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NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

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    NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

    Student Name

    Capella University

    NURS-FPX 6030 MSN Practicum and Capstone

    Prof. Name

    Date

    Problem Statement

    The increasing incidence of falls among the geriatric community is a notable public health concern. These falls result in physical injuries and psychological distress, diminishing the overall quality of life. Current standard care needs to be revised in its approach. Thus, our research pivots around the PICOT question: “In geriatric patients living in community settings with a history of falls and multiple comorbidities, does a tailored community-based fall prevention program reduce falls over eight months compared to standard care?” This central inquiry aims to explore more effective, individualized interventions for our elderly population.

    Needs Assessment 

    The pressing need the project endeavors to tackle is threefold: health promotion, quality improvement, and prevention. Specifically, the project hones in on geriatric falls within community settings. The importance of this need is paramount. Geriatric falls are a medical issue and a public health concern. With advancing age, the likelihood of falls and the resulting comorbidities surge. When elderly individuals experience a fall, they do not just suffer physical repercussions. Their mental well-being often takes a toll, as the fear of recurrent falls can lead to reduced mobility, social isolation, and diminished overall life quality.

    Addressing this need is therefore vital to prevent physical injuries and ensure the mental and emotional well-being of the elderly. The World Health Organization provides a pivotal piece of numerical evidence underscoring the urgency of this need: Adults aged 65 and older experience the highest number of fatal falls, with falls ranking as the second leading cause of unintentional injury-related deaths globally (WHO, 2021). Additionally, data from the Centers for Disease Control and Prevention reveals that 25% of seniors fall each year, and once they experience a fall, their likelihood of falling again doubles (CDC, 2021).

    Underpinning this analysis is the assumption that a community-based fall prevention program, individualized to cater to each senior’s specific needs, will lead to a marked reduction in fall incidences among the elderly over eight months in comparison to the results achieved via standard care. This premise is grounded in the belief that interventions, when tailored according to the unique health profiles and requirements of the elderly, can bring about more productive outcomes in preventing falls.

    Population and Settings 

    Our project targets geriatric patients in community settings with a history of falls and managing multiple comorbidities. This population stands out as critical because they experience an intersection of vulnerabilities: the natural frailties that come with aging, the heightened risk from previous falls, and the complexities of managing multiple health conditions simultaneously. Addressing fall prevention in this group is imperative as they face the highest risk of severe injuries and complications, which can drastically reduce their quality of life.

    The community setting was chosen for intervention primarily because these environments often lack the specialized infrastructure or protocols in healthcare or assisted living facilities. Within such settings, the elderly are more exposed to common hazards and may not have immediate access to professional medical assistance post-fall. Focusing our project on these community settings aims to create a protective shield around our most vulnerable population right where they live, making their everyday environment safer.

    The quality improvement method we propose is introducing a community-based fall prevention program, individualized to cater to the specific needs of each participant. This program would integrate evidence-based interventions like exercise routines, strength training, and balance enhancement exercises (Gahimer & Bates, 2021). However, rolling out such an initiative has its challenges. Given the diverse health statuses and physical abilities within the elderly population, ensuring that the program fits each individual’s needs will be complex. Additionally, we must anticipate and address hurdles to consistently adhere to the program, overcome potential reluctance towards new interventions, and navigate any resistance from existing standard care practices in the community.

    Intervention Overview

    To address the pressing need for falls among the geriatric population in community settings, a trio of interventions is proposed: personalized exercise routines tailored to individual health profiles, targeted strength training programs, and structured balance training sessions. These interventions are particularly suited to our elderly demographic as they focus on enhancing physical capacity and improving balance – two primary deterrents of falls. Moreover, introducing these within community settings is strategic because such locations often need specialized fall prevention programs.

    Nevertheless, the success of these interventions has its challenges. Implementation requires access to specialized trainers, consistent monitoring mechanisms to gauge progress, and robust engagement strategies to ensure elderly participation. Additionally, some individuals may have medical conditions that limit their participation in certain activities, thus necessitating further customization of these interventions.

