Research and Health Practice for Patient Falls and Injuries

Question: Discuss about theResearch and Health Practice for Patient Falls and Injuries. Answer: Patient falls and injuries in hospital setting is major challenge to health care quality and patient safety. Fall is associated with negative issues with reduced mobility for patients, poor functioning and poor quality of life (Staggs et al. 2014). Hence, fall leads to dissatisfaction of patients with care and it is risk to the reputation of the organization too. This essay focused on a hospital in Sydney, which is experiencing high fall rates since the past one year. As a research manager, the review of the process and structure present in the hospital has revealed that poor communication between inter-professional team has been the major contributor to falls and adverse events. In relation to this problem, the essay recommends evidence practice to implement best practice for inter-professional communication during fall management. The essay also highlights the barrier or enablers that may make implementing the best practice easy or difficult. It also discusses about the ethical imp lications of the implementing the best practice evidence in clinical setting. In a private hospital in Sydney, poor inter-professional communication has been found to be the major reason for adverse events and high fall rate in patient. This is a serious issue because the nursing staffs and other health care team are expected to engage in adequate assessment of fall risk in patient and collaborate with the team to follow safety protocols and control measures needed for individual patient (Williams et al., 2016). However, lack of clarity among team members regarding the fall prevention practices and poor collaboration method has been the reason for conflict and confusion between staffs. Either the fall risk assessment process is missed or the actions needed after fall risk assessment process is not communicated to all staffs dealing with one particular patient. Hence, patient safety and quality of care at the hospital has been compromise due to poor communication regarding fall management practices among the interprofessional team. The main communication proble m is that health care team has been a failure in communicating with all relevant individuals regarding fall management practices and protocol that needs to followed for patients. Brock et al. (2013) has also emphasized that ineffective communication among inter-professional health care staff is the major reason for medical error and patient injuries. Therefore, finding the best evidence based approach to team collaboration during fall management practices for the hospital is necessary to reduce fall rate and maintain safety of patient during hospital stay. Based on the analysis of peer-reviewed journal article, one best practice that can be used by the inter-professional team to communicate about fall risk and management is adapting the SBAR (Situation-Background-Assessment-Recommendation) tool in clinical setting (Andreoli et al., 2010). The reliability of this evidence and approach to the organization problem is high because the research tested the tool on two teams experience high fall incidence in their clinical setting. The SBAR tool used situation briefing model to enhance team communication around high priority issues needed for fall prevention and management (Beckett and Kipnis 2009). The situation (S) element of the tool will give an idea about the changes in patient status and treatment plan or procedure for particular patient. The Background (B) component of the tool will describe the background to the patient issue such as the diagnosis of illness, risk factor of fall and the reasons for specific action to prevent fall. After this, the assessment (A) element in the tool can direct staffs to conduct adequate assessment to identify physical health related changes in patients and their need for ADLs or functional support. Finally based on the assessment, the recommendation part will clearly give the idea regarding taking the final course of action for the benefit of patient. The best practices based evidence also explained about the best approach needed to successfully implement SBAR and improve communication among interprofessional team. This included giving education to all staffs regarding breaking down communication process to promote safety, using system approach to safety culture and increasing their competence in using the SBAR tool to enhance communication process (Andreoli et al., 2010). Hence, this evidence-based solution has the potential to address the communication related problem at the hospital and reduce fall rates and injuries. While implementing the SBAR tool as best practice to enhance communication related to fall risk and management among interprofessional team, the motivation of staffs and their commitment to adapt the change might act as the enabler in the change process. This is because motivates individuals are more likely to accept the change and adapt new practices in their daily practice. The psychological traits like the external environment around the health care staffs might maximize the effectiveness of the new practice. For example, a culture of safety facilitates all members to contribute to patient safety and comply to all norms to achieve the desired outcome (Randmaa et al. 2014). This also reflects that best practice can be successfully implemented if systems approach to change is followed in hospital. There is certain barrier to implementing SBAR tool in the hospital too. This includes the diversity of the SBAR conversation. For instance, the tool can used in various situations in clinical practice, however to improve the efficacy of the tool for the Sydney based hospital, it is necessary to structure and design SBAR around communicating the issue of fall risk and management only. Therefore, randomly using the tool for non-urgent task may reduce the effectiveness of the practice for improving interprofessional team communication and reducing injuries (Andreoli et al. 2010). Hence, it is necessary to implement SBAR on the context of issues present at the hospital. The efficacy of the evidence based practice of implementing SBAR tool for improving fall related communication among health care staffs can be improved by examining the feasibility and utility of the SBAR tool for long term care. This will depend on taking the feedback from staffs post implementation regarding any challenges faced in using the tool. This will ensure documentation process and communication process related to fall management and prevention is addressed (Renz et al. 2013). The current study discusses the importance of ethics in the recruitment and selection of focus groups for conducting evidence based practice within a clinical set up. In the context of Sydney hospital, where the proposed plan is to implement