Reflection Journal 10 Assessment Description Students are required to maintain weekly reflective narratives throughout the course to combine into one course-long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum course. In your journal, you will reflect on the personal knowledge and skills gained throughout this course. The journal should address a variable combination of the following, depending on your specific practice immersion clinical experiences: Please focus on the topic: Fall Prevention in Outpatient Radiology Clinic New practice approaches Intra-professional collaboration Healthcare delivery and clinical systems Ethical considerations in health care Population health concerns The role of technology in improving health care outcomes Health policy Leadership and economic models Health disparities Students will outline what they have discovered about their professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and finally, how the student met the competencies aligned to this course. While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center. Benchmark Information This benchmark assignment assesses the following programmatic competencies: RN to BSN 1.3: Understand and value the processes of critical thinking, ethical reasoning, and decision making. 2.6: Promote interprofessional collaborative communication with health care teams to provide safe and effective care. 3.2: Utilize patient care technology and information management systems. 4.2: Preserve the integrity and human dignity in the care of all patients. 5.5: Provide culturally sensitive care. 20XXKRONA HOSPITAL OPERATING BUDGET FOR 20XXRevenuesInpatient $ 25,000,000Outpatient15,000,000Emergency Room10,000,000Laboratory5,000,000Pharmacy1,500,000Home Health and Hospice1,500,000Ambulance Services950,000Substance Abuse250,000Other850,000Subtotal$ 60,050,000Less Chartiy Care18,000,000Net Revenues$ 42,050,000ExpensesPayroll (including nursing salaries)$ 12,500,000Benefits3,000,000Contract Labor100,000Insurance300,000General Services (laundary, security, etc)3,000,000Depreciation 1,500,000Interest Expense300,000Professional Services10,000,000Total Operating Expenses$ 30,700,000Net Income$ 11,350,000 Sheet2 Sheet3 Benchmark - Capstone Project Change Proposal Mananita Gerochi-Caparas Grand Canyon University NRS-493-O503 Professional Capstone and Practicum Davida Murphy Smith October 23, 2022 Benchmark - Capstone Project Change Proposal Background Falling incidences are prevalent among older patients. In so.

1. Reflection Journal 10
Assessment Description
Students are required to maintain weekly reflective narratives
throughout the course to combine into one course-long
reflective journal that integrates leadership and inquiry into
current practice as it applies to the Professional Capstone and
Practicum course.
In your journal, you will reflect on the personal knowledge and
skills gained throughout this course. The journal should address
a variable combination of the following, depending on your
specific practice immersion clinical experiences:
Please focus on the topic: Fall Prevention in Outpatient
Radiology Clinic
New practice approaches
Intra-professional collaboration
Healthcare delivery and clinical systems
Ethical considerations in health care
Population health concerns
The role of technology in improving health care outcomes
Health policy
Leadership and economic models
Health disparities
Students will outline what they have discovered about their
professional practice, personal strengths and weaknesses that
surfaced, additional resources and abilities that could be
introduced to a given situation to influence optimal outcomes,
and finally, how the student met the competencies aligned to
this course.
While APA style is not required for the body of this assignment,
solid academic writing is expected, and in-text citations and
references should be presented using APA documentation
guidelines, which can be found in the APA Style Guide, located

2. in the Student Success Center.
Benchmark Information
This benchmark assignment assesses the following
programmatic competencies:
RN to BSN
1.3: Understand and value the processes of critical thinking,
ethical reasoning, and decision making.
2.6: Promote interprofessional collaborative communication
with health care teams to provide safe and effective care.
3.2: Utilize patient care technology and information
management systems.
4.2: Preserve the integrity and human dignity in the care of all
patients.
5.5: Provide culturally sensitive care.
20XXKRONA HOSPITAL OPERATING
BUDGET FOR 20XXRevenuesInpatient $
25,000,000Outpatient15,000,000Emergency
Room10,000,000Laboratory5,000,000Pharmacy1,500,000Home
Health and Hospice1,500,000Ambulance
Services950,000Substance Abuse250,000Other850,000Subtotal$
60,050,000Less Chartiy Care18,000,000Net Revenues$
42,050,000ExpensesPayroll (including nursing salaries)$
12,500,000Benefits3,000,000Contract
Labor100,000Insurance300,000General Services (laundary,
security, etc)3,000,000Depreciation 1,500,000Interest
Expense300,000Professional Services10,000,000Total Operating
Expenses$ 30,700,000Net Income$ 11,350,000
Sheet2

