Integrating Advanced Care Planning in Community Nursing for Dementia Falls Assignment Sample

Introduction: Strategies for Fall Prevention in Dementia Care Through ACP Integration

ACP is one of the strategic and important ways of introducing ACP into the community nursing setting to achieve better health outcomes while improving the quality of life for ageing individuals living with dementia (Ohr et al., 2021). Dementia is a chronic neural condition that causes cognitive functions such as memory, thinking, and performing daily chores to deteriorate progressively. The decline in cognitive function and physical capacity at old age makes them more prone to falls- the leading cause of morbidity and mortality in such a population group (Ohr et al., 2021).

Consequently, fall prevention is a key issue for consideration while managing senior citizens with dementia. Due to the fact that ACP is the first organized structure that combines diverse tools and techniques from various disciplines to form a unified system for the community nursing practice for the complex needs of the deprived population, which lacks a sober mindset, ACP brings in a multidimensional integrated character in the practice of community nursing. ACP covers more than basic medical care; it records and articulates patient's preferences for future healthcare, especially matters related to the terminal lifetime, in case they become incapable of making such decisions (Hafid et al., 2021). Such proactive and purposeful conduct ensures, therefore, that care adheres to the set values, goals and desires of the person thereby enhancing his /her autonomy and dignity (Hafid et al., 2021).

Aim

The primary aim of this project is to integrate Advanced Care Planning (ACP) within community nursing practices to enhance fall prevention strategies and improve the quality of life for elderly individuals with dementia.

Objectives

• To implement effective tools within community nursing to identify elderly individuals with dementia who are at a heightened risk of falls, focusing on early detection and intervention.
• To utilize ACP to tailor fall prevention strategies to the individual needs and preferences of elderly patients with dementia, ensuring these plans are person-centered and achievable.
• To enhance the skills of community nurses in ACP conversations, empowering them to effectively communicate with patients and their families about fall risks and prevention strategies.
• To conduct a thorough evaluation of the ACP integration into community nursing on reducing falls among elderly individuals with dementia

Literature Review

Assessing the Current State of Service

In judging the position of the current service regard to integrating Advanced Care Planning (ACP) into community nursing practices for stabilising fall prevention among elderly people having dementia, there are important inferences realize. However, today, the practices of community nursing still differ in the way they incorporate ACP with the absence of well-defined protocols and especially minispecific training to dementia care usually serving as the reason for this variation (Kuusisto et al., 2020). Although this is the case in some community nursing teams who are more proactive in exploring and documenting such preferences about care with patients and their families, this is not continuously evident in a lot of settings. In such a vulnerable group, the identification and management of fall risks are largely reactive instead of proactive with interventions arising post-incident to preventive measures.

In addition, several service gaps in care planning therapy personalization are noticed, with one-size-fits-all approach common in some cases, while it does not match the unique needs of the individuals suffering from dementia (Akil et al., 2021). The principles of using tools for assessment of fall risks as well as the misuse of these assessments are not consistently practiced, and little is known of how they can be actively used and altered to recognize the challenges faced by those with problems in cognition. Barriers in communication between providers, patients and families add to the difficulties associated with successful ACP implementation, depriving caregivers of multiple opportunities for meaningful discussion about future care preferences and strategies to avert a fall (Geerlings et al., 2023).

Root causes

Evidencing the Need for Change

Policy directives from organizations such as the National Institute for Health and Care Excellence (NICE) suggest promoting the relative benefits of patient-centeredness through the provision of ACP (Blackwood, 2021). The NHS Long Term Plan underpins its strategy as one based on personalized care, including for dementia service users, thereby suggesting a high level of integration of ACP into care practice. Furthermore, economic evaluations show that improving fall prevention through the use of ACP can help reduce cost burdens to medical systems due to cutting costs on hospitalizations and the need for long-term care (Blackwood, 2021).

This integration assures not only to respond to the patient-preferred option and their quality of life, but also to bring out a tangible economic benefit in relation to the effective optimization the resource usage in the health care system. An important implication of the evidence syndromes is that there is a critical need for the shift toward a more individualized, preventive approach to dementia care, enabled by ACP and that this shift is supported by a body of evidence that these healthcare providers and policymakers need to take on board (Torous et al., 2021).

