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Jarden RJ, Cherry K, Sparham E, Brockenshire N, Nichols-Boyd M, Burgess S, Grieve K, Twomey B, Walters J, Rickard N. Inpatients' experiences of falls: A qualitative meta-synthesis. J Adv Nurs 2024. [PMID: 38808473 DOI: 10.1111/jan.16244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/16/2024] [Accepted: 05/05/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVES Identify and synthesize published qualitative research reporting inpatient experiences of a fall to determine novel insights and understandings of this longstanding complex problem. RESEARCH DESIGN Qualitative meta-synthesis. METHODS Online databases were searched to systematically identify published research reporting inpatient experiences of a fall. The included studies were inductively analysed and interpreted then reported as a meta-synthesis. DATA SOURCES Databases Ovid MEDLINE, Embase, Ovid Emcare, CINAHL Complete, Scopus and ProQuest Dissertations and Theses Global were searched on 3rd August, 2023. RESULTS From 10 included publications, four new themes of inpatients' experiences of a fall were constructed. Themes one, two and three related to antecedents of patient falls, and theme four related to consequences. Theme one, 'My foot didn't come with me: Physiological and anatomical changes', encompassed patients' experiences of medical conditions, medication, and anatomical changes. These aspects contributed to alterations in balance and strength, and misconceptions of capability in activities of daily (inpatient) living. Theme two, 'I was in a hurry: Help-seeking', encompassed patients' experiences striving for independence while balancing power and control, minimizing their own needs over care of others', and unavailability of support. Theme three, 'I couldn't find the call light: Environment and equipment', encompassed patients' experiences of not being able to reach or use equipment, and environment changes. Theme four, 'It was my fault too: Blame and confidence', encompassed patients' expressions of blame after their fall, blame directed at both themselves and/or others, and impacts on confidence and fear in mobilizing. CONCLUSIONS Inpatient falls are embedded in a complexity of individual, relational, and environmental factors, yet there are potential ways forward both informed and led by the patient's voice. Strength-based approaches to address the tenuous balance between independence and support may be one opportunity to explore as a next step in complementing the existing multifaceted interventions. IMPACT Inpatient falls are a complex and costly health safety and quality problem. Despite global initiatives in the prevention of inpatient falls, they remain intractable. This meta-synthesis provides an in-depth exploration of extant qualitative data on patients' experiences of falls in hospitals. Four themes were constructed expressing the inpatients' experiences: physiological and anatomical changes, help-seeking, environment and equipment, and blame and confidence. Novel considerations for future investigation are offered, drawing from self-determination theory and positive psychological interventions. IMPLICATIONS FOR PATIENT CARE This meta-synthesis elicits new considerations for future interventions based on people's experiences of their fall in hospital, offering healthcare professionals novel directions in fall prevention. REPORTING METHOD The review was reported according to the Enhancing transparency in reporting the synthesis of qualitative research statement (ENTREQ; Tong et al., 2012). PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution. REGISTRATION PROSPERO CRD42023445279.
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Affiliation(s)
- Rebecca J Jarden
- Austin Health, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
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Nan J, Li Z, Zou X, Sun M, Gao J, Jiang Y. Fall risk perception in older adults: A concept analysis. J Clin Nurs 2024. [PMID: 38558421 DOI: 10.1111/jocn.17090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/10/2023] [Accepted: 12/08/2023] [Indexed: 04/04/2024]
Abstract
BACKGROUND Fall prevention is crucial for older adults. Enhanced fall risk perception can encourage older adults to participate in fall prevention programs. However, there is still no unified definition of the concept of fall risk perception. OBJECTIVE To explore the concept of fall risk perception in older adults. DESIGN A concept analysis. DATA SOURCES The literature was searched using online databases including PubMed, Cochrane Library, Embase, CINAHL Complete, PsycINFO, Web of Science, China National Knowledge Infrastructure, WangFang and SinoMed. Searches were also conducted in Chinese and English dictionaries. The literature dates from the establishment of the database to April 2023. METHODS The methods of Walker and Avant were used to identify antecedents, attributes and consequences of the concept of "fall risk perception" in older adults. RESULTS Eighteen publications were included eventually. The attributes were identified as: (1) dynamic change, with features of continuum and stage; (2) whether falls are taken seriously; (3) a self-assessment of the fall probability, which is driven by individual independence; and (4) involves multiple complex emotional responses. The antecedents were identified as: (1) demographic and disease factors; (2) psychological factors and (3) environmental factors. The consequences were identified as: (1) risk-taking behaviour; (2) risk compensation behaviour; (3) risk transfer behaviour; and (4) emotions. CONCLUSION A theoretical definition of fall risk perception was identified. A conceptual model was developed to demonstrate the theoretical relationships between antecedents, attributes and consequences. This is helpful for the development of relevant theories and the formulation of fall prevention measures based on fall risk perception as the intervention target.
