This document provides a literature review on studies related to falls and injuries among older adults. Several studies are compared that explore interventions for preventing falls and factors contributing to falls in healthcare facilities. The research questions, sample populations, and limitations of the studies are analyzed. Most studies used systematic reviews to examine fall prevention strategies and identified predictive risk factors through large sample sizes. However, limitations included a lack of randomized controlled trials and inconsistencies in reporting study methodology.

1. Running head: PROFESSIONAL CAPSTONE AND
PRACTICUM 1
PROFESSIONAL CAPSTONE AND PRACTICUM 5
Falls and Related Injuries
Nanah Kamara Comment by Nelson, Emily Jeanette: Please see
my comments in your previous assignment about how to format
your title page.
GCU
Falls and Related Injuries
Nurses, being the initial contacts for patients in any most health
facilities and the fact they interact or engage with patients more
when compared to other providers of care constitute a critical
component of the healthcare system. Consequently, nurses play
a much huge role in making sure that the healthcare system
provides not only safe care but also and care of high standard or
quality (Sato, Hase, Osaka, Sairyo & Katoh, 2018). However
one of the major healthcare or nursing issue over the years is
the fall and associated injuries which have proved not only
difficult for healthcare providers and facility to manage. The
purpose of this essay is to… Comment by Nelson, Emily
Jeanette: Reference needed
For instance, and according to DuPree, Fritz-Campiz &
Musheno, (2014), Unintentional falls constitute the highest
cause of non-fatal injuries among people over 65 years in the
US. Moreover, one in every three individuals above 65 years
falls at least one time in a given year. In addition, injuries from

2. falls cause the highest number of accidental deaths among
people 65-year-old and above (Tricco, Thomas, Veroniki,
Hamid, Cogo, Strifler & Riva, 2017). Such statistics coupled
with the extent of the costs associated with fall call for proper
intervention to reduce falls and their associated injuries. For
instance, the government spends billions of dollars on fall and
their associated injuries on treating falls. The prevention of fall
would provide increased funds for investment in other social
programs aimed at improving both healthcare and addressing
social or communal problems (Zakrajsek, Schuster, Wells,
Williams & Silverchanz, 2018).
In addition, falls and their related injuries are responsible for
almost 15% of the recorded hospitalization. This increases the
burden of healthcare providers especially given the numerous
stressors like staff shortage, huge workloads, leadership
problems and personal factors among others. An increase in
falls and associated injury, therefore, is detrimental to the
provision of quality care as captured under the healthy 2020
program goal of reducing deaths that result from falls.
Comment by Nelson, Emily Jeanette: Reference needed
Comment by Nelson, Emily Jeanette: Reference needed
Despite this, falls are very complex and difficult to manage or
prevent. Given the implications that falls bear on the patients,
the healthcare providers and the healthcare system as a whole
(Joseph, Henriksen & Malone, 2018), there has been increased
There has been an increased research focus towards fall
prevention and reduction strategies. As a result, there exist a
significant amount of literature regarding the reduction and
prevention of falls. However, the literature regarding the topic I
inconclusive and hence makes the study both significant and
relevant. Comment by Nelson, Emily Jeanette: Reference
needed Comment by Nelson, Emily Jeanette: Avoid using
first and second person pronouns in academic writing.
Comment by Nelson, Emily Jeanette: Reference needed
Given the background to the association between falls, their
associated injuries and improved nursing, this study seeks to

3. explore whether indeed whether awareness creation regarding
falls and the available strategies can improve the practice of
nursing and consequently better healthcare provision and patient
outcomes. To achieve this, the study will be developed using
the procedures of evidence-based solutions which involve
problem identification, data collection, data analysis and report
writing. The PICOT question for the study was whether the
creating of awareness regarding safety measures, tools and
systems and policies among nurses reduces the prevalence of
falls and the related injuries.
The preceding section provides a breakdown of the components
in the PICOT question for the study.
P: P or in the population for the study will be nurses
I: Intervention- the development and implementation of an
awareness program for nurses.
C: Comparison- Nurses who do not go through the awareness
programs.
O: Outcome- Reduced falls, Increased awareness among nurses.
T:Time- 6 months
In conducting the study, a literature review of available
documentation regarding awareness creation and hospital falls
was carried out with a focus on obtaining data to answer the
PICOT question. To ensure that the information collected was
not only valid but also accurate, relevant and reliable all
sources selected for the study had to have been peer-reviewed.
In addition, the sources had to have been developed recently to
provide information that was up to date.
Nanah, you described a clinical problem/issue related to nursing
practice. You included a PICOT statement developed to address
the particular problem with a description of each of the PICOT
elements. I noted a few inconsistencies with APA I noted for
you. Please let me know if you have any questions or concerns!
-E Nelson

