Oilfield's General Hospital: Organization Context of Practice in Nursing - Essay Example

ORGANIZATION CONTEXT OF PRACTICE IN NURSING [Insert al Affiliation] Introduction Considering the ostensible fact that the Canadian population is continuously aging, most people approaching the unstable age of 65, and research indicating that 33% of seniors will experience a fall this year, health facilities are finding it necessary to implement fall protection programs. The globe continues seeking better ways of improving the quality of care through circumvention of fall-related deaths and injuries, but this has not always been easy considering the many social, political, and economic challenges confronting many countries (Edmonston & Fong, 2011). This paper will comprehensively analyze the fall prevention program at Oilfields General Hospital in Black Diamond, explaining its relevance, roles and responsibilities of various parties in the program, as well as its strengths and weaknesses. Additionally, the QA/QI models and principles underlying the program will be explicated to ultimately enable the derivation of recommendations on how the program can be improved to take care of the Canadian aging population. Description of the Fall Prevention Program According to Zerwekh and Garneau (2014), fall prevention programs are best suited for the prevention of fall-related deaths and injuries that cost Canada over $3 billion every year. In its broadest and vaguest form, a fall is an unanticipated occurrence where an individual or patient suddenly comes to rest on the floor, ground, or any other lower level. The fall prevention program is thus the consultation with a nurse, occupational therapist, physiotherapist, and geriatrician where the client’s health is assessed to determine their probability of falling thus aiding in providing apposite safety nursing care and guidance (Capezuti, Malone, Katz & Mezey, 2014). The hospital outlines that anybody who is over 65 years of age, and experiences falls or is likely to experience a fall, those in a position to walk for 25 metres, and those who can securely take part in a controlled exercise program should participate in the program. After enrolling in the program, individuals are expected to attend exercise and consultation sessions twice a week for a duration of six weeks. The hospital’s commitment to plummet fall-related deaths is seen through its provision of consultants including nurses and physiotherapists who are often ill-equipped, but enthusiastic to guide participants through the program (Zerwekh & Garneau, 2014). The depression, confusion, grander sequestration, loss of independence, and mobility resulting from falls among the seniors is more devastating, a factor that reiterates the importance of a fall prevention program at the hospital. Falls among the old Canadians is perceived to be a geriatric syndrome often attributable to pre-disposure to extrinsic and intrinsic risks, precipitating causes such as syncope and dizziness, as well as other unconnected multifactorial causes. According to the Public Health Agency of Canada (2014), “A wide range of chronic conditions can increase an individuals risk of falls, including neurological disorders such as Parkinsons disease, diabetes, arthritis, cardiovascular disease, end-stage renal disease, chronic obstructive pulmonary disorder or the effects of a stroke”. However, most falls among the seniors is attributed to balance, cognitive, and vision impairment, which from an etiological perspective, contributes 2.3% to 7% of the total falls experienced by the aging every year. Similarly, behavioural risk factors such as the continual increase in alcohol use and inactivity among Canadians is also blamed for the increased fall-related injuries and deaths in extreme cases. The hospital’s fall prevention program is positioned on the principle of providing preventive care to needy or susceptible patients or individuals through integration of state legislations guarding and guiding the formation and implementation of fall prevention programs and the customer needs (Scott, Elliott, Wagar, Public Health Agency of Canada & Canadian Electronic Library., 2010). Patients’ needs are taken into perspective in designing the program and ascertaining that it substantively addresses the risks associated with the unprecedented falls by devising mechanisms that ensures that the movement of the predisposed individuals is candidly monitored. Moreover, the hospital recognizes that clinical operations, patient involvement, and consultation are an important part of the expanded quality improvement or quality assurance process (Capezuti et al., 2014). It constantly conducts peer reviews where members of the community are involved and asked to give their perception of the fall prevention program. Negative responses are addressed and relevant corrections concocted and implemented to ensure that the fall prevention program remains relevant in the hospital’s objective of circumventing deaths, and costly injuries resulting from