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A Problem Of Fall Rates In Health Care Centers

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The documented statistics on fall rates in health care centers, especially among the elderly are alarming and projections depict that the situation is likely to worsen. Deteriorating health conditions, physical changes, and medications used to address various conditions and diseases are some of the factors that increases fall rates. In this regard, it is important to devise an approach based on a nursing theoretical model with an objective of preventing falls. Accordingly, the research paper seeks to use Change Theory Fall Model (CTFM) a framework for designing a program for preventing falls among patients in a medical care center. The primary objective of this intervention is to reduce the current rates of fall-related accidents by 50 percent within a period of one year. The study focuses on educating nurses who serve as the primary caregivers in hospitals through the use of brochures, posters, and handouts. In this perspective, the goal of the project is to instill knowledge of nurses regarding fall prevention interventions and ultimately, ensuring that the caregivers apply the gained know how to reduce fall rates among patients. The existing statistics on fall rates from The National Database of Nursing Quality Indicators (NDNQI) and Collaborative Alliance for Nursing Outcomes (CALNOC) will be compared to the data that will be obtained after the implementation of the proposed intervention.

Statistics show that approximately 30 percent of the patients aged 65 years and above experience at least one fall-related accident annually (Hempel, Newberry, Wang, Booth, Shanman, Johnsen, & Ganz, 2013). The chances of fall are directly proportional to age as a consequence of the weakening of the body. According to Bouldin, Andresen, Dunton, Simon, Waters, Liu, & Shorr (2013), over half of the patients aged 80 years and above fall annually. Existing studies show that the major causes of falls in patients include the failure of nurses to adhere to the fall prevention approaches such as the use of waterfall indicators, risk armbands, and socks with high skid resistance. Research has depicted that with workforce education and compliance to the interventions of reducing falls, the risks of falls among patient can be reduced substantially (Hempel et al., 2013). In this regard, the project will serve to bridge the gap between knowledge on fall intervention and the willingness of the staff members to ensure safety in healthcare units.

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In most cases, Human Resource Managers in healthcare centers fail to devote the necessary capital geared towards imparting nurses with knowledge that can reduce the risk of falls. According to a study conducted by Miake-Lye, Hempel, Ganz, & Shekelle (2013), in a medical care institution, only 40 percent of the primary caregivers are well versed with effective approaches to minimizing the rates of patient falls. The study also indicates that in the healthcare unit approximately 53 percent of falls results in injuries, which further worsen the condition of the patient. As such, it is evident that the lack of knowledge on fall prevention among the nurses has detrimental impacts and thus, design an intervention of educating the health care practitioners will go a long way in preventing falls. The project will rely on Clinical Outcomes Management especially Clinical Nurse Leader (CNL), which will serve to impart knowledge using evidence-based data with an objective of facilitating the learning process of primary healthcare givers.


There are various important terms to define with regards to this study. Fall prevention system refers to interventions of eliminating the chances of a fall. The aforementioned term must be distinguished from fall protection system that refers to a mechanism such as safety belt, which is used to ensure that the risk of fall among the patients is minimized (Bouldin et al., 2013). Another important term is safety rounds, which denotes the number of cycles a nurse goes around the hospital to ensure that all precautions of preventing falls such as fall sign, red socks, and armband are in place.

Knowledge of nurses in fall prevention systems, fall protection system, and the number of safety rounds will act as independent valuables in this study. To achieve the objective of this research project, the correlation among the aforementioned independent valuables and the dependent valuable (fall prevention) will be established.


This study has a goal of ensuring that primary caregivers learn, review and effectively implement fall prevention interventions with an objective of reducing the current rates of falls among hospitalized patients by 50 percent. The design of the plan involves educating nurses through the use of handouts, posters, and brochures, in a learning session of fifteen minutes. Medical approaches to preventing falls will be excluded from this study since it is based on a nursing framework (Change Theory). Stroke and surgical patients will also be out of the scope of this project.

