The proposed intervention for this study is comprised of two parts. The first is proper fall assessment upon admission of the elderly patient and the second is customized fall prevention plan for the elderly patient. It is necessary that a thorough and proper assessment is done because the fall prevention plan has to take into consideration all the different factors that would contribute to the elderly patient’s performance in the hospital. The contents of the plan are based on the results of the assessment of the patient. It is customized because the individual characteristics of the patient, including his/her age, physical capabilities, and combination of medications, are different from that of the next elderly patient that gets admitted. To evaluate the effectiveness of the proposed intervention, this research shall conduct the methods described below and analyze the variables described in the succeeding sections.
Methods
The following methods will assess whether the intervention has been effective or not.
Selection of a control and intervention group. The intervention group would be the elderly patients admitted within a one-month period and who shall receive the customized plan. A control group will come from the elderly patients admitted to the hospital within the past six months who match the admitted patients in the study. The control group’s record of falls within the hospital will be used to compare whether the intervention is more effective. The control group will be contacted by the hospital and asked to participate in the survey that is being done. They shall be sent survey questionnaires asking them about the fall prevention procedures they have experienced in the hospital.
Formulate criteria for customized fall prevention plan. The researcher shall meet and discuss with nursing staff and leaders about what consists a customized plan. They shall decide on which aspects would be included in the customized plan. Using the existing protocol or procedures, they would then decide on how to use such instrument to customize the plan for each elderly patient. They then decide on the indicators of a customized plan. A checklist will also be drafted to determine whether such plan is already tailor-made.
Survey of patients’ acceptance and satisfaction of intervention. Questions shall include the length of time for assessment, degree of difficulty, and clarity of questions during interviews. Items asking about satisfaction or acceptance shall be in a likert-scale beginning with not satisfied to most satisfied. The survey shall include a few open-ended questions such as “What difficulties did you encounter in the assessment” and “What are your suggestions to improve the fall prevention program?” These questions will be collated and included in the patients’ feedback data.
Survey of staff’s attitude about customizing plans. Since customizing plans is expected to take longer hours and more detailed interviews by the nursing staff, it is expected that there would be negative reactions from the staff. Questions here are aimed at determining the level of acceptability of the intervention among the staff. Open-ended questions will also be included, such as “What aspects in the customizing process needs to be improved” and “How can we improve the fall prevention plan?”
Interviews with patients, family members, staff, and supervisors. The interviews with the patients and family members focus more on the acceptability of the customized plans and how such plan worked for the patients. The interview with staffs and supervisors focus more on their attitudes towards the intervention.
Obtaining rates of fall incidence before and after the intervention. Since number of fall incidence is the outcome measure, it is very important to gain access to these numbers from the hospitals. An instrument will also be formulated so that the patient or family member can record the number of falls up to six months after the patient’s admission to the hospital.
Variables
The following variables will be measured in the study to identify their relationship. The dependent variable would be fall incidence while the main independent variable is the customized plan. Other independent variables are patient’s characteristics, staff attitude, and patient’s attitude. Control variables as well as instrumental variables may also be identified in the study.
Patients’ characteristics. Each of these (age, gender, residence-whether alone, with family, or in nursing homes, chronic diseases, kinds of medications, fall history) will be evaluated to identify whether there are relationships between these variables and fall incidence. Characteristics will also be combined with customized plan to assess the group effects.
Fall incidence. The number of falls during the hospital stay is the primary outcome measure. This is also the dependent variable of the study.
Staff’s attitude and perceptions. These include being open to customizing, acceptance of customizing, and non-belief of the intervention. The attitude and perceptions will be measured through surveys and interviews.
Patient’s attitude and perceptions. These include acceptance of the intervention, disregard for customizing, and tolerance of assessment procedures. The survey questionnaire can collect these data while the interviews can get more detailed information about the effects of the customized plan in their elderly patient’s hospital stay.
Tools to educate project participants
Participants will be provided information in person and through documents, such as flyers and brochures. During interviews and assessments, the nurse will discuss with them the aims of the research. They will be informed of the procedures that will be done in connection with the data-gathering methods. The participants will be asked to validate the research results too.
Outcomes will be assessed through an evaluation questionnaire and focused-group discussions. A validation workshop will also be conducted prior to the final preparation of the research report. The comments and feedback from the elderly patients, hospital staff, family of elderly, and leaders of the hospital are important contributions to the study. The researcher will prepare a separate form for this data, and include a section in the interviews and questionnaires aimed at obtaining such feedback.
References
Bernard, H.R. (2000). Social Research Methods: Qualitative and Quantitative Approaches. London: Sage Publications, Inc.
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