Nurses’ perceptions of fall risk factors and fall prevention strategies in acute care settings in Saudi Arabia

Exploring nurses' clinical judgment concerning the relative importance of fall risk factors: A mixed method approach using the Q Methodology

BACKGROUND

Nurses are pivotal in averting patient falls through their assessment of cues presented by patients and their environments, rendering clinical judgments regarding the risk of falling, and implementing tailored interventions. Despite the intricate cognitive processes entailed in nurses' judgment, no prior studies have explored their approach to assessing the risk of falling.

OBJECTIVE

This study aimed to examine how nurses judge the risk of falling among patients with different conditions, whether there are differences in the importance of risk factors as judged by nurses, how they justify their judgments, and what attributes of the nurses influence their judgments.

DESIGN

A mixed method approach using the Q Methodology was employed.

SETTING(S)

Three public and private hospitals in Japan.

PARTICIPANTS

Eighteen nurses participated in the study.

METHODS

Participants were tasked with ranking 36 patient scenarios, each featuring a distinct set of fall risk factors. Subsequently, post-sorting interviews were conducted to gather insights into their typical approach to assessing fall risk and the rationale behind their ranking decisions. A by-person principal component factor extraction was employed to examine differences in the rankings of the scenarios. The interview data were analyzed descriptively to elucidate the reasons behind these discrepancies.

RESULTS

Nurses engage in complex cognitive manipulations when evaluating the risk of patient falls, drawing extensively from their wealth of experience while utilizing assessment tools to support their judgments. In essence, nurses identify patients' tendency to act alone without calling a nurse, impaired gait and cognition, sedative use, drains, and limited information sharing among healthcare professionals as key fall risks. In addition, nurses vary in the importance they attribute to certain risk factors, leading to the discrimination of three distinct judgment profiles. One group of nurses judges patients with cognitive impairment and acting alone as high risk. Another group of nurses considers patients with unstable gait and acting alone as high risk. The last group of nurses sees patients wearing slippers as high risk. The post-sorting interviews revealed that their judgments are closely related to the healthcare context and patient population.

CONCLUSIONS

Nurses operate within diverse contexts, wherein they interact with patients of varying characteristics, collaborate with professionals from diverse disciplines, and have access to varying levels of human and physical resources. This nuanced understanding empowers the formulation of judgments that are finely attuned to the specific context at hand.

STUDY REGISTRATION

Not registered.

Evaluation of the use of a nursing diagnosis Risk for Falls in the Community of Madrid (Spain) Primary Care System

PURPOSE

The purpose of this study was to describe the use of the nursing diagnosis Risk for Falls in Primary Care System of the Community of Madrid.

METHODS

A retrospective review of the clinical histories was carried out in 262 health centers from January 2005 to December 2015. The study population are the patients who have recorded in their electronic health record the nursing diagnosis Risk for Falls.

FINDINGS

Frequency of use of the Risk for Falls ND in the Community of Madrid was 53,340 diagnoses, increasing from 650 nursing diagnosis in 2005 to 14,695 in 2015. NOC Nursing Outcomes total identified were 109,145, which represents an average of 2.05 NOC Nursing Outcomes per diagnosis. NOC Nursing Outcomes frequently appeared as follows: Fall Prevention Behavior (35.9%), Safe Home Environment (11.3%), and Risk Control (10.5%). NIC Nursing Interventions total identified were 104,293, representing an average of 1.96 NIC nursing interventions per diagnosis. NIC Nursing Interventions frequently appeared as follows: Fall Prevention (45.9%), Environmental Management: Safety (27%), and Risk Identification (5.8%).

CONCLUSIONS

Nursing diagnosis of Risk for Falls and the care process related to this diagnosis is starting to be used by the primary care nurses of the Community of Madrid.

IMPLICATION FOR NURSING PRACTICE

Risk factors related to the nursing diagnosis of risk for falls identified in our study can be addressed with activities that nurses must implement to prevent falls. Nursing methodology in general and specifically the diagnosis of risk for falls must be included in guides and protocols for the prevention of falls, and its use should be promoted by primary care nurses.

