Running Head: RESEARCH PROPOSAL: PART 4 1
Research Proposal: Part 4
Valerie Vick
UIN # L29354112
Liberty University
Abstract
RESEARCH PROPOSAL: PART 4 2
There has been a considerable amount of research done on falls in the hospital setting due to its
high occurrences. Most of these studies are researching ways to prevent falls based on intrinsic
factors. However, some have taken a more retrospective approach by considering the physical
environment surrounding the falls event. These studies have focused on hospital room design
and its contributory factors for falls. In one specific hospital, nursing staff, fall history, and
patient satisfaction results drove unit staff to consider ways that the hospital door could be
changed to reduce falls. This paper will discuss how the research study will be designed and
what methods will be used to ensure that privacy and ethical concerns are met.
Research Proposal: Part 3
RESEARCH PROPOSAL: PART 4 3
Data Collection
Patients as well as staff verbalized increased dissatisfaction with the bathroom doors in
the inpatient rooms on many occasions. The initiative to attempt to modify the inpatient
bathroom doors was based on this displeasure. The first approach to data collection will be
through staff satisfaction surveys. A multidisciplinary team, consisting of 3 registered nurses, 1
occupational therapists, 3 licensed practical nurses, and 3 unlicensed personnel, who on a daily
basis are actively involved in the care of the patients on this unit, will complete the survey. The
survey will consist of approximately 10 questions. The same staff, which was selected randomly,
will complete the pre-door modification survey and the post-door modification survey.
The pre-modification survey will be completed within seven days, as staff has already
had experience with this door. However, staff will be allotted 60 days with the modified door
prior to taking the survey due to the varying type of patients and care that must be given any
given time. The 10 survey questions pre- and post-implementation Likert scale will consist of a
scale from one to five choices to determine degree of satisfaction: 1=strongly disagree,
2=disagree, 3=neutral, 4=agree, 5=strongly agree. They will encompass questions regarding
adequacy of door opening, patient satisfaction, staff and patient safety, and maneuverability
while assisting patients to and from the bathroom (Appendix A). This survey will be anonymous,
voluntary and administered electronically.
The same members completing the survey will be used to role play and act the part of
staff members and patients. Since only one door will be modified, it will act as the intervention
so that a comparative trial can be performed. The first scenario will consist of assisting a typical
surgical patient with a walker, knee brace and intravenous pole with fluids infusing. In these
cases, most patients require a two-person assist.
RESEARCH PROPOSAL: PART 4 4
There are some instances where a patient will experience a life threatening event in the
bathroom(reference…….). To identify some issues that could arise in this situation, the second
scenario will involve a mock code, where the goal is to acquire quick access to the patient,
position the crash cart within close proximity to the patient, and get the patient out of the
bathroom safely on a backboard, without any undue harm to the patient or responders. Both
scenarios will be performed, video recorded, and timed; one in the modified room and the other
in a non-modified room. The data collected will be through observation.
Statistical data, pre-door modification, will be received from the Patient Safety Division,
telling us the number/location of falls for the previous 6 months. Post-door modification
statistics will be received 6 months post door modification with the number/location of falls.
Appendix A
Pre and Post Door Modification Survey Questions
Likert scale (1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5=strongly agree)
1. The bathroom entrance can accommodate patients in wheelchairs/walkers, and patients attached to a
piece of equipment (e.g., IV pole).
2. The bathroom door swings open and closed without hitting any other doors or equipment.
3. The bathroom doorway comfortably accommodates two or more people (i.e., patient and helper(s)).
4. The bathroom can comfortably accommodate two or more people (i.e., patient and helper(s)) while
inside.
5. The bathroom door closes completely when a person (who may be large or have assistive equipment)
is sitting on the toilet.
6. Patients have commented unfavorably about the bathroom door opening being too narrow.
7. The bathroom door opening can, in your opinion, contribute to an increased fall risk.
8. I feel comfortable and safe assisting patients through the doorway to the bathroom.
9. In the event of an emergency, accessibility to the patient is challenging due to the doorway opening.
10. The bathroom door becomes an obstacle during emergency egress procedures.
RESEARCH PROPOSAL: PART 4 5
The unit that will be used is a 36-bed inpatient post-surgical ward. The patient
population admitted on the inpatient surgical unit at this facility have an increased acuity level.
