Effective Strategies of Prevention of Falls for Geriatric Patients Older Than 65 Years
Geriatric patients represent a problematic category of individuals, who typically suffer from various illnesses and conditions as well as may have different problems with their health. Among the issues, which challenge these patients, may be physiological problems such as restrictions of movement, limited endurance due to chronic diseases and other. At the same time, physiological challenges are often combined with specific cognitive and psychological problems including dementia, Alzheimer’s disease, paranoia, etc. Apparently, the abovementioned factors contribute to the ratio of falls in geriatric patients leading to readmission, morbidity, and even mortality. For instance, Won-Jin, Moonyoung, and Duk-Hyun (2014) argue that elderly individuals were reported to be ten more times likely to be injured after falling on the floor. Moreover, experts approve that patient fall incident make discharge decisions difficult due to different risks to the patients’ health (Wingood, 2018). For these reasons, the intent of the proposed study is to explore the phenomenon of geriatric patients and the risk of their falling setting using the literature review.Apparently, nursing education is one of the most effective initiatives for preventing the risk of falls in geriatric patients since education programs for the nursing staff are directed toward elimination of various shortcomings in the organization of the processes of treatment and care.
The Significance of the Practice Problem
The study intends to explore the phenomenon of the fall of the elderly in medical institutions, approved by several academic studies. For instance, Hill et al. (2015) argue that geriatric patients have higher fall rates than other categories of patients reaching the statistic of 10-17 falls per 1000 patient bed days. The outcomes of fall incidents are diverse, but all of them negatively impact such aspects as the patients’ health and quality of life as well as their financial status. According to Atoyebi, Stewart, and Sampson (2015), 51% of residents in long-term care facilities fall at least once for 12 months, and 10-25% of them suffer from a severe trauma afterward. The main danger of such incidents is not only physical injuries (in up to 30% of the cases) but increased costs of treatment (Hill et al., 2015). Therefore, the outcomes of patient falls have an overall negative impact on the patient population. Along with it, patient fall incidents have risks that involve financial issues. The increase of medical expenses in the case of falls is associated with the increased lengths of hospital stay or frequent readmission as well as the need for treating the outcomes of falls. For instance, in the US, from 700.000 to 1 million patients fall in hospitals on an annual basis and “direct medical costs of falls among older adults, adjusted for inflation, were over $34 billion” (Ambutas, 2017, p. 175). Together with patients and their families, hospitals and clinics also have financial concerns regarding the adverse effect of patient falls associated with the responsibility for their injuries (Ambutas, 2017).
The responsibility for medical facilities is related to specific ethical issues since the nursing staff is responsible for granting high-quality and timely care (Ambutas, 2017). Any fall incident demonstrates that the team of a hospital failed to give the required level of care, which resulted in the patient’s trauma or mortality. Also, fall incidents may lead to financial penalties claimed by patients and their families for unethical care and violation of legal contracts related to care. Therefore, the adverse outcomes of patient fall incidents affect not only patients and nurses but hospitals, clinics and the health care system.
Finally, the outcomes of a fall of a geriatric patient may be ultimately adverse since specific traumas and health conditions may lead to his or her death. Mortality is one of the most severe hazards of patient falls in a hospital setting as it has comparatively high rates in elderly individuals (Ambutas, 2017). For instance, Burns and Kakara (2018) claim that in 2016, a total of 29,668 residents of the US of an adjusted age rate of 61.6 years per 100,000 individuals died as the result of a fall in a hospital facility. Moreover, the analysis of the statistic of patient falls continues to increase as in 2007 there were 18,334 deaths of elderly patients resulting from falls (Burns & Kakara, 2018). Since the ratio of falls in elderly patients in a medical installation setting continues to increase, there is a need for revising the strategies used for preventing such incidents. The investigation would assist in improving the quality of lives of geriatric patients by presenting the most effective solutions of the problem of falls through the literature reviewed.
