Running head: LEARNING PLAN 1: SAFETY IN PARKINSONS DISEASE 1

Learning Plan: Safety in Parkinsons Disease

Rosette Lenon

Ryerson, George-Brown, Centennial Collaborative Nursing Degree Program

Patricia Hynes

February 6, 2017
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Learning Plan: Part 1

Student Name: Rosette Lenon
Faculty Advisor: Patricia Hynes
Clinical Placement: Belmont House Long Term Care Centre
407 Theme & Brief Rationale:

The 407 theme relevant to this learning plan is the challenges and trends in patient safety.

Long term care facilities are designed to assist dependent individuals in their activities of

daily living however the heavy workload, tight budget, and low levels of communication in

the LTC environment contribute to compromised safety of the residents (Halligan, Zecevic,

Kothari, Salmoni & Orchard, 2014). I plan to develop my ability in ensuring that my practice

promotes safety in residents. I plan to focus on falls management and prevention of

aspirations residents with PD these are the major risks for this population.
Overarching Goal & Brief Rationale:

To promote patient safety to residents with Parkinsons disease in long-term care setting with

a focus on falls prevention, and prevention of aspiration by March 07, 2017.

My current placement is composed of residents diagnosed with Parkinsons disease.

They are at a greater risk for falls, and dysphagia due to clinical manifestations of slow

movement, rigidity, tremors and unstable posture (Parkinson Society Canada, 2012). I chose

to focus on falls prevention because it is highlighted as the most common complication that

can impair a residents safety and lead to fractures, disabilities and reduced quality of life

(Snijders, Nonnekes, & Bloem 2010). Residents diagnosed with PD are at the advanced stage

of their disease process, and their wellbeing is highly dependent on the quality of the care

provided by PSWs and RNs care. It is important for nurses in unit and for my practice to

promote safety by recognizing the risks for falls, and knowing how to intervene appropriately.

This is important for my learning as I would like to apply my knowledge in advocating for
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safety through implementing the appropriate falls prevention strategies to these residents.

My rationale for focusing on preventing aspirations is that residents with PD have

motor abnormalities, resulting in the inability to swallow (Parkinson Society Canada, 2012).

Nurses are responsible for quickly identify patients at risk for dysphagia, and have the tools

and processes to assess and implement safety procedures. (Campbell, Carter, Kring &

Martinez, 2016). A speech language pathologist is not always on site, and I would like to be

able to comprehensively assess and implement safety in managing dysphagia. This will help

in my nursing practice because I will be actively assessing and implementing evidence-based

research on dysphagia management in my practice to ensure safety in the residents everyday

lives.
Relevant Practice Documents from the College of Nurses:

An ongoing comprehensive assessment focuses on the nurse using a client-focused

assessment to identify determinants of health and client input (College of Nurses in Ontario

(CNO), 2009). This aspect will be incorporated on my learning plan as I will be monitoring

and assessing residents with PD monthly or as need to ensure that the interventions to prevent

falls and aspirations in place are relevant and appropriate in promoting safety.

Collaborating with the health care is an aspect of competent application of knowledge

(CNO, 2002). This will be a key aspect of my learning plan as I plan to educate and

collaborate with the personal support workers on how to assess for head injuries, as they are

the first and most frequent contact to the residents. They are also a great resource for gaining

knowledge on behaviors, and conditions that may impact their safety in this setting. I will be

able to gain knowledge in all aspect of their care to assess their needs and can promote safety

in their care.

In the long-term care setting, the standard of leadership is indicated by advocating

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for clients and collaborating with health care team to respect the rights of clients (CNO, 2002)

Advocating for the safety of residents with PD exemplify this standard as I am ensuring that

the health care team is knowledgeable on how to promote safety, and that all measures are

taken to prevent adverse events such as falls and aspirations.

Sub-goal 1:

I will develop my ability to apply falls prevention strategies on residents with PD

by creating a chart that include the components of: listing residents at risk for falls (initials),

applying the Morse falls scale, and appropriate falls prevention interventions such as side

rails, assistive devices, and medication adherence, as well develop an in-service to PSWs on

the unit about head injury routine by March 07, 2017.