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Affiliation(s)
- Jiang Nan
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Zhuoran Li
- Department of Nursing, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Xueqiong Zou
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Manyao Sun
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Jing Gao
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Yuyu Jiang
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi, China
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Stephen K, Campbell A. The experiences of older adults with cognitive impairment in using falls prevention alarms in hospital: A qualitative descriptive study. Aust Occup Ther J 2024; 71:132-148. [PMID: 38016634 DOI: 10.1111/1440-1630.12917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/29/2023] [Accepted: 11/01/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Bed and chair sensor alarms are commonly used for falls prevention in hospitals, despite questionable efficacy. Research analysing older adults' experiences of alarms is scarce, and adults with cognitive impairment are consistently excluded. AIM The aim of this study was to explore how older adults with cognitive impairment perceive and experience falls prevention alarms in hospital. METHOD A qualitative descriptive design investigated older adults' experiences of alarms in a Geriatric Evaluation and Management ward in Melbourne. Patients were included if they had been provided an alarm. Semi-structured interviews were the primary method of data collection with two observation sessions and medical record analyses completed to enable triangulation of findings. Data were subjected to thematic analysis, and the Person-Environment-Occupation framework was chosen to add insight into the complexities of older adults' experiences of alarms. FINDINGS All 11 participants had a level of cognitive impairment with delirium, confusion, or impulsiveness recorded in their medical file. Two overarching themes were identified: communication and collaboration with staff and rationalisation of alarm use. Participants' perceived staff were focussed on falls prevention but experienced a lack of communication about the purpose of alarms. Participants wanted an individualised approach to alarms. Some were comforted with the thought of alarms alerting staff, making them feel well cared for and believed alarms were a useful 'back-up'. Others found alarms uncomfortable, frustrating, and restricting. Application of the Person-Environment-Occupation framework provided insight into how enabling and restrictive factors can impact whether the alarm is experienced positively or negatively. Seven unwitnessed falls occurred during the participants' admissions. Thirty-four per cent of alarm triggers observed were considered false alerts. CONCLUSION Older adults commonly reported negative experiences using bed/chair sensor alarms. Occupational therapists have the training to collaborate with people with cognitive impairment and assess the usefulness of alarms in reducing falls, based on how they interact with the older adult's unique person, environment, and occupation domains.
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Affiliation(s)
- Kelly Stephen
- College of Nursing and Health sciences, Flinders University, Adelaide, South Australia, Australia
- Eastern Health, Box Hill, Victoria, Australia
- School of Primary and Allied Healthcare, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Alison Campbell
- College of Nursing and Health sciences, Flinders University, Adelaide, South Australia, Australia
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Dabkowski E, Cooper SJ, Duncan JR, Missen K. Exploring Hospital Inpatients' Awareness of Their Falls Risk: A Qualitative Exploratory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:454. [PMID: 36612780 PMCID: PMC9819707 DOI: 10.3390/ijerph20010454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/16/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
Patient falls in hospital may lead to physical, psychological, social and financial impacts. Understanding patients' perceptions of their fall risk will help to direct fall prevention strategies and understand patient behaviours. The aim of this study was to explore the perceptions and experiences that influence a patient's understanding of their fall risk in regional Australian hospitals. Semi-structured, individual interviews were conducted in wards across three Australian hospitals. Participants were aged 40 years and over, able to communicate in English and were mobile prior to hospital admission. Participants were excluded from the study if they returned a Standardised Mini-Mental State Examination (SMMSE) score of less than 18 when assessed by the researcher. A total of 18 participants with an average age of 69.8 years (SD ± 12.7, range 41 to 84 years) from three regional Victorian hospitals were interviewed for this study. Data were analysed using a reflexive thematic analysis identifying three major themes; (1) Environment (extrinsic) (2) Individual (intrinsic), and (3) Outcomes, as well as eight minor themes. Participants recognised the hazardous nature of a hospital and their personal responsibilities in staying safe. Falls education needs to be consistently delivered, with the focus on empowering the patient to help them adjust to changes in their clinical condition, whether temporary or permanent.
