Assessing knowledge, motivation and perceptions about falls prevention among care staff in a residential aged care setting

Staff's insights into fall prevention solutions in long-term care facilities: a cross-sectional study

BACKGROUND

Falls are one of the most common and serious health issues in long-term care facilities (LTCFs), impacting not just residents, but staff and the healthcare system. This study aimed to explore LTCF staff's current practices around falls prevention, and their suggested solutions for better falls prevention.

METHODS

In the southwest of Ireland, a descriptive cross-sectional study was conducted in 13 LTCF sites, across a range of provider types and facility sizes. A survey, measuring staff knowledge, skills and attitudes, was distributed in physical and online formats. Staff suggestions for prioritising fall and fall-related injury prevention activities, and current staff practices regarding fall incidents were also sought. Content analysis was used to analyse responses, mapping categories and subcategories to the refined theoretical domains framework (TDF) and to an existing fall prevention guideline.

RESULTS

There were 155 respondents (15% response rate), from staff of the LTCFs. Environmental reviews and modifications (aligned to the TDF environmental context and resource domain) were the most common suggestions for preventing both falls and fall-related injuries. Other common suggestions for preventing falls were staff education, monitoring of residents, and using alarm/calling systems, while few staff members, across all roles, reported assessing residents, exercises, reviewing medications, and vitamin D supplements. For preventing fall-related injuries, suggestions included protective equipment, hip protectors and alarm/calling systems. Staff used a standardised approach when responding to a fall incident, with intensive and holistic post-fall control measures. HCAs focussed on transferring residents safely, while nurses of all grades focused more on post-fall assessment. Respondents believed that staff education, communication, increasing staffing levels and enhancing specialist care could support their practice.

CONCLUSION

Noting the low response rate, the results suggest an awareness gap regarding some evidence-based, resident-focussed falls prevention solutions, such as pro-active fall-risk assessment, exercise, medication review, and Vitamin D supplements. These aspects should be included in future fall prevention education programmes in LTCFs.

Motivational Interviewing for Fall Prevention (MI-FP) pilot study: Older Adults' readiness to participate in fall prevention

Older adults' readiness to participate in fall prevention behaviors is largely unknown. We evaluated the feasibility of recruitment for a fall prevention intervention and participants' readiness to participate in fall prevention activities. Patients ≥ 65 years at high fall risk were recruited. Feasibility of recruitment was assessed by reaching the goal sample size (200), and recruitment rate (50%). Surveys assessed participants' readiness to participate in fall prevention activities (confidence to manage fall risks [0-10 scale; 10 most confident] and adherence to fall prevention recommendations). We recruited 200 patients (46.3% of eligible patients), and 185 completed surveys. Participants reported high confidence (range 7.48 to 8.23) in addressing their risks. Their adherence to clinician recommendations was mixed (36.4% to 90.5%). We nearly met our recruitment goals, and found that older adults are confident to address their fall risks, but do not consistently engage in fall prevention recommendations.

Staff knowledge, attitudes and confidence levels for fall preventions in older person long-term care facilities: a cross-sectional study

BACKGROUND

Falls are the most common health problem affecting older people in long-term care facilities (LTCFs), with well-recognised adverse psychological and physical resident outcomes, and high staff burden and financial cost. LTCF staff knowledge and skills can play a vital role in providing and promoting fall prevention care.

METHODS

A descriptive cross-sectional survey study was conducted across 13 LTCF sites in the Southwest of Ireland; a sampling frame facilitated inclusion of a range of provider types and facility sizes. An existing questionnaire, based on fall prevention guidance, and examining staff knowledge, skills and attitudes, was distributed in physical and online formats.

RESULT

The response rate was 15% (n = 155), predominantly healthcare assistants, staff nurses and senior nurses. Almost 90% expressed high confidence levels for delivering fall prevention interventions and being aware of how falls affect LTCFs. However, over half underestimated the fall rate in LTCFs, and only 60% had adequate knowledge. Longer experience in working with older people in healthcare services was associated with greater knowledge (p = .001) and confidence in fall prevention interventions (p = .01), while senior nurses had more knowledge than others (p = .01). LTCF staff had lowest knowledge about "identification systems for residents at high risk of falling", "keeping confused residents near nursing stations", "the effect of using antipsychotic medicine on falls", "using a toileting regimen" and "staff responsibility regarding fall prevention efforts". Despite their knowledge gaps, nearly 50% thought they had enough fall prevention training; their main preference for any further fall education training was face-to-face education.

CONCLUSION

The results, with the caveat of a low response rate, show the need for interdisciplinary fall prevention training that is tailored to both the perceived learning needs and actual knowledge gap of LTCF staff and their preferences for learning delivery, as part of an overall approach to reducing fall-related adverse outcomes.

Implementation strategies supporting fall prevention interventions in a long-term care facility for older persons: a systematic review protocol

INTRODUCTION

Falls are common among older people in long-term care facilities (LCFs). Falls lead to significant morbidity, mortality and reduced quality of life among residents. Fall prevention interventions have been shown to reduce falls in LCFs. However, this may not always translate to effectiveness in real-world situations. We will conduct a systematic review (SR) to identify the implementation strategies used in fall prevention interventions in LCF, describing the effectiveness of strategies in terms of key implementation outcomes and fall reduction.

