Evidence-Base Practice on Healthcare Problem

1 Healthcare Problem 

The senior population was facing issues from problematic health care. The healthcare system lowered the quality of life maintained by the older adult leading to a huge problem that affected the life span of each old person. It is difficult for people to realize the fall risks around them with each risk at every level. Each year, old people get serious injuries every time hence they are at risk of becoming fatal. Fall is classified as a major cause of death and injuries among people aged 65 years old and above. The setting of healthcare and the community may suffer fall at any time of the day. 

2 Significance of the Problem 

There were over 9 million false warriors seconded me including a 28 including pollution program due to their wife’s behavior. This incident took place in the 2013 Tanzanian’s house in dark screws. Falls experience quite a large number of people dying from Falling and getting injuries. Many people choose to fit this year and every other year. Additionally, an estimate of $31 billion medical costs dropped pasts the injuries they had. The population in America is still rising in the number of people in the Fall. 

3 Current Practice 

People lack interventions to treat, cure and prevent the current healthcare issues facing the system to Hospitalize with little risk or health information. And for all the educational purposes, the fall makes sure information about population, and educational materials should reach and become known to the public. Most of the issues these people learn are not associated with the important work they learned their entire life. Most of the patient was educated of their condition through material important as paperwork. It is impossible to make their education useless since matches are almost pointless to have through this health education. 

4 Impact on Background 

In our current world, older people want to lead and seek independence; this nonetheless came about after living in several homes for several years. People tend to appear comfortable in regions near their families hence they prefer not to live they did not like the idea of living in the same place. In the setting where the families to live together and leave their family at home while the rest of the grown people in the family work extra hard to provide for their families back home. Fall could be responsible for creating issues for people to become more difficult to live in that place since they cannot withstand any more injuries occurring around them. The recurrence of these injuries results in families falling to uphold itself and handle this issue well. Also, the injuries sustained during the fall may make people have difficulties in walking downstairs or getting into a bathtub since it is difficult to raise their legs every time. This situation forces the family members to put others in an assisted facility where they receive more attention than at home. They also felt that their loved ones were at safer hand in this place than in their hands. However, most of them reject this order and prefer to stay at home by themselves in a similar setting that possesses some similar lover of their family members. 

B PICO Table 

PICO Table 

P (patient/problem)	Falls
I (intervention/indicator)	Community-Based Fall Safety management plans
C (comparison)	Lack of educational plan, minimum awareness program while in a medical facility or doctor's office
O (outcome)	The decline in the occurrence of falls

1 PICO Question 

When talking about young adults-and does the prevention program assist in reducing the infection rate? 

2A Research and Non-Research Evidence 

The first research evidence established that community-centered interventions of fall safety measure effectively apply in community settings. The research focused on the population that accessed to fall prevention plus education plan and communities that lack fall safety measure plans. It was established that the rate of falls within the communities with a fall safety measure plans was drastically decreased compared to the communities that lacked the interventions (Guse et al. 2015) . When the fall management plan is easily accessible to the senior population, individual learn more concerning the fall risks presented in their homes and what to be cautious about in daily lives. 

The second research evidence established that the fall risk education practice may be activated for several rationales and can absorb differing insight and safety measures plus other distinct approaches (Pohl et al. 2015). There are numerous methods to present fall risk educational insight to the senior population in a manner that is made aware of various factors that may make them understand the level of risk involved. The elderly can benefit from publicizing fall risk aware through the media and information available to their peers, in this way they can do self-evaluation of their fall risk level and safety measure plan. Education on various fall risk factors assists in narrowing down to particular interventions to meet each personalized needs. 

The first non-research evidence established that falls are caused by multifactor. Thus a multipronged fall prevention intervention is needed (Rheaume and Fruh, 2015). The article focused on the inpatient setting and revealed that a proper evaluation of various fall risk causes is vital to implement proper fall prevention interventions. Nurses have to recognize the different causes, so that patient at risk of falling receives timely intervention and to reduce the case of falls. Persons at risk of fall require close supervision and tailored education to meet the specific need of their situation to prevent falls from occurring effectively. 

The second non-research evidence identifies the weakness of nurses to depend on screening to ascertain patients with a high-risk factor for fall (Silva and Hain, 2017). The article further found that there is no replacement of a comprehensive clinical evaluation of risk factors and a management plan that aim for each patient’s distinct situation and capacity of collaboration with to care plan. Further, the article pinpoints the significance of assessment along with the management of each case of fall risk as independent, a single risk factor or multiple cannot be overlooked since even one risk factor result into a fall. Also, one type of intervention cannot act as a fall safety measure for what might prevent a person from a fall cannot prevent another occurrence of fall from a different patient. 