Theoretical Rationale

To solve the problem presented in the research statement, this analysis will adopt the Lewin’s Change Model for managing falls and subsequent injuries in patients. A German-American, Kurt Lewin purposed to use his social-psychology knowledge to develop a nursing model that will affect a realistic kind of change to human conditions. It made him develop an interesting focus in groups, thereby identifying some of the factors that inform changes in people. As such, 3 stages are involved in the course of making people prosperous. He named them Unfreeze, Change, and Freeze. When all the three levels are completely satisfied, it is possible to achieve some significant change situation.

The first level of change is the Unfreezing stage. Probably, it is the most important since it involves preparing oneself for the change process. It is a psychological psyche that persuades a person that there is an urgent need for change and preparing oneself to move out of the comfort zone that does not present any good promises (McAlister, 2013). It is followed by the creation of a situation that should lead to the commencement of the change process. The more an individual appreciates the need for change, the more they will be motivated to desire it more. A person is supposed to set a deadline, and the more they will near the time limit, they will be bound to jump into rapid action and get the job started. Consequently, on the other side of the deadline will be a reward or a punishment. In the absence of a deadline, the patient’s urge to change will be greatly undermined because there will not be a strong need for change. The deadline acts as the motive or urgency that is supposed to strengthen our will towards action.

This stage of getting ready for change includes balancing the benefits against the disadvantages before one decides to take any action. This is called the Force Field Analysis (Sutherland, 2016). Accordingly, it is the parameter that is used to measure the factors that affect the change process, and which the individual is supposed to be aware of. In this regard, the process of “unfreezing” change is all about moving ourselves from the current situation towards the motivation to do something about it.

The second level of change is called the Transition. According to Kurt Lewin, change is more of a process than an event. As such, transition includes the inner journey that people always make while reacting to change. It usually takes place as the individual assumes the needed changes. It is always the hardest part since there is bound to be fear of the unknown. This is where external support is needed to assist the patient in learning about the changes needed and how to work through them.

The last stage is the Freezing stage, though it is known as Unfreezing by some quarters. It involves establishing some sense of stability after making the change needed. The mind is made to accept the acquired changes so that they become the daily norm.

Problem Statement

The issue of falls in medical centers poses serious risks when it comes to patient safety. According to a recent research, accidental falls feature as the most common incidences reported in major health centers, accounting for 2% of all hospital stays (Johan, 2014). Further, it unraveled that fall rates are associated with 3.5 to 10.9 falls per 500 patient days. What is more, the rates of fall in America vary considerably by type of unit. For instance, neurology, neurosurgery, and medical units are known to have lower rates compared to other departments (Johan, 2014). It is also assumed that patients who are contained in the intensive care units (ICU) are less likely to experience incidences of fall than patients in other units that are ambulatory. This is the major reason for the lower fall rates in those units. There are also some patient factors that are likely to lead to falls, including metal status, age, ambulation aids, the severity of illnesses, and others. According to a study conducted by CMC in 2013 revealed that 26% of hospital falls amongst patients lead to injuries, while 2% cause fractures (Coghlan & Jacobs, 2013). What is more, there are significant costs that are accrued while managing outcomes arising from falls. These include costs of patient care, the length of stay increases, and other financial liabilities. In addition, CMS reimbursements have greatly reduced as a result of frequent falls and injuries that are secondary to falls (Johan, 2014). This means that staff members are supposed to receive adequate education pertaining to the consequences of falls so enhance patient satisfaction and preserve the financial resources of health care institutions. The aforementioned study by CMC also highlighted the fact that patients who exhibit serious injuries from falls are always subjected to extra hospital stays that range from 6-12 days of hospital time, thereby leading to higher expenses than originally projected. They are associated with an additional $ 13, 316 more in comparison to their peers (Johan, 2014).

Research Questions

Do the various fall incidences that occur in hospitals lead to higher management costs and patient injuries that undermine their recovery process?

The Kurt Lewin model of change is crucial in imparting medical practitioners with the knowledge and skills required to prevent patient falls. It is based on the philosophy that prevention is better than cure. Based on this, the study will examine how the model equips nursing practice towards fall prevention in medical institutions.

