Fall risk assessment : A prospective investigation of nurses\u27 clinical judgement and risk assessment tools in predicting patient falls in an acute care setting

Falls are a significant problem in acute care, hospital settings, and can have serious consequences, especially for older patients. Fall prevention has therefore been recognised as an important area for research and intervention. In order to target interventions and use resources effectively, a major strategy of many fall prevention programmes has been the development and/or use of risk assessment tools to identify patients who are at high risk of falling. Although many tools have been developed, few have been rigorously tested, and there is currently no evidence to support the clinical utility of fall risk assessment tools. There is a need to conduct further research to establish the efficacy of fall risk assessment tools for inpatient populations. Additionally, nurses clinical judgement in assessing fall risk may aid the development of fall risk assessment protocols and further research is needed to build on limited knowledge in this area. A prospective cohort study was used to evaluate two fall risk assessment tools and nurses\u27 clinical judgement in predicting patient falls. Each patient was assessed for fall risk by the clinical judgement of the nurse caring for the patient and by the researcher using a data collection form containing the two fall risk assessment tools. The study wards comprised two aged care and rehabilitation wards, within a 570 bed acute care tertiary teaching hospital facility in Western Australia. Test-retest reliability of the two fall risk assessment tools and nurses\u27 clinical judgement was established over a twenty four hour period. The ability of the fall risk assessment tools, and nurses\u27 clinical judgements to discriminate between patients with a high probability of falling and , patients with a low probability of falling; was determined by calculating the sensitivity, specificity, positive predictive value and negative-predictive value for each method. The reference criterion used for these calculations was whether or not the patient fell within the hospitalisation period in which they were admitted to the study. In addition, the accuracy of each method was determined by calculating the number of times the risk assessment tool or clinical judgement classified the patient into the correct, fall risk category, expressed as a percentage. The same reference criterion was used for this calculation. Both the fall risk assessment tools and nurses\u27 clinical judgement had good test-retest reliability. When assessing validity, all three methods of determining fall risk showed good sensitivity, ranging from 88% to 91 %,but poor specificity, ranging from 25% to 26%. This meant that the risk assessment methods classified too many patients who did not fall as at high risk for falling. All methods also had limited accuracy, ranging from 35% to 36%, and overall exhibited an inability to adequately discriminate between patient populations at risk of falling and those not at risk of falling. Consequently, neither nurses\u27 clinical judgement nor the fall risk assessment tools could be recommended for assessing fall risk in the clinical setting. In addition, results indicated that there was a large difference between the accuracy of first year enrolled and registered nurses in assessing patient fall risk. First year enrolled nurses accurately predicted fall risk 44.4% of the time while first year registered nurses achieved an accuracy level of only 8.6%. These results are potentially biased, as measuring differences in accuracy between types of nurses was not a main focus of this study and in many cases the same nurse gave multiple judgements about patients\u27 fall risk. The results however, provide an indication that further study is warranted using a specifically methodology to explore this issue. There are a number of specific recommendations arising from the results of this study. It is recommended that further studies be undertaken to assess the reliability and validity of current fall risk assessment tools in inpatient populations. If no valid and reliable fall risk assessment tool can be identified, research should be undertaken to develop such a tool. It is also recommended that studies be conducted to assess changes in fall risk profiles over time to determine if the sensitivity and specificity of instruments changes depending on the timing of the risk assessment. Differentiating between stable and transient risk factors should be an integral component of these types of studies. Further research is also required to determine if there are differences in fall risk factors between different specialties or if a generic risk assessment tool can be used for all inpatient populations. Additionally, further investigation into the clinical judgement of registered and enrolled nurses in .their first year of clinical practice should be undertaken and results reported to appropriate educational institutions. Changes in accuracy of clinical judgement in the first five years of clinical practice should also be measured

Felicity, Trinidad: the musical portrait of a Hindu village

This thesis is based on musicological field work conducted during three visits (1974, 1975, 1977) to Felicity, a village situated in the savannah land of the eastern coast of Trinidad. From 1845 to 1917, East Indian indentured labourers were brought to work on the sugar-cane plantations of several West Indian islands, and their descendants now constitute over one-third the population of Trinidad. The villagers of Felicity, nearly all Hindus, have a musical repertory based almost entirely on north Indian genres. The founders of the village came mainly from eastern Uttar Pradesh, and traditional Bhojpuri folk songs and drumming styles from this region have been passed on in oral tradition and are still performed in the village today. These include byah ke git and lacharl sung at weddings, sohar sung at the birth of a child, lullabies, and songs for the cultivation of rice, as well as repertories and performing practices for the dholak (double-headed barrel drum) and tassa (kettledrum).Music is performed in the three village temples to accompany the sandhya and havan services as well as puja services for the various Hindu deities. The vocal forms include bhaj an, kirtan, and dhun (all sung in Hindi),and Vedic chant (in Sanskrit) . Some of the bhajans (devotional songs in strophic form) have been passed down in oral tradition since the indenture period, but most have been newly introduced to Trinidad either by missionaries from the Indiabased Arya Samaj and Bharat Sevashram Sangha (from the 1920's onwards) or through imported Indian films (1936 onwards). Indian classical music was introduced to the island in 1966, but is not performed in Felicity.Musical change in Felicity since the beginning of the 20th century has followed a pattern of revitalization whereby older Bhojpuri forms in oral tradition are gradually forgotten and newly introduced Hindi forms are adopted by the community. The spoken language in Felicity is now English (Bhojpuri is used only by the older generation); consequently, the difficulty of song texts is an important consideration in the evolution of the musical repertory of the village. In 1974-75, a new repertory of songs devoted to the Hindu saint, Satya Sai Baba, was introduced to the village and adopted in one of the temples. The Sai Baba songs with their simple one- or two-line Hindi texts are easy to learn; their style, characterized by accelerando and loud handclapping, makes them an effective expression for East Indian feelings of ethnic solidarity