SBAR tool to enhance communication about fall management practices among health care staffs, the main focus group includes the nursing staffs, clinicians and other staffs. The successful implication of the project is dependent on the education and training of staffs before the implementation of SBAR tool in clinical setting. However, recruiting the focus groups in the project is a challenging task due to many ethical issues and implications during the process. The first ethical issue related to recruitment is that the focus group may not wish to adapt SBAR tool and attend the training program for effectively using the tool for communication regarding fall risk assessment and fall prevention in patient. This means that ethical issues will arise due to conflict of interest among the focus group. In the Sydney based hospital, the primary target is the nurses and clinicians for improving the fall prevention related communication. However, unless they give the approval for change in practice and accept the new tool, the plan will not be successful. The hospital executive has the ethical responsibility to obtain agreement regarding the change in health care practice (Burke, Evans, and Jarvik, 2014). Therefore, the potential solution to this problem would be to engage in a one-to-one discussion with those nursing staffs or clinicians who resist using the SBAR tool for communication. They need to be made clear regarding the potential benefit of th e tool in reducing the workload and reducing medical errors in clinical practice. Secondly, they also need to be assured that the tool is user friendly and it will not disrupt their flow of work. Instead it would facilitate systematic work process without any disruption and adverse event (Krueger and Casey, 2014. Hence, this approach to addressing ethical issues will influence the decision of focus group and it would help to keep the focus group in line with the project objective of adapting SBAR tool for communication. The issue of conflict of interest and informed consent for the project can be addressed by effective communication with focus group about the purpose of change. The study by Newington, L. and Metcalfe (2014) has also showed that many factors influence recruitment of participants to clinically focused research or project. This includes infrastructure, nature of project and characteristics of recruiter and participants. In the area of infrastructure, issues related to regulations surrounding ethical approval and consent of participant was discussed. By focusing on all the above factor according to ethical perspective, the recruitment process can be optimized. Another ethical issue might arise while dealing with focus group in interview and training session. The moderator who will be involved in teaching about the SBAR tool need to conduct the training in an ethical manner. This mean respecting the participants while speaking and appropriately showing them their mistakes or limitations in past communication process (Harris and Robinson Kurpius 2014). Hence, the ethical responsibility as a moderator is to approach and communicate with the focus group in a non-judgmental ways. No judgment should be passed on their personal values and everthing should be done in a professional manner. A very important factor in making the training session successful is to encourage participants to share their thoughts and opinion regarding the project, This helps to avoid tension or conflict between the focus group and understand their concerns regarding SBAR tool. Therefore, based on the ethical issues present, taking informed consent from participants regarding adapting SBAR tool is necessary. Secondly, ethics application form should be developed in a way to inform everything about the project to participants and obtain their approval for the project. The above ethical implications covered the topic of informed consent, sharing information, conflict of interest and appropriate conduct needed during recruiting focus group. The above elements are relevant to certain items in the ethical application form too. For instance, the ethical responsibility of taking informed consent from participant is relevant to the section of details of the research project, research context and risk and benefits of research project for participants. This is because consent is taken from participants only after the ethics application form clearly clarifies the reader about the main intention of the research project, the potential benefits of research project and any risk to participant (DePoy and Gitlin, 2015). Hence, ethical implication of taking informed consent would help to fulfill the requirements of the ethical application form and it would lead to transparency among the focus group. Another ethical implication of the research project was related to respecting the participants and approaching the focus group in an ethical manner. This is relevant to the code of conduct and consideration of ethical principles regarding human participation in the ethics approval form. This element can be covered by providing all staffs informed consent letters related to promote voluntary participation. All provisions will also be provided to the participants to withdraw from the project if they feel that their rights are violated. Protecting the integrity of the participants will be ensured by describing the benefits of the expected results for professional performance of each health care staffs. The element of appropriate conduct in ethical implication is also relevant with the privacy, confidentiality and anonymity component in ethics approval form (Holloway and Galvin 2016). Hence, this part can be covered by the hospital executive describing about the approach they have used t o maintain privacy and confidentiality of the participants in the hospital. The essay describes the problem of fall in a Sydney based hospital due to poor communication in inter-professional health care team. The solution to this problem was proposed by the evidenced based best practice of adapting SBAR tool for fall management related to communication. This tool was found to systematically communicate about fall risk management activities needed by staffs and how to act accordingly. Certain barrier to the implementation of the best practice evidence was also provided. Secondly, many ethical implications in relation to the recruitment of focused group for implementing the recommended solution were also provided. Association was also established between the ethical implication and key component of the ethics application form too. Reference Andreoli, A., Fancott, C., Velji, K., Baker, G. R., Solway, S., Aimone, E., Tardif, G. (2010). Using SBAR to communicate falls risk and management in inter-professional rehabilitation teams.Healthc Q,13(13), 94-101. Beckett, C.D. and Kipnis, G., 2009. 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