The Morse scale is a straightforward program of evaluating a patient's probability to fall. A majority of nurses rate it as rapid and easy to use. Moreover, it takes less than three minutes to rate a patient. The scale comprises of 6 parameters that are quick and simple to score. Also, it has inter-rater reliability and predictive validity; hence, utilized in acute care locale both in lengthy care inpatient and hospital settings. In this regard, this piece summarizes the study on how Morse implantation reduces the risk factors for fall in the elderly when compared to not using any scale in a long-term care facility. Also, it explains ways in which the findings might be utilized in nursing practice while addressing ethical considerations associated with the conduct of the study.
Summary of Morse Scale Implementation
Goodwin, Child, and Garside highlight the effects of falling among individuals over the age 65 years. First, it results in negative spiral impacts that are morbidity, functional decline, mortality, reducing the quality of life, and lengthy hospitalization (Child, Goodwin, Garside, & Boddy, 2012). In their study, they carried out a standardized literature search. Besides quality assessment of the incorporated studies and synthesis utilizing a meta-ethnographic approach based on the techniques by Hare and Noblit was conducted (Child, Goodwin, Garside, & Boddy, 2012). The search was run in various electronic databases between Jan 1980 and Jan 2012. The databases included Embase and PsychInfo, Medline, and Cochrane Database of Systematic Reviews (Child, Goodwin, Garside, & Boddy, 2012). Moreover, all abstracts and titles were screened by two reviewers. On the other hand, only studies that examined influences on the fall-prevention scheme's implementation amidst community-dwelling older individuals and utilized known qualitative techniques of data acquisition and analysis were included. Further, the review included papers that were published in English. Consequently, the original search criteria generated 4486 probable documents. After screening, 19 studies were incorporated in the systematic review. Three reviewer concepts were singled out after going through the selected article. The first one was the practical considerations that need to be examined when designing and actualizing fall-prevention interventions (Child, Goodwin, Garside, & Boddy, 2012). Three concerns need to be addressed; cost, accessibility and time. Regarding cost, an individual may be forced to acquire assistive tools, fees for attendance and travel to and from the interventions. Therefore, older individuals may lack money to cater for such expenses. As such, the interventions may be provided for free to cater for the less affluent older adults. Also, they may provide these services close to the community via mobile clinics to eliminate the need for the elderly to travel. The second concept is the adoption of a community. There are strong cultural influences on whether or not an older individual perceives the prevention programmes negatively or positively. For instance, the United Kingdom’s South Asian community believe that the old age consequences are beyond an individual’s control. Thus, they accept that fall is the will of Allah or God (Child, Goodwin, Garside, & Boddy, 2012). As a result, measures should be taken to educate such societies that falling can be prevented. The third concept is the psychosocial concept that is classified into; transforming identities and definition of the expert. A fall can have wrecking effects on the quality of life, confidence, and independence. Additionally, it causes physical injuries, functional impairments, psychological trauma and even death. Thus, there is hesitation among the elderly to be viewed disabled and old. Therefore, in practice, health professionals should be very cautious when handling and offering advice to the aged.
Application in Nursing Practice
Balzer, Bremer, Schramm, and Raspe outline their primary research queries by seeking to establish the outcome of non-pharmaceutical or pharmaceutical single interventions and methodized multifaceted programmes for fall avoidance among the elderly regarding the extent of falls and their related injuries (Balzer, Bremer, Schramm, & Raspe, 2012). Moreover, they seek to answer the cost-effectiveness of these interventions and programmes, before examining the social necessities, legal aspects and ethical considerations applicable to the actualization of procedures for fall avoidance among the aged.
They carried out a standardized literature search in 31 databases, between Jan 2003 and Jan 2010 publication period (Balzer, Bremer, Schramm, & Raspe, 2012). Further, the effectiveness of preventive interventions is anchored on outcomes from randomized controlled trials, RCT. Also, the procedures for individual identification at high chances of fall comprised of prospective diagnostic accuracy. About legal, social and ethical considerations, papers with relevant content were considered regardless of their study design. Importantly, data extraction, critical assessment and study selection was carried out by two researchers. A total of twelve thousand references were selected via electronic literature, but only 184 of them met the inclusion criteria after screening (Balzer, Bremer, Schramm, & Raspe, 2012). As such, the authors highlight clinical effectiveness about the references identified. They highlight equipment and tests for the assessment of fall risk. Outcomes from 16 prospective experimental studies and a cluster randomized control trials report demonstrated that simple implementation of a rating scale for fall risk examination is not sufficient to reduce the cases of falls and raise the utilization of preventive interventions (Balzer, Bremer, Schramm, & Raspe, 2012). Thus, it signifies that more effort is required to reduce the over-reliance on instruments and enhance exercise to better the physical functioning. On the other hand, they look at assessment and correction of visual acuity- 2 trials look at the effects of optical acuity superseded by curative measures (Balzer, Bremer, Schramm, & Raspe, 2012). A study on healthy old individuals indicates no side-effects on fall risk, while the other on older people show a significant high fall risk and an increased fracture peril. Therefore, this finding can be applied in nursing practice when giving vision aids to the very old since an increased fall risk cannot be ruled out.