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Affiliation(s)
- Elissa Dabkowski
- Institute of Health and Wellbeing, Federation University Australia, Gippsland, VIC 3842, Australia
| | - Simon J. Cooper
- Health Innovation and Transformation Centre, Federation University Australia, Berwick, VIC 3806, Australia
| | - Jhodie R. Duncan
- Research Unit, Latrobe Regional Hospital, Traralgon, VIC 3844, Australia
| | - Karen Missen
- Institute of Health and Wellbeing, Federation University Australia, Gippsland, VIC 3842, Australia
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Bao G, Liu Y, Zhang W, Luo Y, Zhu L, Jin J. Accuracy of self-perceived risk of falls among hospitalised adults in China: an observational study. BMJ Open 2022; 12:e065296. [PMID: 36549717 PMCID: PMC9791387 DOI: 10.1136/bmjopen-2022-065296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate the accuracy of self-perceived risk of falls in hospitalised adults and explore factors associated with the differences. DESIGN Cross-sectional study. SETTING We conducted the study in two tertiary general hospitals located in Zhejiang province and Shandong province in China. PARTICIPANTS 339 patients were recruited using convenient sampling. The majority of them were men (54%), aged 61-70 (40.1%) and had received secondary school education or lower (82%). OUTCOME MEASURES The Fall Risk Perception Questionnaire and the Morse Fall Scale (MFS) were used to measure patients' self-perceived risk of falls and nurses' assessment. Other risk factors of falls were assessed to identify the determinants of disparities. RESULTS Most patients (74.6%) had a high risk of falls according to MFS. Only 61.9% of the patients' perceived risk matched with the assessment of nurses. Nearly one-third (27.5%) underestimated their fall risk, while the remaining (10.6%) overestimated. Multivariable logistic regression analyses revealed that older age, lower number of comorbidities, not having fear of falling and emergency department were the significant factors associated with underestimated risk of falls (p<0.05). Besides, endocrine department and having fall-related injuries were significantly associated with overestimated risk of falls (p<0.05). CONCLUSION Hospitalised patients were proven to be poor at recognising their risk of falls. Measurement of patients' self-perceived and health professionals' assessment of fall risk should be conducted to evaluate the disparity. This study provides a solid foundation to raise medical staff's awareness of the targeted population, identify the underlying factors and implement tailored fall prevention strategies and education.
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Affiliation(s)
- Guanjun Bao
- Quzhou College of Technology, Quzhou, Zhejiang, China
| | - Yuanfei Liu
- Department of Nursing, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wei Zhang
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ye Luo
- Quzhou College of Technology, Quzhou, Zhejiang, China
| | - Lin Zhu
- Jinan People's Hospital, Jinan, China
| | - Jingfen Jin
- Department of Nursing, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China
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Péculo‐Carrasco J, Luque‐Hernández MJ, Rodríguez‐Ruiz H, Chacón‐Manzano C, Failde I. Factors influencing the perception of feeling safe in pre‐hospital emergency care: A mixed‐methods systematic review. J Clin Nurs 2022. [DOI: 10.1111/jocn.16595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Juan‐Antonio Péculo‐Carrasco
- Centro de Emergencias Sanitarias 061, Andalusian Health Service Provincial Service 061 in Cádiz, Regional Government of Andalusia Cádiz Spain
| | - María José Luque‐Hernández
- Centro de Emergencias Sanitarias 061, Andalusian Health Service Central Headquaters, Regional Government of Andalusia Málaga Spain
| | - Hugo‐José Rodríguez‐Ruiz
- Centro de Emergencias Sanitarias 061, Andalusian Health Service Provincial Service 061 in Cádiz, Regional Government of Andalusia Cádiz Spain
| | - Coral Chacón‐Manzano
- Centro de Emergencias Sanitarias 061, Andalusian Health Service Provincial Service 061 in Córdoba, Regional Government of Andalusia Córdoba Spain
| | - Inmaculada Failde
- Institute of Research and Innovation of Biomedical Sciences of the Province of Cádiz (INiBICA) Preventive Medicine and Public Health University of Cádiz Cádiz Spain