Research question
The objective of the research proposal is to review the literature that will help us to explore the effectiveness of nursing education in the prevention of falls in geriatric patients over 65 years of age. The research question of the proposal is in geriatric patients over 65 years of age. What mechanism or strategies are used in nursing education in fall prevention? According to the research framework, the effectiveness of nursing education in the prevention of falls would be compared with other strategies to prevent falls of patients. Therefore, the general objective of the research is to explore contemporary knowledge of the results of nursing education as a strategy to prevent falls in patients over 65 years of age. The research that is carried out is not a field study, but a review of the academic literature.
Hypothesis:
Research and null hypotheses are the two most critical aspects of the research proposals. According to experts, a hypothesis is a prediction about the statistical differences between or correlations of one or more variables (Henwood, 2014). In contrast, a null hypothesis is a hypothetical statement that presumes the existence of the absence of correlation between the analyzed variables (Henwood, 2014). The research hypothesis of the proposal is: Nursing education in patient fall prevention allows decreasing the statistic of patient falls in geriatric patients of the age of 65 years and older. The null hypothesis of the research proposal is: Nursing education in patient fall prevention does not lead to the decrease of the ratio of patient falls in geriatric patients of the age of 65 years and older.
Independent variable:
The independent variable of the research is the educative experiences of the nurses in the strategies of prevention of falls, while the dependent variable is the proportion of falls of the patients.
Dependent variable:
The dependent variable is the statistics of falls among patients aged 65 or older in medical institutions.
Definition of terms:
Nurse education – the process of sharing knowledge with nursing students or practitioners during which educators develop ethics-based organizational culture and transfer distinctive professional features and skills and human values to students following the principles of professionalism, justice, and equality (Boozaripour, Abbaszadeh, Shahriari, & Borhani, 2018).
A patient fall incident – an incident of falling of a patient in a hospital facility on the same level, from stairs and steps as well as falling after slipping, tripping, and stumbling (Yuying, Ying, Allen, & DeVivo, 2015).
Geriatric patients – a category of patients of an older age (roughly of the age of 65 years and older), who have a range of negative neuropsychological, nutritional, dental, cognitive, and muscular changes; geriatric patients require a more holistic approach to their assessment, care and treatment (Elsig et al., 2015).
Theoretical Framework
The central theoretical framework of the research is the Self-care Deficit Theory (SDT) developed by Dorothea Orem. Being a grand nursing theory, it offers a valid conceptual model for improving the aspects of self-care deficit in patients that are unable to perform free care for themselves. According to Orem, self-care is a range of actions performed by individuals to maintain life, health, and well-being (Shah, Abdullah, & Khan, 2015). Being a human regulatory action, self-care has a form of intentional acts typically available for physically and mentally healthy individuals (Shah et al., 2015). However, the accent of the scholar, who developed SDT, is on the fact that, due to various reasons, patients typically experience a deficit of physical or mental resources and require care and support of nurses. The main benefit of the Self-care Deficit Theory is that its ultimate goal is to enhance health, wellbeing and to sustain lives of the patients through such metaparadigms as health, person, environment, and nursing (Shah et al., 2015). Since the fundamental concept of SDT is the deficit of care, it applies to the investigations that focus on geriatric patients including the current research proposal. The basis for this suggestion is that geriatric patients have a high risk of developing morbidities and comorbid conditions and have restrictions in movement due to their diseases (Schrader et al., 2014). Moreover, this category of patients is more likely to have neuropsychological, cognitive, nutritional, and dental disorders than young and middle-aged adult individuals (Elsig et al., 2015). For the abovementioned reasons, Self-care Deficit Theory is especially relevant for geriatric patients since they experience various barriers to maintaining free care effectively due to multiple diseases and adverse health conditions.
Synthesis of the Literature
The objective of the performed literature review related to the research proposal is the formation of a relevant theoretical basis that supports the validity of the selected research question and the variables of the research. Moreover, the comparison and contrast of the results of different scholarly investigations allow finding the answer to the main question of the research. The scholarly literature selected for the study was obtained from such public online databases as Google Scholar, CINAHL and PubMed/MEDLINE Central. After evaluating the relevance of the found investigations to the selected research question, 25 academic studies were selected for further analysis. The review of the literature revealed that the researchers addressed the problem of finding a practical solution to prevent incidents of falls in geriatric patients in medical facilities through four types of perspectives. The perspective of the first type was the use of assessment tools for finding human-related, organizing-related, and education-related weaknesses. For instance, Pape, Schemmann, Foerster, and Knobe (2015) applied Aachen Falls Prevention Scale for revealing the role of patients in protecting themselves from the risk of falls. Using simple questionnaires, the scholars revealed that patients inadequately assess their individual risks associated with falls and require the assistance of nurses. Moreover, Yuying et al. (2015) found that geriatric patients in a hospital setting are endangered by numerous factors associated with their movement, which potentially lead to falling. Their assessment criteria revealed that older adult individuals are more likely to fall on the same level, from stairs or steps as well by slipping or stumbling, which is why such patients often need the support of knowledgeable nursing staff.