4. References
DuPree, E., Fritz-Campiz, A., & Musheno, D. (2014). A new
approach to preventing falls with injuries. Journal of nursing
care quality, 29(2), 99-102.
Guirguis-Blake, J. M., Michael, Y. L., Perdue, L. A., Coppola,
E. L., & Beil, T. L. (2018). Interventions to prevent falls in
older adults: updated evidence report and systematic review for
the US Preventive Services Task Force. Jama, 319(16), 1705-
1716.
Joseph, A., Henriksen, K., & Malone, E. (2018). The
architecture of safety: An emerging priority for improving
patient safety. Health Affairs, 37(11), 1884-1891.
Sato, N., Hase, N., Osaka, A., Sairyo, K., & Katoh, S. (2018).
Falls among Hospitalized Patients in an Acute Care Hospital:
Analyses of Incident Reports. The Journal of Medical
Investigation, 65(1.2), 81-84.
Tricco, A. C., Thomas, S. M., Veroniki, A. A., Hamid, J. S.,
Cogo, E., Strifler, L., ... & Riva, J. J. (2017). Comparisons of
interventions for preventing falls in older adults: a systematic
review and meta-analysis. Jama, 318(17), 1687-1699.
Zakrajsek, A., Schuster, E., Wells, C., Williams, J., &
Silverchanz, P. (2018). CAREGIVERS OF OLDER ADULTS
DURING CARE TRANSITIONS: INSIGHTS INTO POSITIVE
ASPECTS OF CAREGIVING. Innovation in Aging, 2(suppl_1),
896-896.
Recommendations and Program Improvement
Recommendations
The Families over Coming under Stress program (FOCUS)
provides resilience training to military children and families.
The program works closely with both military and community
mental health resources to provide service and family members
with referral options (Lester et al,2011). From the start, FOCUS
was conceived as a skill-based, family-centered, trauma-

5. informed prevention intervention designed to promote family
resiliency and to alleviate stressful deployment related issues
and events on children and parent. FOCUS was developed on a
family level base, rather than an individual level. All three
foundational programs from which this program was developed
were all directed toward children and parents who were at risk
for psychological and mental disorders or serious life
impairment (Lester et al,2011). Also this program does not
provide services within a mental health diagnosis and treatment
model. My recommendation for the program would be to also
focus on building resilience on an individual level with a
special emphasis on social support on an individual basis.
Higher perceived social support is associated with lower risk of
PTSD (Stecker et al,2010). Increased psychological resilience
and perceived social support may help protect against the
effects of depression and traumatic stress by decreasing fear-
related appraisals, improving emotional regulation, enhancing
self-efficacy as well as stress-related arousal (Stecker et
al,2010). The support that individuals receive not only from
family members, but friends, colleagues, organizations and
community also has a profound impact on individual dealing
with PTSD.
Social Cognitive Theory
Social cognitive theory places emphasis on social influence and
its emphasis on external and internal social reinforcement.
According to Bandura, social cognitive theory adopts an
agentic model of adaptation and change rather than a reactive
dispositional one (Benight and Bandura, 1997, 2004). To be an
agent is to influence one’s functioning and one’s life
circumstances. Individuals play a proactive role in their
adaptation, rather than simply undergo experiences in which
environmental stressors act on their personal vulnerabilities.
Within this agentic perspective, resilience to adversity relies
more on personal enablement than on environmental
protectiveness (Benight and Bandura,1997,2004).
Individuals and their amount of support operates in a

