Preventing Patient Falls
The impending rise in the demand for health services requires effective utilization of the workforce, especially nurses in advanced practice. These nurses are part of a service model aiming to respond flexibly to the ever-changing needs of patients and families. Advanced Practice Nurses (APNs) have been found to enhance the overall quality of care and patient outcomes through the implementation of evidence-based practices (EBPs). For example, patient falls are a common cause of harm during hospitalization and various measures are proposed for prevention. Among the top EBP for fall prevention is the use of intentional rounding (IR) in acute healthcare settings (Morgan et al., 2017). APNs can help in implementing this strategy and educating other nurses to improve fall prevention in acute care settings.
The identified article for this discussion deals with intentional rounding to prevent patient falls in an acute adult care setting. According to the researchers, the implementation of IR has gained prominence as an intervention to improve patient safety, outcomes, and satisfaction (Christiansen et al., 2018). Using this approach, healthcare professionals regularly check on patients to ensure their needs are met and risks for falls are identified. The systematic mixed-method review aimed at determining the impact of intentional rounding on patient and nursing outcomes. Additionally, the research aimed at identifying the barriers associated with intentional rounding implementation. Twenty-one articles from CINAHL, MEDLINE, EMBASE, COCHRANE, SCOPUS, and WEB of SCIENCE database were analyzed and findings were synthesized using a narrative approach.
Based on the findings from the research, IR is a more purposeful and structured way to routinely identify the needs of patients. It was observed that the practice is conducted hourly or even 2 hourly during which comfort, pain, and toileting needs are assessed and addressed (Christiansen et al., 2018). The researchers observed that the physical presence and proactive presence of nurses during rounding reassures patients that they will receive regular attention. Overall, the evidence from the research suggests that intentional rounding reduces patient falls by a greater percentage. However, the implementation of this protocol should be accompanied by a robust evaluation and standardized reporting measures to ensure compliance.
Professional ethics and patient safety are important fundamental concepts in nursing. While addressing the issue of patient falls, the APN should adhere to the principles of ethics for nursing practice like beneficence and non-maleficence. It is the ethical responsibility of the nurse to select interventions that can cause the least amount of harm to achieve a beneficial outcome (Morgan et al., 2017). Another ethical issue that must be examined is the commitment of the nurse to the patient and the promotion of safety as outlined in the code of ethics. The nurse is required to promote, advocate for, and protect the health and safety of the patient during care delivery. IR protocol is an intervention aimed at improving patient safety and failure of the nurse to adhere to this practice can lead to serious consequences.
To improve the use and effectiveness of IR in my unit, the Plan, Do, Study, Act (PDSA) cycle would be an effective way to implement change. The first step will involve identifying the change and involving key stakeholders. The second step will involve educating nurses bout intentional rounding and how it can prevent patient falls. Step three will involve implementation, data collection, and reflection on the impact of the change. The last step will involve acting upon the observations, making changes, and fully implementing the practice. One of the barriers to implementing the change in my unit is staff compliance (Christiansen et al., 2018). Issues with staff-patient ratios and the heavy workload of nurses may make it difficult to do hourly rounding and give appropriate attention to individual patients.
Christiansen, A., Coventry, L., Graham, R., Jacob, E., Twigg, D., & Whitehead, L. (2018). Intentional rounding in acute adult healthcare settings: A systematic mixed-method review. Journal of Clinical Nursing, 27(9-10), 1759–1792. https://doi.org/10.1111/jocn.14370
Morgan, L., Flynn, L., Robertson, E., New, S., Forde‐Johnston, C., & McCulloch, P. (2017). Intentional rounding: A staff‐led quality improvement intervention in the prevention of patient falls. Journal of Clinical Nursing, 26(1-2), 115-124. https://doi.org/10.1111/jocn.13401
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