Experts argue that the use of screening tools alone cannot grant the improvement of the problems of patient falls since they may be disconnected from the hospitals’ policies and the practical interventions used by the staff. Morello et al. (2017) argue that the use of 6-PACK intervention, which is a combined instrument for assessment and mitigation of falls, allowed decreasing the incidence of patient falls in a hospital facility. Similar successful results were achieved by Aranda-Gallardo et al. (2017), who used STRATIFY and Downtown risk assessment tools for revealing the most typical factors that lead to patient falls and mitigating them. However, scholars highlight that the use of the assessment tools should not be detached from fall prevention initiatives such as nurse education. For example, Castellini, Demarchi, Lanzoni, and Castaldi (2017) found that irrelevant use of screening tools such as STRATIFY leads to the unbalanced distribution of resources and inadequate training and education programs for personnel. Similarly, Wingood (2018) claims that nurse education programs have to be modified in order to address the most typical gaps in fall-prevention strategies used in hospitals and clinics. Therefore, regular investigation of the risks of falls in geriatric patients cannot be characterized as an effective strategy of fall prevention until nurse apply the results obtained using screening tools for updating their educational programs.
The second perspective considered by the scholars in their search for the solution to the problem of falls of geriatric patients is the role of cognitive and virtual training and stimulation for patients as well as IT tools for nurses. The scientific interest in these methods is connected with technological progress and the potential of different simulation tools to affect the cognitive functions of geriatric patients in a beneficial way. For instance, Blackwood, Shubert, Fogarty, and Chase (2016) revealed that computerized cognitive training of geriatric patients positively affected their cognitive impairments known to influence fall risk. Similarly, in the research by Hsieh et al. (2014) scientists improved body stability of geriatric patients by using Kinect as a virtual reality training system. The scholars presume that the achieved improvement would assist geriatric patients in avoiding the risks of falls, but they do not test the hypothesis. For this reason, experts have not found a direct connection between body stability training and re-education of fall incidents in geriatric patients. Finally, Atoyebi et al. (2015) suggest that along with education on fall prevention, nurses can increase their awareness of fall incidents supplying patients with accelerometers, sensors, electronic walkways, and bed-exit alarm systems. Although the abovementioned strategies for fall prevention may be valid, the experts clearly demonstrate that the major parts of fall prevention practice are not effective unless they involve the assistance of nurses. However, the nurses require specific education and training for assisting the patients to avoid the risk of falling in a correct way.
The third perspective of fall prevention, which may be prospective for patients according to experts, is the introduction of special training and exercise programs for patients under the supervision of nurses. For instance, the investigations performed by Bae and Cho (2014) and Seong-Il and Duk-Hyun (2014) approved that the introduction of programs for training the geriatric patients’ postural balance and muscle strength decrease the statistic of fall incidents. The positive result of the impact of such practice is achieved by improving the physical condition of the patients and rehabilitating their movement functions. For example, in a research by (Kwon-Young, 2014), the experimental geriatric patients aged 65 and more performed indoor gateball exercise for 30 minutes on a daily basis, 5 times a week. Due to these exercises, the experimental group of patients improved its fall index from 36.87±0.11 to 41.75±0.83 (Kwon-Young, 2014). However, the results in decreasing the incidence of falls of geriatric patients through exercising sometimes achieve controversial results. Thus, in the research by Jun-Ihci and Sumiko (2014), the patients demonstrated the increase of self-confidence to prevent fall after a series of rehabilitation exercises. However, the scholars failed to measure the actual impact of physical training of the patients on their ability to avoid falls.
