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Posted: October 27th, 2022

MSN561 – Theoretical Foundation of Advanced Practice Nursing

Application of Concepts from Caring Science RN
United States University
MSN561 – Theoretical Foundation of Advanced Practice Nursing

Introduction
A clinical situation in my experience is working with elderly patients in an assisted living community at risk of falls. One personal observation of our healthcare workers is that many of them deny the risk of falls or overestimate their abilities to prevent falls. Others plainly refuse to use ambulation devices as walkers. Healthcare workers can use diverse mechanisms to improve the health of elderly people without putting them at risk of falls. Evidence-based tools such as Hester Davis Full Risk Assessment have been a primary reason for lowering patient falls and improving safety. Watson’s theory of human caring indicates that nurses should perceive patients as human beings who need care. The theory proposes the need to provide wholesome care that addresses a patient’s environment as they continue to receive care. Healthcare workers should utilize diverse tools to enhance the quality of patient care. The purpose of the paper is to discuss applying concepts from caring science among elderly patients and preventing the risk of falls.
Outcome of Nursing Practice
This paper’s outcome for nursing practice is to reduce the number of falls among elderly patients above 65 years in healthcare settings. The objective is to avoid compromising the health of patients (Kamińska et al., 2018). Studies show that patient falls lengthen hospital stay, compromise the health of patients, and increase the cost of care (Kamińska et al. 2018). The severity of the patient can increase the risk of mortality. CDC indicates that patient falls are preventable and that falling should not be an inevitable part of old age (LeLaurin & Shorr, 2019). The measurable outcome requires a quality improvement model in the healthcare setting.
Centers for Medicare & Medicaid Services (CMS) stopped paying hospitals for patient falls in 2008 to encourage them to take preventive measures to enhance patient safety (LeLaurin & Shorr, 2019). Due to the high cost of care for patients with bone fractures and lengthy hospital stays, healthcare facilities seek mechanisms to improve patient safety and reduce patient falls. For instance, hourly rounding is essential in reducing the risk of falls. Hospitals need to redesign and improve their current practices to enhance patient safety (LeLaurin & Shorr, 2019). The improvement is essential to prevent adverse outcomes that undermine the health of elderly patients and put their families in constant fear.
Falls are significant health events that change the life and condition of elderly persons. Globally, the elderly population over 65 is about 650 million, projected to rise above 2 billion in 2050 (Cuevas-Trisan, 2019). Each year one-third of the elderly sustain a fall, from those, 20 to 30 % will sustain moderate to serious injuries (Fountouki, 2021). The statistics are shocking since they demonstrate a high number of elderly people who experience health complications due to patient falls. The focus should be on addressing the factors that increase the risk of falls.
Falls are the third most reported in hospitals for elderly clients. It extends the hospitalization time and negatively affects their independence. Falls deteriorate the health of the elderly psychosomatically, socially, and economically after suffering fractures, head trauma, and other injuries (Cuevas-Trisan, 2019). Healthcare workers should strive to prevent falls since they cause catastrophic health effects. In some instances, healthcare facilities will fight lengthy lawsuits in court if a family suspects that the healthcare worker’s negligence contributed to a fall that led to death (LeLaurin & Shorr, 2019).
A systematic review and search of articles about the causes of falls in the elderly population published by Fountouki et al. (2021) revealed the common causes of the risk of falls could be classified as internal and external causes. Environmental factors at home include unsafe conditions such as lighting, slippery surfaces, cluttering, rugs, and unsafe shoes. Endogenous factors include physical and mental changes, musculoskeletal, neurosensory, or cardiovascular systems changes (LeLaurin & Shorr, 2019). Some effects of medication cause psychotropics, antihypertensive, polypharmacy, and fear of falling (Fountouki, 2021). The external and internal factors increase the risk factors that deteriorate the health of elderly patients.
Lokhande and Iyer (2020) classified the risks of falls as biological, including effects of aging on the body, such as general body weakness. Others include environmental, socioeconomic, and behavioral factors. Deteriorating health and the biological functioning of organs increase the risk of falls (Nadu et al., 2021). For example, poor cognition such as executive function, attention, problem-solving skills, concentration, and memory are factors that increase the risk of falls. Healthcare workers should strive to use problem-solving mechanisms to provide solutions to the chronic problem of patient falls (Nadu et al., 2021). The problem-solving approach effectively addresses diverse healthcare factors that can undermine the safety of patients in a healthcare facility.
Clinical Nursing Theory
Concept A: Patients who are 65 years and above are at risk of falling. CDC estimates that elderly patients have a 25 percent risk of falling and a 50 percent risk if they have a history of falling (Cuevas-Trisan, 2019). Some of the factors increasing the risk of falling include loss of stability, body and muscle weakness, and poor vision. Other health conditions that increase the risk of falling include heart diseases, diabetes, and depression. For instance, a patient with dementia has a high risk of falling (Cuevas-Trisan, 2019). Falling leads to heart injuries, bone fractures, and hip fractures. The health issues undermines the quality of care and undermines safety.