In the long-term care setting, residents with PD are highly dependent on the nursing

staff to promote a safe environment. Over 70% of residents with PD who have already fallen,

experience a recurrent fall (Allen, Schwarzel, & Canning, 2013). With this finding, the first

activity is to develop a chart of all residents initials with PD including their history of falls,

and apply the Morse Falls Scale on their ability. This will allow me to focus on these

residents as they are recognized as a greater risk for recurrent falls. I plan to also develop

further knowledge on current falls prevention because an article by Danielsson, Nilsen, Ohrn,

Rutberg, Fock & Carlfjord, 2014) states that lack of knowledge and education of registered

staff within nursing homes compromises the safety of the residents. This chart allows me to

apply falls prevention strategies that meet the specific needs of residents with PD, and

achieve my goal of promoting patient safety. It is important that LTC ensures that the falls

prevention strategies are relevant and appropriate for the resident, as PD may deteriorate their

condition over time. Planning to re-assess and review the chart monthly or when adverse

events occur promote an ongoing assessment of their safety in the nursing home.
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Creating a culture of safety requires all members of the health care team to have

the knowledge and education to safely care for a patient (Daniellson et a.l., 2014). Teaching is

an important aspect of the role of an RN regarding their relationship with UAPs. This role

allows me to initiate communication between professions and educate UAPs on safety

regarding falls. Promoting inter-professional teamwork and evidence-based practice, nurses

can initiate collaboration and is known to lead to improved patient outcomes. (Lasater,

Cotrell, McKenzie, Simonson, Morgove, Long & Eckstrom, 2016). Educating PSWs on

knowledge on the head injury routine is beneficial for the unit because they are often the ones

who witness a fall, and can act appropriately on a suspected brain injury. This will enhance

my learning as I am actively developing skills in proving education, collaborate with the team

and apply leadership skills through teaching UAPs.

Activity 1:

Develop a chart on falls management strategies that include the residents with PD and

application of the Morse Falls Scale. Provide rationale to specific intervention to prevent falls

and document its effectivity. I will apply falls prevention strategies in consultation with my

preceptor if needed. The chart will be reviewed monthly or a change in condition to evaluate

effectiveness of falls prevention. Prevention of Falls and Fall Injuries in Older Adults (2002)

will be used.
Activity 2:

Conduct an in-service to PSWs on the floor about the head injury routine assessment when

they witness a fall.

Sub-goal 2:

I want to further develop my ability to promote patient safety by preventing

aspiration/choking to residents with PD by creating a concept map on assessment of

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swallowing abilities, and differentiating interventions for safe swallowing (i.e. EMST,

thickened fluids, assisted devices) and promote inter-professional collaboration by journaling

my participation in a residents family meeting to present my findings on the residents safety

regarding eating by March 07, 2017.

Nurses need to be aware of residents with dementia or a neuromuscular disorder

such as PD due to their increased risks for aspirations (Troche, Okun, Rosenbek, Altmann &

Sapienza, 2014). Safety can be promoted by assessing and monitoring residents with PD for

aspirations. My first activity will be developing a concept map on how to assess swallowing

abilities in residents, differentiating feeding options in patients with Parkinsons and

interventions to prevent aspirations. By differentiating these interventions, I will be able to

apply evidence-based research into my practice. Feeding is an essential component of

providing care; applying this knowledge into my practice is beneficial to my learning because

it is transferrable to every patient I encounter. I will be able to understand the importance of

eating, and can promote safety in my nursing practice.

My second activity will complement my sub-goal as it is promoting inter-

professional collaboration and communication with the residents/family regarding safe eating

practices. I will journal my experience of communicating to the family and the heath care

team about the residents feeding practices. Effective communication and dissemination

between members of the health care team is recommended to prevent the negative outcomes

of dysphagia such as malnutrition, and aspiration pneumonia (Tanner & Culbertson, 2014).