Need for Further Studies

This study’s scope is to access how medical practitioners, especially nurses, could prevent the high prevalence of fall cases amongst patients who are still under recovery. These falls result from metal conditions, severe illnesses, and other situations that could be controlled to prevent further falls. All in all, the study does not look into how the model can be customized to become patient-centered. There is a need for further research to determine how patients can assume the responsibility of managing their own possible falls by using Lewin’s model of change to adapt to their new conditions. In this regard, it will not be resourceful to mentally ill patients but would go a long way in empowering other patients to prevent future falls.

Literature Review

A past study on fall prevention amongst adult patients in various hospitals in the United States, discovered some possible trends and patterns related to fall incidences in America. Accordingly, it collected normative data from various health institutions in America and collaborated with CMC to acquire respective data. In the end, the research stumbled on a total of 315, 817 falls that reflected the rate of 3.5 falls per 1000 patient visits. In addition, both injurious and total falls were highest in the medical unit department, reflecting a rate of 4.03 at 1000 patient days, while 1.08 per 1000 patient visits were associated with injurious falls (Johan, 2014). This source is critical to this study as it will provide a glimpse of the expected findings in measuring the relationship between the probability of a patient fall and the level of practitioner knowledge.


The research will take a quantitative approach with an objective of determining the relationship between the independent variable (probability of a patient fall) and the dependent variable (the level of medical practitioner knowledge). The choice of this method (quantitative study) is informed by the fact that respective data that describes how the variables relate is in numerical form. For instance, quantitative data will be obtained from thirty medical centers in America.

This study’s main purpose is to examine some normative data that capture the prevalence of falls in various medical centers in the United States. It will assume some 20-month secular fall trends before the passage of the rule by the Centers for Medicare and Medicaid Services (CMS) that discourages the reimbursement of hospitals that deal with injuries emanating from patient falls (from hospitals). As such, the study will rely on quantitative data that were collected from the National Database of Nursing Quality Indicators (NDNQI). The sample respondents will be sourced from the departments of adult medical, surgical nursing, and medical-surgical units. The study will rely on more than 300 patient days (Pd) to carry out observations on the sample participants from the three aforementioned units across 30 medical institutions in the United States.

Work Plan

The actual research process will commence on the 10th of January with drafting of a letter to the various healthcare institutions to seek their approval for conducting this study. The next step would be to advertise the research assistant vacancies for 4 individuals. It would be strategic to hire out senior year university students to help in the process of collecting data at the 30 public healthcare institutions. Next, possible secondary sources will be sourced from the Internet to help reinforce the hospital data (primary information). Later in the month, the obtained information will be corrected (cleaned) based on consistency with an objective of minimizing chances of biases and errors. Subsequently, research report writing will ensue and it is expected that the entire paper will be complete in a week’s time.


To complete the data collection process, some financial resources were needed, especially for compensating the four research assistants. The total cost of the project was $ 1, 420, with the four personnel receiving $ 300 for their labor of gathering numerical data from the 30 institutions and CMC’s database. Other funds were used for printing purposes and purchasing stationary. There were also transport, telephone, and internet charges.

The various activities related to the attainment of the underlying research goal, including the financial estimates are summarized in the table below. The whole process will go on for 20 days and will accrue a total of $ 1,420. See appendix A for more details.


Falls are common in healthcare institutions and could result in injuries that are expensive to manage and lead to prolonged patient stays. As such, going by the increased incidences of falls, fall prevention techniques have not been effective in preventing them. Evidence suggests that there is the need to let go of classical patterns and behaviors that focus on curative approaches as opposed to preventive ones. It is because there are financial losses emanating from patient falls. There are also other liabilities, such as legal suits. Medical practitioner time is also accrued in the course of treating injuries arising from falls. Based on this, there is the need to implement a new fall prevention measures that are multi-disciplinary. It includes one that allows staff to contribute ideas and initiatives that will lead to the multi-disciplinary discussions and models. One of them is the Kurt Lewin change model. It is used to enhance the fall risk awareness, thus equip medical practitioners with the skills of preventing patient falls. Thus, the actual research will focus on two main objectives, including to determine a fall management model that is change centered but also motivates staff morale, and to evaluate a fall management nursing model that educates medical practitioners about the consequences of confirmed falls to patients.


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