Several similar investigations of exercising also failed to verify the presence of direct correlation between their interventions and the ratio of patient falls. For instance, the analysis of the effectiveness of Fall Arrest Strategy Training (FAST) by Arnold, Wallker-Johnston, Lanovaz, and Lattimer (2017) revealed that FAST effectively increased the strength of upper extremities of the participants (p=0.007). As a result, the scholars presumed that their intervention led to the decline of the statistic of patient falls. Nevertheless, the analyzed research failed to test the presence of a direct correlation between the application of FAST and the decrease in the statistic of falls in geriatric patients. Lastly, an investigation by Lee and Kim (2017), which analyzed the effect of exercising on fall prevalence in 5,540 geriatric patients, approved that this intervention is effective (Risk Ratio decline to 0.85 in 95% of the cases). At the same time, the scholars approve that the positive effect of exercising on fall prevention significantly increases in the case it is combined with other interventions such as nurse education on fall prevention (Risk Ratio decline to 0.61 in 95% of the cases) (Lee & Kim, 2017). For the abovementioned reasons, such factor as nurse education plays a critical role in assisting patients to avoid the risks of falls.
The scholarly investigations that measure the effect of nurse education on the ratio of falls of geriatric patients approve that the knowledge of nurses in fall prevention is a serious contribution to the decline of patient fall incidence. In particular, Huey-Ming and Chang-Yi (2015) in their study of top ten interventions to prevent adult patients from falls found that nurses often disregard the importance of education in fall prevention. However, using psychometric testing, de Medeiros Araújo et al. (2017) revealed the presence of a positive effect of fall prevention education programs on 16 nursing specialists in a Brazilian hospital. In particular, after special education, the nurses demonstrated the improved control of restlessness in the cases patients were taking medications associated with a high risk of falls (de Medeiros Araújo et al, 2017). However, not every study that assessed the effect of staff education in fall prevention on the ratio of patient falls approved the presence of a beneficial effect of this strategy. For instance, the investigation by Uymaz and Nahcivan (2016), who assessed the effect of hospital education program for nurses on 46 patients, revealed that specific education programs have a potential to improve the effectiveness of fall protection interventions. In the program had a positive impact on the nurses’ knowledge regarding medications as a risk factor for falls and assisted them in developing protective fall behavior (Uymaz & Nahcivan, 2016). However, the scholars indicate that the program failed to reduce the statistic of patient falls although the nurses obtained a higher skill in protecting patients from falls.
A specific part of academic investigations demonstrates that not every educational tool has a high potential to educate the nursing staff in effective fall prevention strategies and methods. For instance, Hoffmann, Neumann, Golgert, and Renteln-Kruse (2015) compared the effects of Longitudinal Urban Cohort Ageing Study (LUCAS) and STRATIFY on the incidence of fall prevention and found that the proportion of fallers dropped to 12,5% and 10,7% respectively. Therefore, LUCAS tool can be characterized as the one that has a more effective program for educating nurses in fall prevention. Disregarding this fact, the experts highlight that it is a problem to develop a universally effective fall prevention education program due to the variable prevalence of patients’ fall-risk factors over time. For this reason, Hoffmann et al. (2015) advise applying LUCAS or STRATIFY tool as a part of continuous staff education and training programs for them to be effective. Thus, the actual effect of education programs in patient fall prevention for the nursing staff depends on their design, the prevalent factors, which lead to patient falls in a particular setting and the longitude of their application. The revealed information is approved by the study performed by Majkusová, Jarošová, Zeleníková, and Kozáková (2016) as these scholars compared and contrasted 53 clinical practice guidelines for nurses that focus on fall prevention of adult patients. Their investigation revealed that the analyzed risk assessment and fall prevention guidelines had a methodological quality of 82% to 84%, which is a high score (Majkusová et al., 2016). At the same time, the scholars come to a conclusion that the success of each program in a concrete hospital setting depends on the ability of the staff to adapt the guidelines to concrete socio-cultural and organizational environments.
