To maintain patients independence by preventing injury and removing hazards from home environment.

Patient Name: Mr Sylvester

Nursing Issue: Risk of injury due to falls, related to decrease visual acuity and physical environmental hazards.

Goal/s: To maintain patients independence by preventing injury and removing hazards from home environment.

Interventions Rationales

Review and discuss findings from home hazard assessment with Mr Sylvester and daughter, Mrs Martin (Crisp & Taylor, 2009).

Assess Mr Sylvester’s level of mobility and balance using the ‘Timed Up and Go Test’ and the ‘Sit-to-Stand Test’ (Australian Commission on Safety and Quality in Health Care, 2009).

Determine whether Mr Sylvester is taking any medication that may increase risk of falling, if confirmed schedule appointment with doctor to explore alternatives (Farley, McLafferty & Hendry, 2011).

Install handrails on front and back steps, indoor stairway, hallway and bathroom (around shower, bath and toilet). (Zona, 2007).

Mark the edges of outdoor steps with white paint (Australian Commission on Safety and Quality in Health Care, 2009).

Install non-slip rubber mats and shower chair in bathroom (Expositor, 2008).

Install 75-watt, non-glare light bulbs throughout house, and night-lights with motion sensors in bedroom, bathroom and hall (Crisp & Taylor, 2009).

Discuss with patient relocating current bedroom to the infrequently used lounge room downstairs, and remove loose carpet and clutter (boxes and chairs). (Gates, Fisher, Cooke, Carter & Lamb, 2007).

Refer patient to an optometrist/ ophthalmologist to determine whether reduced visual acuity may be improved (Crisp & Taylor, 2009).

Ensure that Mr Sylvester wears supportive, well-fitted, flat shoes with good traction (The Prince George Free Press, 2008).

Ensure that there are no loose pavers in backyard, or protruding roots from trees near walking path or clothesline (Department of Health and Aging, 2006).

Refer to physiotherapist to discuss various exercise options that will improve strength and balance, and to assess the need for any walking devices (Australian Commission on Safety and Quality in Health Care, 2009). It is important for Mr Sylvester and family members to be aware of the risks associated with the current living environment, and changes that need to be made to ensure safety. Educating patients about the risks associated with falls improves confidence and reduces fear of falling. Encouraging Mrs Martin to be involved wherever possible, and communicate with her father will provide support, and the opportunity for Mr Sylvester to express emotions, needs and fears (Holland, Jenkins, Solomon & Whittam, 2008).

Recommended by the American and British geriatrics societies for elderly persons who have experienced a fall. The Timed Up and Go test involves rising from a chair, walking 3 metres, then returning to sit in the chair. The time taken to complete test indicates the level of steadiness. The Sit-to-Stand Test indicates level of lower limb strength, coordination and speed. This is measured by the time taken to rise 5 times from a chair without the use of arms. Such tests will help to identify factors contributing to Mr Sylvester’s falls (Australian Commission on Safety and Quality in Health Care, 2009).

Various medications may increase the risk of falls by increasing drowsiness and confusion, for example those containing sedatives and diuretics (Farley, McLafferty & Hendry, 2011).

Handrails will improve steadiness in areas of the home where falls commonly caused, in particular moving up and down stairs, and around bathroom (Zona, 2007).

Highlights each step making it easier to see and reducing the risk of falling (Australian Commission on Safety and Quality in Health Care, 2009).

Non-slip rubber mats provide traction on slippery tiles and wet surfaces (Expositor, 2008).

Adequate illumination will improve patient’s perception of surroundings, making it safer to move around the home. Night-lights will help orient Mr Sylvester when he needs to get out of bed during the night. Motion sensors will also reduce the risk of falling associated with searching for a switch in the dark. (Crisp & Taylor, 2009).

Relocating bedroom to downstairs will save Mr Sylvester the need to negotiate up and down the stairs. The removal of boxes and chairs from patient’s bedroom will reduce obstacles which pose trip hazards. Removing loose carpet on polished floorboards will also reduce the risk of slipping (Gates, Fisher, Cooke, Carter & Lamb, 2007).

Vision deteriorates with age. Mr Sylvester has expressed that he “can’t see well enough” to read anymore. Vision impairment negatively affects many aspects of life, increasing the risk of falls, reducing ones ability to perform daily activities, and has been proven to increase rates of depression and suicide. An eye care practitioner may be able to prescribe appropriate visual aids and/or treatment to improve Mr Sylvester’s vision (Crisp & Taylor, 2009). The ANMC (2006) states that nurses must initiate “necessary contacts and referrals…”.

Loose footwear, for example slippers, increases the risk of falling. Wearing footwear with good traction increases friction and reduces risk of slipping (The Prince George Free Press, 2008).

Raised objects and uneven surfaces pose tripping hazard (Department of Health and aging, 2006).

2 hours of exercise per week has been proven to reduce both the rate and risk of falls in aged people. A trained physiotherapist will individually assess the patient and prescribe an exercise programme that is challenging and safe. For example, Tai Chi has reduced falls in the elderly population, and is a group-based activity, which may improve Mr Sylvester’s social wellbeing by interacting with the community. The Otago Exercise Programme provides the option for Mr Sylvester to exercise from home, and is individually tailored to improve walking, limb strengthening and balance (Australian Commission on Safety and Quality in Health Care, 2009). Through prevention of falls, exercise may improve patient’s confidence and reduce anxiety related to fear of falling (Clemson & Swann, 2008). Proper training in the use of walking devices can improve mobility and confidence, and maintain independence (Farley, McLafferty & Hendry, 2011). Maintaining independence and mobility will reduce the risk of depression related to isolation from social interaction, thus benefiting patient’s psychological wellbeing (Brownie, 2006).