Evidence Matrix 

	Article 1: (Guse, Peterson, Christiansen, Mahoney, Laud & Layde, 2015)	Article 2: ( Pohl, Sandlund, Bergvall-Kåreborn, Lundin-Olsson, & Wikman, 2015).	Article3: (Rheaume,2015).	Article 4: (Silva & Hain, 2017 ).
Background or Introduction	This article evaluated the community version of an effectual evidence-based fall safety measure plan through standard financial aid can generate a community-wide decline of falls due to injuries in the senior population. Also examined whether an improved translation with additional technical aid and capacity building improved the fall decline outcome.	This article aims to investigate older women’s and men’s knowledge of the risk of falls and their practices in prevention measures applied in falls prevention.	In line with the National Database of Nursing Quality Indicators, falls is an “unstructured plunge to the floor.” In the acute care setting seven falls arise for every 1,000 patient days and they depending on various factors	Falls have a multifactorial cause, and its risk factors vary from patient to patient. The main prevention fall is the proper risk factors identified with a suitable management plan to handle all factors.
Review of the literature	This study is containing various references on the qualitative article and a randomized control trial. Information and findings were acquired on inpatient and emergency department records.  Randomized controlled community trial done in adults of 65 years along with adults in (1) 10 control population obtained no special resource or support on fall intervention, (2) 5 standard support population received moderate financial support to initiate Stepping On, and (3) 5 better support communities received financial and technical aid. The inpatient and emergency department primary outcome discharges examined fall with Poisson regression.	This article contains sources from a qualitative study focused group discussion	The study comprised of records and examination records of a patient with the neurological disorder, and rehabilitation setting	The study comprised of records of t he Centers for Disease Control and Prevention (CDC) reports and qualitative data o n the Medical-Surgical-Rehabilitation (MSR) Department
Discussion of Methodology		Focus group discussions qualitative study conducted amongst eighteen people within community dwellers of 10 women and eight men having and with no fall history purposively selected. Participants were distributed in two sets, and every set converged four times for discussions which involved participatory and appreciative plan and reflection strategy. The discussions were recorded in an audio word for word. Qualitative content analysis data was inductively determined.	Older adults and patients with the neurological disorder, and in the rehabilitation environment	The nurse instructor instigated the collection of data from the internal reporting system with an examination of the entire falls (July 1, 2011-June 30, 2012) financial year.
D ata analysis	The article found that when fall management plan is easily accessible to the senior population, individual learn more concerning the fall risks presented and what safety measure to be taken for intervention.	The process of fall risk awareness was categorized into experiencing several feelings, recognition of fall risk, and safety measures. The category grouping has subcategories with a theme of “safety measures in fall risk responsiveness.”	The article focused on the inpatient setting and revealed that a proper evaluation of various fall risk causes is vital to implement proper fall prevention interventions.	.Data collection and analysis was continuous for the staff to ascertain patterns and to change response to management plan of falls plans where the staff gave an account cumulatively to leaders week, month, and year wise. The comprehensive risk factors, rationales, and management plan record were revised each six months
Researcher’s Conclusion	Population-based interventions on fall prevention can be valuable when employed in community practice	The awareness process of falls initiates various rationale involving different feelings and safety measures and singular approaches. This finding stresses possible avenues to pass information to older people regarding fall risk and prevention, involving the media plus their peers.	Persons at risk of fall required close supervision and personalized care and education to meet the specific need of their situation to prevent falls from occurring effectively.	Correct risk factors identified with a suitable management plan is key address fall. In a fall evaluation variable applied to contain both intrinsic and extrinsic factors. any intervention must be personalized for each patient to provide evidence-based safety management care

E. Recommended Practice Change 

Risk education on fall helps create awareness of factors that are classified as a fall risk, taking into account what the individual fall risk level is, as well as learning the preventative measure to be implemented can minimize the risk for falling. Population-centered fall safety measure interventions indicated to decrease community-wide fall injuries from baseline by 17% (Guse et al. 2015). Predetermined substantial differences are present in the section of patients who felt that they have a higher risk for falls both in pre and post-intervention revealing that tailored patient education perception of fall risk can create more awareness to the patient with the risk of fall (Kuhlenschmidt et al. 2016). The research shows that the participants showed increased awareness on fall risk following short education on fall management which implies that fall prevention education is beneficial (Howard, Beitman, Walker & Moore, 2016). Older participant’s experiences and perspective about the understanding of fall risk alongside safety measures employed in their daily lives had numerous correspondence as well as differentiation indicating the necessity of a more personalized fall prevention awareness program (Pohl et al. 2015). Risk evaluation of fall and the intervention tailored to fall safety measures approaches are an efficient care plan in the clinical field to isolate and reduce the fall probability (Cox et al. 2014). 