The studies that focus on the analysis of the application of clinical practice guidelines (CPG) in fall prevention demonstrate that the effect of the implementation of CPG depends on the staff preparedness to put knowledge into action. In Breimaier, Halfens, and Lohrmann (2015) performed a mixed-design study for revealing the effect of fall-prevention education programs on the students in an Austrian university teaching hospital and tested the ability of the participants to apply the CPG-related knowledge. According to their findings, the nursing personnel had to spend at least 1192 hours of training for being able to perform relevant actions that lead to the decrease of the ratio of patient falls (Breimaier et al., 2015). Therefore, the presence of a fall-prevention program in a hospital does not lead to the decrease of the ratio of patient falls unless such program has a CPG that educates the nurses how to apply fall-prevention knowledge and skills.
The analysis of the studies devoted to the assessment of the effect of nurse education on fall prevention ratios demonstrates that the programs are not effective unless they consider the aspects of the setting and the prevalent factors associated with the falls of the patients. For example, a study by Morris and O’Riordan (2017) shows that education programs in fall prevention must to consider multiple factors associated with falls of the patients and rigorously measure the actual performance of CPGs. According to their research, an adequate identification of risks for patients in a concrete facility or unit and the measurement of the effect of a CPG can reduce the incidence of patient falls by 20-30% (Morris & O’Riordan, 2017). For these reasons, nurse education and measurement tools related to fall-prevention have to undergo the procedure of adaptation to concrete conditions of a hospital or unit. This suggestion is approved by the research by Mikolaizak et al. (2017), who found that, in the analyzed clinical setting, the actual effect of fall-prevention strategies used by nurses was low except the cases when they supplied written instructions to their patients. According to their findings, the inclusion of the highlighted criterion allowed the nurses preventing patient falls in approximately 50% of the cases (Mikolaizak et al., 2017).
Another factor stressed by the experts in nurse education is that it is possible to achieve practical benefits from the education of nurses of fall-prevention strategies in the case of developing individualized education programs. Hill et al. (2015) assessed the effect of nurse education programs in fall prevention in 3606 geriatric patients with a median length of stay of 11 days. The intervention groups of patients, who received the care of nurses that had undergone individualized training in fall prevention, demonstrated a considerable decrease in the ratio of falls. Thus, the experimental group had 196 fall incidents per 1000 patient days whereas the control group had 380 fall incidents per 1000 patient days (Hill et al., 2015). Consequently, education programs must to consider such environmental factor as the identity of the patients and skills of the nursing staff. Moreover, a research by Singh (2015) suggests that education programs have to be directed not only toward the nurses of geriatric care facilities but toward every member of the nursing staff.
The findings of the scholar demonstrate that nurse education programs are of a higher effectiveness in the case they provide continuing education and training to interprofessional teams (Singh, 2015). An additional factor associated with the decline of patient fall ratios is a professional certification as a component of specific educational programs. For instance, a longitudinal study of the impact of the presence of national nursing specialty certification in registered nurses and the statistic of patient falls in their units performed by Boyle, Cramer, Potter, and Staggs (2015) approved a positive correlation between these factors. The considered findings suggest that the promotion of national nursing specialty certification is a valuable contribution to the positive effect of educational programs in fall prevention.
The performed systematic review of the literature found in online databases including Google Scholar and PubMed/MEDLINE Central published between 2014 and 2018 proves that nurse education in fall prevention reduces the ratio of falls in geriatric patients. However, the effectiveness of the considered strategy significantly depends on the level of adaptation of CPGs in fall prevention to concrete environmental, organizational, and cultural contexts. For instance, in some clinical settings, the patients can benefit from having educated nurses, who train them using virtual reality systems or exercise programs. In other settings, geriatric patients might benefit from exercising under the supervision of experienced nurses, which increases the strength of their muscles that protect them from falling. Moreover, nurses often require undergoing a practical training that bridges theory and practice and increases the chance to apply a timely and relevant fall-prevention intervention.
