Using the Neuman's System Model to Decrease the Risk of Falls on a Medical-Surgical Nursing Floor

Running Head: NEWMAN’S SYSTEM MODEL 1
Using the Neuman's System Model to Decrease the Risk of Falls on a Medical-Surgical
Nursing Floor
Name:
Institution:

NEWMAN’S SYSTEM MODEL 2
Introduction
Risk for inpatient falls is a severe problem in various hospitals since the falls have the
chances of causing physical injuries and are costly form of harm in many populations (CDC,
2011). The phenomenon is examined by various disciplines including the Neuman’s System
Model (NSM) which incorporates both the individual and the environment in determining client
safety. The overall goal of NSM for nursing is to maintain the utmost client system control
through avoiding stress and intervening to offer support (Turner & Kaylor, 2015). Neuman’s
concept is abstract, universal, and applicable to many people from various cultures as well as age
groups. The model elaborates that stress causes can be categorized and modified using various
nursing interventions. Similarly, various studies have been conducted to determine the factors
that contribute to risk for falls among older inpatients, but no effective mechanism has managed
to completely eradicate inpatient falls.On the other hand, there are many ethical issues that arise
when conducting research regarding inpatient bedside falls, for example, respect for
confidentiality and anonymity, respect for privacy, informed consent and beneficence (Peterson
& Bredow, 2009). Therefore, to prevent falls occurrence, ensure safety of patients, and reduce
fall-linked health care expenses, nurses should measure different risk factors using evaluation
tools to ascertain accurate and appropriate risk for falls diagnosis. According to NSM, inpatient
risk for falls and lack of effective fall-prevention techniques are the primary problems facing the
current populations and nursing practice (Reed, 2013). Hence, this paper will examine the
usefulness of Neuman’s Systems Model in reducing the risk for falls affecting patients in various
hospital environments and the ethical issue that nurses face when conducting research.

Neuman's System Model
The Neuman Systems Model (NSM) depicts a systems-based outline for viewing
communities, individuals, and families. Generally, it is based on systems theory as the client is
analyzed as an open structure, which adapts and reacts to both external and internal stressors
(Reed, 2013). Additionally, (A) NSM encompasses various sub-concepts and concepts including
homeostasis, prevention levels, adaptation, stress, extra and inter personal factors, basic
structure, and optimal wellness. Moreover, Neuman’s concept has been appraised as flexible,
comprehensive, holistic, and system founded perspective for nursing (Reed, 2013). The model’s
primary objective has been concentrated on the response system of the patient towards the actual
and potential environmental stressors. Equally, the model uses every step from primary to
tertiary nursing prevention, intercession for retention, attainment, and maintenance for a holistic
safety of clients.According to Turner and Kaylor (2015), the Neuman Systems Model’s
explanation considers a client to be a person or an individual. As indicated in appendix 1, the
client scheme is characterized by a sequence of broken and solid circles. The central ring is the
basic energy source or structure, which encompasses basic survival aspects common to the
genus. Some examples of basic survival features include genetic reaction patterns, weaknesses,
or strengths of body organs as well as regular temperature range. Similarly, the basic structure
consists of attributes which are distinctive (A) to a particular client or individual such as inborn
musical talent (Reed, 2013).
In appendix 1, the outmost solid circle is known as the (A) normal defense line and
represents a person’s normal condition of wellness or the regular adaptation state, which the
individual has preserved over time. On the other hand, the broken line that is outside the normal
defense line is the flexible defense line. Ideally, the flexible defense line prevents stressors

fromattacking the system of the client by defusing or blocking stressors before they can invade
the normal defense line (NSMPPO, 2011). Equally, the flexible defense line is accordion similar
to its function and when expanded it offers greater protection. However, when it is narrowed and
comes nearer to the normal defense line, its protection ability is diminished.Accordingly, the
NSM includes the prevention concept at the tertiary, primary, and secondary levels. Reed
(2013)asserts that the prevention concept is of specific significance to individuals who work in
professions such as nursing. Interventions can happen at the primary stage to reinforce the
flexible defense line. Similarly, interventions might occur at the secondary stage to assist in the
restoration of the system of the client to equilibrium through treating signs that appear after a
stressor penetrates the defense line. Equally, interventions can happen at the tertiary stage to
maintain stability and prevent more damage after reconstitution has happened (NSMPPO, 2011).
Contributions of Neuman Systems Model (NSM) To the Current Practice of
Nursing
NSM is an efficient tool for examining the systems interaction and can be useful for
decreasing the risk of falls on a medical-surgical nursing floor. According to NSM, the
environment of the patient is viewed as an amalgamation of all extrinsic and intrinsic forces
(Neuman & Fawcett, 2012). Equally, the clients are recognized as the dynamic beings that
frequently deal with the relations of extrinsic and intrinsic factors. The model in Appendix 1
shows the relationship between the personal factors of the client and the environment,
considering the numerous stressors that work against the body’s defense line. The way that
stressors interact can influence whether the defense line is breached or not, as well as if the client
will consequently be at danger for a discrepancy in health.As such, compensating for variations
in environment might in turn maintain and promote wellness (Haggart, 1993).