3. Sheet3
Benchmark - Capstone Project Change Proposal
Mananita Gerochi-Caparas
Grand Canyon University
NRS-493-O503 Professional Capstone and Practicum
Davida Murphy Smith
October 23, 2022
Benchmark - Capstone Project Change Proposal
Background
Falling incidences are prevalent among older patients. In some
specific healthcare settings, the risk of falls may increase. The
outpatient radiology clinic is one of the significant examples of
these settings (Li et al., 2018). More than 800,00 older patients
encounter fall injuries each year and get hospitalized due to
head or hip injuries. However, falls without injuries rates are
quite higher (CDC, 2021). The fall rates are continuously
increasing from 2007-2017, there was an increase of 30% in
death rates in the US, which all occur due to falling risks.
Incidents of falls are the most common issues in elder patients
over the age of 60 years. The risks associated with falls in the
elder include broken bones or fractures of the wrist, arms, hips,
and ankles. The proposed change discussion focuses on this
specific issue and identifies appropriate interventions and
practices that may help address falls and fall injuries.
Falls are one of the common and devastating complications that
can occur during a healthcare procedure. According to several
pieces of information, the United States is high on falls and
there are thousands of people who suffer from falling incidence
every year. Specifically, the rate of falls in the radiology
department is significantly high, and these incidences are more

4. common among older people (Laukhuf, 2020). Fall and injury
prevention remains to be a substantial challenge throughout the
care continuum.
Clinical problem statement
Falls are the most common and severe risk factors among
elderly patients in any healthcare setting. It has been found that
disability and morbidity are the leading factors resulting in falls
among the elderly. Muscle strength, mobility issues, and
imbalance are significant risk factors for falling incidences
among older people. Falls cause severe injuries and a
significant risk of death. Some additional causal factors, such as
chronic conditions, medications, hazards within the
environmental setting (outpatient radiology setting), and other
age factors, like decreased balance, may have significant risks
to the fall. In addition, improper monitoring during diagnostic
care procedures is another crucial risk factor for falls. For
example, patients who change into hospital-approved gowns
before a clinical diagnosis, specifically Magnetic Resonance
Imaging (MRI), are not being monitored or supervised for safety
(Anugwom, 2021).
Therefore, it is vital to understand that there is a need for help
when elderly patients are changing their clothes, as poor
balance while changing clothes may result in falls. Since
changing clothes is a private act, healthcare staff must provide
necessary services or support as needed to protect their privacy
and ensure their safety.
Purpose of the change proposal and in the changing healthcare
system
The main reason for the change proposal is to prevent outpatient
radiology patients to be at risk for falls and prevent falls, and
fall injuries. In recent months our department has experienced
high levels of falls. The outpatient radiology clinic setting is
unmonitored and does not have fall prevention protocols similar
to inpatient settings. Most patients are walkie-talkies and
mostly in and out for a radiology procedure; falls are the least
to happen, however, falls do happen and sometimes with