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DiGerolamo KA, Frankenberger W, Birnbaum S. Children's falls inside the inpatient setting: A qualitative study of parent perceptions and the implications for falls prevention messaging. J Pediatr Nurs 2022; 67:102-106. [PMID: 36084498 DOI: 10.1016/j.pedn.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/31/2022] [Accepted: 08/07/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE To explore how parents understand their children's falls during hospitalization and how they perceive hospital interventions and messaging related to fall risk and prevention. DESIGN AND METHODS Semi-structured interviews were conducted to explore parent-caregiver descriptions of their children's falls during hospitalization. Prospective purposive sampling was used to identify eligible participants. Interviews were conducted with the parent-caregiver who was present at the time of the fall event. Themes were coded both inductively and deductively using a constant comparative method. RESULTS Twelve parent-child groupings participated. Three themes emerged: parental knowledge of risk, parent sense of threat to the identity of the child, and age differences in perception of level of controllability of risk. CONCLUSIONS Falls prevention education is usually delivered as a straightforward presentation of generic factual information about risk factors, with the assumption that families need more information. Findings from this study challenge this approach. This study indicates that parent-caregivers have fairly high levels of knowledge about children's fall risks; parent-caregiver beliefs about the controllability of falls may differ based on age of the child; finally, as has been found in previous studies of adult falls, parent-caregivers may perceive hospital falls prevention measures as a source of potential threat to their child''s already vulnerable social identity. PRACTICE IMPLICATIONS Involving the parent-caregiver in the fall risk assessment and collaborative development of falls prevention interventions may increase family alliance with health advice and reduce the incidence of falls in hospitalized children.
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Affiliation(s)
- Kimberly A DiGerolamo
- Children's Hospital of Philadelphia, Division of Oncology, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America.
| | - Warren Frankenberger
- Children's Hospital of Philadelphia, Center for Nursing Research and Evidence-based Practice, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America
| | - Shira Birnbaum
- Children's Hospital of Philadelphia, Center for Nursing Research and Evidence-based Practice, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America; Rutgers University School of Nursing, 110 Paterson St, New Brunswick, NJ 08901, United States of America
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Guo X, Wang Y, Wang L, Yang X, Yang W, Lu Z, He M. Effect of a fall prevention strategy for the older patients: A quasi-experimental study. Nurs Open 2022; 10:1116-1124. [PMID: 36178024 PMCID: PMC9834535 DOI: 10.1002/nop2.1379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/02/2022] [Accepted: 09/06/2022] [Indexed: 01/19/2023] Open
Abstract
AIM To explore the effect of a fall prevention strategy on older patients based on the Patient Engagement Framework. DESIGN A longitudinal quasi-experimental quantitative design. METHODS Older patients who met the inclusion criteria were recruited from geriatric, oncology, neurology and cardiology departments of a teaching general hospital in China. Development of a fall prevention intervention strategy for older patients was based on the Patient Engagement Framework. Patients in the intervention group were given this fall prevention strategy (N = 58), and those in the control group were given conventional measures (N = 58). The following indicators were compared between the two groups after intervention: (a) number of falls; (b) Knowledge-Attitude-Practice (KAP) score; (c) Modified Fall Efficacy Scale score. RESULTS After the implementation of an intervention strategy in older patients, the number of falls decreased from 3 to 0; the score of KAP and Modified Fall Efficacy Scale was promoted (p < .05).