External and Internal Drivers for Change

National health care policies, for instance, the NHS Long Term Plan, highlight personalized care, decision-making by patients, and a comprehensive approach in applying services, primarily for the elderly with dementia (Entwistle et al., 2022). ACP is needed to follow laws regarding patient rights and standards regarding patient care, also it is important for people to follow the patient preferences and choices and the best interest of patients so older people have written legal documents that may be followed in future if problems appear. The recommendations which are based on practice evidence show the way in which the authoritative bodies including the National Institute for Health and Care Excellence (NICE) can assist in fall prevention, dementia management, and screening. These guidelines support ACP, emphasizing the need to make interventions for individual needs; and promoting the importance of ACP in enhancing care results (Mills et al., 2023).

Projections by the UK suggest an even bigger increase in dementia cases by the year 2040, with the number of cases rising by 57% to 1.60 million people from the 2016 figure. This addition corresponds to about 70% of the level that would be real if the incidence rates per age group remained constant figures that estimated 1.2 million people with dementia in the UK in 2040 some 96,000 more. Moreover, projections indicate a population expansion regarding the people with dementia both able to live on their own and in need of complex care (Aranda et al., 2021).

If focusing on workforce capacities, outpatient care provisioned by primary care providers is an important service for elderly people (Henry and Loomis, 2023). In the United States, there are approximately 175,000 primary care physicians, in stark contrast to the much smaller numbers of specialized professionals: less than 10 thousand adult neurologists, less than 8 thousand geriatricians, and about 1,600 people practising geriatric psychiatry. These numbers fail to come anywhere near the demand with the American Geriatrics Society estimate putting this figure at need for 36,000 geriatricians alone (Henry and Loomis, 2023).

Role of Nurses in Change Management

From the standpoint of the labour force, the practicality of the breed gap, between gradually increasing the number of elderly patients with complex analytical needs and the available products of health care professionals, shows the need for creative models of care. For instance, in the United States, the number of primary care physicians is several times greater than the number of specialists practicing in geriatric medicine, neurology, and psychiatry, suggesting that carers of dementia patients may be disadvantaged with refined and more specific care (Ganguli et al., 2020). This pattern is reflected around the world, with estimates showing a notable rise in the prevalence of dementia, suggesting that in the United Kingdom, there will be over 1.2 million people suffering from dementia in the year 2040. Statistics such as the incidence of MSs across nations, and sizeable time-and-cost investments required in its prevention and management, not only disclose the enormity of the problem but underscore the importance of scalable and sustainable care strategies and systems across the globe (Ganguli et al., 2020).

Additionally, internal factors like organizational policies and procedures, employee training, and quality improvement projects as well as external factors such as health policies and guidelines, and reimbursement structures interact and contribute to the rate of integration of ACP (Coles et al., 2020). Advocacy through their experience acquired clinical skills and leadership, nurses influence this process in advocating for changes that are not only available for immediate health concerns, but they also represent the dignity and autonomy of individuals under their care (Berlin, 2022).

Proposed Change and Patient Benefits

The incorporation of ACP philosophy, which should be focused on the environments in which community nursing practices are taking place, particularly on the ways to prevent falling among elderly patients with dementia, represents an essential turning point towards a more patient-centered and proactive approach that involves patients from early stages of life preventing recurrence or sustaining long-term improvements (Mróz et al., 2023).

Though this method is limited to the physical protection, the advantages it provides exceed the protection borders. Even as ACP helps patients to make the choices for the future when their voice may be diminished in the future, this aspect is seen as the fundamental element, honoring autonomy in the patients' lives (Trang, Herbert and Sansom?Daly, 2022). In addition, ACP provides tremendous relief to the family and caregivers who have to make complex decisions regarding life support, but often find themselves confused about the patient's wishes (Malhotra et al., 2022).

The suggested development encourages a team of disciplines, shared care to use different professionals who are skilled in doing different tasks. The team-based model augmented the completeness of care, which means that in this approach, a patient's health and well-being are taken into consideration from all aspects (Zhao et al., 2023). Besides, the combination of ACP with community nursing contributes to the achievement of the goals of public health as well as ethical standards in medical practice that stresses the need to stimulate individual medical independence, ensure the parity of medical care, and act with respect to the limited medical resources (Li et al., 2022).

