Patient falls have been a problem in hospitals for quite some time.
Nancy Donaldson, RN, DNSc, FAAN, clinical professor and director of the Center for Research and Innovation in Patient Care at University of California San Francisco School of Nursing, took the impact of and attention paid to patient falls into account when she began a project to reduce the incidence of patient falls and the severity of fall-related injuries.
Donaldson was able to begin her project with the help of the Collaborative Alliance for Nursing Outcomes Partners for Quality (CALNOC), formally known as the California Nursing Outcomes Coalition, and information gathered from 33 acute care hospital CALNOC members that identified 77 medical-surgical units to serve as project sites.
Coaches and linkers collaborate
The project, which began in 2002 and lasted through the fourth quarter of 2006, used a telephone-based coaching tactic to collaborate with "linkers," or fall prevention champions, located throughout the CALNOC system.
The idea of a linker was crafted by Donaldson using Havelock's Linkage Model, which emphasizes the transfer of knowledge from knowledge generators to users. In this case, it was the coaches' knowledge being shared with the linkers, who in turn shared their information with a CALNOC hospital.
"In the field of education, coaching is effective, not only for facilitating changes in practice, but also for building individual and organizational capacity for continuous improvement," says Donaldson.
The linker was the facilitator between the CALNOC hospital and the coach. Every three to six weeks, the coach talked with the linker on the phone for 30 to 60 minutes.
The coaching team was made up of six registered nurses with specialized knowledge and skills related to research utilization, evidence-based practice, nursing services administration, and fall prevention strategies.
"We used the telephone because it was too expensive to hold monthly visits," says Donaldson. "We did try to regionalize the calls and most of our coaches made at least one site visit."