ABSTRACTObjective:to analyze the correspondence between the actions contained in the fall prevention protocol of the Ministry of Health and the Nursing Interventions Classification (NIC) by a cross-mapping. Show
Method:this is a descriptive study carried out in four stages: protocol survey, identification of NIC interventions related to nursing diagnosis, the risk of falls, cross-mapping, and validation of the mapping from the Delphi technique. Results:there were 51 actions identified in the protocol and 42 interventions in the NIC. Two rounds of mapping evaluation were carried out by the experts. There were 47 protocol actions corresponding to 25 NIC interventions. The NIC interventions that presented the highest correspondence with protocol actions were: fall prevention, environmental-safety control, and risk identification. Regarding the classification of similarity and comprehensiveness of the 47 actions of the protocol mapped, 44.7% were considered more detailed and specific than the NIC, 29.8% less specific than the NIC and 25.5% were classified as similar in significance to the NIC. Conclusion:most of the actions contained in the protocol are more specific and detailed, however, the NIC contemplates a greater diversity of interventions and may base a review of the protocol to increase actions related to falls prevention.. Descriptors: RESUMOObjetivo:analisar a correspondência entre as ações contidas no protocolo de prevenção de quedas do Ministério da Saúde com a Classificação de Intervenções de Enfermagem (NIC) por meio do mapeamento cruzado. Método:estudo descritivo realizado em quatro etapas: levantamento de ações do protocolo; identificação das intervenções NIC relacionadas ao diagnóstico de enfermagem risco de quedas; mapeamento cruzado; e validação do mapeamento a partir da técnica Delphi. Resultados:foram identificadas 51 ações no protocolo e 42 intervenções na NIC. Foram realizadas duas rodadas de avaliação do mapeamento pelos peritos. Houve correspondência de 47 ações do protocolo com 25 intervenções NIC. As intervenções NIC que apresentaram maior correspondência com ações do protocolo foram: prevenção contra quedas, controle do ambiente-segurança e identificação de risco. Quanto à classificação de semelhança e abrangência, das 47 ações do protocolo mapeadas, 44,7% foram consideradas mais detalhadas e específicas do que a NIC, 29,8% menos específicas que a NIC e 25,5% foram classificadas como similares em significado à NIC. Conclusão:a maioria das ações contidas no protocolo é mais específica e detalhada, contudo a NIC contempla maior diversidade de intervenções e pode fundamentar uma revisão do protocolo para ampliação das ações relacionadas à prevenção de quedas. Descritores: RESUMENObjetivo:analizar la correspondencia entre las acciones contenidas en el protocolo prevención de caídas del Ministerio de la Salud con la Clasificación de Intervenciones de Enfermería (NIC) por medio del mapeo cruzado. Método:estudio descriptivo realizado en cuatro etapas: levantamiento de acciones del protocolo, identificación de las interveciones NIC relacionadas al diagnóstico de enfermería riesgo de caídas, mapeo cruzado y validación del mapeo a partir de la técnica Delphi. Resultados:fueron identificadas 51 acciones en el protocolo y 42 intervenciones en la NIC. Fueron realizadas dos rodadas de evaluaciones del mapeo por los peritos. Hubo correspondencia de 47 acciones del protocolo con 25 intervenciones NIC. Las intervenciones NIC que presentaron mayor correspondencia con acciones del protocolo fueron: prevención contra caídas, control del ambiente-seguridad e identificación de riesgo. Sobre la clasificación de semejanza y abrangencia de las 47 aciones del protocolo levantadas, 44,7% fueron consideradas más detalladas y específicas de lo que la NIC, 29,8% menos específicas que la NIC y 25,5% fueron clasificadas como similares en significado a la NIC. Conclusión:la mayoría de las acciones contenidas en el protocolo es más específica y detallada, com todo, la NIC contempla mayor diversidad de intervenciones y puede fundamentar una revisión del protocolo para ampliación de las acciones relacionadas a la prevención de caídas. Descriptores: IntroductionThe fall is considered an event that causes the individual to end involuntarily on the ground or another low level, with or without injuries11. Health Services Research Group University of Newcastle (HSRG). Australasian Clinical Indicator Report. 15th ed. Newcastle; 2014. 132 p. [cited Ago 21, 2016]. Available from: http://www.achs.org.au/media/87723/ach079_clinical_indicators_approved_tag.pdf
