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Fall Prevention In Hospital: A Study On Evidence-based Practice

Posted on:2012-03-21Degree:MasterType:Thesis
Country:ChinaCandidate:L ChengFull Text:PDF
GTID:2154330335998193Subject:Nursing
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Background Patients are at high risk of falling in hospital. The devastating outcome of falls has made fall prevention one of the important parts in hospital safety management. Current trend in this field is that putting the best evidence of fall prevention into clinical practice by developing an evidence-based clinical practice guideline (CPG) on hospital fall prevention. However, it is still unclear how best evidence could be embedded into hospital fall prevention management system.Objective Based on JBI model of evidence-based healthcare, this study aimed at describing and analyzing the current practice of fall prevention in China, primarily appraising and synthesizing evidence on this regard, developing a clinical practice guideline, evaluating its feasibility and effectiveness by evidence implementation, exploring nurses' experience in this CPG utilization so as to analyzing relevant influential factors. And the clinical practice guideline on fall prevention in hospital was reviewed.Methods Based on JBI model of evidence-based healthcare, in-depth interviews of key informants and a survey were conducted to explore the current practice of fall prevention in hospitals. Evidence on fall prevention in hospital was appraised and synthesized by a systematic review and a content analysis. A clinical practice guideline on fall prevention in hospital was developed. Then a parallel control study was conducted to evaluate its feasibility and effectiveness. Nurses' experience in this CPG utilization was explored by in-depth interviews so as to find relevant influential factors on this evidence implementation. Then the clinical practice guideline on fall prevention in hospital was reviewed according to the Appraisal of Guidelines Research & Evaluation System.Results1. Current practice investigation was done by in-depth interviews of eight nursing managers and a survey of two hundred and thirty-one frontline nurses, which showed that a basic system of fall prevention had taken shape, including fall risk assessment, fall preventative strategies and post fall management. However, there remained four gaps to be bridged, i.e. nurses had not paid enough attention to this issue, and they were not satisfied with the current hospital fall prevention practice. Gaps also existed in insufficient attention from nurses, low level of procedure evaluation, a lack of standard resources and training, as well as ineffective multidiscipline collaboration. So the development of an evidence-based CPG on fall prevention should take the status que into consideration.2. Evidence on fall risk assessment, fall preventative strategies and post fall management in hospital was appraised and synthesized by a systematic review of nineteen RCTs and a content analysis of fifty-eight Chinese articles, which had laid the literature foundation for an evidence-based CPG on fall prevention.3. A draft of clinical practice guideline on fall prevention in hospital was developed, which elaborated the evidence on fall risk assessment, preventive strategies and post-fall management.4. A six-month parallel control study was conducted in one tertiary hospital in Shanghai. A series activity of evidence introduction and implementation were carried out in fall prevention management system of the intervention ward (neurology department). While nurses in the control ward (respiratory department) practiced according to the hospital's original requirement on fall prevention. During the period of intervention, one fall happened in the intervention ward and two occurred in the control ward. Nurses in the intervention group were significantly more contented with current procedures than those in the control group, their alertness on fall prevention and their scores of literarily analyzing a fall case were significantly higher (p<0.05). Nurses'adherence to the changed procedures in the intervention ward were satisfying (mediate 0.9).5. Themes of nurses' experience at each stage of the changing practice emerged as exciting and expecting, doubt and thinking, refusing and acceptance, grinding and initiative, sharing and reflecting. External supervision motivation and intensification, as well as internal cohesion and aroused creativity had assisted in promoting evidence implementation. While barriers were derived from inertia from previous practice, relatively insufficient human resources, lack of equipment, lack of understanding and cooperation from patients and their families, ineffective multidiscipline collaboration. Key elements involved top-level design and role clarification, comparing evidence with current procedures and taking clinical situation into consideration, people orientated as well as emphasis on feedback and motivation.6. The clinical practice guideline on fall prevention in hospital was reviewed according to the Appraisal of Guidelines Research & Evaluation System. The meaning and rigorousness of this CPG were confirmed by the experts. Suggestions on this CPG utilization were pointed.Conclusion1. Evidence-based practice on fall prevention is a continuous quality improvement cycle of finding out and bridging gaps between best evidence and current situation, with consideration of clinical situation, patients'preference and professionals' clinical expertise. 2. The formulated clinical practice guideline has primarily shown feasibility and effectiveness in utilization to a certain extent under Chinese clinical condition.
Keywords/Search Tags:fall prevention, evidence-based nursing, clinical practice guideline
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