Educational Model to Enhance Nursing Students †MyAssignmenthelp

Question: Discuss about the Educational Model to Enhance Nursing Students. Answer: Introduction: Millions of elderly fall and suffer from hip fractures or traumatic brain injury, as reported by the Center for disease control and prevention. As per the report published by the Portuguese health national reports, 4200 incidents of falls and 85 incidents of fall related deaths have been reported (Simpson, Miller Eng, 2011) . Slips and falls and fall related injuries have been considered as one of the prioritized standards of Joint Commission International (JCI) and Health Authority of Abu Dhabi (HAAD) (Hospital Standard, 2008). Cardiovascular attacks have been found to be the most common contributing factors of falls among the elderly (Simpson, Miller Eng, 2011; Abreu, Mendes, Monteiro Santos, 2012). Fall generally occurs due to the altered balance between the brain and the body (Simpson, Miller Eng, 2011). In order to manage falls in elderly it is necessary for an extensive planning and decision making. The decision making process has got seven standards, such as identifying th e triggering agent of falls, setting the criteria, weighing it, seeking for any alternatives, testing and troubleshooting of the problems (Griffith University, 2013). This essay aims to focus on the risk factors of fall, its triggering agents, JCI and the HAAD standards of falls, clinical cycle reasoning related to the scenario faced and possible recommendations. According to Simpson, Miller and Eng, (2011), falls can be defined as an event which results in a person coming to rest inadvertently on the ground, with the inability to correct in due time and is determined by circumstances involving multiple factors that affect stability". Falls can be cause din the elderly due to the effect of certain hypertensive medications that causes dizziness (Simpson, Miller Eng, 2011). Some of the other contributing factors are hypoglycemia and hypertension (Clinical Excellence Commission, 2008; Tsur Segal, 2010). Ischemic stroke is also another risk factor that can contribute to falls in elderly. Other risk factors include bladder and bowel incontinence, confusion and aviation and postural hypotension (Oliver, Healey Haines, 2010). HAAD and JCI Standards HAAD is a renowned and certified health authority by the JC international ((HAAD JAWDA, 2015). HAAD have established the strategies for preventing falls in the elderly. HAAD has established JAWDA as a key performance indicator for detecting the rate of the falls in adults. It will also keep a record of the rate of the sentinel events in hospitals, due to falls (HAAD JAWDA, 2015). Clinical reasoning cycle helps a health care provider to collect the cues, process the pathogenesis related to the signs and symptoms, assessment, planning and implementing the interventions, measuring the outcomes, reflecting and learning form the outcomes. A 76 years old female named Nilou, has been admitted in the rehab ward on 10th February due to the Cerebro Vascular Accident (CVA), a frontal affected region and right sided weakness. The vital signs are all normal. The patient is a widow staying in Al Gharbiya Region of Abu Dhabi, with two sons and one daughter. They visit their mother regularly but no one stays with the patient at night. Collection of cues occurs in three parts. In the initial review the patient has informed that she had been suffering from hypertension and diabetes, for the last 25 years. She takes rosuvastatin, aspirin, ezetimibe and amlodipine, for hypotension and takes glargine and insulin injection for diabetes. The lab tests for the complete blood count and the levels of the urea and electrolytes are normal. No blockage was detected in the vascular ultrasound carotid Doppler. There was acute infarction present in the frontal region, recorded in the magnetic resonance angiography. There was an incident of a fall, where the patient complaint that the bathroom was not nearby and there was no help present to assist her in the bathroom. The second step involves the assessment of the motor functions of the left side, where it graded 5 out of 5. The right side of the head showed some weakness and scored 2 out of 5. The Glasgow comma scale was ranging between 14 to 15. BP was 127/75, RR- 80, HR- 80 . Blood sugar was 17.1. After the application of 10 units of insulin the blood sugar level was found to be 13.4 just after an hour. The third step is Recall. The Morse fall score altered from 60 to 85 due to the incidence of fall, right sided hemiplegia, patient confusion (Plessis, 2015). Furthermore the region of the brain that is the site of motor functions, concentration, emotion and the self awareness was also affected which might have caused the patient to make irrational decisions. Information processing The processing of the information consists of six- sub stages, such as the interpretation, discrimination, relation, drawing of inferences, matching, and prediction. Interpretation- The Glasgow comma scale was within the accepted range, high blood sugar level, high Morse fall risk, decreased strength and sensation of in the right side, confusion due to the affected regions of the brain. Discriminate- High Morse score, confusion and right sided hemiplagia. Relation- Muscular weaknesses causing imbalance Inference- To keep the patient in close monitoring Matching- Cardiovascular attacks are related to higher risk of fall. Prediction- risks of falls in clinical settings might be due to certain factors like medications, lack of trained staffs, lack of mobilizing aids and weak fall prevention strategies. According to (Tsu and Segal, 2010) a large proportion of fall occurs at the bedside in a clinical setting. Having a near miss in the clinical setting can cause the nurse to alert the quality management setting. Proper investigation may cause termination of the unskilled staffs or those who have breached the standards. Whereas a patient might get a femoral fracture, hip fracture, traumatic brain injury and delay in the healing as the patient is an elderly (Oliver, Healey Haines, 2010; CDC, 2016; Simpson, Miller Eng, 2011). There are two main diagnoses related to high risk of falls are impaired step