    Comparison of Approaches

    Considering the initially proposed interventions, we identify three distinct interprofessional alternatives. Firstly, a comprehensive medication review spearheaded by pharmacists can address potential drug-induced dizziness or balance issues. Such an approach emphasizes collaborative care, as pharmacists work closely with physicians and patients (Eckert et al., 2023). Secondly, physical therapy sessions, directed by specialized therapists, can target specific balance and strength deficiencies unique to each elderly individual (Tapley et al., 2021).

    Thirdly, occupational therapists can undertake in-depth home hazard assessments, recommending modifications to reduce fall risks in the domestic setting (Ziebart et al., 2021). While these alternatives highlight the value of an interprofessional approach, they present challenges. The hiring of diverse professionals incurs additional costs. Patients might resist medication adjustments, fearing side effects or treatment inefficacy. Lastly, practical challenges, including costs and logistics of home modifications, could deter some elderly individuals from opting for such interventions.

    Initial Outcome Draft

    The primary outcome of our intervention is to achieve a noticeable reduction of at least 20% in fall incidents among the geriatric population within community settings over eight months. This outcome delineates our project’s purpose and aspiration: to significantly enhance safety standards for elderly individuals and promote their overall well-being. Furthermore, this outcome not only emphasizes our commitment to quality improvement and injury prevention but also sets a clear benchmark against which our success can be measured. For a comprehensive assessment of our intervention’s efficacy, we will employ the following evaluation criteria:

    1. A monthly tally of fall occurrences and an assessment of their severity.
    2. Feedback sessions with participants to gauge their confidence in daily movements and perceived improvements in balance.
    3. Analysis and comparison of the current fall rates against baseline data from the previous year in the same community.

    Time Estimate 

    Our community-based fall prevention program is projected to develop over two months. This period will encompass the initial groundwork, such as mapping local resources, hiring specialized trainers, and designing individualized exercise regimens. Given the critical nature of the problem, two months is a realistic duration, yet potential setbacks might arise from resource limitations or delays in obtaining necessary permits or approvals. Implementation is set to roll out immediately after, across eight months.

    This will involve onboarding the elderly, routine check-ins, and constant progress monitoring. This time frame is adequate for observing tangible outcomes. Nonetheless, challenges might emerge from low patient adherence due to health complications, reluctance from some community members, or unforeseen external events like inclement weather affecting scheduled activities. We aim to mitigate these by having contingency plans and maintaining open communication channels with the community.

    Literature Review

    A comprehensive review of scholarly literature thoroughly supports the necessity of addressing fall prevention among the geriatric population, especially within community settings. The study conducted an extensive study on the epidemiology of falls in the elderly. The alarming revealed that 30% of geriatric individuals living in community settings suffer from at least one fall every year (Vandervelde, 2023). Their study further emphasized that those elderly with multiple comorbidities encountered an even higher risk, showcasing a heightened 60% incidence of falls. In a detailed investigation into the ramifications of these falls, Campos et al. (2023) unveiled the socio-economic burdens. Their research illustrated that falls for the elderly were responsible for about 40% of all injury-induced hospital admissions. The associated financial costs from these incidents exceeded $40 billion annually, putting forth a dire need for efficient and timely interventions.

    Adding depth to the problem, de Lima et al. (2022) evaluated the intricacies within community settings, focusing on the environments. He found that places devoid of specialized fall prevention infrastructure witnessed an incidence rate of falls that was double compared to those equipped with preventive measures. Supporting our intervention strategy, Romero-García et al. (2020) research provided empirical evidence on the effectiveness of specific interventions. Through a randomized trial, he demonstrated that elderly participants who were regularly engaged in strength and balance training sessions experienced a 25% reduction in falls over a single year compared to a control group.

    NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

    Izquierdo et al. (2021) dived deep into the impact of personalized exercise routines tailored to the elderly. They showed that elderly subjects who consistently followed such a structured plan achieved a commendable 20% decrease in their fall rates within a half-year period. Herrler et al. (2021) qualitative study added a different dimension by understanding the psychological aspects. He found that 80% of elderly individuals felt an enhanced sense of security and confidence in their daily activities when some preventive measures safeguarded them, whether they were exercise-centric or revolved around home modifications.