In the United States, it is estimated that one-third of people over 65 years old experience at least one fall a year, with recurrence in half the cases. Approximately 10% of falls result in serious injuries such as fractures, soft tissue injuries and traumatic brain injuries, which
require urgent care33. Kim K, Jung HK, Kim CO, Kim SK, Cho HH, Kim DY, et al. Evidence-based guidelines for fall prevention in Korea. Korean J Intern Med. 2017 [cited Fev 21, 2017]; 32: 199-210. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5214733/ The National Agency of Sanitary Surveillance (ANVISA) published an incident bulletin and identified 9,423 failures in the care of different health facilities. Of them, 3,600 (38.2%)
referred to the fall, is the second cause of notifications. The most common causes are a loss of balance, followed by slipping and syncope. The furniture also contributes, being the bed fall as the most reported, followed by falls in the bathroom and the chair55. Agência Nacional de Vigilância Sanitária. Boletim Segurança do Paciente e Qualidade em Serviços de Saúde - Incidentes Relacionados à Assistência à Saúde - 2015 [Internet]. Brasília (DF); 2016. 30 p. [Acesso
21 ago 2016]. Disponível em: https://www20.anvisa.gov.br/segurancadopaciente/index.php/publicacoes/category/boletins-estatisticos The likelihood of injury to health through accidents, illness, suffering or environmental factors is called risk66. Vincent C,
Wearden A, French DP. Making health care safer: What is the contribution of health psychology?. Br J Health Psychol. 2015 [cited Fev 22, 2017]; 20(4): 681-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26440293 Through Ordinance 529, on April
1, 2013, the Ministry of Health established the National Patient Safety Program (PNSP) to collaborate in the qualification of health care. In the PNSP, six protocols were described, including the fall prevention protocol, whose contents contemplate several actions with the intention of strengthening fall prevention strategies88. Ministério da Saúde. Portaria n. 529 de 1º de abril de 2013. Institui o Programa Nacional de Segurança do Paciente (PNSP). Diário Oficial da
União, Brasília (DF); 2013. [Acesso 15 Out 2015]. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2013/prt0529_01_04_2013.html Therefore, given the patient’s safety context, it is known that nursing is indispensable in the implementation of safe practices, since, through preventive interventions, nurses have
the skills to make decisions regarding care to adequate and harmless assistance33. Kim K, Jung HK, Kim CO, Kim SK, Cho HH, Kim DY, et al. Evidence-based guidelines for fall prevention in Korea. Korean J Intern Med. 2017 [cited Fev 21, 2017]; 32: 199-210. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5214733/ To
make nursing practices more effective, nursing classification systems, useful tools to guide the nurses’ clinical reasoning and establish standardized languages and, consequently, improve the care provided from the scientific base99. Dahlke S, Hall WA, Baumbusch J. Constructing definitions of safety risks while nurses care for hospitalised older people: secondary analysis of qualitative data. Int J Older People Nurs. 2017 [cited Fev 21, 2017]; 1-10. Available from:
https://www.ncbi.nlm.nih.gov/pubmed/28194924 However, it must be recognized that expanding the use of classification systems in clinical practice is a major challenge for nursing care. Thus, national and international studies have been developed based on
the methodology of cross-mapping which allows linguistic and semantic comparison between non-standard terminologies and classification systems1111. Silva CFR, Santana RF, Oliveira BGRB, Carmo TG. High prevalence of skin and wound care of hospitalized elderly in Brazil: a prospective observational study. BCM Res Notes. 2017 [cited Oct 7, 2017]; 10(81): 1-6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5290646/pdf/13104_2017_Article_2410.pdf
12. Liljamo P, Kinnunen UM , Saranto K . Healthcare professionals’ views on the mutual consistency of the Finnish Classification of Nursing Interventions and the Oulu Patient Classification. Scand J Caring Sci. 2016 [cited Oct 7, 2017]; 30(3):477-88. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26551269
