Nurses' Perceptions of Recommended Fall Prevention Strategies: A Rapid Review

Health Professional Perceptions of Delivering Hospital Falls Prevention Education-A Qualitative Study

BACKGROUND

Providing patient falls prevention education can help reduce falls in hospitals, yet research exploring staff perceptions about providing falls education in hospitals is limited.

OBJECTIVE

We sought to determine enablers and barriers to implementing a hospital falls prevention education program (the Safe Recovery Program) from the clinical staff perspective.

METHODS

Purposive sampling was used to recruit health professionals (N = 40) from 12 acute medical and surgical wards at a 450-bed hospital in Perth, Western Australia. Participants were given the option to take part in a focus group or semi-structured interview. Data were analyzed via directed content analysis.

RESULTS

Findings were distinguished into 2 themes, being the barriers and enablers to implementing the Safe Recovery Program. Enabler subthemes were the mode and medium of delivering the program, the use of repetition to instill the learnings, identifying who is best to deliver the program, and utilizing the role of informal carers to reinforce the education. Barrier subthemes were patient cognitive impairments and patient illness, patient risk-taking behavior, timing of program delivery according to patient readiness, time and resource shortage, and communication barriers with non-English speaking patients.

CONCLUSION

A comprehensive approach to program delivery can enable health professionals to implement evidence-based falls prevention education in hospitals. Extant factors must be considered during the implementation phase to ensure the Safe Recovery Program is sustainable and to optimize patient uptake of falls prevention education.

The knowledge, attitude, and practice toward fall prevention of parturients in the obstetric inpatient wards: a comparative cross-sectional study between nurses and parturients

Objective

This study aimed to compare the knowledge, attitudes, and practices of parturients and nurses regarding fall prevention among parturients, with the goal of understanding the cognitive factors contributing to post-delivery fall.

Methods

A cross-sectional survey was conducted among obstetric nurses and women in obstetric ward within 2 days after vaginal delivery. The survey instrument included a self-design questionnaire comprising a demographic information sheet and a KAP questionnaire, which demonstrated acceptable reliability and validity.

Results

A total of 705 nurses and 1,220 parturients completed the survey. Over half of both nurses and parturients exhibited reasonably good knowledge, positive attitudes and appropriate practices related to fall prevention. Significant associations were identified between the education level of parturients and their knowledge and attitudes. Nurses scored lower in the attitude dimension compared to parturients (4.32 ± 1.01 vs. 4.84 ± 0.36, P < 0.001), whereas nurses scored higher than parturients in the practice dimension (3.76 ± 0.44 vs. 3.57 ± 0.48, P < 0.001).

Conclusion

Nurses should focus on enhancing the fall practices of parturients by emphasizing key points for fall prevention and providing guidance in situations of improper behaviors (e.g., unaccompanied activities). Further education programs for nurses should prioritize increasing their confidence and proficiency in fall prevention.

Effect of structured nurse-patient conversation on preventing falls among patients in an acute care hospital: A mixed study

Objectives

Inpatient falls are a major patient safety issue in acute care hospitals. Multifactorial in-hospital fall prevention programs have shown reductions in falls and related risks. One common element of successful programs is active patient involvement. This study objective was to explore patients' and nurses' experiences with a structured intervention to foster patient involvement.

Methods

This study was conducted between September 2020 and April 2021 in a university hospital neurological ward. The studied intervention consisted of a falls information leaflet, and a structured nurse-patient conversation about fall risk-reduction activities. Nurses were trained to deliver the intervention and supported throughout the study. Nurses' and patients' experiences regarding personal involvement, satisfaction, and confidence were surveyed and analyzed quantitatively and qualitatively.

Results

Fifty-six patients recruited by ward nurses received the intervention. After receiving the intervention, patients reported high levels of satisfaction with the in-hospital fall prevention conversation. Twenty-one nurses indicated that they would use the leaflet and communication aid. Twenty-one nurses commented on intervention facilitators and barriers. More specific facilitators included their shared perception that "handing out the leaflet to patients was not problematic" and that the leaflet was seen as "applicable in many patient situations." Their comments indicated two particularly prominent barriers to conducting the intervention in clinical practice: 1) "finding the time for the implementation in the daily clinical routine and workload" and 2) "environmental factors like a noisy and busy atmosphere on the ward."

Conclusions

This study provides insights into a patient involvement intervention featuring a structured nurse-patient discussion about fall risks. The accompanying information leaflet and communication guide require adaptations to facilitate sustainable implementation into the hospital's fall prevention program, but proved useful.

Investigating the biomechanics of falls in older adults in long-term care using a video camera: a scoping review

BACKGROUND

Falls are a worrying and growing phenomenon worldwide that especially affects the elderly. With the development of technology, one way of studying the real-life falls that occur in healthcare settings is by using video cameras.

AIMS

To (a) map the patterns of the research on real-life falls among older adults in healthcare settings as assessed with digital video camera supports; and (b) highlight the advances, the evidence produced, and the gaps still present regarding the biomechanics of falls as assessed technologically.