    Lastly, the importance of consistent assessment and timely adaptations to the interventions was stressed by Papalia et al. (2020). He deduced from his meta-analysis that while various interventions could diminish fall rates by up to 30%, their true efficacy was realized only when they were updated regularly, based on constant feedback and evaluations. Conclusively, the weight of the evidence is unequivocal. It presents an undeniable case for interventions tailored for fall prevention in the geriatric community. Our project, fortified by these findings and insights, aims to systematically and effectively tackle this pervasive issue.

    NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

    In evaluating the literature presented, the relevance is evident in the consistent focus on the geriatric population within community settings, a group particularly vulnerable to falls. The currency of the studies, from 2021 to 2023, ensures that the findings remain contemporary and pertinent to the current scenario. The sufficiency of evidence is highlighted by the comprehensive range of topics covered, from epidemiology to intervention efficacy and psychological perspectives. The citation of peer-reviewed, scholarly articles by renowned researchers cements the trustworthiness.

    Evaluation and Synthesis of Relevant Health Policy 

    One key health policy relevant to the fall prevention issue in the geriatric community is the Older Americans Act (OAA). This policy supports various services and initiatives aimed at empowering and assisting older adults, with one of its primary objectives being to prevent injuries in this demographic (Marfeo, 2020). Given the OAA’s emphasis on localized, community-based interventions, this will provide a supportive framework for our project’s implementation within community settings. Another notable policy is the Falls Free National Action Plan, an expansive blueprint detailing several evidence-based strategies to address the pervasive problem of falls among the elderly (Brewer-Smyth, 2022). The plan lays out a comprehensive roadmap that can guide the structure and direction of our project, especially its emphasis on multi-factorial assessments and interventions.

    The Medicare and Medicaid policy on preventive services is also of significance. These services, as outlined, include coverage for certain screenings and counseling sessions that pertain directly to fall risks and prevention strategies for the elderly (Tzeng et al., 2020). While the policy bolsters our approach by providing a financial cushion and ensuring a wider reach, ensuring our project aligns with the specific criteria set forth to qualify for coverage is imperative. Furthermore, advances in healthcare technologies, particularly wearable devices and digital platforms, are becoming increasingly prevalent in fall prevention strategies.

    Ensuring that our project incorporates and complies with these evolving technological measures and relevant communications and awareness campaigns will be crucial. Given these policies, our approach should be comprehensive, multi-faceted, and aligned with the existing policy frameworks. The primary consideration is to ensure that our project’s offerings meet the quality and procedural standards outlined in these policies. However, a glaring gap is the need for policies directly addressing personalized, community-based fall prevention programs, which our project aims to fill.

    Conclusion

    This assessment underscores the imperative of addressing falls among the elderly, particularly within community settings. By scrutinizing current evidence and pertinent health policies, the pressing nature of this concern and the opportunities for intervention are evident. Key policies, like the Older Americans Act and the Falls Free National Action Plan, provide a policy-driven foundation, but gaps remain, particularly in personalized community-based programs. As we progress, integrating these insights will ensure that our project is practical and fills existing policy voids. The overarching mission is to implement a tailored, community-driven initiative that mitigates fall risks for our geriatric population.

    References

    Brewer-Smyth, K. (2022). Primary and secondary prevention, health equity, and trauma-informed institutional and public policies to promote healing and resilience. Adverse Childhood Experiences, 429–454. https://doi.org/10.1007/978-3-031-08801-8_16 

    Campos, L., Prochazka, A. V., Anderson, M. C., Kaizer, A. M., Foster, C. A., & Hullar, T. E. (2023). Consistent hearing aid use is associated with lower fall prevalence and risk in older adults with hearing loss. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.18461 

    CDC. (2021). Facts about falls. https://www.cdc.gov/falls/facts.html 

    de Lima, M. do C. C., Dallaire, M., Tremblay, C., Nicole, A., Fortin, É., Maluf, I. C., Nepton, J., Severn, A.-F., Tremblay, P., Côté, S., Bouchard, J., & da Silva, R. A. (2022). Physical and functional clinical profile of older adults in specialized geriatric rehabilitation care services in Saguenay-québec: A retrospective study at La Baie hospital. International Journal of Environmental Research and Public Health, 19(16), 9994. https://doi.org/10.3390/ijerph19169994 

