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Clinical Problem of Falls in Older Patients: Change Project

Clinical Problem

Falls in older patients is one of the critical clinical problems that can frequently be faced in the current nursing practice. Despite the efforts made by nurses and other healthcare specialists, the evidence suggests that falls are the main cause of fatal injuries among senior individuals (Centers for Disease Control and Prevention, 2017). In addition, fall-related injuries can result in severe consequences to the health of patients, which leads to poorer nursing outcomes and downsizing of the quality of care. Notably, this problem affects not only patients and their families but also hospitals resulting in increased expenses.

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However, falls are potentially preventable (deWit & Kumagai, 2014). Therefore, it is essential to gather the evidence and compile a list of practices that will help to minimize falls and fall-related injuries in senior patients. The reason for choosing this issue is the fact that one out of every three older people experiences fall-related injuries because of negligence. Nevertheless, patients can be neglected not because of poor nurse operation but to due to the problem of the nursing shortage, which results in the phenomenon when specialists have to serve many patients simultaneously (Ungar et al., 2013). Thus, the purpose of the future project is to find evidence proving that regular exercising has a positive effect on patients with balancing problems and patient education and instruction in terms of working out will help decrease the number of falls in senior patients.

Proposal Requirements

In terms of the future project, many parties have to be involved in granting approval for it. In particular, it is necessary to receive permission from the hospital in which the evidence will be collected. The hospital’s administration will have to review all the procedures that patients will undergo and the forms they will have to fill in to be eligible for inclusion in this project. In addition, the approval from the institution’s faculty is essential to be able to proceed with the project implementation. The aspects that should be considered to ensure it includes everything necessary for the approval are project description and objectives, project organization and communication plan, the list of approvals and forms, the planned budget if required, and preliminary timeframe for carrying out all the steps of the change project.

Preparation for the Project

To prepare for this project, it is essential to gather as much information about the prevention of falls in senior patients as possible. This evidence will serve as a starting point for choosing the educational methods and approaches related to exercising that have proved effective in other countries and across the state as well (Ungar et al., 2013). At this point, it will be possible to search nursing and other medical databases to select the information from evidence-based researches. In addition, it is essential to discuss the proposed topic with the supervisor to achieve confirmation on the PICOT question and refine the aspects of the future research prior to conducting it.


The questions regarding the Capstone Change Project are as follows:

  • Are there any requirements in terms of the level of evidence that can be used for the project?
  • Are there any requirements in terms of the timeframe?
  • Are there any specific forms of consent that should be used for this project?
  • Can the project rely only on the evidence from scholarly researches and my current practice setting or should the scale be extended (Saxon, Etten, & Perkins, 2014)?
  • Is the PICOT question specific enough or should the proposed intervention be more specific?

Quality Indicators

Two quality indicators have been used to identify the clinical problem for the project. They are falls and falls with injury (“Turn nursing quality insights into improved patient experiences,” n.d.). Importantly, they will drive the research in the correct direction to achieve evidence-based results. In particular, The National Database of Nursing Quality Indicators (NDNQI) specifies that two events of falls that occurred within one month should be considered a case of the repeat fall within the institution (“Turn nursing quality insights into improved patient experiences,” n.d.). Therefore, the instances when one person has fallen at least two or more times will be included in the analysis. In addition, the classification provided by NDNQI related to fall-related injuries (none, minor, moderate, major, and death) will be used to interpret the gathered data. Therefore, these two quality indicators will help in building the construct of the entire project.

PICOT Question

The elements of the PICOT question that can be formulated based on the scope of the problem and quality indicators are as follows:

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  • P = In senior hospitalized patients;
  • I = Patient education on regular exercising;
  • C = Current hospital fall prevention program;
  • O = Minimizing falls in senior patients;
  • T = Within three months?

Therefore, the question for the future change project is: In senior hospitalized patients, what is the effectiveness of patient education on regular exercising conducted by nurses versus current hospital fall prevention program in minimizing falls and fall-related injuries in senior patients within the period of three months?


Centers for Disease Control and Prevention (CDC). (2017). Important facts about falls. Web.

deWit, S. C., & Kumagai, C. K. (2014). Medical-surgical nursing: Concepts & practice (2nd ed.). New York, NY: Elsevier.

Saxon, S. V., Etten, M. J., & Perkins, E. A. (2014). Physical change and aging: A guide for the helping professions (6th ed.). New York, NY: Springer.

Turn nursing quality insights into improved patient experiences. (n.d.). Web.

Ungar, A., Rafanelli, M., Iacomelli, I., Brunetti, M. A., Ceccofiglio, A., Tesi, F., & Marchionni, N. (2013). Fall prevention in the elderly. Clinical Cases in Mineral and Bone Metabolism, 10(2), 91-95.

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