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Affiliation(s)
- Xiaobei Guo
- Nursing Department, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
| | - Ying Wang
- Nursing Department, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
| | - Lei Wang
- Nursing Department, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
| | - Xueke Yang
- Nursing Department, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
| | - Weimei Yang
- Internal Medicine, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
| | - Zhihui Lu
- Nursing Department, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
| | - Mei He
- Intensive Care Medicine, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
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Relying on myself: The lived experience of being at risk for falling in the hospital among older adults. Geriatr Nurs 2022; 47:116-124. [PMID: 35905634 DOI: 10.1016/j.gerinurse.2022.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 11/20/2022]
Abstract
Inpatient fall rates have not significantly decreased the last decade. Older adults have an estimated 50% greater inpatient fall rate than younger adults. How older adults perceive their own fall risk affects their adherence to fall prevention recommendations. The aim of this phenomenological study was to understand the lived experiences of being at risk for falling in the hospital among older adults. Nine participants (N=9) aged 65 years and older (female=55%) were interviewed twice using online video-conferencing after hospital discharge, and interview data was analyzed using van Manen's interpretive phenomenological method. Five major interpretive themes emerged: Relying on Myself, Managing Balance Problems in an Unfamiliar Environment, Struggling to Maintain Identity, Following the Hospital Rules, and Maintaining Dignity in the Relationships with Nursing Staff. Hospitalized older adults employed their self-efficacy to manage balance problems in the hospital. Additional fall prevention interventions supporting hospitalized older adults' self-management of fall risk are needed.
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Adult Inpatients’ Perceptions of Their Fall Risk: A Scoping Review. Healthcare (Basel) 2022; 10:healthcare10060995. [PMID: 35742046 PMCID: PMC9222288 DOI: 10.3390/healthcare10060995] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/22/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022] Open
Abstract
Patient falls in hospitals continue to be a global concern due to the poor health outcomes and costs that can occur. A large number of falls in hospitals are unwitnessed and mostly occur due to patient behaviours and not seeking assistance. Understanding these patient behaviours may help to direct fall prevention strategies, with evidence suggesting the need to integrate patients’ perspectives into fall management. The aim of this scoping review was to explore the extent of the literature about patients’ perceptions and experiences of their fall risk in hospital and/or of falling in hospital. This review was conducted using a five-stage methodological framework recommended by Arksey and O’Malley. A total of nine databases were searched using key search terms such as “fall*”, “perception” and “hospital.” International peer-reviewed and grey literature were searched between the years 2011 and 2021. A total of 41 articles, ranging in study design, met the inclusion criteria. After reporting on the article demographics and fall perception constructs and measures, the qualitative and quantitative findings were organised into five domains: Fall Risk Perception Measures, Patients’ Perceptions of Fall Risk, Patients’ Perceptions of Falling in Hospital, Patients’ Fear of Falling and Barriers to Fall Prevention in Hospital. Approximately two-thirds of study participants did not accurately identify their fall risk compared to that defined by a health professional. This demonstrates the importance of partnering with patients and obtaining their insights on their perceived fall risk, as this may help to inform fall management and care. This review identified further areas for research that may help to inform fall prevention in a hospital setting, including the need for further research into fall risk perception measures.
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Healthcare professional perspectives on barriers and enablers to falls prevention education: A qualitative study. PLoS One 2022; 17:e0266797. [PMID: 35476840 PMCID: PMC9045665 DOI: 10.1371/journal.pone.0266797] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/28/2022] [Indexed: 11/19/2022] Open
Abstract
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.
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Aihara S, Kitamura S, Dogan M, Sakata S, Kondo K, Otaka Y. Patients' thoughts on their falls in a rehabilitation hospital: a qualitative study of patients with stroke. BMC Geriatr 2021; 21:713. [PMID: 34922484 PMCID: PMC8684226 DOI: 10.1186/s12877-021-02649-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with stroke in rehabilitation wards are at an increased risk of falling. Although patients' participation in establishing medical safety is considered crucial, there is limited evidence on their perspectives of falls. This study aims to comprehensively elucidate the subjective falling experience of patients with stroke who have been admitted to rehabilitation wards. METHODS Twenty-three consecutive patients with stroke (44 to 90 years) who experienced a fall during hospitalisation were interviewed within 1 week after the fall, and thematic analysis was used to analyse the data. RESULTS Five themes surrounding fall events were extracted from the narratives: 'Psychological background before the action', 'Support for the action', 'Direct causes of the fall', 'Patients' awareness after the fall', and 'Changes in attitudes and behaviours after the fall'. 'Psychological background before the action' comprised hastiness or hesitation to call for help. Participants often took an action based on 'Support for the action' derived from their past experiences of moving safely, their confidence, and/or motivation to challenge themselves to move. 'Direct causes of the fall' consisted of unfamiliar actions, training fatigue, the surrounding environment, reduced physical function due to paralysis, lack of attention, overconfidence in their ability, and insufficient prediction of falls. 'Patients' awareness after the fall' consisted of re-affirming difficult movements, the need for rehabilitation, a reduced ability to move, an increased risk of falling, the need for attention while moving, a fear of falling, and a lack of lessons learned from falling. Finally, patients demonstrated 'Changes in attitudes and behaviours after the fall' such as embodying a positive attitude to cope with the risk of falling or behavioural changes to reduce the risk of falling. CONCLUSIONS Comprehensive information on patients' perspectives before and after the fall was elucidated, uncovering many aspects including the psychological background for why patients engaged in risky behaviours resulting in falls, presence of positive thinking, and behaviour after the fall. By incorporating the patients' views on fall incidences and their assessment, we can develop appropriate prevention strategies against falls.
