Research analysis on Nursing assignment


Ladder Falls
During 2013 ICU Physicians at their weekly meeting made the observation
that falls and specifically falls from ladders were increasing at their hospital.
They also noted that recent patients admitted to ICU with “fall from ladder”
resulted in a number of deaths and severe head injuries.
Unfortunately, no data was available to them on the incidence of ladder falls,
mortality and patient outcomes to support their observation.
A researcher from the National Trauma Research Institute was approached to
undertake a retrospective descriptive study of patients admitted to the Alfred
Hospital following a ladder fall over a five year period.
582 Cases were identified who were admitted to the hospital following a ladder
fall. Among these 58 were admitted to ICU with 15 dying in hospital. The
majority of the cases were men over 50 years of age. Many failed to return to
work or were left with permanent disabilities. Poor patient outcomes were
associated with head injuries and low temperatures on arrival at the hospital.
VicHealth was informed about the results and expressed an interest in
funding a Public Awareness Campaign to reduce Ladder Falls. However, such
a program could not be effectively implemented without fully understanding
why these falls were occurring. Issues such as the patient's job and OHS
training, the condition of the ladder, was the fall witnessed, weather condition,
footwear, and mechanism of injury were put forward as issues that need to be
The researcher also discussed informally the circumstances of the fall with a
number of patients admitted to the hospital following a ladder fall. Anecdotal
feedback was that the majority of falls were in a domestic situation with
around half of the patients having prior OHS training in their workplace.
At this time the hospital identified that falls from ladders were increasing over
the last two years.
You are asked to develop a study that will inform the VicHealth Public
Awareness Campaign to reduce falls from ladders.


1.Project title: Studies to bring awareness to VicHealth Public for the reduction of falls  from ladders


