Description
For this assignment you will:
1. review the 2 current and trustworthy/scholarly research articles on a relevant patient safety topic (you are not
to use articles/readings reviews that you ve obtained from another student this exercise is to help you develop
your skills in research) ARTICLES ARE ALREADY ATTACHED HERE. CHECK THE EMAIL OR
ATTACHEMENT
2. For each article:
a. Read the Abstract, Introduction, Discussion/Results
b. Determine if this is an article that is of interest to you and offers information/evidence that will
inform/improve patients safety
c. For the articles you deem appropriate as above, complete the following steps.
3. Provide a summary (in your own words) of the information in the abstract, introduction, discussion/results.
Create a heading for each of the 3 areas, so that you instructor can clearly identify your summary.
4. In the summary of the abstract, identify if the article is qualitative or quantitative research.
5. Create a heading called implications and identify how this information can potentially enhance patient
safety.
6. Create a heading called Personal Reflection and identify how YOU can incorporate or champion the
adoption of this information in your practice or care area
7. Review the attached rubric for a detailed breakdown on the assignment and expectations
8. The paper must:
a. Utilize the APA guidelines
b. The paper MUST be checked for grammar and spelling prior to submitting accurate, legible and well written
communication is very important to patient safety
c. The paper must include a cover page and reference list
d. The paper must include an introduction and a conclusion
e. The body of the paper must be 5 6 pages double spaced
f. The 2 articles that you review MUST be included in a reference
REMINDERS: just focus on making the 5 pages for the body. I will be the one to make the cover page ans
reference page. I will only pay for the 5 pages for the body of essay
September-October 2016 Vol. 25/No. 5 329
Kay Klymko, PhD, ARNP, FNP-BC, is Nurse Practitioner, Florida Health Care Plans, Daytona
Beach, FL.
LuAnn Etcher, PhD, GNP-BC, is Associate Professor, Spring Arbor University School of
Human Services, Arbor, MI.
Joan Munchiando, BSN, RN-BC, CRRN, CMSRN, NE-BC, CDP, is Director of Specialty
Programs, Nursing Administration, NICHE Co-Coordinator, Beaumont Health System, Royal
Oak, MI.
Mary Royse, MSN, RN, CMSRN, CDP, is Clinical Nurse Specialist for Medical & Acute Care of
the Elderly Unit, Beaumont Health System, Royal Oak, MI.
Acknowledgments: The authors thank Therese Swann, RN, and Kelly Marie Ellsworth, who
provided assistance with literature searches during their graduate programs at Wayne State
University (Detroit, MI).
Video Monitoring: A Room with a
View, or a Window to Challenges in
Falls Prevention Research
Approximately 1 million falls
occur annually in acute care
settings in the United States,
with incidence of 2.3-7 falls per
1,000 patient days (Gray-Micelli &
Quigley, 2012; Oliver, Healey, &
Haines, 2010). Wu, Keeler, Rubenstein,
Maglione, and Shekelle
(2010) reported estimated additional
costs of $3,500 for a fall without
injury, with costs increasing to
$16,500-$27,500 for additional falls
without injury or when serious
injury occurs. In 2008, the Centers
for Medicare & Medicaid Services
designated falls as a hospitalacquired
condition (HAC) and challenged
hospital reimbursement for
HACs deemed preventable (Quigley
& White, 2013). Although the National
Database of Nursing Quality
Indicators reported falls and trauma
decreased 14.7% from 2010 to 2013
in select hospital engagement networks,
wide variation remains
across hospital settings.
Ongoing research aimed at advancing
methods to detect and prevent
falls is important. Although
general antecedents to falls in hospitalized
patients have been reported
(Oliver et al., 2010), their relevance
in the context of emergent
falls prevention technologies (e.g.,
video monitoring [VM]) is not well
understood. Understanding antecedents
to patient falls may facilitate
the design of reliable, valid
tools for concurrent use with VM
interventions in hospital settings.
Maximizing the validity and reliability
of a VM intervention will
enable further testing regarding the
intervention s ability to reduce falls
and improve outcomes.
Purpose
The purpose of this study was to
explore antecedents to falls in the
acute care setting from the lived
experiences of a diverse sample of
expert health professionals, patient
care assistants (1:1 safety sitters), VM
technicians, nurses, and fall prevention
experts. The following research
questions guided the study: (a) How
are the antecedents to a preventable
fall in patient rooms on a medical
unit described (b) How do the identified
antecedents appear on the
screen to a VM technician monitoring
patients on a medical unit (c)
What are the environmental conditions
and patient behaviors that
should precipitate fall prevention
action during VM
Review of Literature
A review of the relevant literature
was conducted using CINAHL,
PubMed, Scopus, and Google
Scholar databases. Keywords included
falls, fall prevention, hospital, video
monitoring, and nursing research.