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Affiliation(s)
- Saika Aihara
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan.,Department of Rehabilitation, Faculty of Health Science, Tohoku Fukushi University, Sendai, Miyagi, Japan
| | - Shin Kitamura
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan.,Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Masayuki Dogan
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan
| | - Sachiko Sakata
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan. .,Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
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13
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Dolan H, Slebodnik M, Taylor-Piliae R. Older adults' perceptions of their fall risk in the hospital: An integrative review. J Clin Nurs 2021; 31:2418-2436. [PMID: 34786777 DOI: 10.1111/jocn.16125] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/18/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The objectives of this review are to determine what is currently known about older adults' perceptions of their own fall risk in the hospital and associated factors and explore how perceived fall risk in the hospital is assessed. BACKGROUND Every year, up to one million patients suffer an accidental fall in the hospital. Despite research efforts during the last decade, inpatient fall rates have not significantly decreased, and about one third of inpatient falls result in injuries. Limited evidence suggests that assessing hospitalised patients' perceptions of their fall risk and engaging them in their own fall prevention can reduce inpatient falls. DESIGN An integrative review. METHODS An electronic literature search was conducted in the Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Embase, Google Scholar, OpenGrey, ProQuest Dissertations & Theses Global, PsycINFO and PubMed. Data extraction and quality assessments were independently performed by two reviewers. PRISMA guidelines were followed for reporting this review. RESULTS Twenty-two studies met the inclusion criteria. The findings suggest that hospitalised older adults inadequately estimate their own fall risk. Most participants did not perceive themselves as at risk for falling in the hospital. Educational and motivational interventions can change the patients' perceptions of their own fall risk in the hospital and engage them in fall prevention. The desire to remain independent and feeling vulnerable were associated with fall risk, and the relationship with nursing staff may affect how hospitalised patients perceive their own fall risk. CONCLUSIONS Hospitalised adults, and specifically older adults, do not adequately estimate their own fall risk. Factors associated with these perceptions must be further explored to develop assessment tools and interventions to decrease inpatient fall rates. RELEVANCE TO CLINICAL PRACTICE Nurses' understanding and assessment of hospitalised adults' perception of their own fall risk is important to consider for reducing inpatient falls.
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Affiliation(s)
- Hanne Dolan
- College of Nursing, The University of Arizona, Tucson, Arizona, USA
| | - Maribeth Slebodnik
- Arizona Health Sciences Library and College of Nursing, The University of Arizona, Tucson, Arizona, USA
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Heng H, Slade SC, Jazayeri D, Jones C, Hill AM, Kiegaldie D, Shorr RI, Morris ME. Patient Perspectives on Hospital Falls Prevention Education. Front Public Health 2021; 9:592440. [PMID: 33796493 PMCID: PMC8007862 DOI: 10.3389/fpubh.2021.592440] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/19/2021] [Indexed: 12/02/2022] Open
Abstract
Hospital falls remain an intractable problem worldwide and patient education is one approach to falls mitigation. Although educating patients can help their understanding of risks and empower them with prevention strategies, patient experiences of hospital falls education are poorly understood. This study aimed to understand the perspectives and preferences of hospitalized patients about falls prevention education. Three focus groups were conducted in Australian hospitals. A phenomenological approach was used to explore patient perspectives and data were analyzed thematically. The focus groups revealed that most people did not realize their own risk of falling whilst an inpatient. Experiences of falls prevention education were inconsistent and sometimes linked to beliefs that falls were not relevant to them because they were being cared for in hospital. Other barriers to falls mitigation included poor patient knowledge about hospital falls risk and inconsistencies in the delivery of falls prevention education. A strong theme was that individualized, consistent education, and small interactive groups were helpful.
