Write a paper (1,500-words) in which you analyze and appraise each of the (15) articles identified in Topic 1. Pay particular attention to evidence that supports the problem, issue, or deficit, and your proposed solution.
Hint: The Topic 2 readings provide appraisal questions that will assist you to efficiently and effectively analyze each article.
Refer to “Sample Format for Review of Literature,” “RefWorks,” and “Topic 2: Checklist.”
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center
Topic 2: Checklist
Review of Literature and Incorporating Theory
Instructions:
This checklist is designed to help students organize the weekly exercises/assignments to be completed as preparation for the final capstone project proposal. This checklist will also serve as a communication tool between students and faculty. Comments, feedback, and grading for modules 1-4 will be documented using this checklist.
Topic Task Completed Comments / Feedback Points
Review of Literature
• Analyze and appraise each of the 15 articles identified in module 1. (15 articles). _____ / 90
• Analysis organized using the sample provided in “Sample Format for Review of Literature.”
_____ / 10
Total _____/100
Incorporating Theory • Identified a theory that can be used to support proposed solution. _____ / 10
• Main components of theory described. _____ / 10
• Rationale for selecting theory provided. _____ / 10
• Discussed how theory works to support proposed solution.
_____ / 5
• Explained how theory will be incorporated into project. _____ / 5
Total _____/40
This is what I did for last week’s assignment
Identifying a Problem
Falls in the elderly are common especially in the hospitalized population. According to the CDC there is an elderly fall in every 17 seconds that require medical treatment and every 30 minutes an older person die from fall (Hill & Fauerbach, 2014). There are 2% to 12% patient’s at least experience fall during hospital stay and it may be higher on stroke units (Hill & Fauerbach, 2014). Fall can cause serious injuries to the patient, lead to death, and inconvenience to the staff, unhappy families, and loss of money to the hospital and can even lead to law suits. Falls needs to be prevented and reduced in the hospitals. Are we doing enough to prevent falls? Does the call light and side rails are enough? Checking patient every hour can meet their needs. Hourly rounding can significantly prevent falls during hospital stay.
Most of elderly hospitalized patients have multiple health problems. They may have physical imbalance due to advanced age, dementia, Alzheimer disease, confusions, electrolytes imbalance, cardiac arrhythmias, hypoglycemia, hypoxia, ECT. Medications such as blood pressure medications, diuretics, laxatives, narcotics and sedatives can lead to falls in elderly patients. Diuretics can increase the patient need to go to bathroom frequently and more prone to fall. Falls can cause minor as well as major injuries such as a skin abrasion, fractures, contusions and head traumas. Environmental conditions such as wet or slippery floors, unreachable belongings, multiple IV lines, bed wetting also increase fall rate in elderly patients. I strongly recommend hourly rounding with each patient can reduce or prevent falls in hospital for some extent, while doing proper rounding we can monitor and resolve most of the patient needs.
Hourly rounding is a promise that between patient and nursing staff that they will be return in every hour to meet patient needs. This will help to build a positive relationship and improve patient and family satisfaction. Quality care provided during their hospital by being physically present for patient needs.
Nurse’s main priority during work is their patient safety, which include to recognize who are at high risk for falling. Patient falls are identified as a quality indicator and resolved by quality care by nursing staff (Hicks, 2915). In 2008 Center for Medicare and Medicaid services identified falls as a hospital acquired condition and no longer reimbursed due to the condition should be prevented by using evidence based care (Hicks, 2015). The financial imbalance happens to the hospitals due to fall. An estimated 19 million cost in 2000 and 30 billion in 2010 to care for fall injuries (Hicks, 2015). The nurses have to take charge to prevent falls to protect the hospital from financial crisis.
Many of these falls occurs while patient to use the washroom for elimination needs. It is important to meet patient needs as needed in order to prevent falls. Hourly rounding can significantly reduce call lights. Hourly rounding done by either nurse or nursing assistant to make sure the patients’ needs such as pain, position and potty are met every hour. Educating the staff the purpose of hourly rounding, accountability and improving patient safety. Hourly rounding logs are placed on each patient’s door for the staff to initial and document patient’s position. Hourly rounding logs are monitored by the manager daily for employee to be accountable for their responsibility. This was enforced to reduce the fall and improve patient satisfaction. This will reduce the need for the patient to get up without assistance.