Predictors and Outcomes of Falls in Older Adults Presenting to the Emergency Room in Saudi Arabia: A Cross-Sectional Analysis

INTRODUCTION

Saudi Arabia is witnessing a demographic shift characterized by a rising elderly population. Cases of fall in this demographic have emerged as a significant health concern, especially in emergency room (ER) settings. Despite this, there is limited research on the causes and outcomes of such incidents. This study intends to bridge the gap in understanding the factors leading to falls in elderly patients presenting to ERs and the subsequent outcomes. Such understanding is pivotal for the formulation of effective prevention strategies and enhanced healthcare services for the elderly.

METHODS

To achieve the study's objectives, we employed SPSS software for Windows, version 28.0 (IBM Corp., Armonk, NY) for data analysis. We collected demographic information, including age, gender, education, employment status, and location, to measure patient satisfaction with the quality and responsiveness of emergency care, using Likert scale responses via electronic survey conducted as a cross-sectional study from January 2023 to August 2023, summarizing it using descriptive statistics. We analyzed categorical variables by frequencies and percentages. Chi-square tests were utilized to examine differences in distribution across categories for fall factors, and a p-value below 0.05 was deemed significant. Through logistic regression, we pinpointed the predictors of falls among older adults, showcasing the strength and direction of these relationships. Adjusted odds ratios with 95% confidence intervals were documented. A perception survey was also conducted to evaluate ER patient satisfaction.

RESULTS

Our results shed light on various aspects of fall prevention and emergency care. There was a pronounced representation in age groups of 18-24 and 25-34 years, indicating the need for interventions tailored to different age groups. Patterns were identified where subjects engaged in limited physical activity and consumed alcohol infrequently. Mobility and balance problems were commonly found, stressing the need to address these issues. Chronic conditions such as hypertension and diabetes correlated with fall incidents. Additionally, sociodemographic factors like gender, education, and employment status played a role in influencing the risk of falls. Although age and location seemed to have a less pronounced effect, there exists an opportunity to enhance communication and patient participation in emergency care for improved experiences.

CONCLUSION

The findings from our study provide crucial insights into the prevention of falls and enhancement of emergency care for Saudi Arabia's elderly population. By revealing the intricate relationships between sociodemographic attributes, health indicators, chronic ailments, and incidents of falls, we emphasize the need for well-rounded interventions. There is a pressing requirement for comprehensive fall prevention initiatives tailored to specific risk groups. Additionally, improving ER services is integral to ensuring the safety and well-being of older adults. This research can serve as a foundational resource for healthcare professionals and policymakers to devise robust strategies to reduce fall-related injuries and elevate the quality of emergency care outcomes.

The impact of safety culture, quality of care, missed care and nurse staffing on patient falls: A multisource association study

AIMS

To examine the association between nursing unit safety culture, quality of care, missed care and nurse staffing levels, and inpatient falls using two data sources: incidence of falls and nurses' perceptions of fall frequency in their units. The study explores the association between the two sources of patient falls and identifies if nurses' perceptions of patient fall frequency reflect the actual patient falls recorded in the incident management system.

BACKGROUND

Inpatient falls are associated with severe complications that result in extended hospitalisation and increased financial consequences for patients and healthcare services.

DESIGN

A multi-source cross-sectional study guided by the STROBE guidelines.

METHODS

A purposive sample of 33 nursing units (619 nurses) from five hospitals completed an online survey from August to November 2021. The survey measured safety culture, quality of care, missed care, nurse staffing levels and nurses' perceptions of patient fall frequency. In addition, secondary data on falls from participating units between 2018 and 2021 were also collected. Generalised linear models were fitted to examine the association between study variables.

RESULTS

Nursing units with strong safety climate and working conditions and lower missed care were associated with lower rates of falls using both data sources. Nurses' perceptions of the frequency of falls in their units were reflective of the actual incidence rate of falls, but the association was not statistically significant.

CONCLUSION

Nursing units with a strong safety climate and better collaborations between nurses and other professionals, including physicians and pharmacists, were associated with lower incidents of patient falls.

RELEVANCE TO CLINICAL PRACTICE

This study provided evidence for healthcare services and hospital managers to minimise patient falls.

PATIENT OR PUBLIC CONTRIBUTION

Patients who had experienced a fall, which was reported in the incident management system, from the included units in the five hospitals were part of this study.

Perception of Health Teams on the Implementation of Strategies to Decrease Nursing Errors and Enhance Patient Safety

Background

Patient care is a public health issue all over the world, with nursing errors in hospitals being a significant source of harm to patients and a hindrance to the healthcare system's efficiency.

