Challenges to implementing an APN-facilitated falls management program in long-term care

Capezuti, Elizabeth; Taylor, Jo A.; Brown, Holly; Strothers, Harry; Ouslander, Joseph G.

doi:10.1016/j.apnr.2005.11.002

Cited by 26 publications

(59 citation statements)

References 20 publications

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“…(Colon-Emeric et al, 2007) 2) Not developed in view of context (2/8 studies) (ColonEmeric et al, 2007;Etheridge et al, 2014) 3) Too long (1/8 studies) (Resnick et al, 2004) 4) Not user-friendly (1/8 studies) (Resnick et al, 2004) 5) Absence of measurable outcomes (1/8 studies) (Etheridge et al, 2014) 1) Good credibility, way to promote evidence based practice, keep up-to-date with progress in a field (3/8 studies) (Capezuti et al, 2007;Colon-Emeric et al, 2007;Resnick et al, 2004) Quote Nurse practitioner: "I think it is better to do stuff that has been proven to be effective . .…”

Section: Barriers Facilitatorsmentioning

confidence: 99%

“…(Colon-Emeric et al, 2007) 2) Provide tools for implementation (2/8 studies) (Chapman and Newenhouse, 2013;Resnick et al, 2004) Quote Director of nursing: "Getting prepared to implement them (i.e., the guidelines); 'tooling them' by developing tools for each guideline as each one is different and unique." (Resnick et al, 2004) Individual professional awareness, knowledge, attitude, motivation of the individual professional toward the intervention 1) Staff feeling helpless, frustrated, and concerned about ability to control fall management; overwhelmed by excess protocols and required training (6/8 studies) (Capezuti et al, 2007;Colon-Emeric et al, 2007Etheridge et al, 2014;Wagner et al, 2010;Williams et al, 2011) Quote Staff development nurse: "Sometimes they get a little too much overload. You got guidelines for care plans, tube feedings, [tracheostomy] care, HIPAA, OSHA, dysphagia protocol 1) Raising awareness and interest (3/8 studies) (Capezuti et al, 2007;Chapman and Newenhouse, 2013;Colon-Emeric et al, 2014) Quote Licensed practical nurse: "A lot of the falls policies that we were learning we already had in place, but it's still that reeducating and reminding everybody of these things."…”

Section: Barriers Facilitatorsmentioning

confidence: 99%

“…(Resnick et al, 2004) Individual professional awareness, knowledge, attitude, motivation of the individual professional toward the intervention 1) Staff feeling helpless, frustrated, and concerned about ability to control fall management; overwhelmed by excess protocols and required training (6/8 studies) (Capezuti et al, 2007;Colon-Emeric et al, 2007Etheridge et al, 2014;Wagner et al, 2010;Williams et al, 2011) Quote Staff development nurse: "Sometimes they get a little too much overload. You got guidelines for care plans, tube feedings, [tracheostomy] care, HIPAA, OSHA, dysphagia protocol 1) Raising awareness and interest (3/8 studies) (Capezuti et al, 2007;Chapman and Newenhouse, 2013;Colon-Emeric et al, 2014) Quote Licensed practical nurse: "A lot of the falls policies that we were learning we already had in place, but it's still that reeducating and reminding everybody of these things." (ColonEmeric et al, 2014) 2) Sense-making to understand underlying fall causes (1/8 Resnick et al, 2004) knowledge deficit of quality improvement processes, (Wagner et al, 2010) poor falls management (Chapman and Newenhouse, 2013) and computer skills (Capezuti et al, 2007;Chapman and Newenhouse, 2013 (Wagner et al, 2010) 4) Low awareness (1/8 studies) (Colon-Emeric et al, 2007) studies) (Colon-Emeric et al, 2014) 3) Staff being motivated to learn and use skills regularly (1/8 studies) (Resnick et al, 2004) Resident residents' motivation and compliance 1) Resident/family noncompliance (2/8 studies) (Chapman and Newenhouse, 2013;Wagner et al, 2010) Quote Nurse supervisor: "It's not that we don't know [hip protectors] are effective, we just don't have many [residents] that will wear them."…”