6. cultural context which includes beliefs, ideas and values people
hold about people and their social relationships which they take
part (Johnson and Thompson,2008) Therefore, these contexts
can affect the receipt and provision of social support by having
influence of an individual’s own definition of support,
evaluation and appraisal of events, and propensity to give, get,
accept or reject support (Beardslee et al,2011).
Suggestions
There are several ways that building resilience in the military
can be strengthened. Responsibilities, definitive clear policies,
and broad guidance to implement these strategies. For accurate
program evaluations, resilient policies should be directed. Using
standardized measures to compare various programs, such
evaluations may provide information for military members and
their families for informed decisions about program selections.
A common major challenge in regards to building a solid
resiliency program within the military culture is getting support
from senior operational leadership. It is extremely important
that operational commanders fully understand their role in
building a resilient force. It is especially important to design
programs with the involvement of senior military leaders in
order to motivate service members’ interest by promoting values
that are important to the service cultures (RAND, nd). Without
strong leadership, military resilience programs cannot be
successful. Overall, strong leadership and command will allow
the success of resilience programming and will progress the
current status and resilience of service members and their
families.

7. References
Beardslee, W., Lester, P., Klosinski, L., Saltzman, W.,
Woodward, K., Nash, W., Leskin, G. (2011). Family-Centered
Preventive Intervention for Military Families: Implications for
Implementation Science. Prevention Science, 12(4), 339–348.
http://doi.org/10.1007/s11121-011-0234-5
Benight, C. C., & Bandura, A. (2004). Social cognitive theory
of posttraumatic recovery: the role of perceived self-
efficacy. Behavior Research and Therapy, 42(10), 1129-1148.
doi:10.1016/j.brat.2003.08.008
Johnson, H., & Thompson, A. (2008). The development and
maintenance of post-traumatic stress disorder (PTSD) in civilian
adult survivors of war trauma and torture: A review. Clinical
Psychology Review, 28(1), 36-47.
doi:10.1016/j.cpr.2007.01.017
Lester, P., Mogil, C., Saltzman, W., Woodward, K., Nash, W.,
Leskin, G., Beardslee, W. (2011). Families Overcoming Under
Stress: Implementing Family-Centered Prevention for Military
Families Facing Wartime Deployments and Combat Operational
Stress. Military Medicine, 176(1), 19-25. doi:10.7205/milmed-
d-10-00122
Stecker, T., Fortney, J., Hamilton, F., Sherbourne, C. D., &
Ajzen, I. (2010). Engagement in mental health treatment among
veterans returning from Iraq. Patient Preference and
Adherence, 4, 45–49.
Running Head: PROFESSIONAL CAPSTONE AND
PRACTICUM 1
PROFESSIONAL CAPSTONE AND PRACTICUM 5
Professional Capstone and Practicum

8. Nanah Kamara Comment by Nelson, Emily Jeanette: As
previously stated in your other papers, this is not the correct
title page per APA guidelines. Please let me know what
questions you have about this.
GCU
Literature ReviewProfessional Capstone and Practicum
Introduction
Falls and the injuries that arise from them constitute a huge
problem for healthcare providers such as nurses, the affected
individuals, communities and the government. This is because
not only are falls expensive to manage, but they impose huge
financial and non-financial burdens to the healthcare providers
and system. This has led to increased focus and research
attention towards the best practices of preventing or reducing
falls in healthcare facilities generating an increased body of
literature regarding the topic and especially focusing on the
nurses given the huge role that they play being the primary
caregivers. Based on the background, this paper provides a
literature review of studies on fall and their related injuries that
focus on finding possible interventions to enable nurses to
prevent or reduce the prevalence of falls. Comment by Nelson,
Emily Jeanette: Reference needed Comment by Nelson, Emily
Jeanette: Good intro and thesis.
Comparing research questions
In conducting the study, eight peer-reviewed publications and
articles were reviewed to provide data regarding the
implementation of interventions and strategies aimed at
reducing or preventing falls and their associated injury. Most of
the studies had huge similarities when it came to the issue of
research questions in that they sought to explore the strategies
for fall prevention or the factors that are responsible for in-
hospital falls. Comment by Nelson, Emily Jeanette: Reference