Additionally, nurses can use NSM to explain the various risks for falls. Just as some
stressors might interact to breakthe defense line of the body, risk for falls augments with the
blending of various risk factors. Neuman and Fawcett (2012) assert that a higher figure of
stressors will automatically enhance risk for falls. In essence, risk factors including medications,
environmental factors, and disease processes can contribute to imbalances which result in falls.
Only by reducing stressors, increasing defense lines, or upholding a balance linking the two can
falls be prevented and wellness maintained. According to NSMPPO (2011), it is essential to
focus on the common interaction of extrinsic and intrinsic factors as well as on the need of an
individual to adapt to different environmental changes. Adaptation happens when an individual
reacts positively to variations using acquired and innate mechanisms. If maladaptation or
adaptation occurs, illness or wellness will inexorably follow. Since adaptation can happen at
different levels, wellness and illness can also be measured in terms of the interaction between
health, environment, person, and nursing. Equally, if an individual cannot adapt to various risk
factors, he/she is likely to suffer from a fall (Neuman & Fawcett, 2012). Furthermore, risk for
falls takes into account multivariable danger factors’ compound interaction in accounting for
various fall risks as well as measures the level of risk on a range of varied levels. Risk factors
change the health state of a patient towards illness or wellness when applied to risk for falls
because the higher the stressors’ number, the higher the incidences of fall risks. Accordingly,
Neuman and Fawcett (2012) argue that despite augmented risk of falls, a fall will only happen if
a patient cannot adapt to various stressors.
The overall goal of NSM for nursing is to maintain the utmost client system control
through avoiding stress and intervening to offer support.According to Neuman and Fawcett
(2012),Neuman’s concept is abstract, universal, and applicable to many people from various

cultures as well as age groups. The model elaborates that stress causes can be categorized and
modified using various nursing interventions. Equally, NSM stresses on the need for individuals
to be dynamically balanced to enable nurses to easily identify problems, agree on goals, and use
the necessary prevention and intervention methods to avoid risk for falls. Moreover, NSM’s
intervention and prevention techniques are observed for simplicity, generality, clarity,
importance, and accessibility(Skalski, DiGerolamo & Gigliotti, 2006). NSM, on the other hand,
concentrates on numerous significant concepts including illness/wellness, basic structure, and
degree to reaction, open system, stability, content, prevention, and stressors. The major nursing
intervention, according to NSM, is prevention mechanisms that focus on keeping stress response
and stressors from detrimentally affecting an individual.
According to Reed (2013), primary prevention is an intervention utilized when stressors
have not infiltrated the normal defense line. Primary prevention can be used in patient
intervention and assessment in reducing and identifying probable risk factors. Similarly, primary
intervention is utilized in inpatient bed falls through assessing the fall risk of a patient and
lessening stressors that might put the client at a risk of falling (NSMPPO, 2011). Moreover,
primary intervention can be demonstrated by nurses when they ask patients if they can move a
phone near to them so that it can be reachable, or ask patients if they require help to the
restroom. Hence, the moment primary intervention or defense fails then nurses initiate the
secondary prevention mechanism. Secondary prevention is associated with the events that occur
after a client reacts to a particular stressor (NSMPPO, 2011). This can be illustrated when a
patient attempts to answer a ringing phone or try to reach the restroom. For instance, a stressor
may include a ringing handset that is far from the patient or the necessity to rise from the bed and
visit the bathroom. Hence, if an individual possesses risk factors such as unsteady gait, older age,

or a falling history, the factors might influence how the individual will respond to particular
stressors. Tertiary prevention, on the other hand, is an intervention that starts during a
reconstruction and protects the patient’s system through conserving energy and concentrating on
regaining strength (NSMPPO, 2011). Tertiary prevention occurs after a patient sustains a fall and
the action that the nurse takes afterwards. As such, tertiary interventions include actions such as
calling for assistance, alerting the physician, and helping a patient to go back to bed.
Skalski, DiGerolamo and Gigliotti (2006) argue that Neuman’s concept has always been
used broadly in nursing education and practice. The model has been utilized to guide the nursing
practice for patient care engagement in areas of surgery and medicine, pediatric nursing,
women’s health, mental health, gerontology, and community as client. Consequently, NSM is
essential for nurses who believe that the patient is a holistic person who responds to stress, since
it usually predicts the results of the implemented interventions for the aim of strengthening the
defense lines against stress. Accordingly, Neuman’s model is significant for community health
circumstances and fall risks interventions. The model is essential in acute care environment since
it concentrates on maintaining, attaining, and regaining patients’ stability (Skalski, DiGerolamo
& Gigliotti, 2006).
Application of Neuman Systems Model to the Problem
Primary prevention is an essential factor in averting inpatients’ risk for falls. Equally,
nurses should work jointly to assist in reducing falls among clients in various hospitals. Hence,
education is vital to preventing patient falls because educating nurses demonstrates the
significance of inpatient risk for falls problem. Additionally, inpatient fall intervention or
prevention is efficient in enlightening nurses on how to handle various stressors among