METHODS AND ANALYSIS

The search will include scientific papers in electronic databases, including PubMed, CINAHL, Embase, PsycINFO, Scopus and Web of Science, and published theses. The SR will consider all original research that empirically evaluated or tested implementation strategies to support fall prevention interventions in LCF, published in English or Arabic between 1 January 2001 and 31 December 2021, where data are presented on the implementation strategy (eg, audit and feedback, champions) and/or implementation outcome (eg, fidelity). Clinical trials, quasi-experimental studies and quality improvement studies will be eligible for inclusion. Two researchers will complete abstract screening, data abstraction and quality assessments independently. The screening process will be presented using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. Data will be extracted into a standardised table, including the country, year, authors, type of study, primary clinical outcome (falls rate and/or risk reduction as available), implementation strategy and implementation outcomes. Implementation strategies will be defined and categorised using the Expert Recommendation for Implementing Change Taxonomy. Implementation outcomes will be defined and categorised using the Implementation Outcomes Taxonomy, and clinical outcomes of the intervention effectiveness for falls preventions will be reported as formulated in each study, with a final narrative synthesis of data.

ETHICS AND DISSEMINATION

Ethical approval is not required for this study, and the results will be disseminated via peer-reviewed journals and presented at international conferences.

PROSPERO REGISTRATION NUMBER

CRD42021239604.

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

Aim

This study aimed to explore nurses’ perceptions of the factors associated with falls and of fall prevention strategies in acute care settings in Saudi Arabia.

Design

This is a cross‐sectional, correlational, descriptive study.

Methods

Data were collected from 102 nurses using a survey on the risk factors and prevention strategies of injurious falls.

Results

We found that impaired balance and muscle strength, limited mobility, and an inability to follow safety instructions were reported as the top factors in falls. Multidisciplinary fall prevention strategies are effective in reducing the prevalence of falls. Nurses with higher levels of education had higher perceptions towards the risk factors of falls. Formal patient safety training, including fall prevention education programmes, were shown to reduce falls by making nurses more aware of fall risk factors and prevention strategies. The findings of this study can be used to inform managers about factors that may contribute to falls in acute care settings.

Educating health professionals to implement evidence-based falls screening in hospitals

OBJECTIVE

International evidence-based guidelines advise traditional Falls Risk Assessment Tools (FRATs) should not be routinely used to predict the risk of a patient falling in hospital. However, disinvestment from existing services can be challenging. This study applied evidence-based approaches to education design to implement best practice guidelines.

DESIGN

Mixed methods using questionnaires to evaluate health professionals' knowledge of evidence-based falls risk assessment and mitigation, followed by semi-structured interviews with individual health professionals.

SETTING

Five Australian hospitals.

PARTICIPANTS

There were two cohorts per hospital; Cohort 1 (C1) comprised 10 clinical leaders from nursing and allied health professions. Cohort 2 (C2) included clinicians involved in routine hospital falls screening and prevention.

METHODS

46 clinical leaders received a 3-h high quality education workshop on the latest evidence in hospital falls risk assessment and how to implement a new falls screening and management tool. They were also taught the practical skills to deliver a 1-h education session to C2 (n = 129).

RESULTS

The education workshop significantly changed C1's views about evidence-based guidelines for falls screening and prevention. C1 were significantly more likely than C2 to feel confident in assessing falls risk and judging and implementing the best mitigation strategies. After the workshop, C1 were prepared and motivated to educate others on falls prevention and were satisfied with the skills gained. Six months after the workshop, C1 reported feeling more prepared for preventing falls.

CONCLUSION

Health professionals benefitted from an interactive education workshop on how to use a new evidence-based hospital falls screening tool to help mitigate risk. An abridged version of the workshop did not result in long lasting effects. Education is an important element aiding disinvestment from non-evidence-based services, and implementation of clinical guidelines.

Improving hospital falls screening and mitigation using a health professional education framework

OBJECTIVE

Although health professional education has the potential to mitigate hospital falls risk, the best methods to develop, deliver and evaluate health professional education remain unclear. This study applied evidence-based approaches to education design to improve falls risk mitigation.

DESIGN

Mixed methods using questionnaires to evaluate health professionals knowledge of evidence-based falls risk assessment and mitigation, followed by semi-structured interviews with individual health professionals.

SETTING

Five large Australian hospitals.

PARTICIPANTS

For each hospital, 10 clinical leaders from nursing and allied health professions were invited to participate in falls workshops.

METHODS

46 participants received a three-hour education program on the latest evidence in hospital falls risk assessment and how to implement evidence-based falls screening and management. This was based on the "4P" education model (Presage, Planning, Process and Product). They were taught practical skills to enable them to educate other health professionals.