In the theory of psychosocial development, Erikson indicates that awareness of the risk of falls will reduce the falls and the consequences of the falls (Maree, 2021). For instance, patients should be aware of their abilities and limitations due to age or other health conditions. The analysis of the risk of falls with the application of an assessment tool will evaluate the mentioned risk and use nursing judgment to identify specific risks and formulate a fall prevention plan (Maree, 2021). The approach will be successful if the person acknowledges the risk and follows the advice to reduce falls and maintain quality of life. The use of specific tools for the risk of falls has not proven to be superior to the nurse’s clinical judgment (Meyer et al., 2018).
Concept B: Patient falls continue to be a significant issue affecting patient care. Centers for Medicare and Medicaid Services (CMS) admit that at least one million falls occur across hospitals in the USA (Kamińska et al., 2018). Patient falls have been classified as a hospital-acquired conditions. The adverse effects of falling show the need to exercise caution. Using evidence-based tools such as Hester Davis Full Risk Assessment has been a primary reason for lowering patient falls and improving safety (Kientz & Hester, 2020). Healthcare workers should strive to use evidence-based tools to enhance the safety of patients in the healthcare settings.
In the absence of medical or mental conditions, the lack of awareness or underestimation of the risk of falls increases the risk of adverse events. For instance, denial of being old and frail or overestimating physical capabilities will put a patient at risk of failing to take precautions (Kientz & Hester, 2020). Process number 6 from the 10 Caritas, as per Jean Watson’s caring theory, calls for commitment to look for solutions in a creative way (Leone-Sheehan, 2021). Applying this process to reduce falls will improve the outcome of our nursing interventions for our elderly clients.
In the presence of morbidities related to aging, a detailed assessment of the functional capacity can be used in clinical settings. Nadu et al. (2021) published a cross-sectional study with 130 hospitalized elderly clients to apply variables such as activities of daily living, Morse scale for risk of falls, fear of falling, and pain as tools to assess the risk of falls, and follow fall prevention guidelines in nursing interventions (Leone-Sheehan, 2021). The study effectively provides quality information that healthcare workers can use to enhance the safety of elderly patients.
Proposition
Patient falls among elderly people are common due to their deteriorating health condition. Poor cognitive, and neurological conditions, cardiovascular diseases, and accidental falls are factors that put patients at risk of falling (Maree, 2021). While the health of elderly patients remains challenging, healthcare workers can exercise caution to prevent falls. Evidence-based tools such as the Hester Davis Full Risk Assessment can be used to improve environmental safety and reduce the risk of patient falls (Kientz & Hester, 2020).
Watson’s Theory of Human Caring and the Clinical Nursing Theory
Watson’s theory of human caring indicates that nurses should perceive patients as human beings who need care. Human beings cannot be treated as objects but as humans who cannot be separated from self and nature (Slade & Hoh, 2020). The theory encourages nurses to view patients as people with emotional aspects, spiritual, and physical needs. The care should include educating patients about their sickness to improve the quality of patient outcomes. Watson’s theory encourages nurses to enhance the quality of the environment (Slade & Hoh, 2020). The objective is to ensure the patient feels cared for in all aspects, which improves the recovery process.
The physical environment and safety of the patient in healthcare determine the health outcomes. Nurses should adhere to the fall prevention policies such as installing bed alarms, using bed rails and ensuring the call bell is within reach of a patient at all times (Cuevas-Trisan, 2019). In some cases, nurses can use fall mats, wear wristbands to indicate the severity of falling, and use a clip alarm. Some healthcare settings can use camera monitoring systems to enhance the safety of patients. Nurses should explore all the available mechanisms, and restraint should be used as a last resort for violent patients (Cuevas-Trisan, 2019). For instance, nurses should strive to spend time with patients to enquire how they feel and determine the appropriate interventions such as repositioning. Nurses should be conversant with the aging process, resulting in poor balance, bad eyesight, and health conditions that weaken the body.
Discovery
Watson’s theory of human caring is applicable in different healthcare settings. The theory is applicable in clinical practice and research. The theory relates to the arguments of Florence Nightingale, who believed that the environment plays a significant role in the treatment process (LeLaurin & Shorr, 2019). The middle-range theory is effective since it combines practice and theory. Nurses should realize that theories apply in everyday settings in the delivery of care. Theories influence evidence-based care practices that foster quality outcomes (LeLaurin & Shorr, 2019). The improved practices enhance patient comfort and reduce the incidences that compromise patient safety.
Conclusion
Falls are a significant risk for the quality of life of elderly persons, producing negative changes in their quality of life. Falls deteriorate the health condition of the elderly psychosomatically, socially, and economically after suffering fractures, head trauma, and other injuries. Falls can be addressed by applying nursing criteria or assessment tools to design nursing interventions to reduce falls, even when they are not entirely preventable, at least to reduce them. Some elderly clients are in denial of the biological changes due to aging. The lack of acknowledgment signals failure to reach the ego integrity as per Erickson’s theory, getting into despair after falls and injuries that change their quality of life (Haroon et al., 2018). Process number 6 from the 10 Caritas, as per Jean Watson’s caring theory, calls for commitment to look for solutions in a creative way. Applying this process to reduce falls will improve the outcome of our nursing interventions for our elderly clients. Further research is needed about the importance of using clinical nurse criteria versus fall assessment tools in the effectiveness of recognizing the risk of falls and their prevention.

