PROPOSAL 1 1
Research Proposal: Part 1
Nicole L. Gardner
Nursing Research 500
College of Nursing, Liberty University
Author Note
Nicole Gardner
I have no known conflict of interest to disclose. Correspondence concerning this article
should be addressed to Nicole Gardner. Email: nlgardner@liberty.edu
PROPOSAL 1 2
Background
Falls are a major concern for every hospital in the nation. Falls are problematic because
they can cause serious injuries for any patient involved. Since this is a national problem, The
Joint Commission created the National Patient Safety Goals (NPSG). The purpose of these goals
are to improve patient safety. The goals focus on problems in health care safety and how to solve
them. Some of the specific goals include; identifying residents correctly, medication safety,
preventing infection, preventing falls, and preventing bed sores (Nursing Care Center National
Patient Safety Goal, 2020). With falls directly relating to a lot of injuries for hospital patients,
this contributes to increased hospital costs; thus giving reason to put responsibly on nurses to put
prevalence and prevention in place. Each year about $50 billion is spend on medical cost related
to non-serious fall related injuries and $754 billion on serious or fatal fall injuries (Poe et al.,
2018).
According to research falls are attributed to a multitude of factors. Those including age,
mobility, cognitive limitation, and medications that can cause high fall risk. Additional factors
may include those such as the physical environment, flooring, footwear, and even assistive
devices. Multiple fall based safety initiatives have been set in place by local hospitals, the most
common being the John Hopkins Fall Risk Assessment Tool (JHFRAT). This was developed to
assess the risk of an unanticipated falls in the inpatient setting and put precautions in place (Poe
et al., 2018). The JHFRAT is a highly used evidence based fall safety initiative. It combines a
fall protocol and fall-prevention products. Nurses use the JHFRAT to put patients in either a
high, moderate or low category. Factors that are evaluated are age, fall history, medication use,
elimination, patient care equipment, mobility, and cognition. Based upon the calculated score,
different precautions are put in to place (John Hopkins Fall Risk Assessment Tool, n.d.).
PROPOSAL 1 3
Studies have indicated that with the use of some form of fall initiative and scoring that
falls are reduced in upwards to 60% (Nursing Care Center National Patient Safety Goal, 2020).
The importance of having a fall initiative in place is key to help with patient safety in any
hospital organization. Nurses need to be made aware of the different implementations structures
that are possible and seek out the best option for their facility and the best option that shows the
greatest reduction of serious falls.
Research Proposal
Falls with injuries in acute care settings continue to be the most reportable and life
treating among hospitalized patients. Multiple initiatives have been brought forward to help
decrease falls, but which one is best? The hospital I am employed at always going with what is
best evidence based. Evidence-Based Design helps guide the decisions and environmental
design to achieve the best possible outcomes for our facility and others alike.
I would like to review different evidence-based fall preventions programs to see which
has had the greatest success. The JHFRAT is the most well-known, but is it the best? Different
floors in every hospital have different requirements. Patients on a med-surg floor may require a
different scale/initiative based upon the multiple restrictions or equipment they use. Patients that
may be on a stepdown floor possibly need different guidance due to having respiratory or cardiac
issues that come in to play. Physical environmental conditions could also play a huge factor: bed
placement, how big the bathroom is, or even distance from the bed to bathroom.
Research Question/Hypothesis
The research proposal will focus on answering the research questions, “Which evidence-
based fall tool kit is best for reducing falls in acute care hospitals” and “Is having only one tool
kit or scoring technique appropriate for all the floors in an acute care hospital.” Objectives
PROPOSAL 1 4
include 1: Decrease falls and injuries to patients, 2. Reduce injuries related to falls, 3. Improve
staff and patient satisfaction.
The hypotheses for this research is that patient safety will improve and falls will be
decreased after finding the correct evidence-based fall tool kit for each unique floor in an acute
care hospital. Trial and implementation of a correct tool kit will take place on the med-surg floor
and then a specific stepdown floor. Staff will be responsible for scoring patients and putting
appropriate precautions in place. Manual audits would need to take place to make sure
precautions are in place. Surveys can assess if the improvements made helped with staff and
patient satisfactions.
PROPOSAL 1 5
References
John Hopkins Fall Risk Assessment Tool. (n.d.). John Hopkins Medicine. Retrieved February 6,
2021, from
https://www.hopkinsmedicine.org/institute_nursing/models_tools/fall_risk.html#:~:text=
The%20Johns%20Hopkins%20Fall%20Risk%20Assessment%20Tool%20(JHFRAT),a
%20comprehensive%20protocol,%20and%20fall-prevention%20products%20and
%20technologies.
Nursing Care Center National Patient Safety Goals. (2020, October 28). The Joint Commission.
https://www.jointcommission.org/standards/national-patient-safety-goals/hospital-
national-patient-safety-goals/
Poe, S. S., Dawson, P. B., Cvach, M., Burnett, M., Kimble, S., Lewis, M. …Hill, E.E. (2018).
The johns Hopkins fall risk assessment tool: A study of reliability and validity. Journal
of Nursing Care Quality, 22(1), 10-19. doi:10.1097/NCQ.000000000000301
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