inpatients. It is essential that before the nurses leave the room of patients, they should ensure that
patients have everything they may need are within reach including phones, call bell, beverages,
urinal, and glasses. Moreover, preventing stressors is a crucial step in the primary prevention of
inpatient falls. Nearly 50% of every fall in hospitals occur or happen at the patients’ bedside
(Skalski, DiGerolamo & Gigliotti, 2006).Many patients try to reach for ringing phones and
portable urinals that are not placed close to the bedside or on the bedside table and they end up
falling. Such falls can be avoided by examining the periphery as well as asking the patients
questions that relate to issues such as the need to use the bathroom or phone.
Skalski, DiGerolamo and Gigliotti (2006) assert that insufficient communication between
nurses and the clients contributes to incomplete understanding of the requirements of fall risk
individuals. Nurses should identify the patients who are at the risk of falling as well as the
necessary actions and methods that should be exploited to prevent inpatient falls. For example,
nurses can use bedside posters to enable them monitor how patients move from the bed to the
bathroom. This assists nurses in developing the required plans and actions for offering safe
toileting approaches. Posters can help when a particular nurse cannot be able to assist a specific
patient when the patient presses the call bell because he/she wants to go to the bathroom. Every
available nurse will be able to assist such a patient to the bathroom by looking at the poster that
was placed by the previous nurse. Essentially, nurses should always respond quickly when a
patient calls for assistance because most patients would try to get up on their own in order to visit
the bathroom and as a result they end up falling or increase their risk of falling (Aronowitz &
Fawcett, 2015). In essence, when a nurse cannot visit the patient’s room for one reason or
another, the nurse should notify other nurses and they will be able to help the patient by simply
looking at the poster to view how the client was always transferred from the bed.

A study created the Morse Fall Scale (MFS) which is used in hospitals as a standardized
fall possibility assessment tool. The MFS examines risk factors that enhance patients’ falls
including the patient’s environment and age (Dykes et al., 2011). According to MFS, if a client
has a current record of falling within the past four months, the client is given 35 points. If a client
suffers from an impaired mental condition or a secondary opinion, 25 points is adjoined to the
client’s score respectively. When the client attains 50 points score, the client is categorized as a
high fall threat or risk. According to Dykes eta al (2011), a study indicated that the use of MFS
hadextensively lower rates of falls compared to various control groups that did not utilize MFS.
Equally, the study encompassed over 10,000 patients, indicating 87 falls in a control cluster,
compared to 65 falls in an intervention cluster using the MFS (Dykes et al., 2011). According to
MFS, the issue of hourly rounding is insufficient and it should be changed so that nurses can
make their rounds after every 30 minutes. Possibly, a sitter should be assigned at the bedside of
each patient who falls under the category of high fall risk. The issue of a sitter can be costly, but
it will prevent the expenses linked to inpatient falls injuries. Degelau et al., (2012) posit that
various inpatient falls were a result of infrequent hourly rounding by nurses. Rounding each hour
might not be sufficient for patients who are confused or those who void frequently. Hence, it is
vital that patients who attain such criteria are rounded on frequently to prevent falls.
Technological advances are increasingly being adopted and used in different health care
environments. Sahota et al., (2014) contend that even with the technological advances in the
chair and bed alarms, a recent group randomized study realized no reduction in inpatient bedside
falls. The study utilized sensors that would alarm when the pressure of patients was not recorded
for over five seconds. It would be beneficial for extreme fall risk clients to have bed alarms that

go off during a movement shift towards the bed’s edge, instead of waiting for an alarm after five
seconds.
Using the Neuman's System Model to Design a Study that aims to Decrease the Risk
of fall on a Medical-Surgical Nursing Floor
Falls among hospitalized patients is a serious threat to the safety of patients. According to
Quigley et al., (2016), accidental falls complicates about 2% of hospital stays. However, the rate
of falls significantly varies by unit type. For instance, the highest rate of falls is evident in
medicine units, neurology, and neurosurgery whereas lower rates of fall are recorded in intensive
care units and surgical ward (Cangany et al., 2015). There are risk factors associated with patient
falls including the utilization of ambulatory aids, slippery floor, and the severity of illness,
mental status, and age. Approximately 25% of all fall leads to injury whereas 2% cause
infrastructures (Quigley et al., 2016). The costs related to falls include increased hospital stays,
patient care cost, and liability cost. For all these reasons, the paper aims to design a study that
aims to outline nursing interventions that can be utilized to minimize falls as a result of medical
surgical nursing floor.
Proposed Research Question
What are some of the nursing interventions that can be utilized to minimize the number
of falls on a medical surgical nursing floor?
Target population
The target population for the research study are patients in the medical surgical unit
or/and personnel offering their services in this unit

The main variable of interest
The variable of interests includes the number of falls in the medical surgical unit and the
evidence-based nursing interventions. The dependent variable is number of falls in the medical
surgical unit and the independent variables are the application of the evidence-based nursing
interventions. Therefore, the decline in falls in the medical surgical unit greatly depends on the
type of nursing interventions put in place. For instance, educating nurses on the effect of slippery
floor on the fall risk as well as increasing nurse awareness on various prevention strategies such
as the use of bed alarms in minimizing falls at the surgical unit. Equally, fall intervention
strategies such as the implementation of safety rounds and toileting schedule, using fall
prevention pamphlets to create awareness among patients regarding falls, as well as discussing
and reviewing medications that contributes to risk of falling among patients in the surgical ward
will be analyzed.
Proposed Analytical Method to Answer the Proposed Research Question
The proposed method I will utilize to answer the proposed question is qualitative research
study design. This study design provides readers with a wide range of research tools and
methodological approaches to perform their studies. Depending on the research focus, proposed
participants, and the research question, qualitative researchers can either adopt ethnographic,
phenomenological, or ground theory approach. Through qualitative research, researchers are in a
position to analyze human experience in both social and personal contexts as well as gain a
deeper comprehension of how these factors influence individual experiences (Flick, 2009).
Additionally, qualitative research helps nurses in comprehending illness and health experiences
with the aim of providing patient-centered care.