https://www.ncbi.nlm.nih.gov/pubmed/2727... . It should be emphasized that cross-mapping is the method enabling the insertion of the standardized nursing language in health institutions since it allows a consistent comparison between the practice already developed by the nurses and the content of the classification systems1414. Tosin MH, Campos DM, Andrade LT, Oliveira BG, Santana RF. Nursing interventions for rehabilitation in Parkinson’s disease: cross mapping of terms. Rev. Latino-Am. Enfermagem. 2016 [cited Oct 7, 2017]; 24:e2728. Available from: http://www.scielo.br/pdf/rlae/v24/0104-1169-rlae-24-02728.pdf http://www.scielo.br/pdf/rlae/v24/0104-1... . Although the fall prevention protocol presents a multi-professional approach, most of its actions are performed by the nursing team, which remains longer direct care to the patient when compared to other health professionals. In view of the diversity of actions contained in this protocol, the need arises to compare it with the standardized nursing language to investigate the applicability of the NIC regarding the patient safety, specifically to the prevention of falls. The protocol is an objective tool, easy to access and free of charge. For this reason, it is believed that the results of this research can subsidize important advances in nursing care and highlight the importance of standardized language in helping to prevent falls. In this context, the study had as objective to analyze the correspondence between the actions contained in the protocol of falls prevention of the Ministry of Health with the NIC by means of the cross-mapping. MethodThis is a descriptive study
performed by cross-mapping. It is a useful tool to analyze the data contained in the nursing process, comparing existing information with the reference classifications, as NIC in this case1515. Luciano TS, Nóbrega MML, Saparolli ECL, Barros ALBL. Cross mapping of nursing diagnoses in infant health using the International Classification of Nursing Practice. Rev Esc Enferm USP. 2014 [cited Ago 8, 2016]; 48(2):250-6. Available from:
http://www.scielo.br/pdf/reeusp/v48n2/pt_0080-6234-reeusp-48-02-250.pdf Data collection was carried out between May and December 2016 and the research was carried out in four stages. The first step included the study of the fall prevention protocol of the Ministry of Health1616. Brasil.
Agência Nacional de Vigilância Sanitária. Fundação Oswaldo Cruz. Programa Nacional de Segurança do Paciente (PNSP). Anexo 01: Protocolo de Prevenção de Quedas. Brasília; 2013. 15 p. [Acesso 2 out 2015]. Disponível em: http://www20.anvisa.gov.br/segurancadopaciente/index.php/publicacoes/item/prevencao-de-quedas In the second stage, interventions for the prevention of falls in the NIC were selected through consultation with the NANDA-I/NIC link from the nursing diagnosis (ND) “risk of falls”1717. Diagnósticos de Enfermagem da NANDA: definições e classificação 2015-2017/ [NANDA Internacional]. Porto Alegre: Artmed; 2015. 488 p.. All the interventions and priority suggested additional optional nursing activities to solve the problem were listed, according to their definitions. The third stage consisted in the development of the cross-mapping between the actions of the protocol and NIC interventions related to the “risk of falls”. The instrument developed by the authors to develop the mapping contemplated the actions of the protocol organized in three thematic categories in the left column (direct practices for fall prevention, patient/family orientations, evaluation,
and monitoring); and a column to the right where the corresponding NIC interventions were inserted, with the description of the domain, class, NIC intervention title and activities. The following rules1818. Coenen A, Ryan P, Sutton J. Mapping nursing interventions from a hospital information system to the Nursing Interventions Classification (NIC). Nurs Diagn. 1997 [cited Ago 21, 2016]; 8(4): 145-51. Available from: https://www.ncbi.nlm.nih.gov/pubmed/9624992
The fourth stage corresponded to the analysis and refinement of the mapping by expert nurses, using the Delphi technique, a method used to obtain the consensus of opinions among a group of specialists through the application of structured questionnaires, circulating among the participants, with the statistical feedback of each response. Regarding the number of skilled nurses, this method does not establish the number of participants to guarantee the
representativeness of the results but defines that success refers to the qualification of the participants1919. Scarparo AF, Laus AM, Azevedo ALCS, Freitas MRI, Gabriel CS, Chaves LDP. Reflexões sobre o uso da técnica Delphi em pesquisas na enfermagem. Rev RENE. 2012 [Acesso 2 out 2016]; 13(1): 242-51. Disponível em: http://www.revistarene.ufc.br/revista/index.php/revista/article/view/36
For data analysis, Excel version 2016 was used to calculate the