Falls have been reported to occur
during times of position change
and ambulation, and are often
unwitnessed (Deandrea et al., 2013;
Hitcho et al., 2004; Oliver et al.,
2010). Therefore, emerging interventions
using assistive technology
for fall prevention (e.g., electronic
sensors, infrared sensors, fall detectors,
bed alerts, microphones, pressure
sensors, floor sensors, cameras,
VM) are gaining attention quickly.
They provide a window through
which falls can be examined in a
new way, with previously obscured
information now available regarding
hospital-based falls and their
antecedents.
As one of the most recent technologic
advancements, VM uses inroom
cameras installed at vantage
locations to provide real-time viewing
of patient activity through computer
visualization, which differs
RReesseeaarrcchh ffoorr PPrraaccttiiccee
Kay Klymko, LuAnn Etcher,
Joan Munchiando, Mary Royse
This qualitative study using focus groups of hospital personnel supports
known antecedents to falls in a video monitoring (VM) setting.
Although VM can improve the understanding of behaviors
leading to falls, further research is needed to support VM methods.
330 September-October 2016 Vol. 25/No. 5
from other forms of assistive technologies
used to prevent falls. VM
staff members are trained to view
the screen, detect an impending fall
event, and intervene. In a hospitalbased
study, Hardin, Dienemann,
Rudisill, and Mills (2013) evaluated
the impact of webcams with central
monitoring and alarmed virtual bed
rails as surveillance devices. They
found a significant difference
(p<0.05) in the fall rate per 1,000
admissions. More recently, Potter
and co-authors (2016) analyzed
video-monitored falls in hospitalized
patients and found weakness
affecting ability to move, gait problems,
and occluded pathways were
contributors to falls. In addition, the
time between the patient beginning
to leave the bed and occurrence of
the fall was under 2 minutes.
Dupree, Fritz-Campiz, and Musheno
(2014) noted VM should be used as
part of a targeted solution to reduce
falls in hospitalized patients who are
unwilling or unable to use the call
light. An additional study by
Burtson and Vento (2015) included
VM as part of a fall prevention program.
Improvements in quality outcomes
and cost were demonstrated
over 2 years. The current study will
begin to fill a gap regarding
antecedents to falls seen in VM, and
may support development of a VM
intervention for further testing.
Sample and Setting
Participants were recruited using
fliers posted on the hospital unit,
and through announcements on
the hospital website and at staff
meetings. Interested persons contacted
primary investigators (PIs)
who were not affiliated with the
hospital. Hospital-affiliated personnel
were invited to participate in
the study if they were at least age
18; could speak English; had experience
as a patient care assistant (1:1
safety sitter), VM technician, registered
nurse (RN) from the VM unit;
or were fall prevention experts. The
sample consisted of 34 participants
in four homogenous groups: fall
prevention experts (expert nurses,
geriatricians [n=9]), RNs from the
VM unit (n=10), VM technicians
(n=6), and patient care assistants
throughout the hospital (n=9).
The study setting was an academic
medical center in southeast
Michigan where VM had been
implemented in five rooms to
enable concurrent VM of eight
patients. Patients were screened for
acceptance into a monitored bed by
a group consisting of the administrative
manager, director of specialty
programs, and charge nurse.
Admission criteria for VM (= age 65
with acute illness putting the
patient at risk for/exhibiting delirium,
or high risk for fall) were developed
in collaboration with unit
geriatricians and nurse leaders.
Focus groups were conducted in
a classroom at the hospital. Each
focus group lasted approximately
60-90 minutes and followed a semistructured
format. Groups were
audio-recorded and conducted by
the PIs, who had no hospital affiliation;
field notes also were written.
After a brief introduction, PIs used
several questions related to the
study s purpose (e.g., what behaviors
predict or precede a fall, how
would those behaviors appear to a
VM technician, what specific
behaviors would alert you to take
action to prevent a fall ).
This study was approved by
Wayne State University and the
study site s Human Investigation
Committee and Institutional Review
Board. Measures to assure confidentiality
of all shared content were
explained through verbatim reading
of the informed consent followed by
participant consent before the focus
groups.
Methods and Design
Focus group methodology was
consistent with Morgan and Krueger s
(1998) inclusive approach.