Compared to quantitative approaches, qualitative research approach offers researchers
various opportunities. For instance, the use of qualitative research can help nurse researchers to
explain why various nursing intervention strategies are crucial in reducing patient falls and
improving the quality of life of individuals in medical surgical ward. Besides, interviewing
nurses who have utilized various intervention strategies to minimize the number of falls in
medical surgical units will help in providing significant insights on strategies that are effective in
reducing or preventing patient falls in this hospital department. In addition to interviewing
nurses, various online websites will be searched to identify articles that discuss the subject under
study or help in providing details on how nurses can prevent fall in surgical medical wards. The
online websites include PubMed, EbscoHost, and CINAHL databases. To identify the most
appropriate peer reviewed articles, the following key words will be utilized: nursing intervention,
falls prevention, inpatient falls, patient falls, patient safety, and surgical wards. However, only
articles published within the last ten years will be included in the study.
Overview of Qualitative Research Approaches
Qualitative researchers can utilize one of the following approaches to carry out their
research including ethnography, phenomenology, and grounded theory. These approaches are
based on distinct philosophical beliefs and aid researchers in answering various questions based
on the research being conducted. Following is a brief overview of these qualitative
methodologies.
Grounded theory
The primary objective of this theory is to create a theory via constant comparison
process. The process entails collecting data concurrently and analyzing the same data. The

process of analyzing data leads to the design of theories that are based on the data collected and
in the real world scenarios. Through this theory, researchers can elucidate how individuals
understand social interactions (Suresh, 2014). Likewise, they also guide and inform practice
nurse on how they can transform the social world to benefit the patient. Ground theory also
enhances the interaction between data analysis, data collection, and sampling. The collection of
study participants is based on whether the person in question has experienced the situation being
studied.
Ethnography
As a research approach, it primarily focuses on analyzing cultural groups and cultures.
Besides, it primarily uses observation and other data collection methods such as quantitative
data, focus group, and interviews. Ethnography is not concerned with individual experiences
rather on how people behave and think as subgroups or groups (Ritchie et al., 2014).
Phenomenology
The aim of the above research approach is to comprehend individuals based on their
subjective experiences. The researchers are expected to view the world or the issue being
discussed from the perspective of the study participants. Phenomenological studies can either be
interpretive or descriptive. The later is primarily concerned with describing the study participants
experiences whereas in the former, the research depends on his/her preconception to interpret the
data collected via interviews (Ritchie et al., 2014).

The Underlying Philosophy of Science on Which the Qualitative Method Is Based
Researchers utilizing qualitative research comprehend the significance of theories and
beliefs that characterize their work. Qualitative research is defined by four philosophical
generalizations. These assumptions are as discussed below:
Methodology: As a philosophical assumption, methodology refers to the methods
utilized in conducting the research and they are emerging and induction. These methods are
shaped by the experience of the researcher in data collection and analysis (Ritchie et al., 2014).
Axiological: It primarily focuses on the role that values play while conducting research.
It is important for researchers to inform the study participants about the research values.
Accordingly, it is important for them to actively report the biases and values including the nature
of data they intend to collect (Ritchie et al., 2014).
Epistemological: Through this philosophical assumption, it is important for a researcher
to be close to the subjects under study so as to obtain subjective evidence. The collection of
subjective evidence is based on the views of an individual while on the field.
Ontological: According to this assumption, researchers often embrace the concept of
multiple realities. For this reason, they often explore distinct type of evidence from multiple
experiences and perspectives.
Interpretive Frameworks
These are beliefs that controls the action of the researcher and they form the cornerstone
of the above four philosophical assumptions. Interpretive frameworks include social science
theories including control, political influence, attribution, and leadership and theories such as

participatory, advocacy, and social justice theories. The aim of using these theories is to solve
social issues or bring about transformation in the society. The main interpretive framework
utilized by researchers include social constructivism, post positivism, pragmatism, feminist
theories, postmodernism perspectives, queer theory, critical race theory, critical theory, and
disability theory. In conducting qualitative research, it is important to use the earlier mentioned
assumptions as well as the interpretive framework.
Describing Typical Research Situation in Which Qualitative Methodology Would Be
Used
The setting of the study is in a hospital setting, to be precise surgical wards. Nurses and
patients will be randomly selected for inclusion in the study. The study participants will be
interviewed or asked to fill an open-ended questionnaire regarding the study subject. Given the
fact that nurses are mandated to fill the risk assessment tool, I will be compelled to peruse on the
patients chart to find out if their summary page contains any fall risk message. I will then
interview patients who are at risk of falling to find out if they are indeed using the white board,
bed plugs, and the yellow armband. I will also interview the nurses in charge to determine if they
have knowledge on how they can prevent or reduce the risk of fall by applying a wide range of
evidence-based nursing intervention strategies.
To back up the evidence obtained from the interview process, the earlier mentioned
databases will be assessed to find out information on how various nursing intervention strategies
can be applied to minimize or prevent falls in surgical wards. For instance, Degelau et al., (2012)
conducted a study on how to prevent falls in medical surgical units. The author in the study
provided various intervention strategies that nurses in the medical surgical ward should apply to

