. Another issue was that the questionnaire part of the study was a self-report style, which meant that there could be reporting bias in terms of what the nurses wanted to say about the LEAF program and what they felt uncomfortable noting, despite the fact that the results were kept anonymous.
Findings
Overall, there was a decrease in the rate of falls after the implementation of the LEAF program, from 25 to 22 falls, which is a change of 12% (Johnson, 2015). This suggests that LEAF program has a net positive effect on the number of falls in this type of unit, despite the fact that the sample size is small and may be prone to bias. This result was placed in the context of previous research on the topic and it was found that the LEAF program, and its focus on hourly rounding, has been shown to be significantly associated with a reduction in the incidence of falls in a number of different nursing units and scenarios.
The effects of hourly rounding on the nursing staff themselves were also considered. 82% of the participating nurses felt that the LEAF program had a positive impact on the number of falls in the unit, despite the fact that they do not see many falls. The participants also felt that the hourly rounding element of the LEAF program was challenging because of staffing levels and the number of demands on their time within the unit, which made it difficult to stick to an hourly rounding routine whilst still meeting the needs of the patients themselves (Johnson, 2015). Interestingly, 20% of the respondents also felt that their colleagues did not contribute enough to meeting hourly rounding needs, which suggests that communication is a key element in determining whether an hourly rounding regimen will be successful in preventing fall. 58% of the nurses also felt that hourly rounding was only done by nurses, rather than physicians, so this could also be an area for improvement.
Article Summary & Relevance to Nursing
Overall, the study gave insight into the use of the LEAF program and its focus on preventing falls in a trauma unit. It suggests that the LEAF program and hourly rounding can have a positive effect on the number of falls observed, as seen in this study. It was also shown that nurses generally feel comfortable with hourly rounding and believe that it has a positive impact on the number of falls. This type of mixed-method design is useful in understanding the effects of an intervention not only on the patients, but on the nurses themselves. In practice, this is important as the nurses themselves have to be accepting of the program before it can be successfully implemented. This survey is also a useful tool for analyzing how best to implement an hourly rounding schedule and the problems that nurses sometimes have when implementing it.
In terms of practice, the results of this study show that hourly rounding as part of the LEAF program reduces the number of falls in the trauma unit. It suggests that this type of program will be a useful tool in helping elderly and at-risk patients. Overall, the relevance of this study to nursing is that it shows how to implement an hourly rounding schedule, and the difficulties that are present when trying to implement it. Further research could investigate whether the results of this study are consistent with results in a larger hospital, or focus specifically on the elderly. Despite this, the study gives support to the idea that hourly rounding is one of the best ways of preventing falls, and that it can be implemented in specific units as a protective mechanism for patients on these units. It also suggests that discussions with nurses about how to implement fall prevention programs is a useful tool.
References
Campbell, B. (2016). Patient falls: Preventable, not inevitable. Nursing Made Incredibly Easy, 14(1), 14–18.
Johnson, S. K. (2015). Measuring the effectiveness of a flexible multidisciplinary hourly round fall prevention program. Retrieved from http://scholarworks.calstate.edu/handle/10211.3/135864