Authors defined the focus group as
a research technique that collects
data through group interaction on a
topic determined by the researcher
in which the researcher s interest
provides the focus, whereas the data
themselves come from the group
interaction (p. 7).
Findings
Antecedents to a Preventable
Fall
Antecedents to a preventable fall
in the patients rooms had a clear
demarcation. They were represented
by the major themes of environmental
factors and behavioral representations.
Challenging Hazards within
the Room
Hazards in the room were environmental
factors represented by
structural and process issues. Structural
issues included characteristics
of the room itself and items in proximity
to patients. Process issues
were related to events experienced
by patients.
Structural issues within the room.
Participants agreed patient rooms
were often crowded. As one patientcare
assistant noted, the walker,
the computers, the table, and the
IV poles and the beds and it s all
stuffed into one room and there s
like this much room (holding arms
up demonstrating width) to walk to
the bathroom Extreme room
temperatures also were reported as
an issue. One fall prevention expert
noted, people are hot or cold,
that s when they start pushing the
blankets, IV line see that a lot.
Unit noises can be foreign to
patients, occurring at variable times
and levels. As one RN described,
It s confusing for the VM patients
for that voice (audio) to be in that
room.
Concerns emerged regarding
lines attached or close to the
patient, who could become entangled
in or trip on them in getting
out of bed or ambulating (e.g., feeding
tube, suctioning equipment,
indwelling urinary catheter bag,
monitoring line, intravenous line,
call lights, phone line). One
patient-care assistant explained,
Tubing and the IV pole you
know, you see someone starting to
get up and you know they re
hooked up to monitors and that s
like, oh, no! In addition to lines,
patients may try to free themselves
of soiled bedding or clothing, as
Research for Practice
September-October 2016 Vol. 25/No. 5 331
Video Monitoring: A Room with a View, or a Window to Challenges in Falls Prevention Research
one VM technician said, On midnights,
they used to tell us (in staff
education on fall prevention) when
the patient is wet, they start trying
to get out of bed.
The bedside table provides the
patient easy, routine access to personal
items (e.g., cell phone, water).
Inaccessible personal items can
prompt patients to reach unsafely.
One patient-care assistant voiced,
If that s (bedside table) not near
them they ll reach and then roll
right out…
Vulnerable times for a fall reported
by participants included the day
of admission, day of discharge, in
the morning at awakening, meal
times, shift changes, and staff
breaks. Night was a particular concern,
as one patient-care assistant
described, when it gets dark, in
the evening people that are completely
fine during the day just start
getting a little confused and that s
when they ll get up they ll be
more likely to fall.
Process issues within the room.
People entering or leaving a
patient s room were reported to
increase vulnerability to a fall. One
RN described asking the VM technician
to monitor patients more
closely for about 5 minutes after she
left the rooms because patients may
reconsider their needs and try to get
out of bed unattended without calling
for help. Further validation was
provided by another RN, who
remarked: How many times have
you heard a nurse say, I was just in
that room
Behavioral Phenomena
Exhibited by Patients
Patient behaviors described as
antecedents to falls were differentiated
by two sub-themes: physical
behaviors and psychological/emotional
phenomena.
Physical behaviors exhibited by
patients. A behavior frequently
described by participants was restlessness.
One fall prevention
expert described a lot of nonpurposeful
behavior like picking,
fidgeting; picking at blankets, picking
at themselves, picking at the
lines, picking at the bed, picking at
whatever may be around them
before they decide to climb out of
the bed. Participants reported,
The patient may sit up abruptly
and provide visual signals such as
looking around the room or a
dead stare into the camera as if to
say, Okay, who s going to see me
here, can I get away Reaching was
perceived to increase risk for falls,
with patients described as misjudging
the distance to an object. As one
RN explained, A patient was sitting
in a chair and went to reach for
something she dropped on the
floor, and just over-reached and just
slid right out, right under the
table
Participants reported a pattern
and order of movements progressing
in magnitude/required strength
as the patient prepared to get out
of bed. Initial fine movements
(e.g., restlessness, picking, looking
around) often were followed by
more gross movement (e.g., sitting
up suddenly and straight, scooting
to the edge of the bed with the hips,
rolling over). Finally, as described
by one participant, the patient may
show a whole body and gracious
roll of unprecedented strength as
he or she moves out of bed.
Issues associated with ambulation
were reported to be antecedent
to falls, such as improper use of
unfamiliar assistive devices, excessive
speed in walking, foot dragging,
unsteadiness, syncope, and verbalizations
of dizziness or lightheadedness.
