NUR 675 Module 3 Milestone One Example

Milestone One: Practicum Proposal for a Fall Reduction Project on a Medical-Surgical Unit

[Student Name]

Southern New Hampshire University

NUR 675: MSN Seminar: Preparation for Practicum

Module Three Milestone One

[Instructor Name]

[Date]

Milestone One: Practicum Proposal for a Fall Reduction Project on a Medical-Surgical Unit

A practicum proposal has to convince three audiences: a preceptor who will commit time and access, faculty who must judge whether the experience meets graduate standards and the student, who needs a plan realistic enough to finish. The strongest proposals begin with a real problem at the site, defined with data, and propose work the student can complete within the practicum hours. This proposal describes a quality and leadership practicum on a medical-surgical unit at Oak Hollow Medical Center, a composite community hospital, where inpatient falls have increased sharply. It argues that a focused project to understand the unit's falls, select an evidence-based intervention and test it on a small scale will meet a real need and build the advanced competencies the practicum is designed to develop.

The Problem at the Site

The unit is a 32-bed adult medical-surgical unit with a high proportion of older patients. Over the past twelve months, its fall rate rose from 3.1 to 6.2 falls per 1,000 patient days, and seven falls caused injury, including a hip fracture. The unit's own incident data show that most falls happened overnight, after ten in the evening and before six in the morning, that most involved patients trying to reach the bathroom alone and that more than half of the patients who fell had received a sedating medication in the previous six hours. Bed alarms were documented as on in fewer than half of cases where they had been ordered.

For context, Bouldin et al. (2013) analyzed data from more than 1,200 hospitals participating in a national nursing quality database and reported an average fall rate on adult units of a little over three and a half per thousand patient days, with roughly a quarter of falls causing injury. The unit's current rate is well above that average, while its rate a year earlier was below it, which suggests that something changed and is worth understanding.

What the Evidence Suggests

Dykes et al. (2010) tested a fall prevention tool kit in a cluster randomized trial on medical units in four hospitals. The intervention used a validated risk assessment to generate tailored prevention plans, communicated through bedside posters, patient education handouts and care plans. Fall rates were lower on intervention units, with the benefit concentrated among patients aged 65 and older, although the trial did not show a significant reduction in injurious falls. Hempel et al. (2013) systematically reviewed hospital fall prevention studies and concluded that programs combining several components can lower fall rates, although the size of the effect differed greatly from study to study. They emphasized that how programs were implemented, including staff training, leadership support and adherence to the intervention, strongly influenced effectiveness, and that many studies did not report adherence at all. Together these sources suggest that the unit's project should tailor interventions to its own fall patterns and pay close attention to whether staff actually carry them out.

Site, Preceptor and Support

The practicum will take place on the student's own hospital but on a different unit from the one where she works as charge nurse, to avoid confusing her staff role with her student role. The preceptor is the hospital's director of quality, a nurse with a master's degree and experience leading improvement projects, who has agreed to meet weekly and to provide access to fall data and the falls committee. The unit's nurse manager supports the project and will serve as a secondary contact. The hospital's nursing research council was consulted about whether the project requires ethics review, a question addressed in a later module.

Objectives and Timeline

The practicum's five objectives, developed in Module Two and reviewed with the preceptor, are to analyze twelve months of fall data by time, risk factors and injury by week four; evaluate three evidence-based strategies against the unit's patterns and recommend one by week six; plan a small PDSA cycle of the chosen strategy with the manager by week eight; lead an interprofessional huddle on fall risk medications and mobility by week ten; and present results of the first test cycle with a recommendation by week twelve. The timeline allows about 120 practicum hours over twelve weeks, with the first four weeks devoted to data analysis and literature review, the next four to planning and the last four to testing and reporting.

Scope and Feasibility

The project is scoped to a single unit and a single test cycle, not a hospital-wide program. The student will not attempt to change hospital policy or purchase equipment; instead, she will recommend an approach and test it on nights, when most falls occur. If the test shows promise, the unit can expand it after the practicum ends. Risks to feasibility include staff turnover, competing unit priorities and delays in data access. The preceptor has already arranged access to the data, and the manager has agreed to schedule the huddle and test cycle during a period without other major initiatives.

How the Project Will Be Evaluated

The project's success will be judged at two levels. For the unit, the primary measure during the test cycle is the number of falls per 1,000 patient days on nights, tracked weekly on a run chart, with injurious falls tracked separately. Because a single unit has relatively few falls, a short test cannot prove an effect, so process measures will be emphasized: how many high-risk patients have a toileting schedule written into the plan, bed alarm activation when ordered and completion of the medication review in the interprofessional huddle. For the student's learning, the preceptor will assess each objective using the evidence named in the objectives table, and the student will keep a weekly reflective log on leadership challenges, such as persuading staff to change routines. A brief summary of results and recommendations will be left with the manager and falls committee so that the unit can continue the work after the practicum ends.

Conclusion

The unit's doubled fall rate, concentrated at night and linked to unassisted toileting and sedating medications, is a real problem with clear data. Evidence from a randomized trial and a systematic review points toward tailored interventions carried out with attention to adherence. A twelve-week practicum with a qualified preceptor, five measurable objectives and a scope limited to one unit and one test cycle offers meaningful work for the site and the advanced learning the practicum requires.

References

Bouldin, E. D., Andresen, E. M., Dunton, N. E., Simon, M., Waters, T. M., Liu, M., Daniels, M. J., Mion, L. C., & Shorr, R. I. (2013). Falls among adult patients hospitalized in the United States: Prevalence and trends. Journal of Patient Safety, 9(1), 13-17. https://doi.org/10.1097/PTS.0b013e3182699b64

Dykes, P. C., Carroll, D. L., Hurley, A., Lipsitz, S., Benoit, A., Chang, F., Meltzer, S., Tsurikova, R., Zuyov, L., & Middleton, B. (2010). Fall prevention in acute care hospitals: A randomized trial. JAMA, 304(17), 1912-1918. https://doi.org/10.1001/jama.2010.1567

Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., Shier, V., Saliba, D., Spector, W. D., & Ganz, D. A. (2013). Hospital fall prevention: A systematic review of implementation, components, adherence, and effectiveness. Journal of the American Geriatrics Society, 61(4), 483-494. https://doi.org/10.1111/jgs.12169