Perception of Clinical Fall Prevention Programs by Adults

Perception of Clinical Fall Prevention Programs by Older Adults

This working paper is a critique of the article dubbed “Strategies for Reducing Falls in Long-term Care” by Willy and Osterburg that was published in 2014. The two authors posit that falls among older adults in Long-Term Care (LTC) facilities is prevalent, and that the falls cause undesirable complications and even death among the LTC residents. The authors use both qualitative and quantitative techniques to analyze, discuss and attempt to come up with a solution for the problem. The objective of this working paper is to evaluate the article in regard to the terms used, the strengths and weaknesses of the studies mentioned in the article, coherence, as well as ethical considerations.

Terms and Scope of the Article

Evidently, the article aims at addressing nurses because LTC residents require the service of nurses abundantly. Therefore, the language that is adopted by the article fits in the context of the nursing practice. Some of the prominent terms that are variously used in the article include falls, fractures, root cause analysis, and wheel chair use. The falls form the subject of the article; that they are risks towards the health of older adults. When the LTC residents fall, they are likely to experience fractures, which comprise of damages to their body tissues, more especially, the bones. The third term, root cause analysis, implies finding the causative agent(s) of something. In the context of the article, the root cause analysis involves finding the reasons why older adults fall frequently in the LTC facilities. Wheel chair use seems to be the immediate solution adopted by healthcare workers in the LTC facilities to prevent falls among older adults. However, the authors in the article dispute that on many occasions, wheel chair use is not always the right solution to preventing falls.

Contrary Opinions and Strengths of the Literature

One of the significant aspects of the article is that it uses quantitative studies to bring up the facts about the subject. For instance, in the introduction of the article, two quantitative studies are used which include: “Rubenstein, L. Z., Josephson, K. R., & Robbins, A. S. (1994). Falls in the nursing home.  Annals of internal medicine ,  121 (6), 442-451” and “Centers for Disease Control and Prevention. Falls in nursing homes.  www.cdc.gov . Accessed December 12, 2013”. The two studies are important in presenting statistics concerning the subject. For instance, according to the studies, between 50 and 75 percent of residents in nursing homes fall each year. Secondly, the studies also assert that older adults in LTC facilities fall at a mean rate of 2.6 falls per person each year. Lastly, the studies give an approximate figure of 1800 residents in nursing homes who die from falls every year. These statistics are important in supporting the thesis statement of Willy and Osterburg’s article.

In regard to contrary opinions, Willy and Osterburg give two case studies where healthcare workers arrived at a wrong conclusion concerning the cause of falls among the respective patients. In the first case study, the healthcare workers come to a conclusion that Harold cannot stand because his bones are stiff. When a root cause analysis is conducted, it is found that Harold has a sore in his mouth, which makes him unable to eat. He therefore cannot get the energy to stand if he does not get enough nutrients. The second case is about Ruth who suffers from dementia and is consequently confined in a wheel chair. Ruth keeps on falling from the wheel chair despite all efforts meant to make her stay in it. When a root cause analysis is conducted, it is established that she suffered a hip injury while playing tennis. She therefore most probably experiences pain when confined in a wheelchair and attempts to free herself. The two case studies present a contrary opinion in terms of diagnosis of patients in LTC facilities. The authors posit that a root cause analysis is the most effective method of establishing the causes for falls among older adults as well as forging a solution.

Weaknesses

Willy and Osterburg only use secondary sources in dissecting the subject. It would have been prudent if the two authors conducted a study in some of the LTC facilities to establish how older adults felt about the LTC facilities and why they fall. Secondly, the authors would have compared reasons given by the patients versus those of the healthcare workers. From such comparisons, the authors would have provided conclusive recommendations or solutions to the problem.

Ethical Issues

According to the authors of the article, healthcare workers in LTC facilities seemingly come up with solutions without finding out the real causes of falls among older adults. Therefore, to a large extent, the healthcare workers are giving wrong remedies. It is unethical for healthcare workers to conduct shallow analysis of the patients’ conditions because the remedy they recommend only worsens the situation of the concerned patients. For instance, confining a patient like Ruth in a wheel chair was subjecting her to excruciating pain, a situation that would have been avoided if the healthcare workers conducted a conclusive analysis.

Summary

The subject of the article is well defined; causes of falls among older adults in LTC facilities. The causes are also evident in the article such as lack of conclusive analysis by the healthcare workers. The solutions are also well-articulated. One of the prominent solutions is conducting a root cause analysis. The other one is staffing enough nurses in LTC facilities to avoid transferring nurses from one department to another. Such a measure would ensure that nurses develop a personal relationship with the patients, a factor that will enhance the well-being of older adults in the LTC facilities.

Table of Qualitative and Quantitative Studies Used In the Article

References

Willy, B., & Osterberg, C. (2014). Strategies for reducing falls in long-term care.  Annals of Long Term Care ,  22 .