SY001 Practicum Experience Journal Entry

Objective(s)

1. Analyze organizational insights regarding the issue of falls in the facility.
2. Design a training program for providers to reduce the number of falls among patients using the Agency for Healthcare Research and Quality (AHRQ) tool kit.
3. Recommend a falls prevention strategy to reduce the organization’s fall rate.
4. Observe the unit protocol for fall assessments on admission to determine if there are gaps to providing a safe environment to reduce injurious falls.
5. Ascertain and analyze new opportunities that avail me of in my academic pursuit to achieve attainment and reader undiluted nursing expertise to health organization.
6. Reinforce communication skills, especially listening to ascertain the needs of my patients and staff to render better therapeutic care. I will identify and interpret ideas for a better outcome

Part 1: Professional Development and Reflection

Throughout this practicum experience, I have managed to achieve several objectives and I am still working on others. I have managed to analyze the insight of the organization towards the issue of falls. I have identified the common reasons why fall prevention is difficult and concluded how a training program could help in addressing this issue. The remaining objectives including recommending a prevention strategy and observing the use of the proposed protocol in the organization have been partially achieved. I intend to continue implementing the fall prevention strategy and analyze new opportunities that may be available. In addition, I have begun working on a plan to engage all stakeholders and employ effective communication and listening skills during the program.

WGU’s Personal Theoretical Framework for Advanced Practice Nursing

To ensure the achievement of all the objectives by the end of the practicum, the plan is to actively engage in clinical activities. I intend to participate in a wide range of activities like regularly assessing patient cases to develop skills in patient care. Secondly, I intend to dedicate enough time to monitor the fall prevention program and consult with experts when necessary. I will maintain a keen eye on organizational processes and work collaboratively with other healthcare professionals to plan changes to the strategy appropriately. Lastly, I will engage in regular reflection sessions to assess progress toward achieving objectives. I will seek input and feedback from my colleagues to identify strengths and areas for growth.

Throughout the practicum experience, I have experienced a few challenges and still anticipate more. One of the challenges is limited access to some patient cases that require expert care. I have also observed that changing some aspects of care in the organization is difficult because of the status quo and limited resources. I anticipate challenges like communication barriers among inter-professional teams due to varied interests and technological issues with monitoring falls. To address some of these challenges, I intend to seek diverse learning opportunities using case studies and simulations. I will engage stakeholders including staff members and executive management to discuss areas that need change. I will also seek mentorship to ensure my objectives align with the organizational expectations.

Part 2: Connections to Your Site

The specific objectives for this part include:

1. Describe a practice issue observed during my practicum experience.
2. Analyze the observed problem using appropriate evidence from the literature.

• Formulate a plan to address the observed healthcare issue differently.

An issue that I have observed during the practicum experience is the increasing number of falls among patients with dementia. The complexity of managing falls in this population stems from cognitive impairments, which affect their ability to recognize environmental hazards and follow safety instructions (Gliner et al., 2022). For example, I have observed that most patients fall when trying to get out of bed or access the bathroom. The use of bed alarms and regular monitoring has worked among a few patients but remains ineffective in minimizing the number of falls. Consequences of falls like physical injuries, prolonged hospitalization, increased costs, and legal actions that follow necessitate prompt interventions in the facility.

Understanding the Benefits of Simulation for Learners: The 4 Key Aspects of Simulation Experience

The issue of falls among patients with dementia is observed across many institutions and the risk factors are well-understood. Cognitive impairment is one of the greatest risk factors that causes falls in this patient population (Meyer et al., 2020). The number of falls in this population is threefold compared to other elderly patients. Within the context of my specialty, observing falls in patients with dementia is a critical concern for geriatric patients. In my observation, the use of individualized care plans is a strategy that can help to meet the needs of these patients. The plans take into consideration the stage of the disease, mobility status, and environmental context (Peek et al., 2020). This approach is different from what is observed in the literature whereby fall prevention protocols like hourly rounding and the use of bed alarms are prioritized (Gliner et al., 2022). Integrating these concepts into practice can help to enhance fall prevention in the facility and improve care for patients with dementia.

The issue of falls among patients with dementia has been addressed in a manner that is consistent with the literature. One example is that the institution uses hourly rounding to identify patients at risk for falls (Peek et al., 2020). Secondly, risk assessment during the admission of patients and the use of bed alarms is widely adopted in the facility. Regarding the use of personalized care plans, the facility has not yet explored how this intervention can help more patients. Issues like staffing and lack of adequate education about this approach hinder its use in the facility.

Given the various evidence-based approaches observed in the literature, my plan to address this issue differently involves the use of educational initiatives. I believe providing education to patients, families, and caregivers on the risk of falls and fall prevention can significantly address the issue (Peek et al., 2020). I will organize an education session that will emphasize environmental modifications, safe mobility techniques, and the recognition of early signs of instability. This approach will increase awareness among patients and families regarding the issue of falls and enhance compliance with specific interventions used in the facility.

References

Gliner, M., Dorris, J., Aiyelawo, K., Morris, E., Hurdle-Rabb, D., & Frazier, C. (2022). Patient falls, nurse communication, and nurse hourly rounding in acute care: Linking patient experience and outcomes. Journal of Public Health Management and Practice : JPHMP, 28(2), E467–E470. https://doi.org/10.1097/PHH.0000000000001387

Meyer, C., Hill, K. D., Hill, S., & Dow, B. (2020). Falls prevention for people with dementia: A knowledge translation intervention. Dementia (London, England), 19(7), 2267–2293. https://doi.org/10.1177/1471301218819651

Peek, K., Bryant, J., Carey, M., Dodd, N., Freund, M., Lawson, S., & Meyer, C. (2020). Reducing falls among people living with dementia: A systematic review. Dementia, 19(5), 1621-1640. https://doi.org/10.1177/1471301218803201