Several patient-care assistants
indicated chair sitting also can cause
problems. When patients fall
asleep or rest their arm over the arm
rest and all it takes is a slip of the
arm and you get off balance and fall
forward, or push the table away
from in front of them.. , they
increase their risk for fall due to
reduced protection from the bedside
table and/or chair arm rests.
Psychological and emotional behaviors
exhibited by patients. One RN
described the challenge when cognitive
changes occur suddenly and
unexpectedly (as in delirium):
you have some elderly person coming
in with a UTI (urinary tract
infection); they get that infection
and they re very impaired you get
the infection cleared up and then
they re fine again. Agitated or confused
patients often needed fears
allayed, as one VM technician
voiced he s crying he wants to
get up he wants to go home he
just wanted somebody to listen. He
wanted somebody to understand
his story and once you did that, he
laid back down.
Antecedents Appearance
During Video Monitoring
Participants generally agreed VM
can provide a distorted view of reality:
It s not as clear you can t really
see what they re doing exactly.
However, they agreed VM provided
a view otherwise unavailable unless
in the room. VM distortions described
by participants included the
room appearing far way, partial
visualization of the room, patient
movements appearing as slow
motion, lack of clarity despite
infrared capability in the dark, and
patient behaviors appearing accentuated.
These distortions led staff to
respond to observed patient behavior
(movement) by using audio
communication to the room or
sending staff to the room.
Participants indicated audio communications
actually precipitated
behaviors that could lead to a fall.
For example, a sleeping patient is
awakened with confusion and fear
of the intercom voice.
Environmental Conditions
and Patient Behaviors
Prompting Action
Participants identified VM antecedents
that warranted increased
awareness or further action to avoid
a fall. Structural environmental factors
included changes in the ambient
environment (sound and light
levels, room temperature), and
changes in the local environment
(loose or running cords, wet floors,
personal care objects out of reach,
overcrowding, room changes). Process-based
environmental factors
included changes in patterns of
activity (shift change, visitors, mealtimes,
being awakened from sleep).
Patient-based factors prompting
action fell into two categories: physically
based (being soiled, in pain,
with sensory deficits, physiological-
332 September-October 2016 Vol. 25/No. 5
ly compromised, delirium) or psychologically/emotionally
based (dementia,
anxiety, presence of psychological
disorders, patient unwilling
to follow safety parameters,
patient misperception of capabilities).
Analysis
Oral recordings and field notes
were transcribed manually after
each focus group. Two PIs not affiliated
with the hospital conducted
separate data analyses starting with
a first and second reading of the
transcripts. Initial coding involved
compressing the text based on
themes (e.g., behavioral and environmental
conditions determined
to be antecedents to falls). After the
initial coding scheme, a second
level of coding included an inductive
approach based on new knowledge
gained from the interviews.
Trustworthiness
Lincoln and Guba s (1985) four
criteria to ensure trustworthiness in
qualitative investigations were used
in this study. To assure credibility,
non-hospital researchers were
assured by confirming the reliability
of the findings through comparing
the consistency of the codes
and their thematic grouping
between the non-hospital affiliated
PIs. Additional peer debriefing also
was obtained through a review of
the collective codes/themes by the
hospital PI and consultant clinical
nurse specialist of the research team
as a means to obtain further
insights regarding the final thematic
coding schema. Triangulation of
the data also was accomplished by
comparing the audio recordings of
the focus groups with the field
notes. Transferability of the findings
was supported through use of
purposive sampling and the rich
participant descriptions provided in
the findings. Confirmability of the
results as supported by the data was
enhanced with a cross-comparison
of the decision trails used by the PIs
to collapse the thematic coding
schema. Dependability of the
methodological procedures was
enhanced through study design
consultation with an external
expert in qualitative methodology.
Limitations
The sample was restricted to selfselected
groups of individuals.
Participants also represented one
hospital setting. The study lacked a
focus group of patients who had
experienced a hospital fall.
Discussion
Video-monitoring technology
provides an intervention not previously
available to healthcare
providers. This study was a beginning
elucidation of the appearance
on a VM screen of many of the
known antecedents to falls in
patient rooms. Focus group participants
in this study identified
antecedents to hospital falls generally
consistent with patient-specific
factors and environmental risk factors
as previously identified in the
literature; this expanded prior work
on knowledge of antecedents
(Deandrea et al., 2013; Oliver et al.,
2010) and confirmed its relevancy
in a VM inpatient environment.