Literature Gap

The importance and integration of Advanced Care Planning (ACP) to community nursing practices, most especially dementia individuals dealing with fall prevention, have been made keenly known from the gaps noted in the current literature that need additional exploration and research (Coles et al., 2020). The lack of studies that delve into the applied aspects of ACP within the realm of community nursing is an obvious oversight, creating a grave gap in the recognizing of how such vital conversations may be best conducted and implemented into day-to-day nursing practice.

Vision and Goals

If the ACP is to be embedded within community nursing practices as a fall prevention intervention strategy for the aged people with dementia, vision and goals are vital to plot a straight course for the project as purposed to achieve its goals consistent with other organizational goals. A vision statement well defined, like the beacon, leads all project related activities as they try to unite with a common goal. In the creation of this project, the vision might coincide with the overall ambitions of a health institution, such as the NHS Trust, in such regard, to include patient safety, quality of care, and conforming to the Trust's Vision and Values statement.

Vision Statement

"To revolutionize dementia care within our community by seamlessly integrating Advanced Care Planning into nursing practices, thereby setting a new standard for patient-centered care.”

SMART Goals

Discussion

Examine transformational leadership and its impact on change management

Transformational leadership significantly influences change management because it encourages its followers to go beyond individual needs for the sake of the organization (Peng et al., 2020). This leader is one who can be able to articulate the future in that way the vision is clear and definable the reason being that individuals can be able to pursue a common goal. Transformational leaders perform well in creating that work culture of trust and respect, not only that employee's engagement hikes but encouraging employees to participate in the change on their own (Siangchokyoo, Klinger and Campion, 2019). Additionally, transformational leaders foster creativity and innovation in their followers; they question current mindsets and evaluation within the group. Besides change management, this culture of innovation is important so that organizations can adapt and branch out in response to outside conditions and possibilities (Shafi et al., 2020).

Discuss the application of models such as Kotter's 8-Step Change Model

Kotter's 8- Step Change Model is an expansive structure created for the purpose of promoting and ensuring effective organizational change process (Laig and Abocejo, 2021). It starts off with creating a sense of crisis urgency relative to the desired change- which pulls or drives the necessary loyalties and encouragement from the influential stakeholders. This sense of urgency is instrumental in the process of overcoming complacency and helping to gain the required speed in the right direction (Laig and Abocejo, 2021). Vison communication is the step four communicates the reasons for the change and what is in it for the people who are the members of the organization hence they become part and parcel of the process (Errida and Lotfi, 2021).

Step five in the model underscores empowering the broad-based action by removing the factors creating resistance to change and enabling the individuals to contribute to the change process (Kang et al., 2020). This last stage makes sure that the change operates through the rhizomatic model and not the surface (Kang et al., 2020).

Outline the steps in the delivery plan, including timelines, goals, and specific interventions

Systematically review potential risks and challenges in implementing ACP and fall prevention strategies

The implementation of ACP and fall prevention strategies in Agyeidi and Beyer's community nursing model applied to elderly persons with dementia involved a set of risks and challenges that required thoughtful assessment and tactful addressing (Albasha et al., 2022).

A number of training and education gaps in the nursing staff awareness and competence and suboptimal implementation of ACP and/or fall prevention measures can be considered another major challenge (Pivodic et al., 2022). The trainees must be trained well to make sure that the organization's appropriate skills and knowledge are passed in their minds. Stakeholder engagement is equally important since without inclusion of all parties involved in the ACP process, their active participation, families' involvement, caregivers, and patients, care plans would lack their wishes and the required support of their families, pointing to the necessity of strategies for meaningful participation (Pilch et al., 2021). Moreover, interdisciplinary teamwork is of utmost importance to prevent diverse manifestations of various falls and whole as well coordinated approach to the detection of that problem, which implies more integrated situations communicated among all members of the health care group (Pilch et al., 2021). Implementation is rendered difficult by the lack of economic capabilities, and the proper application of these initiatives requires good resource management as well as the organisational support needed to prioritise these initiatives (Budhwar et al., 2023).

Discuss the need for iterative improvements based on evaluation outcomes

New approaches to the healthcare management along with the patient requirements change over time (Wager, Lee and Glaser, 2021). Iterative improvements allow adopting ACP and fall prevention methods to new challenges as well as additional insights about elderly patients with dementia for the transition to further developed forms of these technologies over time. This guarantees that the interventions carry credibility to the latest formulations of clinical evidence and best practices (Wager, Lee and Glaser, 2021).