concordance of the mapping through the frequency analysis. The 80% index was adopted as the minimum level of agreement in the mapping validation2121. Macedo APMC, Mendes CMFS, Candeia ALS, Sousa MPR, HoffmeisterI LV, Lage MIGS. Validation of the Nursing Activities Score in Portuguese intensive care units. Rev Bras Enferm. 2016 [cited Out 2, 2016]; 69(5): 881-7. Available from: http://www.scielo.br/pdf/reben/v69n5/0034-7167-reben-69-05-0881.pdf
ResultsWe identified 51 actions in the fall prevention protocol of the Ministry of Health, organized into three thematic categories: direct practices for falls prevention (n = 23); patient / family guidelines (n = 14); evaluation and monitoring (n = 14). In the second step, the 42 NIC interventions related to the NANDA-I risk of falls were listed, being 19 of the basic physiological domain, 10 of the behavioral, eight of the safety domain and five of the physiological complex. In the third stage, 25 (59.5%) of the 42 NIC interventions corresponded to 43 (84.3%) of the protocol. The NIC interventions with the highest correspondence with the protocol actions were: prevention of falls (6490) (n=26), control of the environment - safety (6486) (n=7) and risk identification. The fourth stage of the study contemplated the analysis and refinement of the mapping by expert nurses, from two Delphi rounds. As for the characteristics of the experts, most were females (80%) with an average of 14 years of professional experience (Table 1). Table 1 In the first round, the experts analyzed the matching of 43 protocol actions with 25 NIC interventions. The level of agreement above 80.0% was obtained in 88.4% (n=38) of the actions. Four actions of the protocol considered as unmapped (assessing the level of dependence and autonomy after the installation of equipment, guiding the patient to get up progressively from the bed and with the help of a professional of the care team; and reported on the occurrence of falls) were considered to be mapped by some experts and therefore included in the second round of Delphi together with the five mapped protocol actions that obtained agreement below 80.0% (periodically review and adjust prescription of medicines that increase the risk of falls, stimulate the preparation and distribution of educational material to prevent the risk of falls, guide the person responsible for the influence of the diagnosis on the increased risk of falling, identify the patient at risk by means of Bedside or bracelet, and periodically supervise comfort and safety of the patient). The result of the second round Delphi pointed out that 90.7% (n = 39) of the cross-mapping obtained agreement of 80%, and 9.3% (n=4) agreement of 100% among experts. Thus, the final mapping presented correspondence of 25 (59.5%) NIC interventions with 47 (92.2%) protocol actions. It should be emphasized that there were actions of the protocol that corresponded with more than one NIC intervention (Table 2). Table 2 Regarding the classification
of similarity and comprehensiveness of the 47 actions of the protocol mapped2020. Zielstorff RD, Tronni C, Basque J, Griffin LR, Welebob EM. Mapping Nursing Diagnosis Nomenclatures for Coordinated Care. J Nurs Scholarsh. 1998 [cited Ago 2, 2016]; 30(4): 369-73. Available from: https://www.ncbi.nlm.nih.gov/pubmed/9866299 Figure 1 Figure 2 shows the 17 NIC interventions and the four actions of the protocol that did not correspond, after analyzing the experts. Figure 2 DiscussionRegarding the main results of the first stage of the
study, which refers to the survey of 51 actions of the protocol of the Ministry of Health for the prevention of falls, it is noted the prioritization of care related to “direct practices for prevention”, such as: identify the patient at high risk through signaling at the edge of the bed or bracelet, move the patients safely, allocate the patient at high risk for falls near the nursing station and arrange personal hygiene care. On the other hand, an international study, whose objective was to
identify the most effective actions to prevent falls in adults, identified the valuation of practices focused on environmental control. The most applied activities in the hospital sectors were to maintain high bed grids, to wear non-slip shoes and to keep the call light within reach of the patients2222. Tzeng HM, Yin CY. Perceived top 10 highly effective interventions to prevent adult inpatient fall injuries by specialty area: A multihospital nurse survey. Appl Nurs
Res. 2015 [cited Jan 10, 2017]; 28: 10-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24933119 The protocol also highlights the importance of involving the patient and the family in the prevention of falls, since it contemplated 11 actions in this context. Among the most used strategies, it is mentioned the education of the
