Design, delivery and evaluation of a simulation-based workshop for health professional students on falls prevention in acute care settings

Preventing hospital falls: feasibility of care workforce redesign to optimise patient falls education

OBJECTIVE

To examine the feasibility of using allied health assistants to deliver patient falls prevention education within 48 h after hospital admission.

DESIGN AND SETTING

Feasibility study with hospital patients randomly allocated to usual care or usual care plus additional patient falls prevention education delivered by supervised allied health assistants using an evidence-based scripted conversation and educational pamphlet.

PARTICIPANTS

(i) allied health assistants and (ii) patients admitted to participating hospital wards over a 20-week period.

OUTCOMES

(i) feasibility of allied health assistant delivery of patient education; (ii) hospital falls per 1,000 bed days; (iii) injurious falls; (iv) number of falls requiring transfer to an acute medical facility.

RESULTS

541 patients participated (median age 81 years); 270 control group and 271 experimental group. Allied health assistants (n = 12) delivered scripted education sessions to 254 patients in the experimental group, 97% within 24 h after admission. There were 32 falls in the control group and 22 in the experimental group. The falls rate was 8.07 falls per 1,000 bed days in the control group and 5.69 falls per 1,000 bed days for the experimental group (incidence rate ratio = 0.66 (95% CI 0.32, 1.36; P = 0.26)). There were 2.02 injurious falls per 1,000 bed days for the control group and 1.03 for the experimental group. Nine falls (7 control, 2 experimental) required transfer to an acute facility. No adverse events were attributable to the experimental group intervention.

CONCLUSIONS

It is feasible and of benefit to supplement usual care with patient education delivered by allied health assistants.

An appropriate simulation-based training for surgical technology students

BACKGROUND

Using simulation in an appropriate education plan which has always been challenging; To be used alone or in combination with other methods and the order of it's use. This article was intended to compare student's knowledge, clinical skill and readiness-capability using simulation and combination of it with traditional training methods to collect necessary evidence for development of an appropriate simulation- based educational plan for surgical technology students.

METHODS

This is a controlled pre/post-test quasi-experimental study in 2019. All surgical technology students who had selected the scrub and circulate course (n = 28) were randomly divided into two groups. One of the groups was educated with traditional training method (TTM). On the same day, the other group was educated with simulation training method (STM). After two weeks, group α received simulation training and group β was subject to traditional training. Multiple-Choice Test for Knowledge Assessment and Clinical Skills as well as Readiness-Capability (KCSRC) of appendectomy Surgery checklist were used in this study. Data were analysed after each training method, after Two weeks and after blended education.For data analysis, Mixed-Design ANOVA and SPSS software 24/v were employed.

RESULTS

The mean scores of knowledge, clinical skills, and readiness-capability were 14.2 ± 2.91, 44.42 ± 17.74, 21.58 ± 4.18 in group α and 12.66 ± 3.21, 41.17 ± 16.19, and 18.58 ± 7.85 in group β, respectively. The comparison between mean scores of KCSRC before the first training and after combined training in each group showed that the mean of all scores significantly increased in group α (p < 0.0001), which indicates that the education plan starting with TTM and continued with STM has the most significant effect on results.

CONCLUSION

According to the results of the study, it seems that starting the education plan for surgical students with TTM and then continuing with STM would be more effective on education of students, especially on students' long term learning.

Implementing Patient Falls Education in Hospitals: A Mixed-Methods Trial

Patient education is key to preventing hospital falls yet is inconsistently implemented by health professionals. A mixed methods study was conducted involving a ward-based evaluation of patients receiving education from health professionals using a scripted conversation guide with a falls prevention brochure, followed by semi-structured qualitative interviews with a purposive sample of health professionals involved in delivering the intervention. Over five weeks, 37 patients consented to surveys (intervention n = 27; control n = 10). The quantitative evaluation showed that falls prevention education was not systematically implemented in the trial ward. Seven individual interviews were conducted with health professionals to understand the reasons why implementation failed. Perceived barriers included time constraints, limited interprofessional collaboration, and a lack of staff input into designing the research project and patient interventions. Perceived enablers included support from senior staff, consistent reinforcement of falls education by health professionals, and fostering patient empowerment and engagement. Recommended strategies to enhance implementation included ensuring processes were in place supporting health professional accountability, the inclusion of stakeholder input in designing the falls intervention and implementation processes, as well as leadership engagement in falls prevention education. Although health professionals play a key role in delivering evidence-based falls prevention education in hospitals, implementation can be compromised by staff capacity, capability, and opportunities for co-design with patients and researchers. Organisational buy-in to practice change facilitates the implementation of evidence-based falls prevention activities.