F. 1 Key Stakeholders 

One main stakeholder will be the federal government; it offers Medicare since they reimburse billions of dollars in medical bills for associated injuries among elderly individuals. The government can offer to fund for community-based fall prevention programs which individual with Medicare could learn and attend about prevention methods of fall risks. Another key stakeholder is hospital systems because they are treating several individuals who experience falls-related injuries. The last important stakeholders are the older population. This group will benefit by receiving learning and education on preventing falls. Also, they will be educated about the intervention they could embrace in their everyday life. 

2 Barriers 

Time is one factor that may be a barrier to change. Adequate time is necessary to asses an individual's risk factors for falls and generate individualized fall prevention interventions to implement. It will take money and time to educate fall risks, educators and caretakers, to correctly asses the extrinsic and intrinsic factors for falls. The interventions are effective for patients when they are specific to an individual’s environment or situations. One barrier that could affect the translation of the research into practice is funding that is necessary to generate the community-based fall prevention programs. Each city will have multiple programs and accommodating the needs of each community is expensive because it requires people to run the program and a place to hold it. Also, funds are necessary for advertising the program to make it public acquaintance a fall deterrence initiative is accessible to the community. 

3 Strategies for Barriers 

Hospitals and Medicare endowments help assist with the funding of this program. Some of the money raised from hospital and Medicare grants is used to treat fall injuries and prevent them from occurring: these initiatives could save Medicare money in the long run. Also, the hospital grants can be used to provide education to individuals that will be running these programs in the communities. Volunteers can be used to educate another individual in the communities who are interested in educating prevention strategies and fall risk assessment. Volunteers would be crucial when it comes to running the initiatives since they may help to save money because they will be delivering their services at no cost because they want to impact their communities. 

4 Indicator to Measure Outcome 

The number of fall-related injuries and falls will be used to gauge the bearing of community-based fall deterrence initiatives. Questioners will be distributed to the population of older adults in every community inquiring about the education they have received and if they have experienced any falls after being educated. Another way to gauge the outcome would be by examining how many fall-related incidences are being treated in community hospitals. It will also provide a good indication of the falls that have been prevented by comparing the result to the results of the previous years. It will provide a clear picture of the number of falls that have been prevented. Likewise, Medicare could send out a survey to individuals who were used to avert falls to gauge their acquaintance on fall risks and intrusions which could be used to avert falls. Debate groups can be used to unify the community and examine what their opinions and thoughts are in the community-based fall preclusion initiative. If all this information is merged, it will immensely help to measure the result of these outcomes. 

References 

Cox, J., Thomas-Hawkins, C., Pajarillo, E., DeGennaro, S., Cadmus, E., & Martinez, M. (2015). Factors associated with falls in hospitalized adult patients. Applied Nursing Research , 28 (2), 78–82. https://doi-org.wgu.idm.oclc.org/10.1016/j.apnr.2014.12.003 

Guse, C. c., Peterson, D. J., Christiansen, A. L., Mahoney, J., Laud, P., & Layde, P. M. (2015). Translating a Fall Prevention Intervention Into Practice: A Randomized Community Trial. American Journal Of Public Health , 105 (7), 1475-1481. 

Howard, B. S., Beitman, C. L., Walker, B. A., & Moore, E. S. (2016). Cross-cultural Educational Intervention and Fall Risk Awareness. Physical & Occupational Therapy in Geriatrics , 34 (1), 1–20. https://doi-org.wgu.idm.oclc.org/10.3109/02703181.2015.1105344 

Kuhlenschmidt, M. L., Reeber, C., Wallace, C., Chen, Y., Barnholtz-Sloan, J., & Mazanec, S. R. (2016). Tailoring Education to Perceived Fall Risk in Hospitalized Patients With Cancer: A Randomized, Controlled Trial. Clinical Journal Of Oncology Nursing , 20 (1), 84–89. https://doi-org.wgu.idm.oclc.org/10.1188/16.CJON.84-89 

Pohl, P., Sandlund, M., Ahlgren, C., Bergvall-Kåreborn, B., Lundin-Olsson, L., & Melander Wikman, A. (2015). Fall risk awareness and safety precautions taken by older community-dwelling women and men--a qualitative study using focus group discussions. Plos One, 10(3), e0119630. doi:10.1371/journal.pone.0119630 

Rheaume, J. (2015). Retrospective Case Reviews of Adult Inpatient Falls in the Acute Care Setting. MEDSURG Nursing , 24 (5), 318–324. Retrieved from https://wgu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=110306123&site=eds-live&scope=site 

Silva, K. B. (2017). Continuous Quality Improvement. Fall Prevention: Breaking Apart from the Cookie Cutter Approach. MEDSURG Nursing , 26 (3), 198–213. Retrieved from https://wgu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=123430221&site=eds-live&scope=site