9. needed Comment by Nelson, Emily Jeanette: Reference
needed; paragraphs should be at least three sentences.
For instance Tricco, Thomas, Veroniki, Hamid, Cogo, Strifler
& Rivaet al., (2017) in their study “Comparisons of
interventions for preventing falls in older adults: a systematic
review and meta-analysis” provide a detailed exploration of
thedifferent strategies and approaches that have been previously
used in preventing falls while Natalie Callis, (2016) “
prevention: Identification of predictive fall risk factors”
explores the factors that lead to falls within health facilities.
For example and according to Natalie Callis, (2016), fall and
their associated injuries occur due to insufficient training, poor
communication, hospital design, and lack of leadership among
others. Subsequently, the construct of the research questions
provide a basis for which the association between the topic of
falls and their associated injuries and the PICOT question for
the study can be drawn. Comment by Nelson, Emily Jeanette:
Reference needed
Comparing the sample population
Most of the studies selected for the review had been developed
through systematic reviews. This implied that the authors
adopted a specific, detailed approach to answering specific
research questions. In addition, the authors relied on studies
regarding the topic for the data used during development. Most
of the studies drew data from government and literature sources
such as MEDLINE, CENTRAL, Health Management
Information Consortium, EMBASE, CINAHL, Web of Science,
Allied and Complementary Medicine Database, and
Physiotherapy Evidence Database (PEDro). Comment by
Nelson, Emily Jeanette: Reference needed Comment by
Nelson, Emily Jeanette: Reference needed
Subsequently, the studies were able to capture huge populations
from the reviewed studies and their responses towards the issue
of fall reduction or prevention and the role that nurses can play
in ensuring that falls and their associated injuries are reduced

10. within the hospital facilities. For instance, Tricco, Thomas,
Veroniki, Hamid, Cogo, Strifler & Riva, (2017) in their study
reviewed 54 publications with a population of 41596 while
Cameron, Dyer, Panagoda, Murray, Hill, Cumming & Kerse,
(2018) in their study “Interventions for preventing falls in older
people in care facilities and hospitals” Recorded 95 trials and
138,164 participants from their reviews an indication of the
extent through which the studies went during data collection.
Comment by Nelson, Emily Jeanette: Reference needed
Comment by Nelson, Emily Jeanette: Reference needed
Moreover, the studies were developed through evidence from
nurses, government officials, health leaders and the general
public to ensure that all stakeholders of the health system were
taken into account and to provide valid, accurate and reliable
information on the issue of falls as well as the strategies for
ensuring that falls are reduced or prevented in line with the
health goals that are captured under the Healthy 2020 program.
Comment by Nelson, Emily Jeanette: Reference needed;
paragraphs should be at least three sentences.
Delete this extra line. You do not need this space between
sections.
Comparing study limitations
The studies used in the development of the paper as shown
provide important and comprehensive data can be used in
answering the PICOT question. Despite this, the study suffers
from the shortcomings of using a literature review as the basis
for data collection. For example, the use of a literature review
makes it difficult to independently verify the data or findings
from other studies. In addition, by reviewing a few studies, the
research may leave out very important pieces of information
regarding the topic or PICOT question. Comment by Nelson,
Emily Jeanette: Reference needed Comment by Nelson, Emily
Jeanette: Reference needed
However, the use of peer-reviewed sources to carry out the
research helps to eliminate some of the limitations of the study

11. by ensuring that the data obtained has been thoroughly
scrutinized and that the findings are reliable, accurate and valid.
Comment by Nelson, Emily Jeanette: Reference needed;
paragraphs should be at least three sentences.
Conclusion
In conclusion, all studies under review indicated that there
exists a huge problem when it comes to the issue of falls and
injuries of individuals or patients within a health facility.
Regardless there exists a positive association between the
training of nurses on injury prevention or reduction and a
decline in the number of falls. There is, therefore, a need for
additional research to identify both the extrinsic and intrinsic
factors that lead to falls, evidence-based practices that can
reduce or prevent fall and the role of the caregivers such as
nurses in preventing or reducing falls and their associated
injuries.
Nanah, you appropriately compared the settings, samples, and
limitations of your literature. You also included
recommendations for future research. There were a few
inconsistencies with APA I noted for you. Let me know if you
have any questions or concerns! -E Nelson
References
Callis, N. (2016). Falls prevention: Identification of predictive
fall risk factors. Applied nNursing Rresearch, 29, 53-58.
Cameron, I. D., Dyer, S. M., Panagoda, C. E., Murray, G. R.,
Hill, K. D., Cumming, R. G., & Kerse, N. (2018). Interventions
for preventing falls in older people in care facilities and
hospitals. Cochrane database of systematic reviews, (9).
Comment by Nelson, Emily Jeanette: This is a database,
but what journal did the article originate?
Tricco, A. C., Thomas, S. M., Veroniki, A. A., Hamid, J. S.,
Cogo, E., Strifler, L., ... & Riva, J. J. (2017). Comparisons of

