NURS-FPX 4900 – Capstone in Nursing

Assessment 4: Patient, Family, or Population Health Problem Solution – Reducing Hospital Falls in Older Adults

Course and Assessment Overview

Course: NURS-FPX 4900 – Capstone in Nursing (Capella University)

Assessment: Assessment 4 – Patient, Family, or Population Health Problem Solution

Length: 1,500–2,000 word written report (approximately 5–7 double-spaced pages, excluding title page and references), consistent with published NURS-FPX 4900 samples

Format: Word-processed, double-spaced, 12-point font, academic referencing style as required

Submission: Upload to the Assessment 4 dropbox in the LMS when all previous assessments for the same problem have been completed

Assessment Context

Many Capella capstone assessments require learners to identify a significant patient, family, or population health problem and design, justify, and evaluate a feasible evidence-based solution within their practice context. In this version of Assessment 4, you will complete a capstone-style problem-solution paper focused on reducing inpatient falls among older adults in an acute-care setting. The assessment integrates prior work related to needs assessment, stakeholder analysis, and change planning into a cohesive solution proposal and evaluation strategy.

Scenario and Focus

The selected problem is a persistently high rate of inpatient falls among adults aged 65 years and older on a medical–surgical unit. These fall rates exceed national benchmarks and have resulted in patient injuries, prolonged lengths of stay, and increased organisational costs. Earlier assessments examined baseline data, organisational context, stakeholder involvement, and potential interventions. Assessment 4 requires synthesis of this work into a practical, evidence-based solution and evaluation plan that could realistically be implemented in the selected clinical setting.

Assessment Instructions

1. Introduction (Approx. 200–250 words)

• State the specific patient, family, or population health problem (inpatient falls in older adults) and the practice setting

• Briefly explain why this problem is clinically, ethically, and financially significant, using local and national data when available

• Identify the purpose of the paper and outline the main sections

2. Problem Description and Significance (Approx. 350–400 words)

• Describe the scope and nature of the falls problem in the setting, including rates, trends, severity of injuries, and associated costs

• Compare local data to national benchmarks or evidence-based guidelines

• Discuss key contributing factors, including intrinsic risks (age, comorbidities, cognitive impairment, polypharmacy) and extrinsic risks (environmental hazards, staffing levels, communication gaps, and workflow issues)

• Explain the impact of inpatient falls on patients, families, staff, and the organisation

3. Evidence-Based Intervention Proposal (Approx. 500–600 words)

Propose a specific, evidence-informed intervention or intervention bundle designed to reduce falls and fall-related injuries among older adult inpatients. Examples include multifactorial fall risk assessment with tailored interventions, hourly rounding, assisted toileting protocols, bed and chair alarms, mobility programs, staff education, and patient-family engagement strategies.

Summarise at least 3–5 recent peer-reviewed studies or clinical guidelines supporting the proposed intervention

• Describe the core components of the intervention, who will deliver them, and how frequently

• Explain how the intervention aligns with best-practice recommendations and organisational priorities such as patient safety goals, accreditation standards, or Magnet principles

4. Implementation Plan (Approx. 300–350 words)

• Identify key stakeholders, including nursing staff, nurse leaders, physicians, rehabilitation professionals, quality and safety teams, patients, and families

• Outline a realistic implementation timeline, including planning, staff education, pilot testing, and full implementation

• Address anticipated barriers such as staff workload, resistance to change, or technology limitations, and propose strategies to mitigate them

• Identify required resources, education, policy updates, or workflow changes

5. Evaluation and Outcomes (Approx. 250–300 words)

• Define specific, measurable outcomes to evaluate effectiveness, such as falls per 1,000 patient days, falls with injury, length of stay, patient satisfaction, and staff compliance with fall risk assessments

• Explain how outcome data will be collected, analysed, and reported

• Describe how evaluation findings will support continuous quality improvement and sustainability of the intervention

6. Interprofessional and Patient/Family Considerations (Approx. 150–200 words)

• Discuss how interprofessional collaboration among nursing, medicine, physiotherapy, occupational therapy, and pharmacy will support the intervention and improve outcomes

• Explain how patients and families will be engaged through education, shared decision-making, and active participation in fall-prevention strategies

