Knowledge about Utilization of Ambulatory Aids and falls among

The Elderly Hospitalized Patients.

Linda Ngameduru !N" #$N

Presented to %r. Tilghman &n partial fulfillment of the re'uirements of NU!$ ()* Thesis !esear+h

,-PP&N $TATE UN&.E!$&T/ HELENE 0UL% $,H--L -0 NU!$&N1

%e+ember 2 )*34

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Introduction The spe+ifi+ aims for this study are to in:estigate the ;nowledge about utilization of ambulatory aids su+h as +anes wal;ers and7or +rut+hes and falls among hospitalized patients age <2 and older. The information obtained from this resear+h study will help to gain insight to assist the health+are pro:iders to effe+ti:ely assess and pro:ide ade'uate patient edu+ation for patients who use ambulatory aids su+h as +anes wal;ers and7or +rut+hes. This proposal will study patients on a 8edi+al"surgi+al unit rehabilitation unit and the orthopedi+ unit who are using assisti:e de:i+es. The intent of this resear+h is to a++omplish the following= 3>. to identify if there are differen+es in tea+hing about the use of ambulatory aids among patients ages <2 and older. )>. to identify the ;nowledge le:el of patients ages <2 and older about the utilization of ambulatory de:i+es. The resear+h 'uestion for this study is= 6hat is the ;nowledge of patients ages <2 and older about the utilization of ambulatory aids? Background/Significance of the Problem This pro@e+t is important be+ause Aamong <2 years old women nearly one in three B4*C> will fall after age 92 o:er half of women will suffer a fallD B,%, )*3)>. &n a )**9 report the 6orld Health -rganization B6H-> estimated that about one third of elderly people will fall at least on+e a year B6H- )**9>. Thirteen per+ent of men age <2 E <F and a pea; of 43C at the age 9* E 9G will suffer a fall and one"third to one"half of the elderly li:ing at home tend to fall or do a+tually fall and hospital falls a++ount for 4)C of all reported patient safety in+idents B,%, )*3)>. The ,%, also reported that among ).4 million elderly people with nonfatal fall in@uries that were treated in the

emergen+y departments in )*3* o:er <<) *** of them were hospitalized B)*3)>. The elderly population annual dire+t and indire+t +ost of fall asso+iated in@uries is pro@e+ted to rea+h H2G.F billion in )*)* B,%, )*3)>. As personsI age in+reases so does the ris; of falling and when falls o++ur it leads to multiple in@uriesJ as a result ma;ing falling the leading +ause of in@ury death in older adults o:er the age of <2 B#ulat ,astle !utledge K Luigley )**9J 6H- )**9>. &n the United $tates the elderly population that uses ambulatory aids su+h as +anes is slightly more than G million and about 3.2 million use wal;ers B#ateni K 8a;i )**2>. The use of these assisti:e de:i+es has been found to be a response to the disablement pro+ess and is widely re+ognized as enabling independen+e and pre:enting disability in daily a+ti:ities among frail elderly people B#ateni K 8a;i )**2J Kedlaya et al. )*34>. Howe:er some resear+hers ha:e found that these assisti:e de:i+es may also +ontribute to the ma@ority of elderly falls due to la+; of appropriate use of ambulatory aids B#ateni Heung Mettel 8+li!oy K 8a;i )**GJ $te:ens et al. )**F>. A++ording to Haglund B)**F> there are about )2 3GG wal;ers asso+iated falls and 4 )9F +ane asso+iated falls among the older population e:ery year and these ma;e a++ount for about <*C of su+h in@uries Bp. 3G<G>. Therefore identifying fall ris; fa+tors helps to e:aluate the problems redu+e the +ost of falls redu+e patientsI physi+al and psy+hoso+ial effe+ts of fall to the elderly people as well as help plan indi:idual and inpatient inter:ention strategies B,helly et al. )**9>. Methods: This will be a non eNperimental study with a des+ripti:e design.

