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Introduction
The aim of the project is to answer the following question: What is the effectiveness of increased patient education and participation with regular exercise/physical therapy versus current hospital fall prevention programs with limited exercise/physical therapy, in promoting balance and stability thus minimizing falls and fall-related injuries, in senior patients within a period of three months? . The change plan consists of four major steps: the design of the program based on patient education and physical therapy, the measurement of the baseline of falls and fall-related injuries in a facility, the intervention based on two prevention strategies (education about risks related to falls and exercises), and the evaluation of the plan (the comparison between the fall rates in the control group and the established baseline). The patients will be divided into two random groups, intervention and control, to ensure that the results are valid and generalizable. All internal stakeholders (patients, nurses, providers) will be involved in project implementation, which is based on Lewins theory of planned change.
Content
The literature review presents research that addresses the effectiveness of exercise in elderly patients and their influence on older adults stability and balance. It consists of the two parts, synthesis (the review of the information presented) and comparison (the comparison of information and the implications for its use). The nursing theory section introduces the concept of the Health Belief Model and describes how patients health belief system needs to be changed to help patients comprehend the importance of physical activity and exercise. The section dedicated to change theory introduces the Lewins Three-Step Change Theory in the context of nursing, emphasizing how its stages (unfreezing, moving, and refreezing) will be supported by nurses (via emotional intelligence) and hospital administration (by controlling the process). It also discusses what strategies can be used to overcome stakeholders resistance, e.g., informative strategy and positive example.
The section Implementation Plan identifies resources, strategies, and stakeholders necessary for plan implementation. It addresses educational requirements and communication strategies (with patients and providers) used during research. It also outlines the four stages of the plan in detail and identifies what safety considerations (e.g., patient safety, the principles of beneficence and nonmaleficence, interventions that do not go beyond the nurses scope of practice) are necessary for project implementation. The section Evaluation and Dissemination of Outcomes presents the evaluation plan. Current fall rates will be used for the pre-project assessment; a quantitative method will be used to gather and assess data related to falls and injuries in the facility.
Both pre- and post-assessments are to be used to compare the outcomes of the intervention (the control group) with the baseline rate. The dissemination plan will include discussions with patients about the improvements in their muscle strength and stability. The fall incidence rates will be presented to nurses and hospital administration. It is also suggested to send project outcomes to nursing organizations for further dissemination. The section Sustaining Change identifies barriers for implementation (ever-changing environment and nurses unwillingness) and discusses the role of stakeholders in the promotion (nurses), incorporation (administrators), and supply (the researcher) of the project outcomes. Lewins theory of planned change is presented as the most suitable for project implementation. Patients are viewed as potential supporters of the change sustaining.
Conclusion
The projects aim is to evaluate the effectiveness of patient education and exercise programs in decreasing fall and fall-related injuries rates in the facility. It consists of four sections: program design, baseline measurement, the intervention of the program, and the evaluation of its outcomes. As the project is based on evidence-based literature and other resources, its implementation is necessary to emphasize the importance of practical (focused both on education and exercise or physical therapy) interventions. Pre- and post-assessment will compare the effectiveness of the change project to the current fall prevention program in the facility.
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