Roles of Nurses in Assessment and Prevention of Fall Risks in Older Adults
Introduction
Older patients are often reported to be involved in adverse fall events. Nurses within the healthcare settings have a significant role in ensuring that the old are secure in their hospital beds since they could result in severe injuries. Hospitals utilize various policies that assess the risk of falls among geriatric patients, including the risk screening tools, especially for patients above sixty-five years (Chu, 2017). Patients’ independence and mobility should be maximized by employing an appropriate nursing care plan. Old patients should be assessed on their gait, balance, and strength. Time up and go, 4-stage Balance Test, and 30-second chair stand test are tools used to determine patients at risk of falling. Nurses should perform a patient’s health history, including the fall history, physical examination, and medical review (King et al., 2018). Limited mobility, vision impairment, frailty, and environmental hazards are the common causes of falls among old patients. Educating the patients on the safety precautions, balance training, and assisting the patients to move from bed to chair are prominent interventions that lower the risk of falls.
Literature Review
Combining certain medications such as sedatives and diuretics increases the fall risk among old patients in hospitals. Falls among seniors have elevated mortality rates and injuries that prolong the hospitalization period. Some patients develop the fear of falls, which increases their peril of falls. Various nurses’ roles in assessing and preventing falls in hospital settings. Some nursing responsibilities include lowering the old patients’ beds, locking the bed wheels, keeping patients’ wards free from clutter, and improving lighting in the patients’ rooms (Luzia et al., 2018). The nurse should educate the patients on using supporting mechanics such as grabbing bars, handrails and making the elimination equipment and handrails and making for the patients. Nurses have the duty of frequent old patients. Performing the pharmacological review is critical to determine the safety of the patients’ medications and ensure they won’t affect their ambulating ability. Nurses are responsible for communicating the risk of falls for their clients to the family and hospital staff.
Risk assessment of the role of the nurse in the health facility. The nurses can determine if there are risks of falling among their clients through comprehensive evaluations. Nurses should decide if the patient is above sixty-five years, has fecal/urinary incontinence, balance difficulties, history of falls, visual or cognitive impairment. Patients taking more than four medications are at risk of falls and environmental hazards such as the informal restraints of feeding tubes, catheters, and IV tubing (Hshieh et al., 2018). Assessment of risk of osteoporosis, fear of falling, and client’s functional ability should be used to evaluate the risks for falls. Nurses should assess other falling hazards include dizziness, light-headedness, and irregular heartbeats. The assessment is always client-centered, whereby the patient is interviewed on their risk for falls. Nurses should determine the high or low-risk factors and rate the falls for each old patient in danger of falls (Hshieh et al., 2018). Updating the patient’s fall risk assessment depends on the patients’ present conditions and medical interventions.
Discussion
Aged patients mostly have osteoporosis, and therefore their body support framework is suppressed physiologically. Nurses have to conduct a fall risk assessment to plan and implement the appropriate interventions. During the evaluation, the nurse utilizes both the subjective and objective data to construct a dependable nursing diagnosis related to the risk of falls among the old clients. The nurse is supposed to test the gait of the patient using the Tug, Timed Up- and –Go, the test which involves directing the patient to stand from a chair, walk about ten feet at their regular pace (Alves et al., 2017). If the patient takes longer, more than twelve seconds, to complete the simple task, the patient has a higher risk for a fall. A balance test is performed, too, where the old client is assessed in standing for four different positions for ten seconds each (Luzia et al., 2018). The patient is requested to stand on their feet, stand on one foot, move one foot halfway in front, and then entirely for the set duration—patients who can’t maintain their balance in at least three positions. The thirty-second chair stand test is performed, and the patient can sit on the chair. The nurse counts on the number the patient can sit and stand within the duration; few counts mean a high risk for falls.
Nurses play fundamental roles in preventing older patients from falls by creating care plans that are closely monitored for the patients. The nurses have to complete the risk assessment for falls and document the possibility of the risks (Abbasi et al., 2017). Reporting the falls cases for the patients’ falls to the physician is the responsibility of nurses. The physicians give orders on the appropriate medical attention that will be combined with the nursing interventions to avoid future falls for the patient. Call lights are used to alert the nurses on the patients’ assistance, and nurses should be quick to respond and address the issues immediately. This prevents patients from struggling and slipping out of their beds due to delayed aid. The nurses always lower the hospital beds for the old patients to avoid falls and lock the beds, and side bed rails should be used to keep patients safe from falling (Lemoyne et al., 2019). The nurses have the duty of ensuring the floors for the old patients is clean and dry to avoid slipping. Patients should always be safely handled by the nurses when getting them from bed or assisting them in ambulating. Nursing teamwork should be considered in such a scenario for healthy body mechanics.
