Patient safety and falls: A qualitative study of home care nurses in Norway

Concept analysis of patient safety in home care: a hybrid model

BACKGROUND

Patient safety in home care is a fundamental and complex concept in nursing. This concept includes a number of challenges in patient care. Studies have shown that there is no clear and uniform definition for this concept.

OBJECTIVE

The objective of the present study was to analyse patient safety in home care in Iran.

METHODS

The study was done using a hybrid model at three phases, including theoretical, field work and the final analysis. We searched valid databases including MEDLIN and CINHAL; electronic references including Web of Science, Scopus, Ovid, ProQuest, PubMed and Persian databases including Magiran, IranDoc and SID during 2008-2022, using these Persian and English keywords: Patient Safety, Safety, Home Care Service, Domiciliary Care, Home Care and Home Health Care. A total of 16 articles were searched in the theoretical phase and then analysed by content analysis. In field work phase, nine participants were interviewed (nurse, family and patient) and then the interviews were analysed by the content analysis method. In the final analysis phase, a general analysis of the previous two phases was performed and after determining the attributes, antecedents and consequences, a final definition of patient safety in home care in Iran was presented.

FINDINGS

Based on different studies, patient safety in home care is a multifaceted concept, which encompasses physical, mental, social and practical dimensions. Evaluation, prevention, participation and commitment to the safety culture are the core features of this concept. The patient care concept depends on the commitment of the involved participants, adequate resources, environmental conditions, support of the involved centres (home care agency, hospital and the insurance), self-efficacy and the ability of the caregivers (nurses).

CONCLUSION

Defining the concept of patient safety in home care provides a basis for the development of a safe patient care system at home. This concept analysis for patient safety in home care could be a guide for future studies.

Identification of Contributing Factors of Falls and Non-Fall Accidents Among Home Care Clients: A Retrospective Study Using Incident Reports

To prevent falls and other accidents among home care clients, it is essential to gather high-quality information on the factors contributing to the accidents. Incident reporting systems are used in home care units to generate information for risk management. This study aimed to explore the contributing factors of falls and non-fall accidents among home care clients and to evaluate the accuracy of the information on contributing factors gained from the incident reporting system. An existing dataset was used—safety incident reports concerning accidents involving home care clients. The incident reports (n = 323) were stored in the social- and health care organization’s incident reporting database from 2018 to 2020. The free-text narratives describing factors contributing to the event’s occurrence were analyzed using inductive content analysis, and the frequencies of the main category codes were recorded. The results were then compared with the frontline managers’ analyses of the narratives, where the managers used the classification of contributing factors provided by the system. According to incident reports, intrinsic (person-specific), behavior-related and extrinsic (environment-related) factors contributed to accidents among home care clients. Intrinsic and behavior-related factors were reported more often than extrinsic factors. The classified information on contributing factors did not correspond in all respects to the descriptions in the incident reports. To ensure high-quality information for safety management, incident reporting tools must be appropriate for use in the home care context. Both the reporter of an adverse event and the individual responsible for analyzing the report play essential roles in identifying contributing factors of accidents.

A Qualitative Study of Nursing Students' Experiences in Fall Prevention for Older Home Care Clients

The aim of this study was to describe the experiences of nursing students in fall prevention during clinical practice in the context of older home care clients. This was a qualitative focus group study of nursing students (n = 9) who had completed clinical practice in older clients' home care. The data were analysed using inductive content analysis. The nursing students described their experiences regarding falls and fall prevention in older clients' home care from two perspectives: evaluation of falls at older people's homes and fall prevention during home visits. Systematic evaluation of falls was based on physical examination and is the basis of fall prevention. However, evaluation of nutrition and adverse drug effects seemed to be ignored. In addition, fall prevention during home visits included concrete fall prevention in authentic client situations, confidential relationships with older clients, and evidence-based knowledge. From the perspective of fall prevention, there was a lack of comprehensive evaluation and understanding of the meaning of psychological factors, such as fear of falling. In order to be able to prevent falls in the older client population, students need more guidance regarding a comprehensive approach based on evaluation of falls. In addition, there is a need for continuous collaboration between education and home care services to develop educational approaches that interlink knowledge and skills in fall prevention.

Psychometric testing of the Turkish version of the Health Professional Education in Patient Safety Survey: H-PEPSSTR

Nursing students are trained in patient safety issues in clinical settings during their undergraduate nursing education both theoretically and practically. This study aims to test the psychometric properties of the Turkish version of the "Health Professional Education in Patient Safety Survey" which was developed to measure healthcare professional candidates' patient safety knowledge and competence both in the classroom and clinical settings during their education. The data for this methodological study were collected from 305 nursing students in 2017. The tool consisted of 23 items, two main dimensions as classroom and clinical settings and six subscales. Content validity ratings of the scale items were over 0.80. Five modifications were made during the Confirmatory Factor Analyses. Three of the modifications were among classroom items and two of them were from clinical settings items. After modifications, fit indices were calculated as: χ2/df = 2.58, RMSEA = 0.072 and CFI = 0.95 for the classroom. They were χ2/df = 2.23, RMSEA = 0.063 and CFI = 0.96 for the clinical settings. Cronbach's alpha coefficient was 0.97 for both classroom and clinical settings. In conclusion, The Turkish version of the scale is valid and reliable in assessment of patient safety knowledge and competence of nursing students.