12. interventions for preventing falls in older adults: a systematic
review and meta-analysis. Jama, 318(17), 1687-1699.
Comment by Nelson, Emily Jeanette: Spell our Journal
names
Rubic_Print_FormatCourse CodeClass CodeAssignment
TitleTotal PointsNRS-490NRS-490-O504Benchmark - Capstone
Project Change Proposal300.0CriteriaPercentageUnsatisfactory
0-71% (0.00%)Less Than Satisfactory 72-75%
(75.00%)Satisfactory 76-79% (79.00%)Good 80-
89% (89.00%)Excellent 90-100%
(100.00%)CommentsPoints
EarnedContent60.0%Background5.0%Background section is not
present.Background section is present, but incomplete or
otherwise lacking in required detail.Background section is
present. Some minor details or elements are missing but the
omission(s) do not impede understanding.Background section is
present and complete. The submission provides the basic
information required.Background section is present, complete,
and incorporates additional relevant details and critical thinking
to engage the reader.Problem Statement5.0%Problem statement
is not present.Problem statement is present, but incomplete or
otherwise lacking in required detail.Problem statement is
present. Some minor details or elements are missing but the
omission(s) do not impede understanding.Problem statement is
present and complete. The submission provides the basic
information required.Problem statement is present, complete,
and incorporates additional relevant details and critical thinking
to engage the reader.Change Proposal Purpose5.0%Purpose of
change proposal is not present.Purpose of change proposal is
present, but incomplete or otherwise lacking in required
detail.Purpose of change proposal is present. Some minor
details or elements are missing but the omission(s) do not
impede understanding.Purpose of change proposal is present and
complete. The submission provides the basic information

13. required.Purpose of change proposal is present, complete, and
incorporates additional relevant details and critical thinking to
engage the reader.PICOT5.0%PICOT is not present.PICOT is
present, but incomplete or otherwise lacking in required
detail.PICOT is present. Some minor details or elements are
missing but the omission(s) do not impede
understanding.PICOT is present and complete. The submission
provides the basic information required.PICOT is present,
complete, and incorporates additional relevant details and
critical thinking to engage the reader.Literature Search
Strategy5.0%Literature search strategy is not present.Literature
search strategy is present, but incomplete or otherwise lacking
in required detail.Literature search strategy is present. Some
minor details or elements are missing but the omission(s) do not
impede understanding.Literature search strategy is present and
complete. The submission provides the basic information
required.Literature search strategy is present, complete, and
incorporates additional relevant details and critical thinking to
engage the reader.Literature Evaluation5.0%Literature
evaluation is not present.Literature evaluation is present, but
incomplete or otherwise lacking in required detail.Literature
evaluation is present. Some minor details or elements are
missing but the omission(s) do not impede
understanding.Literature evaluation is present and complete.
The submission provides the basic information
required.Literature evaluation is present, complete, and
incorporates additional relevant details and critical thinking to
engage the reader.Utilization of Change or Nursing Theory
(2.2)5.0%Theory utilization is not present.Theory utilization
content is present, but incomplete or otherwise lacking in
required detail.Theory utilization content is present. Some
minor details or elements are missing but the omission(s) do not
impede understanding.Theory utilization content is present and
complete. The submission provides the basic information
required.Theory utilization content is present, complete, and
incorporates additional relevant details and critical thinking to