The nurse ensures that the clients exercise minimal body movements to improve their balance and avoid falls. In instances where more exercises are required, inter-professionalism is employed where the physiotherapists are relied upon. Nurses should provide dietary supplements for foods that strengthen bones. Foods rich in vitamin D such as eggs, beef liver, and oranges can improve the patients’ bone strengths (Chu, 2017). The nurse should assess footwear to ensure that they are appropriate for the patent as they walk and that they can’t slip and fall. The nurse checks on the patient’s visual health to ensure the patient can detect the objects within the surrounding. Old patients are commonly associated with visual impairment such as cataracts, age-related macular degeneration, and presbyopia. Environmental modification is the nurse’s role in ensuring the patient’s safety through appropriate lighting of the wards and providing the patient familiarizes with the hospital settings (Abbasi et al., 2017). Some hospital equipment such as the catheters, IV infusions, and feeding tubes are likely to impede patient’s movement; therefore, the nurse should ensure they are appropriately set. The nurse should discourage the clients from getting from their beds when alone and provide the call bell is within reach of the patient’s bed.
Behavioral therapy is a critical nursing intervention that appropriate risk prevention for falls. The old patients are primarily associated with dementia and require effective management of their mental conditions. The nurse clarifies the need to embrace healthy lifestyles that will improve their ability to balance and avoid falls. Medications prescribed for the old patients could lead to associated seizures, and if chronic, the nurse must inform the physician of alternative medicines that will be safe for the patient (Alves et al., 2017). Nurses should thus conduct a good assessment on determining the drugs prescribed for the old patients and ensure that relevant interventions are taken if the clients have a history of falls. The nurse should always ensure that the patients’ belongings are within reach to provide safe access. Patients can slip from their beds when they stretch to access their personal effects since they lack body balance. Educating the patient on the appropriate procedures if they want to move out of their beds, nurses teach their clients how to utilize the sturdy handrails and discourage them from getting from beds under certain medications. (King et al., 2018) The nurse has the duty of informing the old patients on their risk for falling and encouraging them to seek nursing support in their activities within the hospitals. Nurses should ensure supplies such as the walking cane are available for the old patients.
Conclusion
Hospital falls among old patients should be avoided since it leads to injuries, prolonged hospitalizations, or deaths. Nurses employ different testing techniques to determine the risk of falls for aged patients. The nurses’ responsibility is to carry out a risk of fall assessment and ensure that relevant nursing interventions are put in place for quality health care within the population. The diminished physiological state of the old clients should be the reference point where appropriate interventions will be developed. Providing dietary supplements, environmental modifications, patient education, and lowering patients’ beds are some of the nursing roles in preventing the risk of falls among the population.
References
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Alves, V. C., Freitas, W. C. J. D., Ramos, J. S., Chagas, S. R. G., Azevedo, C., & Mata, L. R. F. D. (2017). Actions of the fall prevention protocol: mapping with the classification of nursing interventions. Revista latino-americana de enfermagem, 25.
Chu, R. Z. (2017). Preventing in-patient falls The nurse’s pivotal role. Nursing2020, 47(3), 24-30.
Hshieh, T. T., Yang, T., Gartaganis, S. L., Yue, J., & Inouye, S. K. (2018). Hospital elder life program: systematic review and meta-analysis of effectiveness. The American Journal of Geriatric Psychiatry, 26(10), 1015-1033.
King, B., Pecanac, K., Krupp, A., Liebzeit, D., & Mahoney, J. (2018). Impact of fall prevention on nurses and care of fall risk patients. The Gerontologist, 58(2), 331-340.
Lemoyne, S. E., Herbots, H. H., De Blick, D., Remmen, R., Monsieurs, K. G., & Van Bogaert, P. (2019). Appropriateness of transferring nursing home residents to emergency departments: a systematic review. BMC geriatrics, 19(1), 1-9.
Luzia, M. D. F., Cassola, T. P., Suzuki, L. M., Dias, V. L. M., Pinho, L. B. D., & Lucena, A. D. F. (2018). Incidence of falls and preventive actions in a University Hospital. Revista da Escola de Enfermagem da USP, 52.