Section: Barriers Facilitatorsmentioning

confidence: 99%

“…You got guidelines for care plans, tube feedings, [tracheostomy] care, HIPAA, OSHA, dysphagia protocol 1) Raising awareness and interest (3/8 studies) (Capezuti et al, 2007;Chapman and Newenhouse, 2013;Colon-Emeric et al, 2014) Quote Licensed practical nurse: "A lot of the falls policies that we were learning we already had in place, but it's still that reeducating and reminding everybody of these things." (ColonEmeric et al, 2014) 2) Sense-making to understand underlying fall causes (1/8 Resnick et al, 2004) knowledge deficit of quality improvement processes, (Wagner et al, 2010) poor falls management (Chapman and Newenhouse, 2013) and computer skills (Capezuti et al, 2007;Chapman and Newenhouse, 2013 (Wagner et al, 2010) 4) Low awareness (1/8 studies) (Colon-Emeric et al, 2007) studies) (Colon-Emeric et al, 2014) 3) Staff being motivated to learn and use skills regularly (1/8 studies) (Resnick et al, 2004) Resident residents' motivation and compliance 1) Resident/family noncompliance (2/8 studies) (Chapman and Newenhouse, 2013;Wagner et al, 2010) Quote Nurse supervisor: "It's not that we don't know [hip protectors] are effective, we just don't have many [residents] that will wear them." (Wagner et al, 2010) 2) Conflict with resident/family goals or expectations (1/8 studies) (Colon-Emeric et al, 2007) 3) Resident boredom (1/8 studies) (Wagner et al, 2010) Not available…”

Section: Barriers Facilitatorsmentioning

confidence: 99%

“…They said: 'Do what you have to do to make it work."' (Etheridge et al, 2014) 3) Leadership lacking quality improvement skills, without listening to and learned from staff or not providing support (3/ 8 studies) (Capezuti et al, 2007;Chapman and Newenhouse, 2013;Etheridge et al, 2014) 4) Clinical leaders asked to assume other leadership roles, adding to high workload (1/8 studies) (Capezuti et al, 2007) 1) Good communication (4/8 studies): sharing information across shifts/disciplines (Chapman and Newenhouse, 2013;Colon-Emeric et al, 2014;Resnick et al, 2004) and between staff/family, (Wagner et al, 2010) communicating care plan, (Chapman and Newenhouse, 2013;Colon-Emeric et al, 2014;Wagner et al, 2010) active listening and addressing communication weakness, (Colon-Emeric et al, 2014) and using diverse communication strategies Quote Department head: "So the communication got to the point where it is at a much higher level, that we are focusing our communication not just on talking, but we are actually handing off valuable information that can prevent falls, that does prevent falls." (Colon-Emeric et al, 2014) 2) Staff involvement and empowerment (3/8 studies) (ColonEmeric et al, 2007(ColonEmeric et al, , 2014Resnick et al, 2004) Quote Housekeeper: "In the beginning .…”

Section: Barriers Facilitatorsmentioning

confidence: 99%

See 4 more Smart Citations

Implementation of fall prevention in residential care facilities: A systematic review of barriers and facilitators

Vlaeyen

Stas

Leysens

et al. 2017

International Journal of Nursing Studies

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Objectives: To identify the barriers and facilitators for fall prevention implementation in residential care facilities. Design: Systematic review. Review registration number on PROSPERO: CRD42013004655. Data sources: Two independent reviewers systematically searched five databases (i.e. MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science) and the reference lists of relevant articles. Review methods: This systematic review was conducted in line with the Center for Reviews and Dissemination Handbook and reported according to the PRISMA guideline. Only original research focusing on determinants of fall prevention implementation in residential care facilities was included. We used the Mixed Method Appraisal Tool for quality appraisal. Thematic analysis was performed for qualitative data; quantitative data were analyzed descriptively. To synthesize the results, we used the framework of Grol and colleagues that describes six healthcare levels wherein implementation barriers and facilitators can be identified. Results: We found eight relevant studies, identifying 44 determinants that influence implementation. Of these, 17 were facilitators and 27 were barriers. Results indicated that the social and organizational levels have the greatest number of influencing factors (9 and 14, respectively), whereas resident and economical/political levels have the least (3 and 4, respectively). The most cited facilitators were good communication and facility equipment availability, while staff feeling overwhelmed, helpless, frustrated and concerned about their ability to control fall management, staffing issues, limited knowledge and skills (i.e., general clinical skill deficiencies, poor fall management skills or lack of computer skills); and poor communication were the most cited barriers. Conclusion: Successful implementation of fall prevention depends on many factors across different healthcare levels. The focus of implementation interventions, however, should be on modifiable barriers and facilitators such as communication, knowledge, and skills. Effective fall prevention must consist of multifactorial interventions that target each resident's fall risk profile, and should be tailored to overcome context-specific barriers and put into action the identified facilitators.© 2017 Elsevier Ltd. All rights reserved.What is already known about the topic? Multifactorial interventions, tailored to each resident's fall risk profile, can reduce the number of falls and recurrent fallers under highly controlled circumstances, but seems to be ineffective under "real-world" conditions, presumably due to poor implementation.Successful implementation of complex, multifactorial interventions in clinical practice involves a tailored, multifaceted approach based on a good understanding of barriers and facilitators for implementation. No reviews exist that comprehensively summarize the evidence on fall prevention implementation barriers and facilitators in residential care settings. What this paper addsSeventeen facilitators and 27 barriers that ...

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