Safety of older people at home: An integrative literature review

AIM

The aim of this review was to examine the relevant health literature, to describe safety in the homes of older and older people's perceptions and understanding of their safety at home based on current literature.

BACKGROUND

Safety is a multifaceted, basic need of older people living at home. Many studies are hospital focused and few focus on safety at home. Research on the safety of older people at home appears to be under-researched.

METHODS

MEDLINE, CINAHL, Scopus and Web of Science databases from the earliest to August 2017 were investigated. The integrative literature review was conducted in December 2017. The full text of the remaining n = 93 papers was then screened for relevance by inclusion and exclusion criteria which reduced the number by 59 to n = 34.

RESULTS

Four dimensions of safety at home were discovered, namely physical, social, emotional and mental, and cognitive safety. Safety dimensions had both positive and negative components. Older people's main wish was to be able to live in their own home for as long as possible. Their perceptions of safety at home was categorised as active living, coping at home, managed living and the knowledge of the existence of disease.

CONCLUSIONS

The safety of older people at home is a worldwide concern. Identification of safety issues can assist in developing measures to help people stay at home for longer as they age. The management of this would need to take account of all four dimensions of safety, in ways that promote ageing at home.

IMPLICATIONS FOR PRACTICE

Learning, understanding and developing new strategies about safety affect everyone who visits the home of older people, and stakeholders have an important role to identify safety risks.

Contributing causes to adverse events in home care and potential interventions to reduce their incidence

The increasing complexity of home care services, pressures to discharge patients quicker, and the growing vulnerabilities of home care clients all contribute to adverse events in home care. In this article, home care staff in six programs analyzed 27 fall- and medication-related events. Classification of contributing causes indicates that patient and environmental factors were common in fall events, while organization and management factors along with patient, task, team, and individual factors were common in medication-related events. Home care settings create specific challenges in identifying and mitigating risks. Some factors, such as variations in home environments, are difficult to address. However, changing care coordination structures and communication methods could ameliorate other factors, including poor communications among staff and limited team and cross-sector communication and coordination. Ensuring that medication ordering and administration processes are optimized for home environments would also contribute to safer care.

Record of the circumstances of falls in the community: perspective in the Iberian Peninsula

Objective:

to determine the diagnosis of the situation regarding documentation of falls and risk of falls in people older than 75 years in basic health units in Spain and Portugal.

Method:

mixed exploratory study in two stages: (i) quantitative descriptive of randomly selected fall records produced in one year (597 records; 197 Spanish and 400 Portuguese); and (ii) qualitative, with the purpose of knowing the perception of health professionals employing semi-structured interviews (72 professionals, 16 Spanish and 56 Portuguese). The study areas were two basic health units in southern Spain and northern Portugal.

Results:

in the fall records, the number of women was higher. The presence of fall was associated with the variables age, presence of dementia, osteoarticular disease, previous falls and consumption of antivertiginous medication. Health professionals perceived an absence of risk assessment instruments, as well as lack of prevention programs and lack of awareness of this event.

Conclusion:

falls are perceived as an area of ​​priority attention for health professionals. Nonetheless, there is a lack of adherence to the registration of falls and risk assessment, due to organizational, logistical and motivational problems.

Factors Associated With the Use of the Reactive Approach to Preventing Patient Safety Events

The aim was to investigate the prevalence of using the reactive approach to patient safety event prevention in home-visit nursing agencies and explore factors associated with this approach. Multiple logistic regression analysis was conducted to investigate possible reactive approach-related factors. Two hundred forty-five agencies (71.0%) reported using the reactive approach to prevent event recurrence. Use of the reactive approach in agencies was significantly associated with having administrators who had attended an education course before employment in an administrative position (odds ratio = 1.95). To increase patient safety knowledge and awareness, administrator candidates must attend a course on home-visit agency management. Nursing researchers and policy makers should reexamine and adjust prerequisites for administrator registration at home-visit nursing agencies in Japan.

Falls Suffered by Elderly People From the Perspective of Health Care Personnel: A Qualitative Study

An exploratory interpretative study was carried out to recognize the factors regarded by health care professionals as potential obstacles to the evaluation, prevention, and documentation of falls in persons above 65 years of age. Focus groups and questionnaires were carried out. Audio recordings were made, and these were subsequently transcribed and analyzed in accordance with the Bardin's thematic content analysis. Four focus groups of four persons were set up, and 16 questionnaires were returned. Four thematic categories were obtained. The analysis showed a lack of data in records of falls, perhaps for reasons of overwork, lack of motivation, awareness, or consistency in the registration systems in use. Health care professionals document two types of fall, depending on the elderly person's ability to carry out everyday tasks. There is not a rigorous and systematic approach for recording falls. Perspectives from health care professionals could help in analyzing the causes of falls and suggesting comprehensive preventive measures.