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7. Conclusion (Approx. 150–200 words)

• Summarise the identified problem and the proposed evidence-based solution

• Reinforce anticipated benefits related to patient safety, quality of care, and cost reduction

• Identify one or two next steps for practice implementation or further evaluation

Assessment 4 Rubric – Patient, Family, or Population Health Problem Solution

Criterion 1: Problem Definition and Significance (20%)

• Distinguished: Clearly and precisely defines the problem; integrates local data and external benchmarks; convincingly explains clinical and organisational significance

• Proficient: Clearly describes the problem and its importance, though some data or benchmark connections may be limited

• Basic: General description of the problem with minimal data

• Below Basic: Problem is vague or insufficiently justified

Criterion 2: Use of Evidence to Support the Proposed Solution (25%)

• Distinguished: Synthesises multiple high-quality, recent sources to justify a clearly defined intervention and its relevance to the setting

• Proficient: Uses appropriate evidence with generally clear justification

• Basic: Limited or descriptive use of evidence

• Below Basic: Minimal or inappropriate evidence

Criterion 3: Implementation Plan and Feasibility (20%)

• Distinguished: Presents a realistic, detailed plan with clear roles, resources, timelines, and barrier-management strategies

• Proficient: Feasible plan with some detail limitations

• Basic: General plan lacking specificity

• Below Basic: Unrealistic or poorly developed plan

Criterion 4: Outcomes, Evaluation, and Interprofessional Considerations (20%)

• Distinguished: Clearly defined outcomes, sound evaluation strategy, and strong integration of interprofessional and patient/family involvement

• Proficient: Reasonable outcomes and evaluation plan with some collaboration discussion

• Basic: Broad outcomes with limited evaluation detail

• Below Basic: Poorly defined outcomes and minimal collaboration

Criterion 5: Organisation, Writing, and Referencing (15%)

• Distinguished: Well-organised, clear, concise writing with accurate academic referencing

• Proficient: Minor writing or referencing issues

• Basic: Noticeable clarity or formatting problems

• Below Basic: Significant writing or referencing deficiencies

Falls among older adults admitted to acute medical–surgical units remain a persistent patient safety issue associated with fractures, functional decline, prolonged hospitalisation, and increased health care costs. A multifactorial fall-prevention intervention that incorporates standardised risk assessment, individualised care planning, hourly rounding, assisted toileting, and targeted staff education is strongly supported by the literature. When nurses integrate these practices into routine workflows and collaborate with rehabilitation and support staff, significant reductions in fall rates can be achieved without adding excessive burden to frontline teams, thereby improving outcomes for older adults and the organisations that care for them.

Additional Practice Implications

Sustained reduction in inpatient falls among older adults requires not only evidence-based interventions but also strong leadership support, staff engagement, and ongoing evaluation. Embedding fall-prevention strategies into daily nursing practice and organisational safety culture enhances reliability and long-term success. Studies demonstrate that multifactorial interventions are most effective when combined with continuous monitoring, feedback, and interprofessional collaboration, reinforcing the nurse’s central role in patient safety and quality improvement initiatives (LeLaurin and Shorr, 2019).

Study References

• LeLaurin, J.H. and Shorr, R.I. (2019) ‘Preventing falls in hospitalized patients: State of the science’, Clinics in Geriatric Medicine, 35(2), pp. 273–283. https://doi.org/10.1016/j.cger.2019.01.007

• Miake-Lye, I.M., Hempel, S., Ganz, D.A. and Shekelle, P.G. (2020) ‘Inpatient fall prevention programs as a patient safety strategy’, Annals of Internal Medicine, 158(5), pp. 390–396.

• King, B., Pecanac, K., Krupp, A., Liebzeit, D. and Mahoney, J. (2018) ‘Impact of fall prevention on nurses and care of fall-risk patients’, Gerontologist, 58(2), pp. 331–340.

• Institute for Healthcare Improvement (2021) How-to guide: Reducing patient falls.

• Oliver, D., Healey, F. and Haines, T.P. (2010) ‘Preventing falls and fall-related injuries in hospitals’, Clinics in Geriatric Medicine, 26(4), pp. 645–692.