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2a. Plain language statement (To be provided in 100 words or less) 
Falls remain the main source of accidental harm mortality across the nation. Among laborers, around 20% of fall wounds include steps. Among development laborers, an expected 81% of fall wounds treated in the U.S (Socias et al., 2014). Ladder fall injuries represent a substantial public health burden of preventable injuries for workers (Mahdian, 2013). The ladder-related injuries during occupational activities are like the hood is increasing and forcing the victims of hospital admission. Therefore, there is need of awareness of public for the reduction of ladder falls. The objective of the research protocol is to facilitate the public for the awareness of ladder falls.
2b. Keywords (Please provide up to five nursing area keywords related to your application. Suggestions include – aged care, clinical, child and adolescent health, community health, family care, Indigenous health, mental health, midwifery, primary health care or other).
1. Ladder fall        2. Occupational injuries        3. Training
4. Reduction strategies    5. Hospitalization    
3. Institution where project will be carried out (if more than one, indicate the primary institution)
4. Administering institution (full name and address required)
The Alfred Hospital, Melbourne City Centre, Victoria
5.  Has any other funding been sought for this activity?        Yes  0    No  1
If yes, please detail the funding source (name and address of each agency) and the amount requested.
6. Have you or members of the team previously been awarded 
Nurses Board of Victoria Legacy Limited grant or fellowship? Yes   0    No   1 
If yes please state year, name of grant or fellowship, and activity title.
7. Project/Research Plan Outline The project should be completely described. The font must not be smaller than 10 pt. complete this section using the following headings:
a.  Background and significance of the study 
Ladder use is involved in many occupational and non-occupational activities. Falls from ladders can result in serious injury and affect people of all ages. In the United States, falls are the leading cause of unintentional nonfatal injury for all children and adults except for the 15- to 24-year-old cohort, for whom falls from heights are the third leading cause of unintentional nonfatal injury (D'Souza et al., 2007). Falls from ladders in occupational and non-occupational settings are a common cause of major, sometimes fatal, injuries. Ladder-related injury data from occupational and non-occupational studies show that males aged 35 to 55 years are at highest risk for injury (O’Sullivan et al., 2004). The public is at risk for ladder injuries, yet receives little, if any, instruction on ladder use and safety. Non-occupational ladder-related injuries account for one-half to two thirds of injuries from ladder-related falls, even though ladders may not always be necessary for the tasks being performed. It indicates that deviser factors are influencing the ladder related injuries. Therefore, a study is desired to understand the issues of ladder falls and how to prevent them so that the accidental injuries can be minimized.
b.     Research question and Aims and/or hypothesis.
The research question developed is “awareness to VicHealth Public for the reduction of falls from ladders”. The basis for the development of question is available literature pertaining to prevalence, cost, and severity of ladder-related injuries
To bring awareness to the public who resides at VicHealth of all ages treated in emergency departments
To educate the people for the implications of risk towards ladder injuries utilizing visual presentations
To train the public for the possible reduction of risk and minimize the potential of injuries
To evaluate the public for the possible safety precautions
c.    Method with information on the research design
Ladder fall injury cases for this study will be identified and recruited for the study utilizing the available guidelines (D'Souza et al., 2007). Persons who were injured at work and later visited hospital will be enrolled and included in the study. The participants will be divided into groups depending on the type of injury and time of admission into hospital. A series of questions will be asked the participants to know the experiences, attitudes, and opinions within the population of interest. A self?administered questionnaire will be provided to patient to fill their demographics. 
Eligible participants with all ages and resided at VicHealth will be included in the study. The data obtained from the study will be analysed for the significance and to understand the causes leading to the ladder falls
d. Research Process (participants, data collection, data analysis)
Descriptive statistics (frequencies, column percentages, means, and standard error of the mean) will be calculated for demographic, occupational, and injury related variables (eg, age, body part) by type of ladder. Frequencies and percentages will be presented for the variables related to the activity, source, and mechanism of the ladder fall. Unconditional multivariate logistic-regression models will be used to estimate odds ratios and the associated 95% confidence intervals of a work-related fracture as a function of the type of ladder being used. To determine those factors with independent predictive value, the final multivariate model declares statistical significance at a level of 0.05. Interactions will be evaluated for several pairs of variables (eg, ladder type and height) using a hierarchically well-formulated logistic regression model (Kleinbaum, 1994) approach that includes both lower order terms of the two-way higher order interaction. All analysis will be performed using the SAS system version 9.1 (SAS Institute, Inc, Cary, NC, USA).
e. Dissemination of findings
The data will be analysed for the characteristics of workers. The educational background, literacy percentage, occupation and family history will be measured and included in the assessment. The injury characteristics will be recorded. The body part(s) injured from the ladder fall will be distributed across the body; however, among all ladder falls, most frequently injured will be notified for instance, arm, elbow, or shoulder etc. The ladder conditions will be recorded for the possible defects about their characteristics. The possible mechanism will be deduced for the ladder fall. The risk factors will be identified for the fractures. The findings will be presented in the form of figures and tables. A representative finding is shown in Fig-1 (Lombardi et al., 2011)


8. Ethical Considerations


(Consideration must be given to informed consent, confidentiality, potential harm to participants, data storage and security and withdrawal from the study)
The study will be conducted in accordance with the guidelines from local ethical committee and with the signed consent from each participant. The data will be kept confidential and will not be disclosed to third party without approval from the study co-ordinator. As the patients are from diverse sources and with different spiritual behaviour. Respect will be given for the patient values and no disappoint will be made to their values. In addition, respect for the dignity of older people will be given towards human values; autonomy for taking their decisions voluntarily. The considerations should also be extended to the patient caregivers, older people, and their relatives.


9. Budget



S No
Cost ($)
Total Cost
Equipment (this should not exceed $500) and materials
Data Processing
Stationery, duplicating, printing, postage etc.
Accommodation, laboratory facilities, etc.
Administrative costs of Institution
Personnel: The cost incurred towards the charges for the investigators to organize and for the conduct of study. About twenty personnel are required at a cost of $ 100 (20 $ x 5 hours). The remuneration for the patients for the participation is $ 5 per patient and about 600 patients are planning to enrol in the study to get a meaningful of data and have adequate power of the study
Equipment: Study preparation material, computer, printer, accessories and small equipments for the recording and printing of data
Data processing: The data so collected will be processed, analysed by investigator and statistician will perform statistical analysis 
Travel: Expenses towards travelling of investigators from laboratory to hospital and/or residence of patients
Stationary: For the purpose of printing and making, duplicate copies of the data if required
Accommodation: Expenses towards the accommodation for investigators and patients
Administrative cost: Maintenance charges for the administrative staff excluding charges incurred for investigators
Miscellaneous: Charges for housekeeping, laboratory maintenance and refreshment charges