The reason for this is because these post-operative patients are unique in that they require
intravenous (IV) poles for fluids and some have indwelling catheters, tubes and drains.
Furthermore, post-surgical orthopedic patients, which account for 50% of the population on this
unit, require the assistance of other medical devices and assistance from staff members when
ambulating and transferring. These physical elements are associated with this patient population
in them performing offending postures that relate to increased falling such as pulling, turning,
grabbing, pushing, and pulling[Pti17]. High risk medications and opioids can also impair their
physical and cognitive limitations. These intrinsic factors place patients at a higher risks for
falls, and account for this unit having an increased number of falls reported.
Research Design
Falls that occur on this unit are while patients are ambulating to or from the bathroom
with a bathroom door that opens towards the free space in the room, unlike standard doors that
open parallel to the wall. This impedes the flow of traffic and blocks visibility. The incidence
rate corresponds with a previous study that revealed there are more falls associated with a
bathroom door that must remain closed in order to be out of the way of traffic[Cal12]. The
design method that will be used to carry out this quantitative research will be both correlational
and quasi-experimental. One component of the research hypothesis is that once the modification
of the bathroom is made to increase the width of the opening that falls will decrease. The quasi-
experimental design approach will be used as the group studied will not be randomly selected.
The group will specifically be orthopedic patients with the greater risks involved. The
manipulation of the door will be the independent variable in examining the significance and
RESEARCH PROPOSAL: PART 4 6
prevalence of falls. The other component is to try to determine the amount of time necessary for
responders to gain access to the patient during a mock code blue. The correlation is
hypothesized that once the door is widened, that the time-to-patient would decrease, making this
a negative correlation[Gra17].
Sample and Sampling Procedure
Orthopedic patients will be used as the sample as they are the most common type of
patient on the unit. They are also the victims of most falls on the unit and have the most
difficulty ambulating to the bathroom with the mobility devices that they require.
The assessment of the subjects identified will be based on the nursing staff’s assessment
of the fall risk by using the Johns Hopkins Fall Risk Assessment Tool, and the level of assistance
required by staff when ambulating[Joh17]. The projected number of subjects will be 14. They
will differ in sex, age, and socioeconomic status, and active duty status. The only similarity will
be the type(s) of surgery received, which would be lower extremity and back surgeries. All other
types of surgeries (e.g. gynecological, gastrointestinal, urological, etc.) will be excluded.
Ethics/Institutional Review Board
While most of the subjects used will be active duty, special care and consideration must
be taken to ensure that informed consent is voluntary and not coerced. In reference to
participants that are active duty, their superiors will not be involved, therefore cannot influence
their subordinate’s decision to participate or not[The16]. Subjects’ names will not be used to
protect confidentiality. Protected health information will be de-identified using safe
harbor[Gra17]. There will not be potential risks involved. The expected benefits would be the
decrease in the fall risks previously identified.
RESEARCH PROPOSAL: PART 4 7
References
Calkins, M., Biddle, S., & Biesan, O. (2012). Contribution of the designed environment to fall
risk in hospitals. The Center for Health Design and The Facilities Guidelines Institute.
Concord: Ideas Institute. Retrieved November 1, 2017, from
https://www.researchgate.net/publication/265510269
RESEARCH PROPOSAL: PART 4 8
Gray, J., Grove, S., & Sutherland, S. (2017). The practice of nursing research: Appraisal,
synthesis, and generation of evidence (8th ed.). St. Louis: Elsevier.
Johns Hopkins Medicine. (2017, November 2). Fall Risk Assessment. Retrieved from Institue fo
Johns Hopkins Nursing:
https://www.hopkinsmedicine.org/institute_nursing/models_tools/fall_risk.html
Pati, D. V., Cloutier, A., Yang, J., Harvey, T., & Lee, J. (2017, February). Physical design factors
contributing to patient falls. Journal of Patient Safety. Advanced online publication.
doi:10.1097/PTS.0000000000000339
The American Health Lawyers Association. (2016). Informed consent in miltary medical
research: A guide for military service members. Washington, DC: The American Health
Lawyers Association
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