falls. Under the hospital’s fall prevention program, initiatives such as educating people about the risk factors, vision screening and rectification, consolidation exercise coupled with balanced training, medication administration and review, and provision of safer walking or working environments are provided (Black, B., Mayberry, R., Hiline Videoworks., & Fit as a Fiddle, 2010). The hospital’s multifaceted intervention program also certifies quality enhancement through collaboration with nursing practitioners and physicians as well as the community or families of the predisposed individuals to ensure that all risk factors are sufficiently addressed and plummeted. Apparently, the hospital also ensures that changing patients’ needs and the continual advancements in medicine are incorporated in the program. For instance, through the use of EHR (electronic health records), the hospital tracks all information related to a particular person’s health pinpointing the chronic biological risks they are exposed to as far as falling is concerned (Edmonston & Fong, 2011). This helps in swift implementation of corrective measures when the patient experiences a fall. Analysis of the Fall Prevention Program The hospital’s fall prevention program is centred on the common notion that quality programs are fundamental in attainment of a healthy, vigorous population. While the program has been able to circumvent impulsive institutionalization and improve the quality of life for older people, its services are often deemed belligerent due to reduced efficiency in implementation of quality improvement procedures. For instance, the processing of latest medical records and expert advice on falls and related risk factors takes too long (Zerwekh & Garneau, 2014). The delay subsequently compromises the quality of responses during emergencies. Similarly, since the program heavily relies on exercise, availability of modern training facilities for the participants including nurses and physicians can be considered to be of utter significance in improving the quality of the program (Black et al., 2010). However, due to financial constraints, the acquisition of modern training facilities prerequisite in the program’s success has proven to be difficult. Through constant peer reviews, the program has been made more professional by allowing sensitive and professional interactions. People from diverse professional, socioeconomic, educational, and cultural backgrounds have been brought into the program. This is a clear indication of the hospital’s dream to provide splendid care through embracing diversity and inclusion in care delivery. This success could not have been attained in the absence of the multidimensional quality assessment model employed by the hospital where social and behavioural factors are assessed and their impact on delivery of quality care determined. Cultural differences between the various participants have also been contained, and instead of being perceived as an obstacle in the prevention of falls, it has been used as a unifying factor that has served to positively contribute to the program’s success (Black et al., 2010). As important participants in the program, nurses engage in preparation of presentations on how older people can manage their drug-nutrient interactions and medication (Edmonston & Fong, 2011). They are closely assisted by pharmacists who review the medication of the adults to pinpoint expired medications, and cooperate with the nurses in counselling older adults and advising them to willingly participate in the program, answering clients’ questions, and assessing participants to ensure that they are correctly following directions with regards to medical prescriptions and exercise sessions (Capezuti et al., 2014). It is also the responsibility of the nurses to encourage the older people to persistently communicate with the physicians to update them on their health conditions, latest medications, and reasons for prescribing a particular medication and the impending results or side effects. Given the inordinate chance to participate in the hospital’s fall prevention program, I will incessantly be providing guidance to the old people to avoid the frustration ordinarily experienced by old people when under the care of supercilious nurses (Black et al., 2010). I will show them the deserved cooperation as well as encourage them to open up about their health conditions. Moreover, I will be assisting the physician in undertaking coordinated medication management including undertaking activities such as assessment of the elder’s level of osteoporosis, calcium supplements, and vitamin D level as well as changing the dosages. Within a year in the program, I will ensure that participation rate increases by 50%. This will be attained by persuading families to send old adults into the program. Community-based groups will be used increasing public awareness about the program and the importance of plummeting falls related deaths, through the exercise and medication initiative (Zerwekh & Garneau, 