Design

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The study design will be a 'uantitati:e des+ripti:e +orrelation study using sur:ey method. The design will be used to eNplore and des+ribe a relationship among :ariables without trying to manipulate or +ontrol the situation. There is no random assignment or +ontrol. A sur:ey will be used to gather information. The study will be +ondu+ted in a hospital in an urban +ity. The use of the design will +ontrol eNtraneous :ariables through the following= All +ommuni+ations will be the same for all resear+h parti+ipants the written +ommuni+ation will be eNa+tly the same and the pro+edures for +olle+ting data will be the same for all parti+ipants. Setting The setting is 8edstar Union 8emorial Hospital. This proposal will study patients on a 8edi+al"surgi+al unit rehabilitation unit and the orthopedi+ unit. Population and Sample The proposed resear+h will use non"probability sampling. There is no random sele+tion of study parti+ipants. The parti+ipants are representati:e of the population. The estimated sample will be 2*. &t +an also be +al+ulated after data analysis. The statisti+al power +an be +al+ulated to +onfirm whether any non"signifi+an+e results are due to a la+; of relationship between the :ariables or is due to a la+; of statisti+al power. The sampling method will be a +on:enien+e sample. The $ub@e+ts in+lusion +riteria is the followingJ indi:iduals <2 years of age or older that utilize ambulatory aids who are admitted to a parti+ipating ward or unit at the hospital indi:idual <2 years and older who are English spea;ing. The sample will in+lude both genders. The eN+lusion +riteria would be the following= non"English spea;ing indi:idual are eN+luded from the study patients on units

other than the 8edi+al"surgi+al unit rehabilitation unit and the orthopedi+ unit will not be in+luded.

Ethical Considerations ( uman Sub!ects Protection" This study is less than minimal ris;. Parti+ipants will not benefit from parti+ipation in this study. Howe:er information gained will assist the health+are pro:iders to effe+ti:ely assess and pro:ide ade'uate patient edu+ation for patients who use ambulatory aids su+h as +anes wal;ers and7or +rut+hes. A Letter of &n:itation eNplaining the study to the parti+ipants will be pro:ided to parti+ipants. The study does not re'uire a H&PPA wai:er be+ause patients will not be identified by name date of birth hospital identifiers or any method that identifies indi:idual by name. This sur:ey will be +ompletely anonymous no names or +onta+t information will be +olle+ted. The only demographi+ data to be +olle+ted will in+lude approNimate age range. ,onfidentiality will be maintained by the following= 3>. $ur:eys will be answered in +onfiden+e7indi:idualJ this is not a group effort. )>. the results of this resear+h will only be reported in the aggregate for the total group of parti+ipants. 4>. ,ompleted sur:eys will be ;ept in a +losed manila en:elope. G>. All information that is gathered will be ;ept in a lo+;ed file that is a++essible only to the Prin+ipal &n:estigator or in password"prote+ted ele+troni+ database. 2>. All indi:idual re+ords will be destroyed with 4* days of the +on+lusion of this resear+h. Measurement Methods/Inter#ention ($ariables/Instruments" The :ariables that will be measured are the following= Elderly Patient= is indi:idual age <2 and abo:e as indi+ated in the EH!78edi+al !e+ord. 5&678K (.*9 2

Ambulatory aids= patients who use a +ane wal;er +rut+hes or a wheel+hair. 0alls will be identified by health +are professionals and the patient. BThe Ngameduru E Tilghman Utilization of Ambulatory Aids Luestionnaire will be used for data +olle+tion>. Knowledge= an identified measurement tool +alled Ngameduru E Tilghman Utilization of Ambulatory Aids Luestionnaire will be used. &npatient= indi:idual admitted in an institution for any ;ind of illness or disability for )G hours stay or more. The resear+h tool to be used is the Ngameduru"Tilghman Utilization of Ambulatory Aids Luestionnaire. The tool in+ludes 34 sur:ey type 'uestions. The sele+tion of ea+h item on the sur:ey instrument is based on a re:iew of the literature about assisti:e de:i+es patient ;nowledge of ambulatory aids and falls in the elderly. The tool was de:eloped by 5oan Tilghman !N Ph.%. ,!NP ,NE and Linda Ngameduru !N"#$N. The tool was submitted to three eNperts on falls in the elderly and ris; pre+autions to pre:ent falling to establish +ontent :alidity. . The eNperts re:iewing the sur:ey instrument identified that all items on the sur:ey instrument were :alid. There was 3**C agreement among the eNperts on the +ontent :alidity of the tool. Data Collection Procedures The data will be +olle+ted in the following steps= After obtaining permission from the ,oppin $tate Uni:ersity and parti+ipating fa+ility &!# the in:estigator will= 3>. ENplain the purpose of the study prior to see;ing +onsent. )>. Parti+ipants will be as;ed to parti+ipate after pro:iding eNplanations about the study. All parti+ipants will be informed that parti+ipation is :oluntary and that they may