prevent falls including designing a standardized evaluation process; getting support from the
organization; conducting risk factor interventions; communication to the unit staff and patients’
risk factors as well as surveillance and observation of the patients. Accordingly, the authors
recommended on the importance of auditing to enhance continuous improvement and learning. A
similar study was conducted by Ireland et al., (2013). In their studies, the authors provided
nurses with four recommendations to prevent falls in the surgical ward. The recommendations
included the need to recognize and listen to the clinical realities and expertise of the staff.
Secondly, it recommended on the significance of simplifying the implementation of the nursing
intervention approaches. Thirdly, is the need to acknowledge that things that appear to be simple
such as preventing falls in the medical surgical ward becomes very complex when the needs of
the patient are to be met. Lastly, the authors urge nurses to view the process of preventing falls
among patients in the surgical ward as a continuous quality improvement process. Graham(2012)
in his study argued that the application of evidence-based nursing interventions such as fall
alarms, environmental aids, medication management, fall prevention team and future technology
are crucial in preventing falls in medical surgical unit.
Analysis of the strengths and weaknesses of the Qualitative Research Method in
answering the research question proposed
Qualitative research plays an essential role in research development because it allows
researchers to collect comprehensive data via open-ended questions. Equally, the use of
interviews is crucial in investigating the role played by nurses in the surgical unit to prevent falls.
In addition to interviews, the researcher can obtain data via a wide range of techniques including
focus group discussions, personal observations, interviews, and case studies. For instance, by
spending time with night shift workers, it becomes easier to observe the main causes of patients’

falls in the surgical unit. Accordingly, I will be able to observe how nurses are making use of
various devices to minimize the rate of falls in the surgical unit. Equally, through focused
discussion groups, nurses can outline various evidence-based intervention strategies that they are
utilizing to reduce or prevent falls in the surgical unit. However, the qualitative research method
exhibits its strengths and weakness.
Strengths of Qualitative Research
The major strength of the above research design is that it permits researchers to cover
subjects and issues in detail and in-depth. Besides, interviews are not restricted to specific
questions. On the contrary, they can be guided or redirected in real time by researchers. The
research framework and direction can be easily revised in case new findings and information
resurface (Creswell, 2013). The data is based on human experience making it more powerful and
compelling compared to that which is collected via quantitative research. Subtleties and
complexities about the covered topic and research is often not taken into consideration by other
research studies. The gathering of data is achieved from few cases or individuals making it
possible to transfer the outcomes of the research to other settings.
Weaknesses of Qualitative Research
Research quality greatly relies on the researcher’s skills. For this reason, it can be
influenced by researchers’ biases and personal idiosyncrasies. It is quite difficult to demonstrate,
assess, and maintain rigidity. The amount of data obtained makes its analysis and interpretation
time-consuming (Creswell, 2013). In some instances, qualitative research is not understood and
accepted, to be precise by the scientific community. Researcher’s presence in data gathering
process is mandatory and therefore, can influence or affect subject response. Anonymity and

confidentiality issues might result in various challenges during the presentation of the study
findings.
Research/Scientific Misconduct
According to D’Angelo (2012), research misconduct denotes the falsification, plagiarism,
or fabrication in performing, proposing, or reporting research or in reviewing research results.
Fabrication involves the making up of results or data and reporting or recording them as true
(D’Angelo, 2012). For instance, a researcher can fill and complete trial enrollment documents
using fake participants’ names and informationso as to meet the recruitment expectations and
pressures.Equally, falsification is the manipulation of research equipment, materials, processes,
or omitting, or changing results or data such that the study is not precisely shown in the study
record. Falsification occurs when a researcher manipulates and fabricates the results of a
particular research(D’Angelo, 2012). Plagiarism, on the other hand, denotes the appropriation of
other people’s words, results, processes, or ideas without offering them appropriate credit.
However, before a researcher’s act is categorized as misconduct, various measures have to be
analyzed including examining whether the act was committed recklessly, intentionally, or
knowingly(D’Angelo, 2012).
Altman (2008) asserts that scientific misconduct happens when researchers falsify or
fabricate information, or plagiarizes ideas or data within a study report. For an action to be
categorized as a misconduct it must have been done deliberately, and the accusation must be
verified through sufficient evidence. Equally, a misconduct definition can extend to
confidentiality breaches and publication/authorship violations. Conversely, individuals who
report misconducts or whistleblowers are required to act with honesty since they can face severe