5. injuries. Implementing fall prevention strategies in an
outpatient radiology setting will definitely provide quality
patient care in the constantly changing healthcare system. The
main purpose of the change proposal is to have fall prevention
protocols, continued assessment and monitoring of patients, and
education about fall prevention.
PICOT question
In elderly adult patients in the outpatient radiology clinic (P)
what is the effect of placing push button alarms while changing
in the dressing room (I) compared with no alarm system (C)
reducing the incidence of falls (O) within four weeks (T)?
The literature search strategy employed
The research methodology is selected by the extraction of data
from the existing information taken from the secondary
analysis. Under the research strategy, a criteria appraisal tool
was implicated for the evaluation of functional mobility over
the fall risks for older people. The collection of the information
brings into account by taking the opinions and preferable
choices of elder people. There was no need to take consent from
them, as no risks to confidentiality breaching were there under
research. The eligibility criteria are based on the inclusion and
exclusion criteria. Under inclusion, peer-reviewed articles are
selected to address the issues and prevention of falls among
adults. However, in the exclusion criteria, the papers that do not
support fall prevention strategies for older people are excluded
from the study (Riazi et al., 2017).
Evaluation of the literature
Fall incidences are very common as well as devastating
complications that can arise during a radiology diagnostic
procedure. These incidences are high among older people at an
outpatient radiology clinic. Hence, the topic is basically focused
on bringing change against falling incidences and preventing
falls in an outpatient radiology clinic.

6. Patient fall is a common problem observed in healthcare
organizations. This has become a leading factor for disability
and morbidity. Patient falls result in several injuries and also
develop a risk of death (Bhasin et al., 2020). Changing clothes
in outpatient radiology clinics and imbalances may cause falls
and the unavailability of healthcare staff can result in falls and
fall injuries. An intervention has been developed to save elderly
people from falling while changing their clothes. Push button
alarm in the clinical setting has supported many patients and it
has also provided assistance for balancing (Kandakoglu et al.,
2020). The push-button alarm system has been useful in
improvement in the overall health of patients. This has been a
very effective way of dealing with clinical issues in no time and
in decreasing clinical risks. Changing clothes is a basic
requirement for radiology diagnostic procedures. The
application of push-button alarm systems in dressing rooms in
outpatient radiology clinics will help patients while changing to
approved MRI-safe hospital gowns.
(Please see Literature Evaluation Table)
Applicable change or nursing theory utilized.
Changes bring a multitude of different reactions to different
individuals. Change may have two sides – the positive which
brings forth advancement to the person, to an organization, or
community; the negative brings downsizing, changes in routine,
and sometimes an uproar among employees. There are multiple
change theories that can be used. For my change proposal,
Lewin’s Theory of Planned Change Theory will be applied.
Lewin’s Theory of Planned Change has three stages: unfreezing,
change, and refreezing. Unfreezing is the first stage, which
involves the process of finding a method to assist individuals in
letting go of an old pattern of behavior and facilitating
individuals in overcoming resistance and group conformity
(Kritsonis, 2005). The second stage is change which involves
the process of a change in thoughts, feelings, and/or behaviors
(Udod and Wagner, 2018). The third stage involves establishing
the change as a new habit (Udod and Wagner, 2018).

7. Lewin’s three-step change theory can be applied to a change
proposal project. This change theory is more rational and
realistic due to the linearity of the theory. The driving factor in
my project is the prevention of falls. Education about falls
brought about by the decreased mobility and age of the elderly
population and making safety a priority is the unfreezing stage.
The second stage is patients having the awareness of fall
prevention and fall safety. The third stage would be patients and
staff have established the standard of patient safety and fall
prevention when having testing and procedures in the outpatient
radiology clinic. The continual realization of the change
proposal is supported by reeducating and encouraging the nurses
to adopt the proposed evidence-based practice for fall
prevention.
Proposed implementation plan with outcome measures
Nurses are an essential part of a healthcare organization.
Creating a strategic plan for a capstone change proposal permits
nurses to effectively use their unique nursing skills. A strategic
plan will define how to improve patient safety and quality of
care. This may include multiple stages to work toward a single
goal which is fall prevention. Centers for Disease Control and
Prevention recommends frequent assessments to help identify
patients who are at high risk for falls.
Strategies:
· The chief strategy in the nursing practice interventions that
will be implemented is screening patients for falls. All patients
will be screened upon check-in for their scheduled outpatient
radiology diagnostic testing. Assessment and proper monitoring
will assist to recognize patients as high risk for falls.
· Integrating trained and efficient patient care technicians to
provide assistance for patients as needed.
· Educating elderly adults about fall prevention and the factors
of falls is another key strategy to be implemented.
· Providing a safe environment such as clean non-slippery
floors, and handrails in hallways, bathrooms, and dressing
rooms.

