Let’s develop a theoretical framework for a change project aimed at reducing patient falls on a medical-surgical unit.

Theoretical Framework:

This change project will utilize a combined theoretical framework drawing upon two relevant theories:

1. The Theory of Planned Behavior (TPB): This theory, developed by Ajzen (1991), posits that an individual’s intention to perform a behavior is the most proximal determinant of that behavior. Intention is influenced by attitudes toward the behavior, subjective norms (perceived social pressure), and perceived behavioral control (belief in one’s ability to perform the behavior). TPB is relevant because it provides a framework for understanding the factors that influence nurses’ adherence to fall prevention protocols.

2. Donabedian’s Structure-Process-Outcome (SPO) Model: This model (Donabedian, 1966) is a widely used framework for evaluating healthcare quality. It emphasizes the interconnectedness of structure (resources and organizational characteristics), process (activities and interventions), and outcomes (results of care). The SPO model is applicable as it provides a framework for assessing the impact of a fall prevention intervention on patient outcomes.

Process and Logic of Theory Selection:

These theories were chosen because they offer complementary perspectives on behavior change and healthcare quality improvement. TPB provides a framework for understanding the individual and social factors influencing nurses’ behavior related to fall prevention, while the SPO model provides a framework for evaluating the impact of a fall prevention program on patient outcomes.

Application of Theories to the Project:

• TPB: This theory will guide the development of interventions aimed at improving nurses’ attitudes toward fall prevention, strengthening subjective norms (e.g., through peer education), and enhancing perceived behavioral control (e.g., by providing training and resources).
• SPO Model: This model will be used to evaluate the impact of the fall prevention program by assessing changes in the unit’s structure (e.g., availability of fall prevention equipment), process (e.g., adherence to fall prevention protocols), and outcomes (e.g., number of patient falls).

Framework Guiding the Study:

The framework guiding this study is a combination of TPB and the SPO model, visualized as follows:

                                    Structure (Resources, Unit Culture)
                                            ^
                                            |
                                            |
                                            v
Personal Factors <----------------------------> Process (Fall Prevention Practices)
(Attitudes, Subjective Norms, Perceived        (Adherence to protocols, use of equipment)
Behavioral Control)                               ^
                                                    |
                                                    |
                                                    v
                                            Outcomes (Patient Falls)

Assumptions of the Framework:

• Nurses’ adherence to fall prevention protocols can be improved through targeted interventions.
• Changes in nurses’ attitudes, subjective norms, and perceived behavioral control will influence their fall prevention practices.
• Improving fall prevention practices will lead to a reduction in patient falls.

Key Components of the Framework:

• Personal Factors (TPB): Nurses’ attitudes toward fall prevention, perceived social pressure to engage in fall prevention practices, belief in their ability to effectively prevent falls.
• Process (SPO): Nurses’ adherence to fall prevention protocols (e.g., risk assessment, environmental safety checks, patient education), appropriate use of fall prevention equipment.
• Structure (SPO): Availability of fall prevention resources (e.g., equipment, staff training), unit culture related to patient safety.
• Outcomes (SPO): Number of patient falls, fall-related injuries, cost of fall-related care.

Application of Elements to the Phenomenon:

• Personal factors: Influence nurses’ motivation to engage in fall prevention practices.
• Process: Represents the direct target of the intervention and the mechanism through which falls are reduced.
• Structure: Provides the context and resources that support or hinder fall prevention efforts.
• Outcomes: Are the ultimate measure of the intervention’s effectiveness.

Applying Theory to Elements:

• TPB: Interventions will target attitudes through education and awareness campaigns, subjective norms through peer education and leadership support, and perceived behavioral control through training and provision of resources.
• SPO Model: Changes in structure (e.g., new equipment) and process (e.g., improved adherence to protocols) are expected to lead to positive changes in outcomes (reduction in falls).

Rationale for Sample Selection Criteria:

The sample will consist of registered nurses working on a medical-surgical unit with a high rate of patient falls. This population is chosen because they are directly involved in patient care and are the target of the intervention.

Pertinent Research Using the Framework:

Research on fall prevention in hospitals often utilizes elements of TPB and the SPO model. Studies have shown that interventions targeting nurses’ attitudes and beliefs can improve adherence to fall prevention protocols (e.g., [cite a relevant study]). Research on the impact of fall prevention programs on patient outcomes also aligns with the SPO model (e.g., [cite another relevant study]). A critical analysis of this research will be included in the project.