patient/companion, mainly in Brazilian reality, in which the hospitalized patient, in most cases, has the presence of the companion2323. Urbanetto JS, Creutzberg M, Franz F, Ojeda BS, Gustavo AS, Bittencourt HR, et al. Morse Fall Scale: translation and transcultural adaptation for the portuguese language. Rev Esc Enferm USP. 2013 [cited Jan 10, 2017]; 47(3): 569-75. Available from: http://www.scielo.br/pdf/reeusp/v47n3/0080-6234-reeusp-47-3-00569.pdf
Interventions
involving “evaluation and monitoring” are also of great relevance for fall prevention in the context of the Ministry of Health protocol. Assessing the risk for falls is an essential component of any prevention program to identify patients at risk to correct the situation and, finally, to avoid the occurrence of falls. It is recommended that the evaluation is performed at the admission of the patient and at least every three days during the period of hospitalization and when there is a transfer
of the unit, there is a change in its clinical condition or after the occurrence of a fall2525. Higaonna M, Enobi M, Nakamura S. Development of an evidence-based fall risk assessment tool and evaluation of interrater reliability and nurses’ perceptions of the tool’s clarity and usability. Nihon Kango Kagakkaishi. 2016 [cited Jan 23, 2017]; 1-15. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27714985
In general, the assessment for the risk of falls involves the collection of factors such as history of falls, mental
and sensory alteration, mobility, age, medications in use, the presence of osteoarticular diseases, alterations of balance, inactivity, and alterations of vision and hearing. The identification and evaluation of these factors in an individualized way allows the implementation of fall prevention strategies according to the characteristics presented by the patient2525. Higaonna M, Enobi M, Nakamura S. Development of an evidence-based fall risk assessment tool and
evaluation of interrater reliability and nurses’ perceptions of the tool’s clarity and usability. Nihon Kango Kagakkaishi. 2016 [cited Jan 23, 2017]; 1-15. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27714985 Regarding the possible contributions of the risk assessment for falls, a Japanese study described the effectiveness of a prevention
program and identified a 60% reduction in the drop rate of hospitalized patients. This multidisciplinary program was based on interventions that included assessment of the risk of falls through a standardized instrument, modifications to the environment, teaching to the patient, family/companion and team, and implementation of a prevention protocol in which patients with at least one were considered to be at high risk. Fallout educational material was provided to patients and caregivers,
including posters alongside the beds, and for patients considered unable to request assistance, movement alert devices were used2626. Ohde S, Terai M, Oizumi A, Takahashi O, Deshpande GA, Takekata M, et al. The effectiveness of a multidisciplinary QI activity for accidental fall prevention: Staff compliance is critical. BMC Health Serv Res. (Online). 2012 [cited Fev 19, 2017]; 12(197): 1-7. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3502440/ Despite the existence of different instruments for
the assessment of the risk of falls, it is important that the health services use those that are validated for the specific populations to minimize the chances of bias or error in the identification/classification of the risk2525. Higaonna M, Enobi M, Nakamura S. Development of an evidence-based fall risk assessment tool and evaluation of interrater reliability and nurses’ perceptions of the tool’s clarity and usability. Nihon Kango Kagakkaishi. 2016 [cited Jan 23,
2017]; 1-15. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27714985 In Brazil, the St Thomas Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY), developed in England in 1997, has been translated and adapted with the
inclusion of some items, such as medication use and age equal or superior to 60 years old. However, there are no Brazilian studies about its validation1616. Brasil. Agência Nacional de Vigilância Sanitária. Fundação Oswaldo Cruz. Programa Nacional de Segurança do Paciente (PNSP). Anexo 01: Protocolo de Prevenção de Quedas. Brasília; 2013. 15 p. [Acesso 2 out 2015]. Disponível em:
http://www20.anvisa.gov.br/segurancadopaciente/index.php/publicacoes/item/prevencao-de-quedas Concerning the main results of cross-mapping, 47 of the 51 actions contained in the protocol for falls prevention were mapped to 25 NIC interventions. The NIC interventions that presented the highest correspondence with the actions of the protocol were prevention against falls (6490), environmental control (6486) and risk