8. Measurable Outcomes:
1. Develop a fall guideline questionnaire or screening questions
for ages 60 and above.
Rationale: An assessment tool to help detect at-risk fall
patients. Help educate patients on key factors and external or
environmental factors that cause falls. Approaches to prevent
falls and decrease injury. 2. Placement of push button alarms in
high-risk areas of falls such as bathrooms and dressing rooms
will prevent or decrease the incidence of falls. Rationale:
Having a tool near you for safety like a push button alarm will
alert healthcare workers of patient needs. The push button alarm
is a safety net that would prevent the incidence of falls and
other injuries. 3. Having an extra staff like a patient care
technician (PCT) would be a positive effect on elderly patients.
Rationale: The availability of a PCT would be a big help for
elderly patients that come to the outpatient radiology clinic
alone. There is a percentage of older adults with no companion
or family members with them that come for radiology diagnostic
testing. Having a PCT or extra staff would be beneficial for
these patients for safety and decrease the incidence of falls.
Discussion of how evidence-based practice was used in creating
the intervention plan
Under the interventions, nurses can choose the standard risk
assessment and implicate the appropriate prevention strategies.
Under the risk assessment plan, they need to assess the
following interventions such as:
· Maintaining mobility and agility of patients
· Helping outpatients change from their own clothes to the
approved hospital gowns with the assistance of a patient care
technician (PCT)
· Improving the check-in process by incorporating fall
questionnaires and assessments for patients in the outpatient

9. radiology clinic
· The placement of push-button alarms must be accessible to
patients in the outpatient radiology clinic, especially when they
are in the dressing room while changing
· The need to educate patients on the dangers of falls, especially
in unmonitored settings
Nurses can incorporate evidence-based practice to minimize the
negative impact of environmental and cultural perspectives that
way outpatients can feel comfortable and be aware of falls in
outpatient settings. Technical interventions and clinical-based
interventions can be applied and utilized. Technicians doing the
radiologic testing must remember to adjust procedure table
height according to patient height – not too low nor too high,
proper lighting, and call light if assistance is needed.
Environmental measures, such as non-slippery floors in
hallways and in radiology rooms. Patients having outpatient
radiology procedures can be at a higher risk because of
unmonitored settings. These patients need monitoring so that
fall injuries can be prevented among the elder people (Barker et
al., 2019). The push-button alarms for the outpatient radiology
clinic should be applicable to all outpatients and educate them
about fall prevention. A sole nurse should not be responsible for
intervention, but the whole team should be involved (Guerbaai
et al., 2022).
Plan for evaluating the proposed nursing intervention
Tai chi (functional mobility with gentle exercise) is one of the
specific strategies, which is used in many countries to implicate
in health centers and clinics to prevent falls among adults
(Huang et al., 2020). Tai chi is a type of functional exercise,
which can be provided to patients who have crossed 60 years
and admit frequently to hospitals. Under this technique, mind-
to-body exercise is carried with slow movement to make the
muscles active and strengthen to move. This type of
intervention also includes gentle massage and improving
postural balance. Slow exercises are highly effective for the
management of the condition and improve the functional