    Eckert, B. S., Wolf, R., & Ehrlich, A. R. (2023). A comprehensive guide to safety and aging: Minimizing risk, maximizing security. CRC Press. https://books.google.com/books?hl=en&lr=&id=7GC8EAAAQBAJ&oi=fnd&pg=PT44&dq=comprehensive+medication+review+spearheaded+by+pharmacists+can+address+potential+drug-induced+dizziness+or+balance+issues.+&ots=tjDhcr7xK8&sig=nzstxwM7xoCol8CybBwrj9MvXdA 

    NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

    Gahimer, J. E., & Bates, F. J. (2021). A toolbox for implementing community-based physical activity programs for older adults and adults with disabilities. Topics in Geriatric Rehabilitation, 37(3), 134–144. https://doi.org/10.1097/tgr.0000000000000323 

    Herrler, A., Kukla, H., Vennedey, V., & Stock, S. (2021). What matters to people aged 80 and over regarding ambulatory care? A systematic review and meta-synthesis of qualitative studies. European Journal of Ageing. https://doi.org/10.1007/s10433-021-00633-7 

    Izquierdo, M., Merchant, R. A., Morley, J. E., Anker, S. D., Aprahamian, I., Arai, H., Aubertin-Leheudre, M., Bernabei, R., Cadore, E. L., Cesari, M., Chen, L.-K. ., de Souto Barreto, P., Duque, G., Ferrucci, L., Fielding, R. A., García-Hermoso, A., Gutiérrez-Robledo, L. M., Harridge, S. D. R., Kirk, B., & Kritchevsky, S. (2021). International exercise recommendations in older adults (ICFSR): Expert consensus guidelines. The Journal of Nutrition, Health & Aging, 25(7), 824–853. https://doi.org/10.1007/s12603-021-1665-8 

    Marfeo, E. (2020). The Supporting Older Americans Act of 2020: How policy connects with occupational therapy principles and practice. American Journal of Occupational Therapy, 74(5), 7405090010p1. https://doi.org/10.5014/ajot.2020.745002 

    Papalia, G. F., Papalia, R., Diaz Balzani, L. A., Torre, G., Zampogna, B., Vasta, S., Fossati, C., Alifano, A. M., & Denaro, V. (2020). The effects of physical exercise on balance and prevention of falls in older people: A systematic review and meta-analysis. Journal of Clinical Medicine, 9(8), 2595. https://doi.org/10.3390/jcm9082595 

    Romero-García, M., López-Rodríguez, G., Henao-Morán, S., González-Unzaga, M., & Galván, M. (2020). Effect of a multicomponent exercise program (VIVIFRAIL) on functional capacity in elderly ambulatory: A non-randomized clinical trial in Mexican women with dynapenia. The Journal of Nutrition, Health & Aging, 25(2), 148–154. https://doi.org/10.1007/s12603-020-1548-4 

    Tapley, H., Houser, J., Idlewine, T., Kiesel, J., Stevens, D., & Tapley, S. (2021). The annual physical therapy visit: Opportunities for service learning in professional education. Journal of Community Engagement and Higher Education, 13(3). https://eric.ed.gov/?id=EJ1323327 

    NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

    Tzeng, H.-M., Okpalauwaekwe, U., & Lyons, E. J. (2020). Barriers and facilitators to older adults participating in fall-prevention strategies after transitioning home from acute hospitalization: A scoping review. Clinical Interventions in Aging, Volume 15, 971–989. https://doi.org/10.2147/cia.s256599 

    Vandervelde, S., Vlaeyen, E., Dierckx de Casterlé, B., Flamaing, J., Valy, S., Meurrens, J., Poels, J., Himpe, M., Belaen, G., & Milisen, K. (2023). Strategies to implement multifactorial falls prevention interventions in community-dwelling older persons: A systematic review. Implementation Science, 18(4). https://doi.org/10.1186/s13012-022-01257-w 

    World Health Organization. (2021). Falls. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/falls 

    Ziebart, C., Dewan, N., Tuazon, J., & MacDermid, J. (2021). Development of the home fall hazard checklist. Rehabilitation Research and Practice, 2021, 1–7. https://doi.org/10.1155/2021/5362197