The implementation of continuous evaluation gives important information on the underlying effect that planned strategies have on performance (Carayon et al., 2020). Emerging through response to feedback comments of patients, families, and clinicians manifest themselves (van der Schaar et al., 2020).

This responsiveness facilitates stakeholder involvement and improved satisfaction since they are convinced that their inputs result into professionals implementing tangible modifications and improvements in the care process. When a change takes place in any healthcare practice such as the introduction of ACP as well as strategies for fall prevention despite the fact that all changes are for the benefit of the people, it is likely to have unintentional effects. The iterative progress rejects both negative changes in patient care or disruptions in the staff's workload for the healthcare system (Johnson et al., 2020).. Through the pursuit of iterative enhancements, these healthcare institutions maintain the efficiency of resource utilization (Mahajan et al., 2022).

Stakeholders and the Project Management Team

Analysis

Route Cause Analysis

In principle, RCA is dedicated to finding the root causes of reported incidents that tend to occur in the healthcare system, as well as other industries, after-all the emphasis on finding out the said causes is on what is driving the incident right down to addressing the roots of the same- instead of simply managing the said symptoms (CPPS and P.Eng, 2021). From a human resources point of view, especially if we analyze the implications of RCA in healthcare, as a part of projects centred on integrating the approaches of ACP and fall prevention for elderly individuals, those that suffer from the individual dementia develop a strategic importance (CPPS and P.Eng, 2021). It starts off with the realization of a situation that is sometimes in the form of an unforeseen trend or problem such that falls among patients are higher than normal or that ACP protocols are not being implemented properly. The RCA process then goes a few levels further to analyze how and why this event occurred, using tools such as the fishbone diagram to map out factors at play in different domains such as the process, people, policies, procedures, environment, and equipment which could have led or contributed to the actual event (Holifahtus Sakdiyah, Eltivia and Afandi, 2022).

RCA analyzes the problem-generating event and its contributory elements by dissecting it in a systemic manner and one can find not only a single but several root causes that dialectically interact in creating the problem (SET?AWAN et al., 2020). This comprehensive analysis is put in place to ensure that the interventions are the necessary steps to the cause of the problem vice the short cuts. For example, if communication breakdowns between the staff and families about an ACP turn out to be a powerful contributing factor, the solution covering not only better training of the staff, but also establishing new informational resources for the families and how they can negotiate with staff (Madariaga, 2020).

5 ‘whys'

Process Mapping

Lewin`s 3 step model

Unfreeze: In the first place, this essential stage involves readying the organization for change, which must bring down hegemony and dismantle the current status quo.

Change (Transition): The development of a way out and the ‘unfreezing' of organization and its acceptance to change obliges to move forward towards the new method of operating. The adoption stage refers to using ACP and fall prevention schemes in the routines of everyday tasks for community nursing practices.

Refreeze: The goal of the last step is to sustain the organization after the change has occurred because of a revision in the standard operating procedure that is done by establishing the new practices. This suggests that in the form of ACP and fall prevention integration, this should mean that the new techniques become fully part and parcel of organizational culture and that employees practice these methods on a consistent basis.

Interaction of Needs model

The Interaction of Needs model, developed by researchers specializing in organizational behaviour and psychology, provides a paradigm to comprehend the relationship and dynamic interaction between the various needs of the different stakeholders within an organization and how different needs influence the process of change and the process of coming up with coherent decisions. Although the model was not specifically designed for healthcare but rather for all business environments, it presents a great potential to implement projects and programs such as the integration of ACP and strategies for fall prevention initiatives in with integrated focus on patients, professionals, and organizational needs.

The basis of the Interaction of Needs model is drawing the main attention to the dynamic dialectical relationship between individual and societal needs. In regards to health care this model can clarify how the needs of the old patients with dementia e.g. safety, autonomy, and dignity, the professional needs of the nurses and other health care providers e.g training, support and effective interventions and the organizational needs love for compliance, efficiency and good outcome of health care need can intersect to some extent.

Kotter`s 8 step model of change

NHS Change Model

Implementing a project such as aligning Advanced Care Planning (ACP) and fall prevention – approaches in community nursing practices based on the NHS Change Model will entail bringing these eight elements to fit within the particular settings and difficulties of the project (Wright, Gabbay and May, 2021). For instance, forming a shared mission to ensure the quality of life and protection lifestyles for senior patients with Alzheimer's condition brings the stakeholders around the same goal. An effective leadership on different fields can promote the fact that ACP and fall prevention are critical, and it will also be possible to engage the front line staff, patients and their families to make the change process more open (Oh et al., 2021).