10. capacity of older people. The systematic review and meta-
analysis of Huang et al. (2020) have found that Tai Chi
improves the rates of fall prevention by 31% (Nyman, 2020).
Concerning the different demands of the patients, not all the
strategies can fit in an intervention, as the needs of the patients
differ according to their requirements, circumstances, and
situations. yoga, meditations, and appropriate diet. The diet is
enriched in vitamins such as vitamin D. The evaluation of a
nursing care plan for improving fall intervention in older
patients is done using the appraisal tool, named “fall risk
factors”.
Identification of potential barriers to plan implementation, and a
discussion of how these could be overcome
The potential patients' self-imposed barriers that inhibit them to
undergo effective care plans include:
· Patients may not be confident about how to relate the
precautions with fall prevention strategies
· Older people who are restricted to their beliefs may not
support massage and other logistical support.
· Sedentary behavior, lower self-efficacy, stigmatization, denial
of risks, and failures of availability of adequate nurse staff to
provide critical care support to patients are some of the specific
barriers that can encounter major fall risks, which may impact
patients’ health outcomes (Edminster et al., 2021).
Thus, in order to overcome these issues, the incorporation of the
tai chi program into the U.S. National Institute of Health’s
National Centre has resulted in a significant improvement in the
health of older people, by improving the risks of falls,
flexibility, coordination, muscle strength, and physical
condition. Also, intervention suggested that Tai chi had a
positive impact on the economy of the U.S. by reducing falls
among patients who had Parkinson’s disease, vestibular
rehabilitation, cognitive impairment, dementia, and
osteoarthritis (Chen et al., 2022).
REFINE (Reducing Falls in In-patient Elderly) is one of the
trusted techniques to assess the health and life quality of older

11. people. Under this technique, their bedside sensor ring
(telecare) tends to monitor all the healthy activities of patients
and provide them with benefits to utilize in the future use (Vass
et al., 2009).
Conclusion
The inclusion of various strategies and implementation of
practices need to be incorporated to reduce the incidence of
falls among older people, such as the inclusion of gait, balance,
Tai chi, functional training, and vitamin D supplements. Nurses
and radiology staff should also focus on fall education as well
as on determining high-risk fall patients by including a fall
questionnaire at the check-in of patients. Environmentally
appropriate lighting in rooms and bathrooms and hallways and
having handrails to assist patients for extra stability. The
placement of push alarm buttons strategically will allow
patients to be able to seek help when needed. The proposed
extra staff for patients such as patient care technicians (PCT) is
part of the intervention that will be able to prevent falls or fall
injuries. Along with these interventions, nurses should
encourage and maintain the mobility and agility of elderly
patients, so that their muscles do not stiffen to perform any
activities. A patient care provider (or technician) should also
monitor patients’ activities while they are changing or dressing,
or walking to the bathroom without support. Continuous
assessment and monitoring of patients while in the outpatient
radiology clinic may prevent falls. Being vigilant with our
elderly patients about fall prevention, being safe, and
heightened awareness of their personal routines may help
decrease falls.

12. An appendix section, for evaluation tools and educational
materials, etc.
https://www.cdc.gov/steadi/pdf/STEADI-fall-risk-factors-
checklist-print.pdf
Reference
Anugwom, O. (2021). Effective Implementation of Hourly
Rounding Using the 4Ps Reduces the Fall Rate among Older
Adults 65 Years and Older in a Skilled Nursing Facility
(Doctoral dissertation, University of Massachusetts
Global).https://search.proquest.com/openview/a6dda1793a0abc5
73bbaabff878a5296/1?pq-origsite=gscholar&cbl=18750&diss=y
Barker, A., Cameron, P., Flicker, L., Arendts, G., Brand, C.,
Etherton-Beer, C., & Hill, K., (2019). Evaluation of RESPOND,
a patient-centered program to prevent falls in older people
presenting to the emergency department with a fall: A
randomized controlled trial. PLoSMedicine, 16(5).
https://journals.plos.org/plosmedicine/article?id=10.1371/journa
l.pmed.1002807
Bhasin, S., Gill, T. M., Reuben, D. B., Latham, N. K., Ganz, D.
A., Greene, E. J., & Peduzzi, P. (2020). A randomized trial of a
multifactorial strategy to prevent serious fall injuries. New
England journal of medicine, 383(2), 129-140.