<

withdraw from the study at any time without any penalty or +onse'uen+es. 4>. the sur:ey will be distributed to the parti+ipants allowing 4* minutes to pi+; the +ompleted sur:ey ba+;. The sur:ey +an also be read to the parti+ipants by the nurse per re'uest. G> Parti+ipants will +omplete the sur:ey instrument ANgameduru E Tilghman Utilization of Ambulatory Aids Luestionnaire.D 2>. Anonymity and +onfidentiality will be maintained at all times. There will not be any names or any identifying information on the sur:ey instrument. <>. All sur:ey instruments that ha:e been +ompleted will be ;ept in a lo+;ed +ontainer in the Thesis Ad:isors offi+e and will be destroyed within 4* days after the resear+h is +ompleted. Data %nal&sis The data will be analyzed to answer the resear+h 'uestion. The resear+h 'uestion for this study is= 6hat is the ;nowledge le:el regarding the utilization of ambulatory aids among elderly hospitalized patients? $P$$ :ersion software will be used for entering data +oding data and data analysis. The sample will be des+ribed using fre'uen+y distribution and +ross tabulations. $ummary tables will be pro:ided for parti+ipant response. %ssumptions/'imitations The assumptions for the study are= The parti+ipants will self report and answer sur:ey 'uestions honestly. The potential limitations for the study are the study is limited to hospitalized patients ages <2 and older using some type of assisti:e de:i+e for ambulation and mobility. The study results are limited to the population studied. The sample size is small and repli+ations of the study would in+rease the generalizability of

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the findings. An attempt to +ontrol would be to assure the parti+ipant is representati:e of the study. Dissemination of findings The finding will initially be disseminated at thesis presentation. The findings will also be disseminated at the agen+y where data +olle+tion o++urred B8edstar Union 8emorial Hospital #altimore>. The in:estigator plans to submit abstra+t for presentation at a national or state nursing +onferen+e. Budget/(ustification There is no budget re'uest for this study eN+ept +oping fees. Parti+ipants will not be paid to be part of the study.

!eferen+es #ateni H. Heung E. Mettel 5. 8+li!oy 6. E. K 8a;i #. E. B)**G>. ,an use of 6al;ers or +anes impede lateral +ompensatory stepping mo:ements? Gait Posture 20 B3> (G"94. #ateni H. K 8a;i #. E. B)**2>. Assisti:e de:i+es for balan+e and mobility= #enefits demands and ad:erse +onse'uen+es. Archives of Physical Medicine and Rehabilitation 86 34G E 3G2. #ulat T. ,astle $. !utledge 8. K Luigley P. B)**9>. ,lini+al pra+ti+e algorithms= medi+ation management to redu+e fall ris; in the elderly"part ) summary algorithm. Journal of the American Academy of Nurse Practitioners 20 B3> 3"G. ,enters for %isease ,ontrol and Pre:ention. B)*3)>. National ,enter for &n@ury pre:ention and ,ontrol. Division of nintentional !n"ury Prevention. ,helly 5. E. ,onroy L. 8iller 1. Elliott 8. N. Horne 5. L. K Hudson 8. E. B)**9>. !is; fa+tors and in@ury asso+iated with falls in elderly hospitalized patients in a +ommunity hospital. Journal of Patient #afety$ % B4> 3(9"394. Haglung K. B)**F>. 6al;ing aids may do more harm. Journal of the American #ociety$ 8 3G<G"3G<F.

KOllstrand"Eri+son 5. K Hildingh ,. B)**F>. .isual impairment and= a register study.

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Journal of &linical Nursin' (8 B4> 4<<"4(). Kedlaya %. Lorenzo ,. T. Allen K. L. Kuang T. Tala:era 0. K Andary 8. T. B$eptember )*34>. Assisti:e de:i+es to impro:e independen+e. Medsca)e. !etrie:ed from http=77www.emedi+ian.meds+ape.+om7arti+le74)2)G("o:er:iew. Liu H. H. Ea:es 5. 6ang 6. 6oma+; 5. K #ullo+; P. B)*33>. Assessment of +anes used by older adults in senior li:ing +ommunities. Archives of Gerontolo'y and Geriatrics$ *2 )FF E 4*4. $te:en 5. Thomas K. The L. K 1reenspan A. B)**F>. Unintentional fall in@uries Asso+iated with wal;ers and +anes in older adults treated in U.$. emergen+y departments. Journal of +he American Geriatrics #ociety *, 3G<G"3G<F. 6orld Health -rganization B)**9>. -./ 'lobal re)ort on falls )revention in older a'e. 6orld Health -rganization 1ene:a.

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