Practice Recommendations
The advantage of the review is that it includes the information obtained not only through academic sources published in English but also in Spanish and Brazilian (in the analysis, the research used English translation in their publication.). Therefore, the strength of the research is its attempt to find the correlation between nursing educations in the prevention of falls. The proportion of falls prevention through the consideration of a set of tests those are not limited to American medical environments. Although the literature reviewed, have specific differences in their design and goals. Research proved that the education of nurses in the prevention of falls has a positive effect on the problem of falls in medical institutions. The analysis of the academic literature devoted to the issue of nursing education in the prevention of falls allows us to affirm that no universally useful education program leads to the reduction of the proportion of falls in geriatric patients. The reason for this suggestion is that each medical institution has unique environmental, organizational and cultural contexts that require the adoption of a particular CPG. Therefore, the education of nursing personnel in fall prevention strategies is useful in the case of a specific CPG that is adapted to the typical risk factors of geriatric patients. Also, along with education, nurses must receive practical training to be able to put disseminated knowledge into practice.
Project Description
The proposed study intends to explore the phenomenon of geriatric patients and the risk of their falling setting using the literature review. This risk factor of falling might have a subsequent injury or a trauma. The typical client in this setting is a geriatric patient of the age of 65 years and older. The goal of the performed literature review research is to enhance the quality of lives of geriatric patients by exploring the efficacy of modern clinical strategies to reduce the risk of falls. Therefore, the findings of the project should improve the aspects of care for geriatric patients in specific units and nursing homes as well as caring for them in general medical institutions.
The primary stakeholders of the project are physicians, nurses, and the patients of geriatric units and their families. The primary stakeholders of the proposal are nurses and their patients at the age of 65 years and older. The secondary stakeholders are the administration of hospitals and clinics, physicians and personnel of laboratory rooms as well as the families of the patients and their relatives.
The research role in the study is the function of an independent analyst, who searches, verifies, and summarizes the evidence, which approves the presence of a positive correlation between the education of nurses in fall prevention and the decline of fall ratio of geriatric patients in their units and facilities. For the successful completion of the exploration, the research will wear such leadership qualities as honesty and integrity, commitment, accountability, decision-making, and creativity. The study will use such skills as analytical thinking, deduction and induction, summarization, visualization, and time-management. The application of the professional knowledge, skills and individual qualities allowed the investigator is designing the framework of the current proposal and performing a range of critical actions for its further validation.
The possible benefits of the performed literature review include the identification of the most effective strategies for the prevention of falls of geriatric patients in the medical institution (Breimaier et al., 2015). The revealed information would serve as a basis for the update of clinical practice guidelines for nurses, who work in various geriatric units. The expected change would allow putting the suggested recommendations into practice and improving the aspects of inpatient safety and care for patients of the age of 65 years and older. Along with the indicated social benefits, the study proposal is expected to bring specific personal benefits. On the one hand, the process of conducting the research would improve professional competencies of the investigator.
The sources and data collected from the web for the current research will be stored on the researcher’s USB drive for the next five years. The stored information data will be in total control of the personal investigator. The data from the literature review will be saved for the sole purpose of this study for a maximum of five years and kept in a secure location and then destroyed with a hammer.
With this research proposal, the personal investigator hopes to be able to demonstrate that nursing education is an effective strategy that allows reducing the number of falls of patients of 65 years or more in the hospital setting. Consequently, we would like to recommend that nurses and the administration of hospitals and clinics can implement new fall prevention strategies to improve the quality of life of elderly patients and save them from different risks to health, mortality and additional expenses.
References
Ambutas, S. (2017). Continuous quality improvement. Fall reduction and injury prevention toolkit: Implementation on two medical-surgical units. MEDSURG Nursing, 26(3), 175- 197.