Healthcare professional perspectives on barriers and enablers to falls prevention education: A qualitative study

In hospitals, patient falls prevention education is frequently delivered by nurses and allied health professionals. Hospital falls rates remain high globally, despite the many systems and approaches that attempt to mitigate falling. The aim of this study was to investigate health professional views on the enablers and barriers to providing patient falls education in hospitals. Four focus groups with 23 nursing and allied health professionals were conducted at 3 hospitals. Three researchers independently coded the data and findings were analysed thematically with a descriptive qualitative approach to identify and develop themes according to barriers and enablers. Barriers included (i) limited interprofessional communication about patient falls; (ii) sub-optimal systems for falls education for patients and health professionals, and (iii) perceived patient-related barriers to falls education. Enablers to providing patient falls education included: (i) implementing strategies to increase patient empowerment; (ii) ensuring that health professionals had access to effective modes of patient education; and (iii) facilitating interprofessional collaboration. Health professionals identified the need to overcome organisational, patient and clinician-related barriers to falls education. Fostering collective responsibility amongst health professionals for evidence-based falls prevention was also highlighted.

Using Patient Simulation to Promote Best Practices in Fall Prevention and Postfall Assessment in Nursing Homes

BACKGROUND

Fall-related injuries rise with age and are of particular concern for frail populations living in nursing homes.

LOCAL PROBLEM

The Perley and Rideau Veterans' Health Centre is a large nursing home in Ontario, Canada. In 2019, we conducted internal audits of our Falls Prevention Program and identified notable variations in staff's response to a resident fall.

INTERVENTIONS

We developed an in situ patient simulation program of a resident fall.

METHODS

This was a mixed-methods evaluation of participants' perspectives of a simulation-based interprofessional education program for fall prevention.

RESULTS

Participants indicated high-level support for simulation-based learning, with more than 80% of the participants expressing that they will apply these skills in the future when caring for a resident who falls.

CONCLUSIONS

Our findings indicate that simulation-based training is well received by frontline workers in a nursing home setting and can be conducted as part of a typical shift with minimal disruption to resident care.

Motivation: bringing up the rear in nursing education. Motivational elements in simulation. The participants' perspective

BACKGROUND

Motivation is a fundamental element of human behavior and learning. We believe that this aspect has not been sufficiently addressed in the field of simulation-based learning in nursing.

PURPOSE

The aim of this study was to explore the views and perspectives of students involved in simulation-based learning related to their process of motivation. Also, to identify the motivational elements they perceived, as well as the aspects that could reduce their motivation in the simulation sessions.

METHODS

A qualitative study was conducted based on content analysis from 7 focus groups composed of simulation students (n = 101).

RESULTS

The study obtained 26 subcategories, 10 categories, and 2 emerging themes (in total, 17 motivational elements and 7 demotivational elements).

CONCLUSION

The motivational elements were related with the non-directive/imposing style of the facilitator, the adequate structure and planning of the sessions, the possibility of transferring what was learned to the real world, and especially the atmosphere created in the simulation session. The main demotivational elements were directed simulation, an uncomfortable environment, and the planning and structure of the sessions (with an excessive theoretical content or with stringent evaluations).

Hospital falls prevention with patient education: a scoping review

BACKGROUND

Hospital falls remain a frequent and debilitating problem worldwide. Most hospital falls prevention strategies have targeted clinician education, environmental modifications, assistive devices, hospital systems and medication reviews. The role that patients can play in preventing falls whilst in hospital has received less attention. This critical review scopes patient falls education interventions for hospitals. The quality of the educational designs under-pinning patient falls education programmes was also evaluated. The outcomes of patient-centred falls prevention programs were considered for a range of hospital settings and diagnoses.

METHODS

The Arksey and O'Malley (2005) framework for scoping reviews was adapted using Joanna Briggs Institute and PRISMA-ScR guidelines. Eight databases, including grey literature, were searched from January 2008 until February 2020. Two reviewers independently screened the articles and data were extracted and summarised thematically. The quality of falls prevention education programs for patients was also appraised using a modified quality metric tool.

RESULTS

Forty-three articles were included in the final analysis. The interventions included: (i) direct face-to-face patient education about falls risks and mitigation; (ii) educational tools; (iii) patient-focussed consumer materials such as pamphlets, brochures and handouts; and (iv) hospital systems, policies and procedures to assist patients to prevent falls. The included studies assessed falls or education related outcomes before and after patient falls prevention education. Few studies reported incorporating education design principles or educational theories. When reported, most educational programs were of low to moderate quality from an educational design perspective.

CONCLUSIONS

There is emerging evidence that hospital falls prevention interventions that incorporate patient education can reduce falls and associated injuries such as bruising, lacerations or fractures. The design, mode of delivery and quality of educational design influence outcomes. Well-designed education programs can improve knowledge and self-perception of risk, empowering patients to reduce their risk of falling whilst in hospital.