consequences (Altman, 2008). The consequences include reduction in study support, ostracism,
termination, or lawsuits. As such, institutions should adopt procedures that can report and
investigate misconduct findings and protect both the accused and whistleblowers until the
determination is reached. Additionally, researchers who are found guilty of scientific misconduct
can lose their federal funding, limited from supervising any research, or lose their jobs (Fry,
2000). Hence, it is important to conduct thorough investigations of various allegations before
making any conclusions.
EthicalIssue That May Rise During the Conduct of Nursing Research
Research ethics entail requirements on daily job, the protection of subjects’ discipline, as
well as the publication of data in the research. Nevertheless, when nurses partake in different
researches they must deal with three value schemes including science, society, and nursing
(Preshaw, 2016). Equally, the three value schemes can conflict with the values of societies,
subjects, and communities as well as create dilemmas and tensions in nursing. Thus, there are
numerous ethical issues that arise when conducting research, for example, respect for
confidentiality and anonymity, respect for privacy, informed consent and beneficence.
Conversely, the nature of nursing tends to concentrate on protecting dignity, caring and
preventing harm and advocating for nurses’ role including defending the subjects’ rights,
ignoring the exact ethical issues in research (Preshaw, 2016). Currently, nursing research has
been marred with conflicting values, varied ethical issues which result in ambiguity when
making critical decisions. Due to lack of perspicuity in nursing ethical standards, nurses should
create and implement an awareness of the ethical issues and formulate an efficient framework to
tackle human rights problems.

Additionally, any research that involves human participants should be conducted in a way
that respects the rights, dignity, and safety of research participants. This standard has formed the
foundation of ethically acceptable epidemiological and clinical research for years. Currently,
many researchers across the globe have increasingly acknowledged the significance of external
supervision in securing ethical guidance, and the importance of autonomous ethics committees in
establishing research roles. Similarly, critical international guidance and scholarly work have
offered the operational and philosophical framework for enhancing the ethical demeanor of
research as well as building suitable safeguards (Preshaw, 2016). The recent research
development aiming to examine the consequences, nature, and behavior of patient safety
occurrences and their contiguous conditions, and the innovative strategies impact to tackle
patient safety challenges, pose novel research queries that raise unresolved and new, ethical
questions. For instance, what does beneficence ethical principle require in researches that
recognize physician errors in recorded or on-going clinical practice? And what does the standard
of respect for individuals need in studies that encompass the observation of professionals’ and
patients’ behavior? These challenges raised by various patient safety researches have been
troubling to ethics committees across the world.According to Fry (2000), there are various
ethical issues that arise when conducting nursing research including respect for confidentiality
and anonymity, respect for privacy, informed consent, and beneficence.
Fundamental Ethical Principles
According to the Belmont report, basic ethical standards refer to the general decisions
that act as primary justification for the numerous ethical evaluations and prescriptions of
people’s actions. Three fundamental principles are relevant to research ethics affecting human
subjects: justice, beneficence, and respect of persons (HHS.gov, 2016).

Respect of Persons
Respect for persons involves various ethical convictions including the treatment of
individuals as independent agents and protecting people with diminished independence
(HHS.gov, 2016). Thus, respect for person’s principle can be divided into two moral obligations:
the obligation to recognize autonomy and the obligation to protect safeguard people with reduced
autonomy. Additionally, an autonomous individual is a person who can deliberate about personal
objectives and act under the guidance of such deliberations. When researchers respect subjects’
autonomy, they should give weight to the individuals’ independent choices and opinions while
abstaining from impeding their actions except if they are harmful to others (HHS.gov, 2016). To
be disrespectful to an independent agent is to disclaim the considered judgments of that person.
Similarly, it will be unethical to deny a person the liberty to choose or act on specific judgments.
Nevertheless, not every individual has the capacity for self-determination. The capability of self-
determination grows during a person’s life, and various people lose the capacity totally or in part
due to mental stability, illness, or conditions that austerely restrict liberty (HHS.gov, 2016).
Hence, respect for the incapacitated and immature may need defending them as they grow or
whilst they are debilitated.
Beneficence
According to HHS.gov (2016), people should be treated in an ethically way not merely
through respecting their choices and safeguarding them from injury, but also through making
efforts to protect their well-being. Equally, beneficence covers acts of charity and kindness
which go beyond stern obligations. As such, there are two broad rules that act as
complimentaryterms of beneficent actions: do not harm expression and maximize probable

benefits and reduce possible harms. Furthermore, the beneficence principle frequently occupies a
well-elaborated justifying functionin various areas of research encompassing human subjects
(HHS.gov, 2016). For instance, effective methods of preventing inpatient falls and nurturing
healthy recovery are some benefits that act as justifications for conducting research on patients
who face the risk for falls. Additionally, it is essential for research to avoid any harm that might
result from the use of previously acknowledged routine practices that turn out to be dangerous
after a closer investigation (HHS.gov, 2016). Thus, the various assumptions covered by
beneficence principle can result in research conflict as well as force researchers to make difficult
choices.
Justice
The Belmont report posits that justice principle tries to assess and determine the
individual who is supposed to get the research benefits as well as bear its troubles (HHS.gov,
2016). According to the principle, an injustice happens when various benefits to which an
individual is entitled are denied without efficient reasons or when different burdens are imposed
on a person unduly. Moreover, every human subject should be treated equally regardless of their
position, merit, competence, deprivation, age, and experience (HHS.gov, 2016). For instance,
justice is served when researchers treat subjects who encounter fall risks the same way they
would treat healthy subjects in the streets. Furthermore, various conceptions of justice are vital to
research that involves human subjects. The conceptions can guide researchers when selecting
research subjects in accordance to their age, racial and ethnic background, experience, or welfare
patients (HHS.gov, 2016). This will enable researchers to know if they are systematically
selecting these groups merely because of their effortless availability, their compromised