14. engage the reader.Proposed Implementation Plan with Outcome
Measures (3.2)5.0%Implementation plan is not
present.Implementation plan is present, but incomplete or
otherwise lacking in required detail.Implementation plan is
present. Some minor details or elements are missing but the
omission(s) do not impede understanding.Implementation plan
is present and complete. The submission provides the basic
information required.Implementation plan is present, complete,
and incorporates additional relevant details and critical thinking
to engage the reader.Identification of potential barriers to plan
implementation, and a discussion of how these could be
overcome (2.3)5.0%Identification of potential barriers to plan
implementation and /or discussion component is not
present.Identification of potential barriers to plan
implementation with a discussion component is present, but is
incomplete or otherwise lacking in required detail.Identification
of potential barriers to plan implementation with a discussion
component is present. Some minor details or elements are
missing but the omission(s) do not impede
understanding.Identification of potential barriers to plan
implementation with a discussion component is present and
complete. The submission provides the basic information
required.Identification of potential barriers to plan
implementation with a discussion component is present,
complete, and incorporates additional relevant details and
critical thinking to engage the reader.Appendices Inclusive of
Practice Immersion Clinical Documentation
(1.2)5.0%Appendices are not present.Appendices are present,
but incomplete or otherwise lacking in required
detail.Appendices are present with minor elements missing that
do not impede understanding.Appendices are present and
complete. The submission provides the basic information
required.Appendices are present, complete, and incorporates
additional relevant details and critical thinking to engage the
reader.Evidence of Revision 10.0%Final paper does not
demonstrate incorporation of feedback or evidence of revision

15. on research critiques.Incorporation of research critique
feedback or evidence of revision is incomplete.Incorporation of
research critique feedback and evidence of revision are
present.Evidence of incorporation of research critique feedback
and revision is clearly provided.Evidence of incorporation of
research critique feedback and revision is comprehensive and
thoroughly developed.Organization and
Effectiveness30.0%Thesis Development and
Purpose10.0%Paper lacks any discernible overall purpose or
organizing claim.Thesis is insufficiently developed or vague.
Purpose is not clear.Thesis is apparent and appropriate to
purpose.Thesis is clear and forecasts the development of the
paper. Thesis is descriptive and reflective of the arguments and
appropriate to the purpose.Thesis is comprehensive and contains
the essence of the paper. Thesis statement makes the purpose of
the paper clear.Argument Logic and
Construction10.0%Statement of purpose is not justified by the
conclusion. The conclusion does not support the claim made.
Argument is incoherent and uses noncredible sources.Sufficient
justification of claims is lacking. Argument lacks consistent
unity. There are obvious flaws in the logic. Some sources have
questionable credibility.Argument is orderly, but may have a
few inconsistencies. The argument presents minimal
justification of claims. Argument logically, but not thoroughly,
supports the purpose. Sources used are credible. Introduction
and conclusion bracket the thesis. Argument shows logical
progression. Techniques of argumentation are evident. There is
a smooth progression of claims from introduction to conclusion.
Most sources are authoritative.Clear and convincing argument
presents a persuasive claim in a distinctive and compelling
manner. All sources are authoritative.Mechanics of Writing
(includes spelling, punctuation, grammar, language
use)10.0%Surface errors are pervasive enough that they impede
communication of meaning. Inappropriate word choice or
sentence construction is used.Frequent and repetitive
mechanical errors distract the reader. Inconsistencies in

16. language choice (register) or word choice are present. Sentence
structure is correct but not varied.Some mechanical errors or
typos are present, but they are not overly distracting to the
reader. Correct and varied sentence structure and audience-
appropriate language are employed.Prose is largely free of
mechanical errors, although a few may be present. The writer
uses a variety of effective sentence structures and figures of
speech.Writer is clearly in command of standard, written,
academic English.Format10.0%Paper Format (use of
appropriate style for the major and assignment)5.0%Template is
not used appropriately, or documentation format is rarely
followed correctly.Appropriate template is used, but some
elements are missing or mistaken. A lack of control with
formatting is apparent.Appropriate template is used. Formatting
is correct, although some minor errors may be present.
Appropriate template is fully used. There are virtually no errors
in formatting style.All format elements are correct.
Documentation of Sources (citations, footnotes, references,
bibliography, etc., as appropriate to assignment and
style)5.0%Sources are not documented.Documentation of
sources is inconsistent or incorrect, as appropriate to
assignment and style, with numerous formatting errors.Sources
are documented, as appropriate to assignment and style,
although some formatting errors may be present.Sources are
documented, as appropriate to assignment and style, and format
is mostly correct. Sources are completely and correctly
documented, as appropriate to assignment and style, and format
is free of error.Total Weightage100%