identification (6610). These findings corroborate the results of a study that identified nursing care prescribed for hospitalized patients at risk of falls. The most frequent NIC interventions were control of the safety environment (6486) and prevention of falls (6490), differing only in relation to intervention risk identification (6610), which was not mentioned3030. Luzia MF, Almeida MA, Lucena AF. Nursing care mapping for patients at risk of falls in the Nursing
Interventions Classification. Rev Esc Enferm USP. 2014 [cited Nov 15, 2016]; 48(4): 632-9. Available from: http://www.scielo.br/pdf/reeusp/v48n4/0080-6234-reeusp-48-04-632.pdf The intervention NIC drug control (2380) was mapped four times. It is known that some medications may contribute to the occurrence of falls, especially in the elderly and hospitalized patients. The drug classes that are most
associated with falls are hypoglycemic, antihypertensive, psychotropic and opioid3131. Jansen S, Bhangu J, Rooji S, Daams J, Kenny RA, Velde NV. The Association of Cardiovascular Disorders and Falls: A Systematic Review. J Am Med Dir Assoc. 2016 [cited Fev 19, 2017]; 17(3): 193-9. Available from: http://www.jamda.com/article/S1525-8610(15)00562-9/fulltext
Among the non-mapped NIC interventions there
are the promotion of body mechanics (0140), promotion of stretching exercise (0202) and exercise therapy: muscle control (0226), exercise therapy: balance (0222), exercise therapy: joint mobility). The non-identification of these interventions in the protocol signals the importance of a review and inclusion of actions related to muscle stimulation since one of the main risk factors for falls is the reduction of muscle strength. An international review has shown that increased muscle strength
results in a lower risk of falls and injuries, especially in the elderly. Muscle weakness is a factor strongly associated with the risk of falls, especially in certain situations, such as slipping when taking a step and falling when trying to get up from the bed or chair. Muscle strengthening exercises such as stretching, increased balance, endurance, and flexibility significantly reduce the risk of falls3333. Benichou O, Lord SR. Rationale for Strengthening Muscle
to Prevent Falls and Fractures: A Review of the Evidence. Calcif Tissue Int. 2016 [cited Fev 22, 2017]; 98(6): 531-45. Available from: http://link.springer.com/article/10.1007%2Fs00223-016-0107-9 The pain control NIC intervention (1400) also did not correspond to the actions present in the protocol. However, pain is one of the
most prevalent symptoms in people over 65 years old and can cause physical restrictions and changes in the level of consciousness, being a relevant risk factor for falls3434. Marshall LM, Litwack-Harrison S, Makris UE, Kado DM, Cawthom PM, Deyo RA, et al. A Prospective Study of Back Pain and Risk of Falls Among Older Community-dwelling Women. J Gerontol. - Serie A, Biol Sci Med Sci. 2016 [cited Fev 24, 2017]; 71(9):1177-83. Available from:
https://www.ncbi.nlm.nih.gov/pubmed/26757988 The NIC interventions monitoring vital signs (6680), circulatory insufficiency care (4062), circulatory insufficiency venous insufficiency (4066) and cognitive stimulation (4720) were also not mapped. The American
Society of Geriatrics points out that postural hypotension is associated with the risk of falls. Supervising patients on the use of hypotensive drugs, preventing dehydration, stimulating the use of elastic stockings in patients with indication should be practical for the prevention of hypotension and, consequently, of falls3636. Kenny RA, Rubenstein LZ, Tinetti ME, Brewer K, Cameron KA, Capezuti EA, et al. Summary of the Updated American Geriatrics Society/British
Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011 Jan [cited Mar 10, 2016]; 59(1): 148-57. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21226685 Another unmapped NIC intervention was sleep improvement (1850). Sleep deprivation is an influential point for the risk of falls in the elderly, as it can cause daytime sleepiness, cognitive dysfunction and reduction in reflex response time3838. Min Y, Nadpara PA, Slattum PW. The Association between Sleep Problems,
Sleep Medication Use, and Falls in Community-Dwelling Older Adults: Results from the Health and Retirement Study 2010. PAJAR, Pan Am J Aging Res. 2016 [cited Mar 10, 2017]; 2016:3685789. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27547452 The NIC intervention improved visual communication deficit (4978) also did not match the protocol.