2014). Moreover, I will increase the program’s efficiency and productivity by encouraging the nurses to consider provision of care to old adults as part of their God-given abilities, and an opportunity for them to grow professionally. This will unremittingly encourage them to perform more and attention to patients’ health details. Additionally, I will seek more funding for the program. The Canadian ministry of health is a potential partner that can help in bolstering the quality of this fall protection program. Soliciting for support in form of training facilities and additional personnel is a brilliant idea in improving the program. Where possible, fringe benefits will also be offered to nurses and participants who register an exemplary performance or improvement in the program (Black et al., 2010). The long-term objective of the program is to eliminate fall-related deaths, hospitalization, and injuries. However, this will hardly be achieved if the program restricts that participants must be over the age of 60. Given a chance, I will expand the program to include more people, probably from the age of 50. While this can be perceived as a useless extension, its long term benefits is that Canadians will be exposed to exercise and medication early enough thus circumventing the hazy and confusion associated with abrupt occurrence of falls. Such premeditation will also enhance the program’s reputation and public participation (Capezuti et al., 2014). Apparently, the program’s success is largely attributable to the nurses’ proficiency in documentation of findings and their incessant efforts to assess old adult’s perception about the program. The nurses utilize their nursing notes to communicate and discuss findings with interdisciplinary group affiliates thus ensuring that most experts involved in the program are acquainted with the health condition of each and every old adult (Scott et al., 2010). Similarly, nurses, as well as physicians have been using empirically tested fall risk contraptions. Regrettably, the nurses have failed to extend this communication to the members of the community and families of the victims. Patients and their kinfolks are habitually left speculating what transpired. They are hardly updated on the findings of the PFA (patient fall assessment). Hence, while they could help in improving the quality of the program, they are forced to retain helpful information while the fall prevention program continues experiencing challenges such as inadequacy of nurses and protective facilities (Black et al., 2010). Nurses working in the program are ideally supposed to successfully handle all fall-related risks, but their ability to perform effectively is curtailed by the fact that the program’s guidelines and policies stimulates that sensitive biological risk factors can only be handled by the physician or psychotherapist (Scott et., 2010). Similarly, the program has an undersupplied number of medics, a factor that has proven to be a challenge in occasions where profound diagnostic tests such as CT scan or film X-rays are obligatory (Capezuti et al., 2014). What’s more, older adults are often discharged from the program without being trained on fall preclusion strategies due to the obliviousness of the nursing staff. Consequently, they in no time find themselves in the program due to poor education received prior to being discharged. Recommendations Firstly, the hospital needs to reconsider the medication review aspect of the program. According to Black et al. (2010), the tenacity of medication review is to pinpoint and eradicate medication side effects including lethargy and giddiness that potentially upsurges the risk of falling. Similarly, Zerwekh and Garneau (2014) assert that many aging people are oblivious of the fact that medication, if not correctly done, increases fall risks, and their sensitivity to medical side effects increases as they grow old. To reverse the impacts of faulty medication, the hospital should ascertain that the medication regimen are reviewed and modified by the physician only. Nurses should provide substantial assistance in the process, but the physician should take the domineering responsibility (Capezuti et al., 2014). Such a move will ensure that oblivious aging Canadians will not be unnecessarily exposed to more fall risks, thus augmenting people’s confidence in the fall prevention program. The hospital should also hire more nurses who would be able to correctly detect, refer, as well as manage the increased number of Canadians exposed to the risk of falling or those who have ever experienced a fall. RN (registered nurses) and APRN (advanced practice registered nurses) are suitable in transforming and revolutionizing the fall prevention program. Such proficient nurses will be in a position to conduct a clinical assessment of the emotional, physical, and functional effects of the fall on the adults (Zerwekh & Garneau, 2014). Moreover, they will expertly interact with old adults in the fall prevention program to ascertain the knowledge gaps