Communication of best practices in care plans and fall prevention can lead to innovations being shared, and in promoting transparency in measurement, it is easy to track the interventions applied (Dykes et al., 2020). The first human structure that matches the project objectives of system drivers in terms of timing, allocation of resources and securing organizational support is inside. A second one, grounded in building capacity and capability among staff members, enables staff to carry out the necessary change (Mikalef, van de Wetering and Krogstie, 2020). Lastly, applying a real-time learning approach guarantees that the project will be able to respond to challenges and feedback allowing it to make permanent adjustments as it relates to the care of the patients.

Risk Management and Mitigation

Risk management analysis

Risk management cycle and 4 step Risk Management framework

Plan Do Study Act (PDSA Cycle)

Evaluation Methods

The management of a project should be the one that is proactive on a process of appraisal would start at the implementation and undertaken throughout the project (Subramanian and Suresh, 2022). To assess them all is vital to make sure that the successful completion project and find the following points where changes can be made. A startling fact that over 70% of change management projects fail points to the need for pre-, inter-, and post-project evaluation at all stages.

At the beginning of the transformation, it is important to carry out an integrated needs assessment for comprehensive understanding of the existing situation regarding ACP and advanced fall prevention in the community practice as nursing (Cerulus, Bossuyt and Vanderhaeghen, 2021). For this evaluation, a literature survey is done as well as the study is engaged in analysing data retrieved sources. With that in mind, we can realize what have to be done to change and what has to be changed, which further sets the tone for planning and implementation.

Another important aspect of the evaluation process that must be considered alongside the methods of evaluation is stakeholder engagement (Bahadorestani, Naderpajouh and Sadiq, 2020). Survey and Focus group techniques are used to gather feedback from nursing staffs, patients, and other parties for checkpointing perception and expectations. Their insights are a fundamental part of determining the direction that the project will take, as well as ensuring that it meets their requirements and expectations.

Conclusions and Recommendations for Practice

Conclusion

The project was meant to solve a significant gap in community nursing deliverables by incorporating ACP and fall intervention approaches for elderly patients with dementia. The prevalence for dementia, nevertheless in healthcare, is progressing because the dementia number is estimated to go up by 57% from 2016 to 2040, in the UK. This turn makes it a necessity to apply the proactive strategy that will improve the quality of presented care to this mentioned group of patients. The project was originally initiated with an in-depth evaluation forming information on the current status of service, which revealed a significant difference in ACP and fall prevention care. This gap was identified through a literature review, healthcare policy analysis, and the analysis of factors that drive the change in the organization's environment. Nurses are the key drivers of change management processes because the role given to them in these processes was regarded as essential to the success of the processes.

The proposal for change was designed in a quality way, and it was intended to alleviate these gaps and improve outcomes from patients. Four operational goals were sought out to serve as a direction of the project, which targeted staff education, preventative measures and patient safety, and ACP conversations. A rigorous systematic approach was followed throughout the project, and it was based on the PDSA cycle which it follows the plan, do, study, act. During the implementation phase, activities included staff training on intervention policies, integrating ACP and Fall prevention protocols into nursing practices, and continuous monitoring of progress.

Recommendations

To improve the adoption of ACP and measures to prevent falls in elderly individuals with dementia in the community nursing practice three key recommendations have been developed (Frechman et al., 2020). Holistic care approach, among others, is fundamental. This strategy acknowledges that dementia care also involves complex domains of social, economic, and mental well-being and fall prevention (Quinn et al., 2021). It gives equal focus on the psychosomatic aspect of patients. Viewed holistically, healthcare providers develop a person-centered care that enriches the health and life of the elderly person with dementia in turn.

Furthermore, ongoing educational and learning modules offered to nursing personnel must be adopted. These recordings guarantee that the workforce remains current about the most recent ACP or fall avoidance life systems. Since healthcare procedures become outdated with time, maintaining staff awareness and skilled becomes significant as the changing needs of patients necessitate new standards of care. The regular sessions enable the nursing staff becomes in a position to change and implement evidence-based responses efficiently (Rodriguez (Then) et al., 2020).

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