mobility and the altered psychological status. In this phase of the cycle the nurse formulates the interventions against all the problems. The first step is abiding by the hospital protocols regarding the falls. It is first necessary to assess the patient. Interventions can be taken such as keeping the patient under continuous surveillance, accompanying the patient in the toilet, using the yellow risk band for fall risks, placing the bed in the lowest and comfortable position, putting up the side rails (Plessis, 2015). A multidisciplinary team should be used to ensure that the patient regains movement on the right side. Physiotherapy and an occupational therapist can be used. The family members should also be included in the collaborative care approach and should be taught about the daily exercises recommended by the physiotherapist (Plessis, 2015). The goal is accomplished when the patient is discharged from the setting without any record of falls. In addition the family has been given information regarding the maintenance of safe home environment like ensuring a non slippery pathway (Simpson, Miller and Eng, 2011). The experience was quite challenging and I was perturbed as she had shifted out of the bed more than once without a fall. I felt that my care had been incomplete as restraining her to remain in the bed depressed her. A one to one observation could have been done but it is the objective that had prevented me from doing so. Yet I feel that I have tried to contribute my best for giving a proper discharge to the patient. I have been successful in educating the patient and the family regarding the usage of bells when in bed. The improvements that can be achieves would be mentioned in the following sections of recommendations. Recommendations There are several loops and gaps left in the fall prevention strategies even after the adoption of advanced technologies and the preventive measures. Hence a comprehensive strategy is required to so. Oliverm Healey and Haines, (2010) have suggested the use of a movement tracking device that helps in patient tracking without the requirement of one to one observation. Such a device would not only save time but would also be cost effective. According to Agency for Healthcare Research and Quality (AHRQ), the requirements of the elderly patients should always be balanced with fall prevention (AHRQ, 2013). Another fruitful intervention is to include the family in the decision making process and in the physiotherapy sessions, such that they can help out the patient with the exercises even in the absence of the physiotherapists. The final recommendation is to ensure the cross checking of the medication, as the patients is under hypertensive medications and wrong doses can cause unconsciousne ss and fall (AHRQ, 2013). Conclusion Slips and falls are still the biggest possible risk in the field of geriatric care and lots of efforts are currently put and more has to be incorporated in order to decrease the risks. It is evident that stroke is one of the main risk factor as it give rise to hemiplegia and an affected patient will not be aware of his brain and body balance. Bedside falls are also found to be quite common. Many strategies have been set as standards for allowing the caregivers to ensure a safe health care delivery to the elderly population. References Abreu, C., Mendes, A., Monteiro, J., Santos, F. (2012). Falls in hospital settings: a longitudinal study. Revista Latino-Americana De Enfermagem, 20(3), 597-603. https://dx.doi.org/10.1590/s0104-11692012000300023 Agency for Healthcare Research Quality,. (2013). Which fall prevention practices do you want to use?. Retrieved 2 March 2016, from https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtk3.html Centers for Disease Control and Prevention. (2016). Important Facts about Falls | Home and Recreational Safety | CDC Injury Center. Centers for Disease Control and Prevention. Retrieved 8 March 2016, from https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html Clinical Excellence Commission. (2006).Patient Safety and Clinical Quality Program: Third report on incident management in the NSW Public Health System 2005-2006, NSW Department of Health. Sydney. Retrieved 02 March 2016, from https://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0005/258269/incident-management-2008_01to06.pdf Griffith University. (2013). Advanced Clinical Decision Making (3801). Malaysia: Pearson Health Authority of Abu Dhabi (2008). Hospital Standard. (1st ed.). Abu Dhabi. Retrieved from https://www.haad.ae/HAAD/LinkClick.aspx?fileticket=dI0JyhF3pDc%3D Health Authority of Abu Dhabi. (2015). HAAD JAWDA Quality Performance KPI. Health Authority of Abu Dhabi.:Abu Dhabi. Retrieved 02 March 2016 from https://www.haad.ae/HAAD/LinkClick.aspx?fileticket=j73CZWI86MU%3Dtabid=1450 Levett-Jones, T., Hoffman, K. Dempsey, Y. Jeong, S., Noble, D., Norton, C., Roche, J., Hickey, N. (2010). The five rights of clinical reasoning: an educational model to enhance nursing students ability to identify and manage clinically at risk patients. Nurse Education Today. Retrieved 02March 2016, from https://www.utas.edu.au/__data/assets/pdf_file/0003/263487/Clinical-Reasoning-Instructor-Resources.pdf Oliver, D., Healey, F., Haines, T. P. (2010). Preventing falls and fall-related injuries in hospitals. Clinics in geriatric medicine, 26(4), 645-692.doi: 10.1016/j.cger.2010.06.005 Plessis, C., (2015). Falls Prevention and Management for Adult and Pediatric Patients. Abu Dhabi, United Arab Emirates. SEHA. (2014, June, 01). Incidents Reporting and Management through Patient Safety Net. Abu Dhabi, United Arab Emirates. Simpson, L., Miller, W., Eng, J. (2011). Effect of Stroke on Fall Rate, Location and Predictors: A Prospective Comparison of Older Adults with and without Stroke. Plos ONE, 6(4), e19431. https://dx.doi.org/10.1371/journal.pone.0019431 Tsur, A., Segal, Z. (2010). Falls in stroke patients: risk factors and risk management. IMAJ-Israel Medical Association Journal, 12(4), 216. Retrieved 02, March, 2016, from https://www.ima.org.il/Imaj/ViewArticle.aspx?aId=311 Zuccarello, M., McMahon, N. (2013). Strock (Brain Attack). Mayfield Clinic. Retrieved 10 March 2016, from https://www.mayfieldclinic.com/pdf/PE-stroke.pdf