According to the caring around the clock model first the nursing staff need to be educated on the purpose, skills needed for hourly rounding. The nurses should understand the hourly rounding can provide better patient care, increased control over workload and prevent falls. Senior leadership also round on the patients to enhance staff engagement and recognize and coach the nursing staff (Hutchings, 2012). Rounding can reduce call lights and improve patient care.
Falls are a significant reason for morbidity and mortality in elderly. Falls can occur due to many reasons but as a nurse it is our priority to prevent falls and protect the patients. Articles indicates that hourly rounding does improve patients fall. Frequent bedside checking can recognize the need and care provided for the patients to eliminate getting out of bed without assistance. Even though there are many interventions can reduce falls and hourly rounding is key for improving safety and quality care.
References
Hicks, D. (2015, January-February). Can rounding reduce patient falls in acute care? An integrative literature review. Medsurg nursing, 24(1), 51-55.
Hill, E., & Fauerbach, L. (2014, summer). Falls and fall prevention in older adults. Journal of legal nurse consulting, 25(2).
Hutchings, M. (2012, April 12). Caring around the clock: rounding in practice. Nursing Times, 108(49), 12-14. Retrieved from www.nursingtimes.net
Rapid Appraisal
1. Outcomes and challenges in implementing hourly rounds to reduce falls orthopedic units.
The purpose of the study was to evaluate the possibility of adapting and translating a structured nursing rounds to reduce the risk and incidence of fall on two orthopedic unit. Fall assessment and risk assessment data were collected at baseline, during we-week SNRI implementation and 1 year following implementation. Number fall per 1,000 hospital days were 4.5, 1.6 and 3.2 for the three periods. The patients who fell during period were not at greatest risk. This study indicates that the fall rate significantly improved during the SNRI implementation and increased after a year. The study enforce the need for the nurse continue to practice rounding everyday (Tucker, Bieber, Attlesey-Pries, Olson, & Dierkhising, 2012).
2. ‘Caring around the clock’: a new approach to intentional rounding
This article introduce a unique approach to intentional rounding using clock at the bedside. The project was supported, piloted and introduced across 79 wards over 14 months. Article enforce the need for training to achieve commitment from nursing staff to focus on patient benefits. The study identified a 52 percent reductions in the falls. These study also reviewed the literature from Medline and CINAHL. Falls rate were decreased in seven of nine studies that evaluated the rounding and falls (Hutchings, 2013).
3. Can Rounding reduce patient falls in acute care? An integrative literature review
Falls are the leading cause of nonfatal and trauma related injuries in the elderly. Falls in the hospital settings directly related to quality of nursing care. In this literature multiple studies are summarized that rounding decreased falls per 1,000 patient days. Hourly rounding is an autonomous intervention that helps nurse keep patient safe by proactively meeting their needs. Decreasing patient falls improve patient outcomes and decrease the cost related to falls in the hospital (Hicks, 2015). This literature support the intervention to reduce fall by hourly rounding.
4. Caring around the clock: rounding in practice
Introduced hourly ward rounds to a large acute trust to reduction in calls and fall rates. A combination of transformational leadership and meaningful interactions developed new approach to rounding- caring around the clock. The trust piloted on 10 wards with results showing a reduction in falls. But the literature doesn’t specify the percentage of reduction. The literature identified that a successful change of practice required an investment in staff education (Hutchings, 2012). This literature enforce the idea that much education is needed before implementing new research.
5. Falls and Fall prevention in older adults
Patient falls have a tremendous financial effect on our healthcare system resulting from increased healthcare needs and decreased reimbursement issued by insurers. More important is the devastating effect falls with serious injuries inflict on patients and their families. This literature discuss different types of fall, risk factors of fall and to identify the high risk patient by using fall risk assessment tool. The literature discuss many interventions to decrease fall including hourly rounding. During rounds, nursing staff should check the “4 Ps”: pain, potty, positioning and possessions to meet the patient needs (Feuerbach & Hill, 2014). This article support the need for preventing fall and hourly rounding can be one of the interventions.