RESULTS

The education workshop significantly changed participants' views about best practice guidelines for falls screening and prevention. Participants felt more confident in assessing falls risk and judging and implementing the best mitigation strategies. They were prepared and motivated to educate others about falls prevention and satisfied with the skills gained.

CONCLUSIONS

A high-quality education program grounded in a rigorous quality framework improved health professionals knowledge regarding evidence-based falls prevention. Use of evidence-based rationales for behaviour change promotes effective learning.

Education interventions for health professionals on falls prevention in health care settings: a 10-year scoping review

Background

Falls in hospitals are a major risk to patient safety. Health professional education has the potential to be an important aspect of falls prevention interventions. This scoping review was designed to investigate the extent of falls prevention education interventions available for health professionals, and to determine the quality of reporting.

Method

A five stage scoping review process was followed based on Arksey and O’Malley’s framework and refined by the Joanna Briggs Institute Methodology for JBI Scoping Reviews. Five online databases identified papers published from January 2008 until May 2019. Papers were independently screened by two reviewers, and data extracted and analysed using a quality reporting framework.

Results

Thirty-nine publications were included. Interventions included formal methods of educational delivery (for example, didactic lectures, video presentations), interactive learning activities, experiential learning, supported learning such as coaching, and written learning material. Few studies employed comprehensive education design principles. None used a reporting framework to plan, evaluate, and document the outcomes of educational interventions.

Conclusions

Although health professional education is recognised as important for falls prevention, no uniform education design principles have been utilised in research published to date, despite commonly reported program objectives. Standardised reporting of education programs has the potential to improve the quality of clinical practice and allow studies to be compared and evaluated for effectiveness across healthcare settings.

Exploring hospital patient sitters' fall prevention task readiness: A cross-sectional survey

RATIONALE, AIMS, AND OBJECTIVES

Patient sitters provide one-to-one care for hospital patients at high risk of falls. The study aimed to explore patient sitters' task readiness to assist in fall prevention on hospital wards.

METHOD

We conducted a cross-sectional survey. Respondents were patient sitters working in five hospitals providing medical, surgical, and aged care. The survey was developed using a theory of health behaviour change and used closed and open-ended items. Qualitative data were analysed using deductive content analysis.

RESULTS

Participants (n = 90) identified that patient factors, such as confusion, were the most frequent cause of falls (n = 338, 74%); however, the most frequent strategies identified to prevent falls were focused on the environment (n = 164, 63%). The most frequent barrier participants identified to preventing falls (n = 124, 67%) also pertained to patients, including aggressive patient behaviours. In contrast, staff factors, such as handovers being adequate, were identified as the main enabler for sitters being able to complete their tasks effectively (n = 60, 81%). Participants strongly suggested (71%) that further, preferably practical, training would be helpful, even though 84% reported receiving prior fall prevention training. Nearly all participants (98%) were motivated to prevent their patients from falling.

CONCLUSIONS

There is a gap between what patient sitters report as the cause of falls (patient factors) and what was suggested to prevent falls (environment factors). Education and practical training addressing challenging patient behaviours may improve sitters' task readiness to assist in preventing falls on wards. Improving communication and cooperation between patient sitters and nursing staff is also important.

Evaluation of care staff knowledge, confidence, motivation and opportunity for preventing falls in residential aged care settings: A cross-sectional survey

AIMS

To explore care staff knowledge about falls and confidence, motivation and opportunity to undertake fall prevention strategies, in residential aged care (RAC) along with preferences for fall prevention education.

BACKGROUND

Falls account for the majority of adverse clinical events in RAC settings. Care staff in RAC settings are in a key position to influence residents' actions to prevent falls, provided they have the necessary knowledge and skills.

METHODS

A cross-sectional survey design with a purposive sample of 147 care staff at eight RAC facilities was undertaken in 2015. A custom-designed questionnaire examining knowledge, confidence, motivation and opportunity to undertake falls prevention strategies was used.

RESULTS

Only 39 (26.5%) care staff were aware that the residents they cared for were at high risk of falls. Care staff knowledge of intrinsic falls risk factors was very limited, for example, only 18 (13.53%) observed for side effects of medication and just four (1.04%) were aware of continence issues. Conflicting duties also limited care staff time to undertake falls prevention strategies. Preferences for falls prevention education indicated face-to-face interactive discussions in the workplace (n = 98, [66.7%]) with reminder posters displayed around the facility (n = 80, [70.8%]).

CONCLUSIONS

Residential aged care organisations need to engage with care staff to provide tailored falls education incorporating learning preferences and targeting knowledge gaps, to improve awareness of intrinsic risk factor impact and uptake of evidence-based prevention strategies. Despite care staff being highly motivated, they have limited opportunity to assist residents with fall prevention within their workload. RAC management and funding bodies must address opportunity for care staff to fulfil this crucial role to benefit resident safety.

IMPLICATION FOR PRACTICE

This study identified gaps in care staffs' knowledge and skills in undertaking falls prevention strategies in residential aged care settings. These findings will assist residential aged care organisations and health professional educators to design evidence-based falls prevention education tailored to their care staffs' needs and preferences to facilitate adoption.