13. https://www.nejm.org/doi/full/10.1056/NEJMoa2002183
Chen, J., Xue, X., Xu, J., Zeng, J., & Xu, F., (2022). Emerging
trends and hotspots in tai chi fall prevention: analysis and
visualization. International Journal of Environmental Research
and Public Health, 19(14), 8326.
https://www.mdpi.com/1715824
Edminster, B. S. N., CFRN, T., & CEN, N. B., (2021).
Community-Dwelling Older Adult Fall Prevention Improvement
Project. https://repository.usfca.edu/capstone/1360/
Guerbaai, R. A., Kressig, R. W., Zeller, A., Tröger, M., Nickel,
C. H., Benkert, B., & INTERCARE Research Group., (2022).
Identifying appropriate nursing home resources to reduce fall-
related emergency department transfers. Journal of the
AmericanMedicalDirectorsAssociation.
https://www.sciencedirect.com/science/article/pii/S1525861022
001037
Huang, Y., Wu, C., Peng, H., Chen, Q., Fan, X., Xiao, L., ... &
Wan, L. (2020). The correlation between fall prevention
knowledge and behavior in stroke outpatients. Journal of
neuroscience nursing, 52(2), 61-
65.https://journals.lww.com/jnnonline/FullText/2020/04000/The
_Correlation_Between_Fall_Prevention_Knowledge.6.aspx
Kandakoglu, A., Sauré, A., Michalowski, W., Aquino, M.,
Graham, J., & McCormick, B. (2020). A decision support
system for home dialysis visit scheduling and nurse routing.
Decision Support Systems, 130, 113224.
https://www.sciencedirect.com/science/article/pii/S0167923619
302532
Kritsonis, A.(2005). Comparison of change theories.
International Journal of Scholarly and Academic Intellectual
Diversity, 8(1): 1-7.
Li, F., Harmer, P., Fitzgerald, K., Eckstrom, E., Akers, L.,
Chou, L. S., ... & Winters-Stone, K. (2018). Effectiveness of a
therapeutic Tai Ji Quan intervention vs a multimodal exercise
intervention to prevent falls among older adults at high risk of

14. falling: a randomized clinical trial. JAMA Internal Medicine,
178(10), 1301-
1310.https://jamanetwork.com/journals/jamainternalmedicine/ar
ticle-abstract/2701631
Laukhuf, G. (2020). Patient Falls in Radiology. In Advanced
Practice and Leadership in Radiology Nursing (pp. 205-212).
Springer, Cham. https://link.springer.com/chapter/10.1007/978-
3-030-32679-1_18
Nyman, S. R., (2020). Tai Chi for the prevention of falls among
older adults: A critical analysis of the evidence. Journal of
Aging and Physical Activity, 29(2), 343-352.
https://journals.humankinetics.com/view/journals/japa/29/2/arti
cle-p343.xml
Riazi, A. M., (2017). Mixed methods research in language
teaching and learning. Equinox Publishing.
https://researchers.mq.edu.au/en/publications/mixed-methods-
research-in-language-teaching-and-learning
Udod, S.A., and Wagner, J. (2018). Common Change Theories
and Application to Different Nursing Situations. Retrieved from
https://leadershipandinfluencingchangeinnursing.pressbooks.co
m/chapter/chapter-9-common-change-theories-and-application-
to-different-nursing-situations/
Vass, C. D., Sahota, O., Drummond, A., Kendrick, D., Gladman,
J., Sach, T., & Grainge, M., (2009). REFINE (Reducing Falls in
In-patient Elderly)-a randomised controlled trial. Trials, 10(1),
1-9. https://link.springer.com/article/10.1186/1745-6215-10-83
image1.png