6. Hourly rounding for falls prevention: a change initiative
Fall related injuries are the specific concern in elderly population. It is necessary to develop creative strategies to significantly reduce fall and injuries. This article identify the process of starting an hourly rounding in the health care facility. It was not successfully adopted initially then it was reinforced to make changes necessary for the nursing staff to collaborate to improve patient safety (Dyck, Thiele, Kebicz, Klassen, & Erenberg, 2013, p. 153). This article support the need for implementing hourly rounding in the facilities.
7. Hourly rounding: A Strategy to improve patient satisfaction
Hourly rounding is about engaging patient and meeting their needs. Hourly rounding contributes to achieving high levels of patient satisfaction and safety. This article particularly researched at the patient satisfaction during hospital stay but also indicates the improvement in safety. This study more focus on satisfaction and support safety of the patient during rounding (Ford, 2010).
8. Falls prevention for elders in acute care: an evidence-based nursing practice initiative.
This study was taken place an acute medical unit to reduce falls. This particular initiative was taken place due to high number falls. Unit practice council developed evidence-based intervention including teaching to patients, staff, families and a structured hourly patient rounds implemented. This article support the use of hourly rounding to reduce falls (Murphy, Labonte, Klock, & Houser, 2008, p. 33).
9. Hourly Rounding: A Replication Study
Preventing falls in hospitalized patients, increasing patient satisfaction, and decreasing call light usage are constant challenges nurses face every day. This study is done on rounding protocol, demonstrating improvements. Authors found a decrease in the patient fall rate from 6.1 to 2.65 falls per 1,000 patient days, a reduction in call-light usage (62.5%), and an increase in patient satisfaction to 87% (Olrich, Kalman, & Nigolian, 2012). This study support the implementation of doing hourly rounding.
10. Hourly rounding and patient falls: What factors boost success?
A 30-day prospective pilot study was conducted on two units with pre and post implementation evaluation to determine the impact of patient centered proactive hourly rounding on patient falls as part of a Lean Six Sigma process improvement project. Where staff and leadership were engaged in the project from the outset, the 1-year baseline mean fall rate was 3.9 falls/1,000 patient days. The pilot period fall rate of 1.3 falls/1,000 patient days was significantly lower than the baseline fall rate. On Unit 2, where there was no leadership was involved, the 1-year baseline mean fall rate was 2.6 falls/1,000 patient days, which fell, but not significantly, to 2.5 falls/1,000 patient days during the pilot period (Goldsack, Bergey, Mascioli, & Cunningham, 2015, p. 25) . The study support that leadership involvement and documentation for accountability will help to continue rounding and improve fall rate.
11. Effectiveness of Structured Hourly Nurse Rounding on Patient Satisfaction and Clinical Outcomes
Structured hourly nurse rounding is an effective method to improve patient satisfaction and clinical outcomes. This program evaluation describes outcomes related to the implementation of hourly nurse rounding in one medical-surgical unit in a large community hospital. Overall Hospital Consumer Assessment of Healthcare Providers and Systems domain scores increased with the exception of responsiveness of staff. Patient falls and hospital-acquired pressure ulcer decreased during the project period ((Brosey & March, 2014, p. 153). This study support the proposed interventions.
12. Hourly Rounding to Improve Nursing Responsiveness
This systematic review determined that the evidence supporting the use of hourly rounding in inpatient care was of low to moderate strength. Although the individual studies are of weak research design and have inconsistent reporting quality, the quantity and consistency of the evidence on hourly rounding lead us to conclude that it improves patients’ perception of nursing staff responsiveness in units where this may have been a problem, reduces patient falls and call light use, and improves patient satisfaction scores (Mitchell, Lavenberg, Trotta, & Umscheid, 2014, p. 462).
13. Nurses’ Perceptions of Patient Rounding
Nurses identified rounding as valuable and perceived hourly rounding to be beneficial to patients and families but significantly less beneficial to their own professional practice. Challenges to rounding as a practice include issues of documentation, patient ratios, and skill mix. Findings support the need for further research to address the challenges of patient rounding for nursing (Neville, Lake, LeMunyon, Paul, & Whitmore, 2012, p. 83). This literature discuss the nurses and patient benefits regarding hourly rounding but not significantly looking at the fall rate.