Purpose

The purpose of this study was to investigate health teams' perceptions of strategies used to reduce nursing error that affects patient safety.

Patients and Methods

A descriptive study was conducted from January to March 2022 at Najran University Hospital and KKH to better understand the issue. The study included 400 healthcare team members, including nurses, physicians, nurse aides, health workers, and others. The data was collected through the analysis of the health team's characteristics, nursing errors, and strategies for error reduction.

Results

The results of the study led to the development of five strategies and 28 interventions aimed at reducing nursing errors. The study revealed that two-thirds of the participants had a high perception of strategies for reducing nursing errors, while one-third had a low perception.

Conclusion

The study highlights the importance of addressing nursing errors in the healthcare system and provides evidence-based strategies and interventions to reduce them. The findings emphasize the need for ongoing efforts to enhance the perception and understanding of healthcare professionals in reducing errors and improving patient care.

Falls as the result of interplay between nurses, patient and the environment: Using text-mining to uncover how and why falls happen

Objectives

This study aimed to explore, from the perspectives of nurses, how patients, the environment, and the practice of nurses interact with each other to contribute to patient falls.

Methods

A retrospective review of incident reports on patient falls, registered by nurses between 2016 and 2020, was conducted. The incident reports were retrieved from the database set up for the project of the Japan Council for Quality Health Care. The text descriptions of the "background of falls" were extracted verbatim, and analyzed by using a text-mining approach.

Results

A total of 4,176 incident reports on patient falls were analyzed. Of these falls, 79.0% were unwitnessed by nurses, and 8.7% occurred during direct nursing care. Document clustering identified 16 clusters. Four clusters were related to patients, such as the decline in their physiological/cognitive function, a loss of balance, and their use of hypnotic and psychotropic agents. Three clusters were related to nurses, and these included a lack of situation awareness, reliance on patient families, and insufficient implementation of the nursing process. Six clusters were concerned with patients and nurses, including the unproductive use of a bed alarm and call bells, the use of inappropriate footwear, the problematic use of walking aids and bedrails, and insufficient understanding of patients' activities of daily living. One cluster, chair-related falls, involved both patient and environmental factors. Finally, two clusters involved patient, nurse, and environmental factors, and these falls occurred when patients were bathing/showering or using a bedside commode.

Conclusions

Falls were caused by a dynamic interplay between patients, nurses, and the environment. Since many of the patient factors are difficult to modify in a short time, the focus has to be placed on nursing and environmental factors to reduce falls. In particular, improving nurses' situation awareness is of foremost importance, as it influences their decisions and actions to prevent falls.

History of Falls and Bedriddenness Ranks are Useful Predictive Factors for in-Hospital Falls: A Single-Center Retrospective Observational Study Using the Saga Fall Risk Model

INTRODUCTION

In our former study, we had validated the previously developed predictive model for in-hospital falls (Saga fall risk model) using eight simple factors (age, sex, emergency admission, department of admission, use of hypnotic medications, history of falls, independence of eating, and Bedriddenness ranks [BRs]), proving its high reliability. We found that only admission to the neurosurgery department, history of falls, and BRs had significant relationships with falls. In the present study, we aimed to clarify whether each of these three items had a significant relationship with falls in a different group of patients.

METHODS

This was a single-center based, retrospective study in an acute care hospital in a rural city of Japan. We enrolled all inpatients aged 20 years or older admitted from April 2015 to March 2018. We randomly selected patients to fulfill the required sample size. We performed multivariable logistic regression analysis using forced entry on the association between falls and each of the eight items in the Saga fall risk model 2.

RESULTS

A total of 2932 patients were randomly selected, of whom 95 (3.2%) fell. The median age was 79 years, and 49.9% were men. Multivariable analysis showed that female sex (odds ratio [OR] 0.6, 95% confidence interval [CI] 0.39-0.93, p = 0.022), having a history of falls (OR 1.9, 95% CI 1.16-2.99, p = 0.010), requiring help with eating (OR 1.9, 95% CI 1.12-3.35, p = 0.019), BR of A (OR 6.6, 95% CI 2.82-15.30, p < 0.001), BR of B (OR 7.5, 95% CI 2.95-19.06, p < 0.001), and BR of C (OR 4.1, 95% CI 1.53-11.04, p = 0.005) were significantly associated with falls.

CONCLUSION

History of falls and BRs were independently associated with in-hospital falls.