Aranda-Gallardo, M., Enriquez de Luna-Rodriguez, M., Vazquez-Blanco, M. J., Canca-Sanchez, J. C., Moya-Suarez, A. B., & Morales-Asencio, J. M. (2017). Diagnostic validity of the STRATIFY and Downton instruments for evaluating the risk of falls by hospitalised acute-care patients: A multicentre longitudinal study. BMC Health Services Research, 171-9. doi:10.1186/s12913-017-2214-3
Arnold, C. M., Wallker-Johnston, J., Lanovaz, J. L., & Lattimer, L. J. (2017). Does fall arrest strategy training added to a fall prevention programme improve balance, strength, and agility in older women? A pilot study. Physiotherapy Write my essay for me – CA Essay writer Canada, 69(4), 323-332. doi:10.3138/ptc.2016-27EP
Atoyebi, O., Stewart, A., & Sampson, J. (2015). Use of information technology for falls detection and prevention in the elderly. Ageing International, 40(3), 277-299. doi:10.1007/s12126-014-9204-0
Bae, J., & Cho, S. (2014). Effects of community-based comprehensive fall prevention program on muscle strength, postural balance and fall efficacy in elderly people. Journal of Korean Academy of Nursing, 44(6), 697-707. doi:10.4040/jkan.2014.44.6.697
Batras, D., Duff, C., & Smith, B. J. (2016). Organizational change theory: Implications for health promotion practice. Health Promotion International, 31(1), 231-241.
Blackwood, J., Shubert, T., Fogarty, K., & Chase, C. (2016). The impact of a home-based computerized cognitive training intervention on fall risk measure performance in community dwelling older adults, a pilot study. Journal of Nutrition, Health & Aging, 20(2), 138-145. doi:10.1007/s12603-015-0598-5
Boozaripour, M., Abbaszadeh, A., Shahriari, M., & Borhani, F. (2018). Ethical values in nurse education perceived by students and educators. Nursing Ethics, 25(2), 253-263.
Boyle, D. K., Cramer, E., Potter, C., & Staggs, V. S. (2015). Longitudinal association of registered nurse national nursing specialty certification and patient falls in acute care hospitals. Nursing Research, 64(4), 291-299, doi: 10.1097/NNR.0000000000000107
Breimaier, H. E., Halfens, R. G., & Lohrmann, C. (2015). Effectiveness of multifaceted and tailored strategies to implement a fall-prevention guideline into acute care nursing practice: A before-and-after, mixed-method study using a participatory action research approach. BMC Nursing, 14(1), 1-12. doi:10.1186/s12912-015-0064-z
Burns, E., & Kakara, R. (2018). Deaths from falls among persons aged ≥65 years – United States, 2007-2016. MMWR: Morbidity & Mortality Weekly Report, 67(18), 509-514. doi:10.15585/mmwr.mm6718a1
Castellini, G., Demarchi, A., Lanzoni, M., & Castaldi, S. (2017). Fall prevention: Is the STRATIFY tool the right instrument in Italian hospital inpatient? A retrospective observational study. BMC Health Services Research, 17, 171-7. doi:10.1186/s12913-017- 2583-7
de Medeiros Araújo, J. N., Nunes de Lima Fernandes, A. P., Moura, L. A., Palhano dos Santos, M. M., Ferreira Júnior, M. A., & Fortes Vitor, A. (2017). Validation of nursing outcome content Fall prevention behavior in a hospital environment. Revista Da Rede De Enfermagem Do Nordeste, 18(3), 337-344. doi:10.15253/2175-6783.2017000300008
Elsig, F., Schimmel, M., Duvernay, E., Giannelli, S. V., Graf, C. E., Carlier, S., … & Müller, F. (2015). Tooth loss, chewing efficiency and cognitive impairment in geriatric patients. Gerodontology, 32(2), 149-156.
Henwood, K. (2014). Qualitative research. Encyclopedia of Critical Psychology, 1611-1614.
Hill, A. M., McPhail, S. M., Waldron, N., Etherton-Beer, C., Ingram, K., Flicker, L., … & Haines, T. P. (2015). Reducing falls in rehabilitation hospital units using individualised patient and staff education: a pragmatic stepped-wedge cluster randomised controlled trial. Lancet, 385, 2592-2599.
Hoffmann, V., Neumann, L., Golgert, S., & Renteln-Kruse, W. (2015). Pro-active fall-risk management is mandatory to sustain in hospital-fall prevention in older patients – validation of the LUCAS fall-risk screening in 2,337 patients. Journal of Nutrition, Health & Aging, 19(10), 1012-1018. doi:10.1007/s12603-015-0662-1
Huey-Ming, T., & Chang-Yi, Y. (2015). Perceived top 10 highly effective interventions to prevent adult inpatient fall injuries by specialty area: A multihospital nurse survey. Applied Nursing Research, 28(1), 10-17. doi:10.1016/j.apnr.2014.04.005
Jun-Ihci, W., & Sumiko, S. (2014). Self-confidence for fall prevention as well as physical fitness of elderly patients with chronic heart disease. Journal of Physical Therapy Science, 26, 12-17.
