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NURS 4006 Topics In Clinical Nursing

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NURS 4006 Topics In Clinical Nursing

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NURS 4006 Topics In Clinical Nursing

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Course Code: NURS4006
University: Walden University is not sponsored or endorsed by this college or university

Country: United States


Develop a nursing plan that includes suggestions on how to improve performance on the selected indicator. Be sure to provide at least three best practices from the evidenced-based literature to support your suggested nursing plan.


Nursing care plans are extremely effective in providing a means of communication among the nurses and all the nurses need to be familiarized with the term nursing plan. In most of the nursing workplaces, patient care is basically a team effort and it is accomplished by nurses from different shifts in collaboration with the doctors. An effective nursing plan contains all the relevant information about the patient, goals of treatment, strategies to achieve the goal and plan for evaluation of the strategies (Fleig et al., 2016). With a glance on the nursing care plan, understanding the main issue with the patient can be easier. In this paper, some data collected from the inpatient rehab unit will be analyzed. From the analysis an area will be selected which requires more attention and improvement in the performance. The main focus of this paper is to develop a nursing care plan suggesting some strategies to improve the performance of the selected area. Some best practices to evaluate the plan will also be illustrated in the paper.
Analysis of the data
Data was collected from the inpatient rehab unit in four interval of time period. The statistical data was represented in the form of mean, target and actual data. After that, the variance or the deviation in the result from the target to actual data has also been represented. From the wide range of data of various areas, the data regarding fall risk of the patients have been chosen. Fall risk among the patients is most common and it is more likely to happen among the elderly patients. This can be very dangerous if not treated properly that it might lead to the death of the patient too. So, it was important to improve the performance to prevent fall risk. In the datasheet, total fall per 1000 days of every interval has been shown. During the first interval of time, the mean of total fall has been counted as 7.6 and the actual fall is 6.96. Whereas, the target of the fall risk is 3.14 and so the variance is 3.82 which is negative. Again, in the second data collection during the second span of time, the mean fall was calculated as 7.68 and the actual data was zero. So, in this case the variance was 3.14 which were positive. But, in the next time period, the collected data shown a mean of 7.31, where the actual fall was 5.97. The variance calculated from the target produced it was negative 2.83. In the last time span, the mean was 7.38 and the actual fall was 9.19 which presented a huge variance from the target and it was 6.05 in negative. So, the fall count increased among the patients which were alarming from the analysis of the statistics. In order to improve the performance management to prevent fall risk some strategies in the nursing plan is required (Milos et al., 2014).
Nursing plan to improve performance
Many studies revealed that fall probability can be reduced when coupled with the intervention of nurses (Morris,  Bailis & Wiswell, 2014). Fall prevention is essential but it is challenging as there is no compelling evidence that any of the intervention of nurses can be effective enough in preventing risks of falling. However, considering multiple physical as well as environmental factors, some strategies can be implemented in order to create a nursing plan for falls. Some best practices in this regard are as follows.
Recognizing the pain, promoting some appropriate exercises- Incorporating exercise program into the daily routine of the resident patients can improve their balance and it will help to prevent the fall risk and risk of fractures resulting from falls. Many studies revealed fact with evidence that integration of exercise has reduced the risk of fall among patients (Duckham et al., 2015). Researchers recommended exercise program to the patients to improve their gait, strength and balance (Fleig et al., 2016). As per the age and the physical condition of the patient, the exercise plan must be prepared. However, a majority of population are less likely to show their willingness of participating in any exercise program. But, individualized based exercise should be promoted under the supervision of physical therapist in order to prevent cardiopulmonary decomposition from performing wrong exercises (Carande-Kulis, Stevens, Florence, Beattie & Arias, 2015). 
Equipping the resident patients with some protective gear- Use of several items that can be worn by the patients that prevent them from injuries due to fall and the items are proper footwear, hip protectors and helmets (Stubbs, Brefka & Denkinger, 2015). As per the requirement of the patients these equipments can be included in the nursing plan to prevent fall injuries. In a survey of Mayo Clinic, it has been found that many falls occur due to the improper and old footwear (Hatch & Tomé, 2017). Ill-fitting and worn out shoes can contribute to fall as well as they can develop burn, blisters and other issues. For high risk ambulatory elders, helmet can reduce the risk of subdural hematomas sustained from falls. In many studies it is also found that people especially women who discontinued wearing hip protectors were more likely to experience hip fractures due to fall (Stubbs, Brefka & Denkinger, 2015). So, incorporating the protecting equipments in the nursing care plan can reduce fall risk.
Considering calcium and Vitamin D supplementation- The residents of any healthcare centre have little or no sun exposure and their Vitamin D levels are lower than the general population. Some good evidence suggests that Vitamin D supplementation among the older adults can reduce their osteoporosis which has contribution to the fall (Uusi-Rasi et al., 2015). So, providing Vitamin D and calcium supplementation can enhance their bone function which in turn reduces their fall risk.
Fall is common and it is associated with most of the elderly patients. The data collected from Inpatient rehab Unit also illustrated the risk of fall among patients. If it is not controlled then it can lead to loss of life. Preventing the risk of fall is difficult but with some proper strategies in the nursing care plan it can be reduced. This paper described some strategies which can help a patient in this regard. However, nursing intervention and including more staffs for their assistance is necessary to prevent the fall risk.
Carande-Kulis, V., Stevens, J. A., Florence, C. S., Beattie, B. L., & Arias, I. (2015). A cost–benefit analysis of three older adult fall prevention interventions. Journal of safety research, 52, 65-70.
Duckham, R. L., Masud, T., Taylor, R., Kendrick, D., Carpenter, H., Iliffe, S., … & Brooke-Wavell, K. (2015). Randomised controlled trial of the effectiveness of community group and home-based falls prevention exercise programmes on bone health in older people: the ProAct65+ bone study. Age and ageing, 44(4), 573-579.
Fleig, L., McAllister, M. M., Chen, P., Iverson, J., Milne, K., McKay, H. A., … & Ashe, M. C. (2016). Health behaviour change theory meets falls prevention: Feasibility of a habit-based balance and strength exercise intervention for older adults. Psychology of Sport and Exercise, 22, 114-122.
Hatch, A. P., & Tomé, E. (2017). MSDs: Overlooked Opportunity for Health Care Cost Savings and Productivity Loss Prevention. Theory and Applications in the Knowledge Economy, 351.
Milos, V., Bondesson, Å., Magnusson, M., Jakobsson, U., Westerlund, T., & Midlöv, P. (2014). Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care. BMC geriatrics, 14(1), 40.
Morris, B. J., Bailis, S. A., & Wiswell, T. E. (2014, May). Circumcision rates in the United States: rising or falling? What effect might the new affirmative pediatric policy statement have?. In Mayo Clinic Proceedings (Vol. 89, No. 5, pp. 677-686). Elsevier.
Stubbs, B., Brefka, S., & Denkinger, M. D. (2015). What works to prevent falls in community-dwelling older adults? Umbrella review of meta-analyses of randomized controlled trials. Physical therapy, 95(8), 1095-1110.
Uusi-Rasi, K., Patil, R., Karinkanta, S., Kannus, P., Tokola, K., Lamberg-Allardt, C., & Sievänen, H. (2015). Exercise and vitamin D in fall prevention among older women: a randomized clinical trial. JAMA internal medicine, 175(5), 703-711.

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