conditions, their manipulability, or whether they are selecting them for reasons directly linked to
the issue being studied.
Application of Informed Consent and its Elements
One of the primary ethical issues in conducting nursing research is informed consent.
According to HHS.gov (2016), informed consent means that an individual intelligently,
voluntarily and knowingly, and in a manifest and clear manner, offers his/her consent.
Additionally, patients’ rights to autonomy are guaranteed through the use of their informed
consent. For example, when a nurse is conducting a research regarding the risk for falls among
inpatients on the nurses’ surgical floors, the nurse should first seek the patients’ consent before
using their names, data, or incidences in the research. Altman (2008) asserts that autonomy in
any research is the aptitude for personal determination in action that relates to a self plan. In
essence, informed consent aims to incorporate autonomous individuals, rights through self-
determination. Equally, it aims to prevent disrespect on the patient’s integrity and safeguard
personal veracity and liberty. It is evident that people would make informed decisions to be
involved in a research voluntarily, but they should do so if they have the necessary information
regarding the probable benefits and risks of the study. Moreover, informed and free consent
require incorporating a preamble to the research and its objectives or aims as well as a
clarification regarding the research subjects’ selection and the subsequent procedures. It is
important to describe every physical discomfort or harm, every invasion of confidentiality, and
all threats to dignity as well as the manner in which the subjects will be rewarded on the same
(Altman, 2008). Furthermore, it is essential for the subjects to understand if they should expect
any compensation either by gaining novel knowledge through science or rewarded for their
responses. Hence, researchers should offer the subjects with the required information regarding

what they should expect and what they not expect. A disclosure of solutions or alternatives to the
problem that is being researched is vital because when inpatients who are at the risk of falling are
the subjects, they should be informed about ways of preventing falls before they respond to any
study question.
Lowry et al., (2007) contend that it is paramount for the researcher to update the subjects
regarding the methods and techniques that will be utilized to protect their confidentiality and
anonymity and indicate an individual with whom the subjects will discuss the research. It is also
ethical for researchers to present non-coercive disclaimers which indicate that subjects’
participation is voluntary and that there are no penalties when an individual refuses to participate
in the study. Equally, every researcher should have the ethical standards of informing the
subjects various reasons that may make their information to be deliberately withheld. For
example, a researcher can inform the subjects that their information is withheld to avoid altered
deeds during the research process. Besides, when dealing with patients who are faced with the
risk for falls, it is essential for researchers to consider the patients’ emotional,physical, and
cultural barriers by using simple language and few questions. Consequently, researchers must
explain to their subjects the importance of the liberty to withdraw. Freedom to withdraw is
significant, but it brings the issue of how challenging the withdrawal will be after the subject has
developed friendly and personal relationship with a particular researcher (Altman, 2008).
Equally, subjects’ withdrawal at an advanced phase of the research can leave a researcher in a
dilemma because it will affect the results’ validity. As such, the subjects should be respected at
the cost of the study and their interests must always prevail over science and society interests.
Conclusion

Conclusively, inpatient risk of falls can be prevented and completely eradicated under the
nurses’ careful watch. Currently, the practices that are being used to prevent inpatient falls are
not effective and there is a need to develop or adopt new interventions. Moreover, the paper
examined various researches regarding risk of falls on a medical-surgical nursing floor. As a
result, various ethical issues were discussed regarding how nurses conducted research, for
example, respect for confidentiality and anonymity, respect for privacy, informed consent and
beneficence. Additionally, identifying high or extreme fall risk individuals has assisted with
preventing inpatient falls, but various actions adopted to prevent inpatient falls from occurring
have an improvement room.Moreover, Neuman Systems Model(NSM) concentrates on a
person’s reaction to a potential or actual stressor in a particular setting. Similarly, NSM uses
primary, secondary, as well as tertiary prevention mechanisms for maintenance, attainment, and
retention of optimal patient system wellness. NSM harmonizes five patient variables including
spiritual, developmental, socio-cultural, psychological, and physiological in order to define a
patient’s optimal stability. Consequently, NSM concentrates more on the primary prevention of
risk for falls as the most significant form of inpatient fall intervention. Primary prevention
intercessions are deliberately selected to assist patients retain optimal steadiness, strengthen the
outer defense lines, and reduce risk factors that permit stressors to invade the flexible system or
outer barrier of the patient. Once the patient system’s defense wall has been invaded by stressors,
secondary prevention intercessions are adopted to attain wellness and ease symptoms. Tertiary
prevention is associated with interventions after nursing and medical care has been administered
in order to maintain wellness optimal levels.Nurses, on the other hand, need to categorize and
identify intrinsic and extrinsic factors that patients adopt as well as react to appropriately. Hence,

a thorough patient intervention and assessment in reducing and identifying probable risk factors
is a significant step towards preventing incidences of inpatient falls.