and equip them with necessary skills which are imperative in falls preclusion. While many organizations use the MFS (Morse fall scale) in gauging fall risk, Rubenstein and Ganz (2011) unequivocally assert that oral communication is more important than MFS scores in the prevention of falls. People should talk more about the intervention that goes along with individuals’ risk for fall to determine the correct intervention as MFS score hardly communicate any meaningful information (Rubenstein & Ganz, 2011). Hence, the hospital must ensure that all those involved in the fall prevention program are effective communicators. It is through this approach that the cognitive or physical intervention relevant to their specific circumstance can be determined and efficaciously implemented. Moreover, since the nurses will be training old adults, the hospital should ensure that they all have AED/CPR certification (Capezuti et al., 2014). This will guarantee the old adults that they will be handled in the best manner possible hence increasing participation rate. Moreover, research by the Public Health Agency of Canada (2014) indicates that a whopping 67% of Canadians aged 65+ years, often seek medical treatment in an emergency room whereas 16% sought medical attention in a doctor’s office, and an insignificant 2% seek medical attention at the same place where the fall happens. This is illustrated in the pie chart below; Figure 1. Places Where Canadians Seek Help when they Experience Falls Note: retrived from Public Health Agency of Canada. (2014). Seniors Falls in Canada: Second Report - Public Health Agency of Canada. Retrieved from http://www.phac-aspc.gc.ca/seniors-aines/publications/public/injury-blessure/seniors_falls-chutes_aines/index-eng.php In lieu of this, the hospital should increase response time and speed by availing more nurses to areas where falls are likely to occur. For instance, the number of care assistants in wards inhabited by the old should be doubled compared to the number of care assistants in wards often populated by the young people. Changing the Canadian population’s beliefs, knowledge, and attitude towards falls is the domineering objective of this program (Capezuti et al., 2014). That cannot be attained if the number of care providers is small hence an instantaneous action is required. Increasing the number of care assistants will make it likely for old adults to seek medication from emergency rooms and doctor’s offices when faced with the risks of a fall (Zerwekh & Garneau, 2014). Also, for the program to be more effective, the hospital needs to perform a PFA to identify the root causes of the fall within 24 hours. According to Capezuti et al. (2014), a PFA conducted immediately after a fall is more effective as it candidly illuminates even the risk factors that indirectly contributed to the fall. Even if the patient is simply suspected to have fallen, the care giver should observe them for about 48 hours to take note of the delayed complications such as fractures. While the hospital has strived to conduct PFA on all patients who fall within the hospital’s environment, it should include assessment of more multidimensional vital signs including evaluation of the neck, spine, neurological assessment, and taking the readings of orthostatic blood pressure rather than simply relying on bystanders’ description and family history (Capezuti et al., 2014). Moreover, the hospital should give priority to individualized PFA and re-examination of the adult’s health be done by an incorporated multidisciplinary team that includes physical therapists, physician, health care providers, and nurses rather than simply leaving the responsibility to physicians or nurses. This recommendation is informed and bolstered by the fact that working as a team increases the effectiveness and adeptness of a program. The combined medical acumens will enable the team to systematically recognize and scrutinize the risk factors through the PFA. References Black, B., Mayberry, R., Hiline Videoworks., & Fit as a Fiddle (Firm). (2010). Fall prevention at home. Victoria, BC, Canada: Hiline Videoworks. Capezuti, L., Malone, M. L., Katz, P. R., & Mezey, M. D. (2014). The encyclopedia of elder care: The comprehensive resource on geriatric health and social care. Edmonston, B., & Fong, E. (2011). The changing Canadian population. Montréal: McGill-Queens University Press. Public Health Agency of Canada. (2014). Seniors Falls in Canada: Second Report - Public Health Agency of Canada. Retrieved from http://www.phac-aspc.gc.ca/seniors-aines/publications/public/injury-blessure/seniors_falls-chutes_aines/index-eng.php Rubenstein, L. Z., & Ganz, D. (2011). Falls and their prevention. Philadelphia, Pa: Saunders. Scott, V. J., Elliott, S., Wagar, L., Public Health Agency of Canada, & Canadian Electronic Library (Firm). (2010). Falls & related injuries among older Canadians: Fall-related hospitalizations & prevention initiatives. Zerwekh, J. A., & Garneau, A. Z. (2014). Nursing today: Transition and trends. Read More