14. Effects of nursing rounds on patients call light use, satisfaction and safety
A protocol that incorporates specific actions into nursing rounds conducted either hourly or once every two hours can reduce the frequency of patients’ call light use, increase their satisfaction with nursing care, and reduce falls. Based on these results, study suggest changes in hospitals, emphasizing nurse rounding on patients to achieve more effective patient-care management and improved patient satisfaction and safety (Meade, Bursell, & Ketelsen, 2006, p. 58). These literature support proposal of rounding every hour.
15. Inpatient fall prevention programs as a patient safety strategy: a systematic review
Falls are a persistent problem in all healthcare settings, with rates in acute care hospitals ranging from 1.3 to 8.9 falls per 1,000 inpatient days, about 30% resulting in serious injury. The purpose this study was to reassess the benefits and harms of fall prevention programs in an acute care facility. The study shows there was 30% reduction in falls (Miake-Lye, Hempel, Ganza, & Shekelle, 2013, p. 390)
Most of the articles support that the hourly rounding reduce falls. In order to implement nursing rounding, pre education and leadership involvement is necessary.
References
Brosey, L., & March, K. (2014, September 18). Effectiveness of structured hourly nurse rounding on patient satisfaction and clinical outcomes. Journal Nurse care, 30(2), 153-159. http://dx.doi.org/DOI: 10.1097/ncq.0000000000000086
Dyck, D., Thiele, T., Kebicz, R., Klassen, M., & Erenberg, C. (2013). Hourly rounding for falls prevention: a change initiative. Creative nursing, 19(3), 153-158. http://dx.doi.org/Retrieved from
Ford, B. (2010, May/June). Hourly rounding: A Strategy to Improve patient satisfaction Scores. MEDSURG Nursing, 19(3), 188-191. http://dx.doi.org/Retrieved from
Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015, February). Hourly rounding and patient falls: What factors boost success? Nursing, 25-30. Retrieved from www.nursing2015.com
Hicks, D. (2015, January-February). Can rounding reduce patient falls in acute care? An integrative literature review. Medsurg nursing, 24(1), 51-55. http://dx.doi.org/
Hill, E., & Fauerbach, L. (2014, summer). Falls and fall prevention in older adults. Journal of legal nurse consulting, 25(2). http://dx.doi.org/Retrieved from
Hutchings, M. (2012, April 12). Caring around the clock: rounding in practice. Nursing Times, 108(49), 12-14. http://dx.doi.org/
Hutchings, M. (2013, September). Caring around the clock: a new approach to intentional rounding. Nursing management, 20(5), 24-30.
Meade, C., Bursell, A., & Ketelsen, L. (2006, September). Effects of nursing rounds on patients call light use, satisfaction and safety. AJN, 106(9), 58-70. Retrieved from http://nursingcenter.com
Miake-Lye, I., Hempel, S., Ganza, D., & Shekelle, P. (2013, March). Inpatient falls prevention programs as a patient safety strategy: a systematic review. Intern Med, 158(5), 390-396. http://dx.doi.org/DOI: 7326/0003-4819-158
Mitchell, M., Lavenberg, J., Trotta, R., & Umscheid, C. (2014, November 9). Houly rounding to improve nursing responsiveness. The journal of nursing administration, 44, 462-472. http://dx.doi.org/DOI: 10.1097/NNA.0000000000000101
Murphy, T., Labonte, P., Klock, M., & Houser, L. (2008, January-March). Falls prevention for elders in acute care: an evidence-based nursing practice initiative. Critical care nursing, 31(1), 33-39. http://dx.doi.org/doi:10.1097/01.0000306394.79282.95.
Neville, K., Lake, K., LeMunyon, D., Paul, D., & Whitmore, K. (2012, February). Nurses Perceptions on patient rounding. The journal of nursing administration, 42(2), 83-88. http://dx.doi.org/DOI: 10.1097/NNA.0b013e318243365e
Olrich, T., Kalman, M., & Nigolian, C. (2012, Jan-Feb). Hourly rounding: A replication study. MEDSURG Nursing, 21(123).
Tucker, S. J., Bieber, P. L., Attlesey-Pries, J. M., Olson, M. E., & Dierkhising, R. A. (2012, Feb). Outcomes and challenges in implementing hourly rounds to reduce falls in orthopedic units. Evidence based nursing, 9(1), 18-29. http://dx.doi.org/10.1111/j.1741-6787.2011
Last Completed Projects
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