Nursing Capstone- Chapter 2

NursingCapstone- Chapter 2

Correctionsto Chapter 1

Inthe problem statement, the correction is that nurses are mandatedwith the task of ensuring that patient falls in hospitals areeliminated.

Thepurpose of the first chapter of this capstone was to find the bestpractices that can reduce cases of patient falls while they arehospitalized. The problem statement expounded on the effects thatfalls can have on the outcome of patients. Elderly individuals are ata risk of suffering from severe injuries as a result of the fall.Incidences of hip fractures are common with such accidents and thepatients end up spending more time in the hospitals (Bouldin et al.,2013). The registered nurses need to be taught new practices that canhelp them stop patients from falling while in their care. Thepopulation that was likely to suffer from falls are the elderly anddisabled patients that are admitted to hospitals. Almost 50% of thepopulation are at a risk of encountering a fall during their stay inthe hospital (Doran et al., 2014). The setting of the problem showedthat the prevalence of falls is very high. Almost every nurseexperiences at least one fall of a patient during their career. Astudy conducted by Bouldin et al., that was meant to assess the ratesof patient falls reported that 315, 817 patients were seen falling inthe duration of the research. 82, 332 of the falls resulted in bodilyharm (Bouldin et al., 2013). Doran et al. tried to establish therelationship between evidence-based care of patients and falls withina community. The findings indicated that the use of evidence-basedpractice helped reduce the incidences of patient falls (Doran et al.,2014). Other scholarly articles indicated that use of EBP can helpincrease the competence of nurses so that they can control patientsafety and reduce the risk of the patients falling.


Nursesare usually the health caregivers who spend most of the time withtheir patients. While on duty, they are required to perform hourlyrounds so that they can check on the patients. However, these roundsare rarely done on an hourly basis (Mitchell et al., 2014). Thenurses may opt to stay put in the lounge until a patient calls them.The practice is wrong because the patients are put at risk of fallingsince they are not checked up on frequently.

Thenurse leaders are not adequately performing their duties. They failto fully orient the new nurses on safety precautions that mightreduce the risks that a patient may face (Mitchell et al., 2014). Themanagement also does not keenly supervise their nurses to ensure thatthey commit to the hourly rounds. The leaders should also be moreopen to the nurses so that the nurses can speak up if they have anysafety concerns (Mitchell et al., 2014). These practices are thecauses for rising cases of patient falls.

Lackof communication is apparent in the current practices. Nurses rarelybond with their patients during the rounds. Patients are alwaysafraid of being an inconvenience, and they always want to beindependent (Mitchell et al., 2014). Whenever they may be indistress, the patients will fear to call a nurse. If the nurses takethe time to create a friendly relationship with their patients, theycan communicate better and situations, where patients end up falling,will be avoided (Mitchell et al., 2014).


Usingthe SMART criteria, the most viable intervention that can beincorporated in the clinical setting is the implementation of hourlyrounds by the nurses (Mitchell et al., 2014). Instead of nurseswaiting until a patient calls them, they can conduct the rounds tocheck up on them. The nurses on duty can use teamwork to coverdifferent wards at the same time, or they can share the time so thateveryone can have longer breaks.

Thestrategy will ensure that the nurses regularly visit the patients andassess whether they are okay or at a risk of falling. These roundscan also give the nurses some time to bond with the patients, thus,ensuring that communication will be improved in the case of anemergency. The hourly rounds will improve the efficiency of thenurses. The patients will also have greater satisfaction once theysee the attention they receive (Mitchell et al., 2014).

Eliminatingfalls will ensure that the patients’ stay in the hospital is notprolonged. The hospital will also avoid extra costs that arise frominjuries sustained during the falls in their establishments (Mitchellet al., 2014). This system can be quickly enacted while betteralternatives are strategized.


Thenursing theorist relevant to the problem of patients falling is BettyNeuman. She proposed the theory known as the “System Model”(McCrae, 2012). The theory looks into how nursing skills can be usedat different stages to safeguard the wellbeing of the entirepatient’s system from external stress factors (McCrae, 2012). Itdefines nursing as a responsibility of barring any form of stressfrom affecting the patient so that they can improve or maintain theiroptimal level. This theory works for the problem statement becausenurses have to guarantee the safety of their patients, especially byensuring they do not fall while in their care (McCrae, 2012).


Thetheory applies to the evidence-based practice of ensuring thatpatients do not fall while in hospitals. The hourly rounds thatnurses conduct is a move that will prevent any form of externalstress from harming the patient’s wellbeing. Regular visits preventany form of harm coming to the patient due to the action of the nurse(McCrae, 2012).

Usingthe “System Model,” the nurses can fulfill their duties whilealso satisfying the needs of the patient (McCrae, 2012). Fewer fallswill ensure that patients can leave the hospital as soon as they arebetter. They will not have to undergo a prolonged stay due to anyinjury sustained from a fall. The nurses will also feel moresatisfied with their work since the patients will not be coming toany harm (Mitchell et al., 2014).

Ina microsystem, the hospital’s administration can begin theimplementation of this evidence-based practice sections of thefacility that have reported the highest cases of falls. After amonth, the data that was recorded can be analyzed to determine theefficiency of the strategy. If it is seen as viable, it can be fullyincorporated in the entire hospital (Mitchell et al., 2014). At amacro-system level, the local, or federal government can implementthe evidence-based practice of using regular hourly visits tominimize falls on selected hospitals. The data can be recorded overseveral weeks before it is evaluated. If the figures indicate thebenefits of the system, it can then be applied to every hospitalwithin the region (Mitchell et al., 2014).


Theanalysis of the current practices in clinical settings has shown thatthey put the safety of patients at risk. These practices are thereason why the number of patients falling while in the hospital hasbeen increasing. The EBP of using hourly rounds by nurses to monitorthe conditions of patients is a practical idea that can be quicklyeffected. The “System Model Theory” by Neuman has shown that itis the role of nurses to ensure that their patients are protectedfrom any external factors that may harm them. Using the theory, theintervention strategy can be implemented on a micro and macro system.The benefits from the intervention serve the patients, nurses, andthe entire medical facility.


Bouldin,E. D., Andresen, E. M., Dunton, N. E., Simon, M., Waters, T. M., Liu,M., … Shorr, R. I. (2013). Falls among Adult Patients Hospitalizedin the United States: Prevalence and Trends. Journalof Patient Safety,9(1),13–17.

Doran,D., Lefebre, N., O’Brien-Pallas, L., Estabrook, C. A., White, P.,Carryer, J., … Li, M. (2014). The Relationship Among Evidence-BasedPractice and Client Dyspnea, Pain, Falls, and Pressure Ulcer Outcomesin the Community Setting. Worldviewson Evidence-Based Nursing,11(5),274–283.

McCrae,N. (2012). Whither Nursing Models? The value of nursing theory in thecontext of evidence‐basedpractice and multidisciplinary health care.&nbspJournalof Advanced Nursing,&nbsp68(1),222-229.

Mitchell,M. D., Lavenberg, J. G., Trotta, R., &amp Umscheid, C. A. (2014).Hourly Rounding to Improve Nursing Responsiveness: A SystematicReview.&nbspTheJournal of Nursing Administration,&nbsp44(9),462–472.