This shows that an inter-professional approach has a direct impact on the residents well-

being. For my own learning, it will be beneficial to have skills in communicating the family

and use an inter-professional approach as it allows for better quality care for the resident.
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Activity 1:

Create a concept map differentiatinginterventionstofeedingandpreventionofaspirationsto

feedingoptionsinpatientswithParkinsons.Assistwithfeedingonceaweektopromotesafe

swallowingpractices.ThearticleNursinginterventionsforidentifyingandmanagingacute

dysphagiaareeffectiveforimprovingpatientoutcomes:Asystematicreviewupdate(2016)

willused.
Activity 2:

Journal my experience in participating in a family meeting and report my findings on the

residents safe eating practices. Record any challenges and plan to improve communication

and integration into team meetings.

Summary of Activities:

I am now assessing the residents using the Morse Falls Scale and reviewing the RNAO

guidelines for falls prevention. For sub goal two, I am currently communicating with PSWs

on how they feed and I am starting to create the concept map and identify the importance of

EMST.

References

Allen, N. E., Schwarzel, A. K., & Canning, C. G. (2013). Recurrent falls in parkinson's disease:

A systematic review. Parkinson's Disease, 2013, 1-16. doi:10.1155/2013/906274

Campbell, G. B., Carter, T., Kring, D., & Martinez, C. (2016). Nursing bedside dysphagia

screen: is it valid? Journal of Neuroscience Nursing, 48(2). Retrieved from

http://go.galegroup.com.ezproxy.lib.ryerson.ca/ps/i.do?p=AONE&sw=w&u=rpu_main&
LEARNING PLAN 1: SAFETY IN PARKINSONS DISEASE 8

v=2.1&it=r&id=GALE%7CA449418137&sid=summon&asid=2590c5f6141b05859f4bb

e7a640864a1

Canning, C. G., Paul, S. S., & Nieuwboer, A. (2014). Prevention of falls in parkinson's disease:

A review of fall risk factors and the role of physical interventions. Neurodegenerative

Disease Management, 4(3), 203-221. doi:http://dx.doi.org/10.2217/nmt.14.22

College of Nurses in Ontario (2009). Competencies for entry-level registered nurse practice.

Toronto, ON. Retrieved from

https://www.cno.org/globalassets/docs/reg/41037_entrytopracitic_final.pdf

College of Nurses in Ontario (2002). Professional standards, Revised 2002. Toronto, ON.

Retrieved from http://www.cno.org/globalassets/docs/prac/41006_profstds.pdf

Hines, S., Kynoch, K., & Munday, J. (2016). Nursing interventions for identifying and managing

acute dysphagia are effective for improving patient outcomes: A systematic review

update. The Journal of Neuroscience Nursing : Journal of the American Association of

Neuroscience Nurses, 48(4), 215-223. doi:10.1097/JNN.0000000000000200

Lasater, K., Cotrell, V., McKenzie, G., Simonson, W., Morgove, M. W., Long, E. E., &

Eckstrom, E. (2016). Collaborative falls prevention: Interprofessional team formation,

implementation, and evaluation. The Journal of Continuing Education in

Nursing, 47(12), 545- 550. doi:http://dx.doi.org/10.3928/00220124-20161115-07

Martinez-Ramirez, D., Almeida, L., Giugni, J. C., Ahmed, B., Higuchi, M., Little, C. S., . . .

Okun, M. S. (2015). Rate of aspiration pneumonia in hospitalized parkinson's disease

patients: A cross-sectional study. BMC Neurology, 104(15)

Parkinson Society Canada (2012). Canadian Journal of Neurological Science. 55(4), S1-S36
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Registered Nurses Association of Ontario (2002). Prevention of Falls and Fall Injuries in the

Older Adult. Retrieved from http://rnao.ca/bpg/guidelines/prevention-falls-and-fall-

injuries-older-adult

Snijders, A. H., Nonnekes, J., & Bloem, B. R. (2010). Recent advances in the assessment

treatment of falls in Parkinsons disease. F1000 Medicine Reports, 76(2)

http://doi.org/10.3410/M2-76

Troche, M. S., Okun, M. S., Rosenbek, J. C., Altmann, L. J., & Sapienza, C. M. (2014).

Attentional resource allocation and swallowing safety in parkinson's disease: A dual task

study. Parkinsonism & Related Disorders, 20(4), 439-443.

doi:10.1016/j.parkreldis.2013.12.011