References
Fountouki, A., Asimakopoulou, E., Theofanidis, D., (2021) Falls in the Elderly: A contemporary
“Health Epidemic?”. A discussion Perioperative Nursing. (2021) Vol. 10, Issue 3
Haroon, W., Khawaja, A., Ghayas, G., (2018) Ego Integrity, Physical Health Status and Death
Anxiety in Older Adults. Journal of Behavioral Sciences, Vol.28, Nr 1, 2018
Lokhande, S., & Iyer, S., (2020) Correlation of Cognition and Fall Risk in Elderly. Indian
Journal of Physiotherapy and Occupational Therapy July-September 2020, Vol 14, Nr. 3
Meyer, G., Möhler, R., Köpke, S., (2018) Reduce Waste in Evaluations Studies on Falls Risk
Assessment Tools for Older People. Journal of Clinical epidemiology. 102 (2018)
139c143
Nadu, A., Sala, D., Monteiro, O., Costa, P., Okuno, M., (2021) Functional Capacity: Association
With Risk of Falls, fear of falling and Pain in The Elderly. Rev Rene 2021; 22: e62430.
Doi: https://org/10.15253/2175-6783. 202122622430
Kamińska, M. S., Miller, A., Rotter, I., Szylińska, A., & Grochans, E. (2018). The effectiveness of virtual reality training in reducing the risk of falls among elderly people. Clinical interventions in aging, 13, 2329.
LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: state of the science. Clinics in geriatric medicine, 35(2), 273-283.
Cuevas-Trisan, R. (2019). Balance problems and fall risks in the elderly. Clinics in geriatric medicine, 35(2), 173-183.
Maree, J. G. (2021). The psychosocial development theory of Erik Erikson: critical overview. Early Child Development and Care, 191(7-8), 1107-1121.
Kientz, S., & Hester, A. (2020). Predictive Model Development and Validation of the Emergency Hester Davis Scale© for Fall Risk Screening. Nursing: Research and Reviews, 10, 1.
Leone-Sheehan, D. M. (2021). Jean Watson: Watson’s Philosophy and Theory of Transpersonal Caring. Nursing Theorists and Their Work E-Book, 68.
Slade, J. D., & Hoh, N. Z. (2020). Employing Watson’s Theory of Human Caring With People Experiencing Loss and Grief. International Journal for Human Caring, 24(1), 4-11.

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