Picot-Nursing Care Paper

Picot-Nursing Care Paper
Falls for people are leading source of non-fetal and fetal injuries for elderly Americans. Falls are the big concerns for those adults who living in nursing and rehabilitation centers. Falls endanger elderly’s independence and safety and cause economic and personal costs. However, falling is unavoidable consequence of aging. By means of adjusting lifestyle and using evidence-based programs for fall prevention the number of falls among elderly people can be significantly reduced. According to the Centers for Disease Control and Prevention (CDC), more than 1 in 4 elderly people fall every year and 1 out of 5 falls cause serious injuries (Sterling, 2001).
Nursing care provided in elderly people who live in nursing home if used based on evidence-based practice can significantly reduce fall among those residents. In a community of elderly people like nursing homes, nurses are primary care health providers who ensure that life and safety of residents are in good hands. Nursing practice allows nurses to involve in patients’ care in numerous ways, for example, preventing falls in community settings (e.g. in hospitals and nursing homes).
At Vosswood Nursing Center where this author works and practicing his mentorship, for the period of six months the nursing management initiated fall prevention by using hourly nursing rounds instead of depending to previous nursing intervention of using call lights secured at patients’ bedsides, during this period of new intervention trial, the main PICOT question was as described below.
Picot Question- In elderly nursing home residents, what is the effect of hourly nursing rounds compared with using call light on decreasing falls rate?                           P-The population in question are elderly people who live in nursing home.                                   I- Hourly nursing rounds.                                                                                                                 C- Call lights.                                                                                                                                   O- Reducing falls rate.                                                                                                                      T- Six months.
After completion of six months of fall prevention trial, it was discovered that the falls rate was reduced from six falls to two falls per months, skin breakdown was decreased, patient satisfaction scores was increased, and staff satisfaction was improved (Vosswood report, 2017). Nurses who purposeful make patients round at least every hour they are not only restore confidence to their patients, but they also retain time and energy by lessening use of call light (Halm, 2009). For those nurses who make rounds, they can perform scheduled nursing tasks, for instance, dressing change, administering medication, also checking four Ps: position, potty, pain, and possessions (Meade, Bursell, Ketelsen, 2006). Most elderly nursing home residents fall when they are trying to get of bed/chair for bathroom use while they are physically weak and unstable. Implementation of hourly nursing rounds will assist to them to go to bathroom, position them in bed and relieve pressure and put items within their reach, for example, water glass, TV remote, phone, and tissues, or any personal items which patient might to be close by. Hourly rounding is evidence-based practice that decreases falls and pressure sores in elderly residents (patients) in nursing homes and hospitals while enhancing patients’ satisfaction, it promotes nurses to be proactive rather than reactive in attending patients’ needs.                                                   Agency for Healthcare Research and Quality (AHRQ)                                       (AHRQ) is agency whose mission is to produce evidence to make health care safer, more accessible, higher quality, affordable, and equitable, which work with United State Department of Health and Human Services and with other associates to ensure that the evidence-based practice is understood and used correctly (AHRG, 2017). AHRQ was established in 1989 as agency for health care policy and research. It involved in prevention of falls in elderly people and patients in different settings, for example in hospitals and long-term facilities.
Nurse who practices in any setting and provides healthcare for elderly patients needs to be proactive for patients’ safety and fall prevention. By using clinical judgement, expertise and evidence-based practice, nurse can significantly reduce the fall risks and injuries caused by falls. Hourly nursing rounds as evidence-based practice if used as intended will reduce falls rate significantly.
Halm, M.A. (2009). Hourly rounds: what does the evidence indicate? Am J Crit Care. 2009;18(6):581-4.
Meade, M., Bursell, L., Ketelsen, L. (2006). Effects of nursing rounds: on patients’ call light use, satisfaction, and safety.
AHRQ (2017). Which fall prevention practices do you want to use? Retrieved from www.ahrq.gov/professionals/systems/long-term-care/resources/facilities/ptsafety/Itcmodule3.html-88k
Vosswood (2017). Vosswood Nursing Center report: Fall prevention strategies, hourly nursing rounds.
Sterling, A., O’Connor, A., & Bonadies, J. (2001). Geriatric falls: injury severity is high and disproportionate to mechanism. J Trauma. 2001;50(1):116-9.


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