References
Altman, E. (2008). Research Misconduct: Issues, Implications, and Strategies. Greenwich,
Conn: Ablex Publ.
Aronowitz, T., & Fawcett, J. (2015). Thoughts about Conceptual Models of Nursing and Health
Policies. Nursing Science Quarterly, 28(1), 88.
Cangany, M., Back, D., Hamilton-Kelly, T.,Altman, M., & Lacey, S. (2015). Bedside Nurses
Leading the Way for Falls Prevention: An Evidence-Based Approach. Critical Care
Nurse, 35, 82-84.
Centers for Disease Control. (CDC). (2011). Cost of Falls Among Older Adults. Retrieved from
Creswell, J. W. (2013). Research Design: Qualitative, Quantitative, and Mixed Methods
Approaches. Thousand Oaks : SAGE Publications, Inc,
D’Angelo, J. (2012). Ethics in Science: Ethical Misconduct in Scientific Research. London: CRC
Press.
Degelau, J., Belz, M., Bungum, L., Flavin, P., Harper, C., Leys, K., Lundquist, L., & Webb, B.
(2012, April). Prevention of falls (acute care). Health care protocol. Institute for Clinical
Systems Improvement (ICSI), 43-54.
Flick, U. (2009). An introduction to qualitative research. Los Angeles: Sage Publications.
Fry, S. T. (2000). Ethical Issues in Research: Scientific Misconduct and Fraud. Nursing Outlook,
38(6), 296.

Graham, Brid. (2012). Examining Evidence-Based Interventions to Prevent Inpatient Falls.
MedSurg Nursing, 21:5, 267-27
Haggart, M. (1993). A Critical Analysis of Neuman’s Systems Model In Relation To Public
Health Nursing. Journal Of Advanced Nursing, 18(12), 1917-1922.
HHS.gov. (2016). The Belmont Report. Retrieved from, http://www.hhs.gov/ohrp/regulations-
and-policy/belmont-report/index.html
Ireland, S., Kirkpatrick, H., Boblin, S., & Robertson, K. (2013). The Real World Journey of
Implementing Fall Prevention Best Practices in Three Acute Care Hospitals: A Case
Study. Worldviews on Evidence-Based Nursing.10:2, 95-103.
Lowry, L., Beckman, S., Gehrlin, K. R., & Fawcett, J. (2007). Imagining Nursing Practice: The
Neuman Systems Model in 2050. Nursing Science Quarterly, 20(3), 226.
Neuman, B., & Fawcett, J. (2012). Thoughts about the Neuman Systems Model: A Dialogue.
Nursing Science Quarterly, 25(4), 374.
Neuman’s Systems Model PowerPoint Overview. (NSMPPO). (2011). Neuman’s Systems
Model.
Peterson, S. J., & Bredow, T. S. (2009). Middle Range Theories: Application to Nursing
Research. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Preshaw, D. L., Brazil, K., McLaughlin, D., & Frolic, A. (2016). Ethical Issues Experienced By
Healthcare Workers in Nursing Homes. Nursing Ethics, 23(5), 490-506.

Quigley, P. A., Barnett, S. D., Bulat, T., & Friedman, Y. (2016). Reducing Falls and Fall-Related
Injuries in Medical-Surgical Units. Journal Of Nursing Care Quality, 31(2), 139.
doi:10.1097/NCQ.0000000000000151
Reed, K. S. (2013). Betty Neuman: The Neuman Systems Model. Newbury Park, Calif: Sage
Publications.
Ritchie, J., Lewis, J., McNaughton, N. C., & Ormston, R. (2014). Qualitative research practice:
A guide for social science students and researchers. Los Angeles ; SAGE,
Skalski, C. A., DiGerolamo, L., & Gigliotti, E. (2006). Stressors in Five Client Populations:
Neuman Systems Model-Based Literature Review. Journal Of Advanced Nursing, 56(1),
69-78.
Suresh, S. (2014). Nursing Research and Statistics. London: Elsevier Health Sciences APAC.
Tucker, S., Bieber, P., Attlesey-Pries, J., Olson, M., & Dierkhising, R. (2011). Outcomes and
Challenges in Implementing Hourly Rounds to Reduce Falls in Orthopedic Units.
Worldviews on Evidence-Based Nursing. London: Elsevier Health Sciences APAC.
Turner, S. B., & Kaylor, S. D. (2015). Neuman Systems Model as a Conceptual Framework for
Nurse Resilience. Nursing Science Quarterly, 28(3), 213.

Appendix: A Diagram Illustrating the Neuman Systems Model

Using the Neuman's System Model to Decrease the Risk of Falls on a Medical-Surgical Nursing Floor

More Related Content

What's hot

Viewers also liked

Similar to Using the Neuman's System Model to Decrease the Risk of Falls on a Medical-Surgical Nursing Floor

More from PATRICK MAELO

Using the Neuman's System Model to Decrease the Risk of Falls on a Medical-Surgical Nursing Floor