10.    Relevant references to the work of other experts 


Falls remain a main source of accidental harm mortality across the nation and 43% of deadly falls in the last decade (Rockett et al., 2012). Among labourers, roughly 20% of fall wounds include falling from ladders. As a piece of identification, National Institute for Occupational Safety and Health dissected information over numerous observation frameworks (Socias et al., 2014). They used the Census of Fatal Occupational Injuries, the Survey of Occupational Injuries and Illnesses and the National Electronic Injury Surveillance System-word related supplement. Ladder fall injuries speak to a considerable general wellbeing weight of preventable wounds for labourers. Fall is a standout amongst the most widely recognized reasons for significant wounds and in charge of numerous healing facility confirmations in Iran (Mahdian, 2013). Falling may happen at any age, yet kids and the matured individuals are at higher danger for it.  Around 47000 youngsters tumble to their demise yearly, however several thousands more maintain less genuine wounds from a fall. Falls speak to the third driving reason for death in kids and are in charge of 5.9% of adolescence passing because of injury. For the most part, passing because of falls is come about because of head harm. Falls in kids have a tendency to be from patios, tables, windows, and trees, and most regularly tend to happen in homes, trailed by play areas and schoolyards. Non-word related tumbles from steps and frameworks have expanding rate with expanding age. One-fifth of the cases result in hospitalization (Faergemann and Larsen, 2000). Another study demonstrate that the seriousness of damage increments with stature of fall and age. The larger part of information is identified with stepping stool related wounds and is in little example populaces of less than 300 (D'Souza et al., 2007). The wounds incorporate breaks, lead to excessive therapeutic costs and laborer pay claims. Step fall wounds are connected with a wide range of harm examples. In any case, the social insurance expense of these wounds is obscure. O'Sullivan et al., 2004, directed a review observational study on the patients with falling ladder injuries using little number of patients. Lombardi et al., (2011) have directed a take after back investigation of harmed laborers from a broadly illustrative example of US crisis divisions. The examination concentrates on components identified with stepping stool falls in three spaces of the workplace: work gear, work practices, and laborer related elements. The examination uses a progression of survey relating to laborer demographics, harm, stepping stool and work gear and environment attributes, work errands, and exercises.





D'Souza, A.L., Smith, G.A & Trifiletti, L.B (2007) Ladder-related injuries treated in emergency departments in the United States, 1990-2005. Am J Prev Med. 32(5) 413-8 
Faergemann, C & Larsen, L.B (2000). Non-occupational ladder and scaffold fall injuries. Accident Anal Prev. 32(6), 745-50.
Kleinbaum, D.G (1994) Logistic Regression: A Self-Learning Text. New York: Springer Verlag
Lombardi, D.A., Smith, G.S., Courtney, T.K., Brennan, M.J., Kim, J.Y & Perry, M.J (2011) Work-related falls from ladders--a follow-back study of US emergency department cases. Scand J Work Environ Health. 37(6) 525-32. doi: 10.5271/sjweh.3174. 
Mahdian, M. (2013). Fall Injuries: An Important Preventable Cause of Trauma.Archives of Trauma Research, 2(3), 101–102.
O’Sullivan, J., Wakai, A., O’Sullivan, R., Luke, C & Cusack (2004). Ladder fall injuries: patterns and cost of morbidity. Injury. 35, 429–431
Rockett, I.R., Regier, M.D., Kapusta, N.D., et al. (2012) Leading causes of unintentional and intentional injury mortality: United States, 2000–2009. Am J Public Health 102:e84–92.
Socias, C.M., Chaumont, M.C.K., Collins, J.W & Simeonov, P (2014) Centers for Disease Control and Prevention (CDC). Occupational ladder fall injuries-United States,  2011. MMWR Morb Mortal Wkly Rep. 63(16) 341-6

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