Instructions

Assignment Title: A Critical Reflection
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Unit Title: Managing Risk in the Clinical Environment
Unit Code: PSR5101
Introduction
The aim of this essay is to reflect on an identified risk within my current workplace. The setting is an adult mental health unit in a hospital in Perth WA. The risk that will be discussed is ‘fall in older adults’. Through this essay we will analyse ways to reduce potential risks of falls in these adults. The tool used for this reflection will be the Gibbs' Reflective Cycle (1988) model.
Reflection relates to learning through knowledge and experience. It is a highly functional and practical approach that enhances learning through observation and analysis on current and past experiences. Reflective practice is thus often described as a process of learning through experience to gain new insights and understanding.
The Gibbs' Reflective Cycle (1988) is a cycle that is structured into six stages with each stage focussing on one aspect of reflection. These stages are description, feelings, evaluation, analysis, conclusion, and an action plan. In order to understand and reflect on the issue at hand, this essay will focus on analysing the most identified common risk factors for falls in adults. It will also observe the already used falls prevention strategies in older adults and which of these are effective. It will specifically explore ways to reduce risk of fall and develop falls prevention strategies for patients in acute care settings.
Alexander et al. defines falls in simple words stating, "inadvertently coming to rest on the ground, floor or other lower level, excluding intentional change of position to rest in furniture, walls or other objects," (Alexander et al.,2019). Falls are a major cause of concern in patients, especially the elderly. Hospitals report several cases of falls and injuries in elder patients all-round the year. What is a cause of concern is that even though these falls are classed as severe, they are considered to be largely preventable incidents (Cloutier et al., 2016). In observing the cases and incidents, it has been found that both human factors and organizational factors need to be evaluated to handle fall rates in a better manner.
This reflective essay is going to assess and analyse all factors, whether individual or organizational that affect patient falls. The risk factors for falls in older adults are numerous including age, race, gender, and history of chronic health conditions such as stroke, kidney disease, arthritis, depression, and diabetes (Alexander et al.,2019). Other conditions that become reasons for falls include conditions such as muscle weakness, cardiovascular problems, dementia, delirium, grooming, and medication. Using both these factors for assessing risk fall can provide a better idea of fall risks. However, even though risk assessments help in assessing the likelihood of falls, they do not prevent falls and can only provide fall predictions and nothing more.
Description
Falls are common causes of accidents in older adults not only in Australia but also worldwide. As the aging population continues to grow across the world, falls and fall-related injuries are becoming a cause of concern. In older adults, Falls-related injuries are considered as the most common cause of long-term pain, physical impairment, disability, and even death (Baig et al., 2016).
Even though falls may seem insignificant, they are a major cause of harm to the elderly. In fact, due to the sheer intensity and cost of falls, it has been identified as a national issue in Australia. Falls cause an alarming rate of mortality and morbidity in the elderly population in Australia, especially in hospitals. This may be due to both unfamiliarity with the surroundings as well as illness. Hospitals in Western Australia reported more than 5500 incidents in 2016-17 alone. (Post Fall Multidisciplinary Management Guidelines for Western Australian Health Care Settings, 2018).
Due to increase in the aging population worldwide, falls in hospitals is becoming a primary health concern. Despite the Australian Commission on Safety and Quality in Health Care having made care and safety of patients with dementia a key priority, the task in itself is challenging (Ayton et al., 2017). This is because older patients with dementia and mild cognitive impairment (MCI), have exhibited higher prevalence of gait dysfunction. As a result, they show higher risk of falling than their cognitively stable counterparts (Montero-Odasso & Speechley, 2018). The risk of falling in patients increases exponentially with increase in the number of risk factors. Hence patients having more than one risk factor are highly prone to falls than others.
From amongst the various risk factors, some of the most prevalent risk factors fall under two categories, personal as well as environmental factors. The personal factors are classed in those that include human characteristics like health condition, age and functionality. The environmental factors relate to the area in which the elderly are residing and their surroundings. These include falling hazards like bad lighting, stairs, absence of railings, tripping risks, risky furniture etc.
So currently there are many risk factors for falls that have already been identified. As one of the most prevalent causes of fractures, falls are one of the most potent risk factors for the elderly (Baig et al., 2016). Falls often lead to hip fractures in the elderly along with other conditions like soft tissue injuries, head injuries and subdural hematomas. Falls also have psychological and social impact on patients. Elder patients often develop fear of falling after a fall. Post-fall anxiety syndrome is also common among patients. Falls may also result in loss of self-confidence and consequently imposition of functional limitations by oneself (Baig et al., 2016).
The Australian Commission on Safety and Quality in Health Care (ACSQHC) has created guidelines for hospitals and caregivers to help in the prevention of falls and result in harm to older people (Australian Commission on Safety and Quality in Health Care [ACSQHC],2017). 
Feelings
I have worked in a hospital setting for a while and during this time I have made some observations regarding falls in older people. I have identified several risk factors that lead to falls in the elderly and have also pondered over ways these risks can be mitigated. Based on my experience falls in older people occurs due to several reasons. We can divide these reasons into two types- intrinsic factors and extrinsic factors.
Intrinsic risk factors are those that relate to patients themselves and may include characteristics like comorbidities, drug-related issues, poor vision etc. Extrinsic factors relate to the environment around the patients like lighting, building design, floor type, staff attendance etc.
I believe one of the best ways to reduce risk of fall in elderly patients is for hospitals and caregivers to evaluate the risk of each patient individually and the surroundings generally, at regular intervals of time. Based on evaluation, strategies must then be put in place. Currently my workplace has several strategies in force in order to prevent and reduce risk of falls in elderly patients. We have a fall risk assessment in place that helps to determine problems in patients like...