Kwon-Young, K. (2014). Indoor gateball’s influence on life satisfaction and the prevention of falls by the elderly. Journal of Physical Therapy Science, 26(12), 1885-1886.
Lee, S. H., & Kim, H. S. (2017). Exercise interventions for preventing falls among older people in care facilities: A meta-analysis. Worldviews on Evidence-based Nursing, 14(1), 74-80. doi:10.1111/wvn.12193
Majkusová, K., Jarošová, D., Zeleníková, R., & Kozáková, R. (2016). Assessing the methodological quality of clinical guidelines for preventing falls of patients. Central European Journal of Nursing & Midwifery, 7(4), 549-557. doi:10.15452/CEJNM.2016.07.0028
Manchester, J., Gray-Miceli, D. L., Metcalf, J. A., Paolini, C. A., Napier, A. H., Coogle, C. L., & Owens, M. G. (2014). Facilitating Lewin’s change model with collaborative evaluation in promoting evidence based practices of health professionals. Evaluation and Program Planning, 47, 82-90.
Mikolaizak, A. S., Lord, S. R., Tiedemann, A., Simpson, P., Caplan, G. A., Bendall, J., & … Close, J. C. (2017). A multidisciplinary intervention to prevent subsequent falls and health service use following fall-related paramedic care: A randomised controlled trial. Age & Ageing, 46(2), 200-208. doi:10.1093/ageing/afw190
Morello, R. T., Barker, A. L., Ayton, D. R., Landgren, F., Kamar, J., Hill, K. D., & … Stoelwinder, J. (2017). Implementation fidelity of a nurse-led falls prevention program in acute hospitals during the 6-PACK trial. BMC Health Services Research, 171-10. doi:10.1186/s12913-017-2315-z
Morris, R., & O’Riordan, S. (2017). Prevention of falls in hospital. Clinical Medicine, 17(4), 360-362. doi: 10.7861/clinmedicine.17-4-360
Pape, H., Schemmann, U., Foerster, J., & Knobe, M. (2015). The “Aachen Falls Prevention Scale” – development of a tool for self-assessment of elderly patients at risk for ground level falls. Patient Safety in Surgery, 9(1), 1-6. doi:10.1186/s13037-014-0055-0
Seong-Il, C., & Duk-Hyun, A. (2014). Effects of a fall prevention exercise program on muscle strength and balance of the old-old elderly. Journal of Physical Therapy Science, 26(11), 1771-1774. doi:10.1589/jpts.26.1771
Shah, M., Abdullah, A., & Khan, H. (2015). Compare and contrast of grand theories: Orem’s Self-Care Deficit Theory and Roy’s Adaptation Model. International Journal of Nursing, 5(1), 40-42.
Schrader, E., Baumgartel, C., Gueldenzoph, H., Stehle, P., Uter, W., Sieber, C. C., & Volkerf, D. (2014). Nutritional status according to Mini Nutritional Assessment is related to functional status in geriatric patients – independent of health status. The Journal of Nutrition, Health & Aging, 18(3), 257-263.
Singh, I. (2015). Training and professional development for nurses and healthcare support workers: Supporting foundation for quality and good practice for care of the acutely III older person. International Archives of Nursing and Health Care, 1(007), 1-6.
Uymaz, P. E., & Nahcivan, N. O. (2016). Evaluation of a nurse-led fall prevention education program in Turkish nursing home residents. Educational Gerontology, 42(5), 299-309. doi:10.1080/03601277.2015.1109403
Wingood, M. (2018). Documenting fall risk, balance impairment, interventions, and progress. Gerinotes, 25(1), 16-17.
Yuying, C., Ying, T., Allen, V., & DeVivo, M. J. (2015). Aging and spinal cord injury: External causes of injury and implications for prevention. Topics in Spinal Cord Injury Rehabilitation, 21(3), 218-226. doi:10.1310/sci2103-218