Nursing Implications
This study s findings may inform
nurses who are planning to implement
a VM intervention in their
hospitals. Although the Morse Fall
Scale was demonstrated as effective
in predicting falls when used in a
VM inpatient setting (Hardin et al.,
2013), neither that scale nor the
STRATIFY falls risk assessment tool
was designed as a decisional aid for
determining the best strategy to
prevent falls for at-risk individuals.
Moreover, neither of these assessment
tools includes an indicator
(e.g., specific diagnosis of delirium
or dementia) that may guide the
decision to use a VM intervention
versus a different modality (e.g., 1:1
safety sitter). Nurses may believe
these diagnoses are appropriate for
a VM intervention, but this study
suggests nurses must remain cautious
when initiating audio communications
from the VM central
station to patients who are prone to
difficulty with dual-tasking (e.g.,
cognitive aging or impairment).
Further investigations are needed
on the characteristics of patients
who may be best served by VM.
Conclusion
The availability of VM in inpatient
units provides new opportunities
to understand how known
antecedents are viewed and prompt
action in the context of a VM intervention.
The findings from this
study add to existing knowledge,
which can be applied to developing
and refining VM interventions to
prevent falls. Further investigations
conducted with real-time VM designed
to describe and validate
reported antecedents to falls are
needed, despite the inherent methodological
difficulties in designing
and conducting VM research studies
(Hardin et al., 2013). Additionally,
further investigation of
what constitutes an appropriate,
safe VM intervention response is
warranted in light of the finding
that certain VM intervention
responses (audio speaker to the
patient) may trigger a fall in some
patients. Until then, nurses will
need to consider carefully personal
characteristics of patients when
admitting patients to a VM unit and
responding to potential antecedents
to falls detected during a VM
intervention.
REFERENCES
Burtson, P.L., & Vento, L. (2015). Sitter reduction
through mobile video monitoring: A
nurse-driven sitter protocol and administrative
oversight. Journal of Nursing
Administration, 45(7/8), 363-369.
Deandrea, S., Bravi, F., Turati, F., Lucenteforte,
E., La Vecchia, C., & Negri, E.
(2013). Risk factors for falls in older people
in nursing homes and hospitals. A
systematic review and meta-analysis.
Archives of Gerontology and Geriatrics,
56(3), 407-415.
DuPree, E., Fritz-Campiz, A., & Musheno, D.
(2014). A new approach to preventing
falls with injuries. Journal of Nursing
Care Quality, 29(2), 99-102.
Gray-Micelli, D., & Quigley, P.A. (2012). Falls
prevention: Assessment, diagnosis, and
intervention strategies. New York, NY:
Hartford Institute for Geriatric Nursing.
Research for Practice
September-October 2016 Vol. 25/No. 5 333
Hardin, S., Dienemann, J., Rudisill, P., & Mills,
K.K. (2013). Inpatient fall prevention:
Use of in-room webcams. Journal of
Patient Safety, 9(1), 29-35.
Hitcho, E.B., Krauss, M.J., Birge, S., Dunagan,
W.C., Fischer, I., Johnson, S., Fraser,
V.J. (2004). Characteristics and circumstances
of falls in a hospital setting: A
prospective analysis. Journal of General
Internal Medicine, 19(7), 732 739. doi:
10.1111/j.1525-1497.2004.30387.x
Lincoln, Y.S., & Guba, E.G. (1985). Naturalistic
inquiry. Newbury Park, CA: Sage Publications.
Morgan, D.L., & Krueger, R.A. (1998). The
focus group kit. Thousand Oaks, CA:
Sage.
Oliver D., Healey, F., & Haines, T.P. (2010).
Preventing falls and fall-related injuries in
hospitals. Clinics in Geriatric Medicine,
26(4), 645-692. doi:10.1016/j.cger.2010.
06.005
Potter, P., Allen, K., Costantinou, E.,
Klinkenberg, D., Malen, J., Norris, T., … &
Tymkew, H.H. (2016). Anatomy of inpatient
falls: Examining fall events captured
by depth-sensor technology. The Joint
Commission Journal on Quality and
Patient Safety, 42(5), 225-232.
Quigley, P., & White, S., (2013). Hospitalbased
fall program measurement and
improvement in high reliability organizations.
Online Journal of Issues in
Nursing, 18(2), Manuscript 5. doi:10.
3912/OJIN.Vol18No02Man05
Wu, S., Keeler, E., Rubenstein, L., Maglione,
M.A., & Shekelle, P.G. (2010). A costeffectiveness
analysis of a proposed
national falls prevention program.
Clinical Geriatric Medicine, 26(4), 751-
766. doi:10.1016/j.cger.2010.07.005
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