Calhoun, Meischke, Hammerback, & Bohl examined moral and social aspects with 17 papers meeting the inclusion criteria (Calhoun, Meischke, Hammerback, & Bohl, 2011). Three themes evolved from the report; factors considered by the elderly to enhance or hamper the usage of fall prevention, the use of physical restriction measures, and the ethical threats of fall prevention (Calhoun, Meischke, Hammerback, & Bohl, 2011). The elderly have contradictory views on fall avoidance. Therefore, in practice, application of fall intervention should be anchored on the client’s preferences, needs, and consideration of its side-effects.
The research article hypothesizes a multitude of complicated factors that can affect the resolution to take part in a clinically aligned fall prevention scheme. Moreover, the study is based on qualitative interviews with elderly individuals who have experienced a fall. The researchers utilized a purposeful stratified sampling procedure to ensure sufficient balance of non-joiners and joiners. Moreover, interviews were carried out between Feb an Aug 2008 in King County, Washington with participants who had been earlier referred to one of two Seattle-based fall prevention schemes (Calhoun, Meischke, Hammerback, & Bohl, 2011). Further, the inclusion criterion was based on the lists from the two Seattle programs. The interviews were done by research assistants who had been trained in performing semi-structured in-person interviews.
The results revealed that a majority of the participants were women in their early 70s. Additionally, approximately 25% had a household income of 15, 000 dollars annually, and around 50% were college graduates (Calhoun, Meischke, Hammerback, & Bohl, 2011). Among the factors that the researchers examined between joiners and non-joiners, the result revealed that they had similar experiences linked to aging. Also, both were using identical public health terms. On the other hand, the outcome showed that the participants had an emotional response as a result of falling. A majority feared to fall and get injured. Importantly, there were discrepancies in terminology, for instance, the participants’ comprehension and usage of terms such as “physically active” and “independence” is different with how health professional apply the terms (Calhoun, Meischke, Hammerback, & Bohl, 2011). Thus, this can be vital in nursing practice since it necessitates the need to use terminologies harmoniously to overcome the challenge of misunderstanding their real meaning. The researchers provide recommendations for practice in conveying program gains.
The researchers offer various reasons for the increased focus on inpatients falls, including mortality, morbidity and increased cost of care (Simpson, Rosenthal, & Cumbler, 2013). They conducted a literature search using PubMed for papers disclosed before 21st January 2012 that involved in-hospital fall prevention programs (Simpson, Rosenthal, & Cumbler, 2013). Importantly, they did not set a time limit. The results illustrated that there are more than 35 factors thought to be directly linked to inpatient falls. Also, the outcome of the systematic review of tools for fall risk stratification shows that a significant number of the studies utilized tools exclusive to the population of the research or institution. Thus, it is hard to generalize the utilization of these devices in practice. Therefore, this finding might be used in nursing practice in the selection of a tool. Specifically, one has to consider the population of use and the setting. On the other hand, they identified 15 studies with multiple interventions. However, there was no harmony about the approach used to screen patients (Simpson, Rosenthal, & Cumbler, 2013). In this regard, this method can be applied in nursing practice to ensure consensus in the method utilized to screen patients.
Balzer, K., Bremer, M., Schramm, S., & Raspe, H. (2012). Health Technology Assessment. Falls prevention for the elderly, 1-18.
Calhoun, R., Meischke, H., Hammerback, K., & Bohl, A. (2011). Older Adults’ Perceptions of Clinical Fall Prevention Programs: A Qualitative Study. Aging Research, 1-7.
Child, S., Goodwin, V., Garside, R., & Boddy, K. (2012). Implementation Science. Factors influencing the implementation of fall-prevention programmes: a systematic review and synthesis of qualitative studies, 1-14.
Simpson, J., Rosenthal, L., & Cumbler, E. (2013). SAGE. Inpatient Falls: Defining the Problem and Identifying Possible Solutions. Part I: An Evidence-Based Review, 135-143.