The association of visual dysfunction with the risk of falls is significant since hospitalized patients with decreased visual acuity have a higher frequency of falls. Physiological changes in the eyes resulting from aging include gradual loss of visual acuity, decreased peripheral vision, visual accommodation, the perception of depth, and slowness in the process of visual information. The visual system plays an important role in postural maintenance and alterations may impair the maintenance of
balance3939. Abreu HC, Reiners AA, Azevedo RC, Silva AM, Abreu D, Oliveira A. Incidence and predicting factors of falls of older inpatients. Rev Saúde Pública. 2015 [cited Mar 1, 2017]; 49(37): 1-8. Available from: http://www.scielosp.org/pdf/rsp/v49/0034-8910-rsp-S0034-89102015049005549.pdf Four actions of the fall prevention protocol did not correspond to the NIC: to educate professionals about the risks of falls, and inform the responsible person if the patient is released or not to walk; allocate the patient near the nursing station, if possible; and provide immediate assistance to the patient who has fallen to alleviate possible damage. Unattended
falls are more likely to result in injuries with serious consequences for the patient, which reinforces the importance of constant vigilance of patients at high risk4040. Staggs VS, Mion LC, Shorr RI. Assisted and Unassisted Falls: Different Events, Different Outcomes, Different Implications for Quality of Hospital Care. Jt Comm J Qual Patient Saf. 2014 Aug [cited Mar 1, 2017]; 40(8): 358-64. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4276137/ Sharing responsibility for prevention benefits the patients, the professionals and the institution4141. Hayashida KY, Bernardes A, Maziero VG, Gabriel CS. Decision-making of the nursing team after the revitalization of a decentralized management model. Texto Contexto Enferm. 2014 [cited Mar 11, 2017]; 23(2): 286-93. Available from: http://www.scielo.br/pdf/tce/v23n2/0104-0707-tce-23-02-00286.pdf
It is suggested that the action of the protocol “to provide immediate assistance to the patient who suffered a fall to mitigate the possible damages” did not correspond to the NIC since it does not refer to a prevention practice, but to act through the incident. Australian study reinforces the importance of professional training. The researchers investigated the impact of an online training program for nurses on fall risk assessment, post-fall prevention and management, and identified that the proposal contributed
significantly to the implementation of interventions such as: introducing warnings about the risk of falls in the patient charts during mobilization or in the bathroom, elimination of risks present in the environment, use of alarms in the beds and in the chairs, and referral to other health professionals. The findings enabled to conclude that educational programs, aimed at professionals, represent a positive cost-effective method for the improvement of fall mitigation strategies in health
organizations4242. Johnson M, Kelly L, Siric K, Tran DT, Overs B. Improving falls risk screening and prevention using an e-learning approach. J Nurs Manag. 2014 [cited Fev 15, 2017]; 23(7): 910-19. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24848141 Regarding the limitations of the study, it is suggested the possibility of not having contemplated all the actions contained in the protocol, due to its narrative structure. Successive readings of the protocol were carried out to list all actions, and, therefore, it is believed that the methodological approach, including the validation of the mapping by experts, contributed to a greater reliability of the results. ConclusionThe cross-mapping allowed the comparison of the actions contained in the protocol of falls prevention of the Ministry of Health with the interventions standardized by the NIC. Of the 51 actions contained in the fall prevention protocol, 47 were mapped to 25 CIN interventions. It was also found that four (7.8%) protocol actions were not mapped, along with 17 NIC interventions (40.5%). The validation of the mapping showed that the actions contained in the fall prevention protocol were considered more specific and detailed. However, the NIC contemplates a greater number of interventions, enabling to conclude that the protocol is capable of expanding new interventions with a view to reducing the risk of falls, including, for example, improvement of sleep, improvement of communication: visual deficit and pain control. It was observed that the majority of non-mapped NIC interventions are related to the stimulation of muscle strength, which evidences the need to include such interventions since muscle limitations are important risk factors for falls. Finally, it is recommended that unmapped NIC interventions be integrated into the protocol, as well as protocol actions that have not been mapped to be proposed for NICs since such interventions and actions can contribute to the prevention of falls to improve quality and safety in healthcare. References
What are some nursing interventions for safety?The following are the therapeutic nursing interventions for patients at risk for injury:. Guide the patient to their surroundings. ... . Enhance safety through the use of medical alarm systems. ... . Avoid the use of physical and chemical restraints. ... . Utilize alternatives to restraints that can be used to prevent falls and injuries.. When placing a patient in a supine position the nurse would implement which intervention to prevent foot drop?Supine Position
In supine positioning , the patient lies flat on their back. Pillows or other devices may be used to prevent foot drop. Additional supportive devices, such as pillows under the arms, may be added for comfort. See Figure 13.11 for an image of a patient in the supine position.
When transferring a patient from the bed to the chair the nurse should first?When preparing to safely transfer a patient from a bed to a wheelchair, the nurse should first: 1. Determine the patient's arm strength.
How will you prevent foot drop for a patient in a prone position quizlet?To help prevent footdrop, place it at the foot of the bed to keep the patient's feet dorsiflexed.
|