Student Perceptions of Integrative Field Seminar: A Comparison of Three Models

Student perceptions of 63 concentration year MSW students, grades, and faculty perceptions were examined to evaluate differences in educational outcomes and in learning experiences among a traditional classroom model, a mixed or hybrid model, and a webinar online model for delivery of integrative field seminars. No significant differences were found in the grades among the three models. Findings showed strong support for the traditional model for students in local field internships and the webinar model for students in distant site placements. Reciprocity among students and faculty was a major factor in seminar integration and effectiveness, regardless of the mode of delivery

The construction of a survey test in literature for grades four, five and six

Thesis (Ed.M.)--Boston Universit

Cultural Influences on Time Pressure in the U.S. and Taiwan

Levine and Norenzayan’s (1999) multicountry observational study investigated differences in time pressure due to cultural differences (individualism vs. collectivism). They found people in New York City walked more quickly down a sidewalk than people in Taipei, Taiwan. In this study, I investigated whether there would be a difference in walking pace in a smaller United States city (Des Moines, Iowa) compared to Taipei, Taiwan. I examined whether pace would differ by location—an outdoor shopping area vs. downtown. I also examined possible differences in time of day (12pm and 5pm) and day of week (Monday and Friday). The results were that men walked faster than women, younger people walked faster than middle age, or older people. There was no difference in pace by day of week. Controlling for gender and age, people downtown walked faster than those in shopping areas but, there was no significant difference in pace by country

Filamentary Accretion Flows in the Embedded Serpens South Protocluster

One puzzle in understanding how stars form in clusters is the source of mass -- is all of the mass in place before the first stars are born, or is there an extended period when the cluster accretes material which can continuously fuel the star formation process? We use a multi-line spectral survey of the southern filament associated with the Serpens South embedded cluster-forming region in order to determine if mass is accreting from the filament onto the cluster, and whether the accretion rate is significant. Our analysis suggests that material is flowing along the filament's long axis at a rate of ~30Msol/Myr (inferred from the N2H+ velocity gradient along the filament), and radially contracting onto the filament at ~130Msol/Myr (inferred from HNC self-absorption). These accretion rates are sufficient to supply mass to the central cluster at a similar rate to the current star formation rate in the cluster. Filamentary accretion flows may therefore be very important in the ongoing evolution of this cluster.Comment: 19 pages, 8 figures, 2 tables; accepted for publication in Ap

Upotreba participativnih metoda u istraživanju iskustava djece i mladih

Participatory research methods offer a very promising approach for gaining in-depth understanding of young people’s lives. However, when adopting such approaches, researchers need to be aware of methodological and theoretical issues. The aim of this article is to present a discussion of ways in which participatory methods may be used as a research strategy when investigating young people’s experiences and emotions. We explore the potential of these methods as well as some of their limitations.Participativne istraživačke metode nude vrlo obećavajući pristup dubinskom razumijevanju života mladih. Prilikom upotrebe takvih metoda istraživači trebaju biti svjesni metodoloških i teorijskih nedoumica. Cilj ovog članka je raspraviti o načinima na koji participativne metode mogu biti korištene kao strategija za istraživanje iskustava i emocija mladih. U radu će biti istražen potencijal tih metoda, kao i njihova ograničenja

Self-management of musculoskeletal hand pain and hand problems in community-dwelling adults aged 50 years and older: results from a cross-sectional study in a UK population

BACKGROUND: Musculoskeletal pain is common in adults, with the hand being frequently affected. Healthcare services have the potential to be of benefit to adults with hand pain and problems, through promotion and facilitation of self-management. METHODS: This paper explores existing self-management in a UK population of community-dwelling adults aged 50 years and over using data from surveys and a nested clinical cohort study. Self-management of hand problems was considered in three ways: self-directed treatment approaches used, adaptation behaviours adopted and choice to consult with a healthcare professional. RESULTS: The treatment approaches most commonly used were 'exercise/movement' (n = 151, 69 %) and 'resting' the hands (n = 139, 69 %). The use of adaptation behaviour was widespread: 217 (99 %) people reported using one or more adaptation behaviours. Under half of survey respondents who reported hand pain (n = 783, 43 %) had consulted a healthcare professional about their problem during the last year: the lowest rate of consultation was for occupational therapy (n = 60, 3 %). CONCLUSIONS: Self-directed treatment and adaptation behaviours were widespread in adults aged 50 years and over with hand problems, but consultation with a healthcare professional was low