METHODS

A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. CINAHL, PubMed and Google Scholar were searched. All studies regarding falls investigated with video cameras among older individuals in healthcare settings published from 1st January 1990 to 1st January 2022 were eligible. Findings were summarised according to the Patterns, Advances, Gaps, Evidence and Recommendations framework for Scoping Reviews.

RESULTS

In total, 1943 studies were retrieved, and 16 met the inclusion criteria. Studies were mostly conducted in Canada. They described the real-life falls that occurred mainly in common and living areas of long-term facilities among older individuals, mainly females. Thirteen studies investigated falls through biomechanics, while three provided advances in the reliability of the measures as collected with video cameras. Studies reported that the biomechanics of a fall, reflecting the direction of the fall and protective responses, increase or decrease the likelihood of serious impact. In addition, the direction of the landing after a fall has been determined as having a significant impact on the severity and outcome of the fall.

CONCLUSION

The use of video cameras to investigate the biomechanics of falls is a well-established research area that offer interesting insight regarding (a) how to prevent falls and their injuries and (b) the direction of the research in the field of falls.

A dimensional analysis of nursing unit culture

AIM(S)

Organizational culture has been studied for over four decades among nurses, across countries and contexts. However, wide variation exists in how the concept has been defined and at what level of the organization it is measured. The aim of this study was to use a dimensional analysis to conduct a conceptual synthesis of unit culture from a nursing perspective.

DESIGN

Dimensional analysis, rooted in grounded theory methodology, was used to describe unit culture from a nursing perspective.

METHODS

A literature search was conducted in April 2022. Inclusion criteria were (1) peer review publications, (2) used the term 'unit culture' or 'ward culture', (3) references nurses' role in unit culture, (4) published in the last 20 years and (5) written in English. One hundred fifteen articles met inclusion criteria, but dimensional saturation was researched after coding 24 articles.

RESULTS

Findings were synthesized into four core dimensions and 10 subdimensions. Dimensions of unit culture included customs (practice norms, communication and prioritization), shared beliefs (assumptions, values and attitudes), hierarchy (social and informational) and atmosphere (emotional climate and collaboration). Conditions that shape unit culture include individual nurse characteristics, working conditions, unit policies/procedures and leadership. Unit culture impacts nurse work experiences and decision-making processes, which can affect outcomes including nurse wellbeing, practice behaviours and adherence to unit policies.

CONCLUSIONS

Identifying the dimensions of unit culture helps to bring clarity to a concept that is not well defined in existing literature.

IMPACT

This model of unit culture can be used to guide development of new instruments to measure unit culture or guide researchers in utilizing existing measures. Developing measures specific to unit culture are warranted to strengthen researchers' ability to assess how changing conditions of a unit (e.g. leadership, workload) changes unit culture and its related outcomes.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Healthcare Professionals' Insights Regarding the Applicability of the STEADI Falls Prevention Program Among Neurology Patients: A Qualitative Study

Aim

Falls are common among hospitalized patients especially those with neurological health conditions. This highlights the need to implement evidence-based, comprehensive fall prevention programs. However, certain barriers hinder successful implementation of fall prevention programs in hospitals. The aim of this study was to explore the insights of healthcare professionals regarding the implementation of an interdisciplinary falls prevention program among patients with neurological health conditions.

Methods

A qualitative, descriptive design was used to conduct this study. Healthcare providers at two neurology units from two hospitals were invited to attend interdisciplinary workshops on fall prevention using the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) program. Reflective journals were used to collect the data. A total of 23 healthcare providers returned their completed journals and thematic analysis was performed to extract the main themes.

Findings

Thematic analysis revealed a total of four main themes: (1) The STEADI program provides an interdisciplinary approach to identifying fall risks, (2) The STEADI program improves patient safety and facilitates recovery, (3) The STEADI program fails to accommodate all neurology patients, and (4) Time and space constraints hinder success.

Conclusion

Responses to the reflective journals revealed that the participants were able to identify the advantages of using the STEADI program for both healthcare professionals and patients with neurological conditions. The comprehensive and evidence-based approach, coupled with its interdisciplinary nature, was highly appraised by the participants.

The Effectiveness of Remote Video Monitoring on Fall Prevention and Nurses' Acceptance

BACKGROUND

The use of remote visual monitoring (RVM) technology as a "telesitter" in hospitals can reduce falls and increase the efficiency of patient observation.

PURPOSE

This study aimed to examine RVM effectiveness as a strategy to decrease patient falls and investigate nurses' acceptance and perceived usefulness of RVM technology.

METHODS

Remote visual monitoring was implemented within a health system in the Southeastern United States. Falls data 6 months prior to and postimplementation were analyzed, and 106 nurses completed a survey evaluating their acceptance of the RVM technology.

RESULTS

There was a significant 39.15% reduction in falls with injury ( P = .006), and 70.6% of the RVM redirections were successful. Nurses' acceptance and perceived usefulness of RVM were moderate.

CONCLUSION

Implementing RVM has the potential to enhance patient safety by reducing falls with injuries and is considered acceptable and useful by nurses.