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Affiliation(s)
- Hazel Heng
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, VIC, Australia
| | - Susan C. Slade
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, VIC, Australia
| | - Dana Jazayeri
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, VIC, Australia
| | | | - Anne-Marie Hill
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Debra Kiegaldie
- Healthscope Ltd, Melbourne, VIC, Australia
- Faculty of Health Science, Youth and Community Studies, Holmesglen Institute, Melbourne, VIC, Australia
| | - Ronald I. Shorr
- Geriatric Research Education and Clinical Center (GRECC), Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, United States
- Department of Epidemiology, University of Florida, Gainesville, FL, United States
| | - Meg E. Morris
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, VIC, Australia
- Healthscope Ltd, Melbourne, VIC, Australia
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Péculo-Carrasco JA, De Sola H, Casal-Sánchez MDM, Rodríguez-Bouza M, Sánchez-Almagro CP, Failde I. Feeling safe or unsafe in prehospital emergency care: A qualitative study of the experiences of patients, carers and healthcare professionals. J Clin Nurs 2020; 29:4720-4732. [PMID: 32979872 DOI: 10.1111/jocn.15513] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To determine the feelings of safety among patients taken to hospital after requesting urgent care, based on their experiences and those of their carers and prehospital emergency care professionals. BACKGROUND Little research has been performed into the perception of safety in prehospital emergency care settings worldwide, from either the perspective of the patients or from that of healthcare professionals. DESIGN Exploratory qualitative study using focus groups in Spain. METHODS The participants were patients that requested care through the emergency telephone service, their carers and the professionals of the emergency care teams. The structured sampling design was based on an intentional, nonprobability selection following pragmatic criteria. Seven groups of patients/carers and two groups of professionals were formed (65 participants). The recordings were fully transcribed before their validation and codes were assigned to ensure anonymity. The ATLAS.ti software was used for the analysis. The authors took into account the COREQ checklist for qualitative studies. FINDINGS Neither group provided a clear definition of the meaning of feeling safe. It appeared easier to give examples that had a positive or negative influence on their perception of feeling safe. During the analysis of the discourse, six categories were detected after grouping the related codes. CONCLUSIONS For most of the patients' feeling of being safe or very safe arose from the perception of calmness, trust and protection. Defining the perception of safety was not easy. The factors with the greatest effect on feeling safe were related to Information and communication, Person-centred care and Professional competency, without losing sight of other factors such as Accessibility and response times of the emergency teams, Equipment and Healthcare setting. RELEVANCE TO CLINICAL PRACTICE The findings could be used as a knowledge base in future research and for implementing procedures for improving perceptions of safety among patients.
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Affiliation(s)
- Juan-Antonio Péculo-Carrasco
- Provincial Service 061 in Cádiz, Public Company for Health Emergencies, Regional Government of Andalusia, Cádiz, Spain
| | - Helena De Sola
- Institute of Research and Innovation of Biomedical Sciences of the Province of Cádiz (INiBICA), Preventive Medicine and Public Health, University of Cádiz, Cádiz, Spain
| | | | - Mónica Rodríguez-Bouza
- Provincial Service 061 in Cádiz, Public Company for Health Emergencies, Regional Government of Andalusia, Cádiz, Spain
| | - César-Pedro Sánchez-Almagro
- Provincial Service 061 in Cádiz, Public Company for Health Emergencies, Regional Government of Andalusia, Cádiz, Spain
| | - Inmaculada Failde
- Institute of Research and Innovation of Biomedical Sciences of the Province of Cádiz (INiBICA), Preventive Medicine and Public Health, University of Cádiz, Cádiz, Spain
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Twibell KR, Siela D, Delaney L, Avila P, Spradlin AM, Coers G. Perspectives of Inpatients With Cancer on Engagement in Fall Prevention. Oncol Nurs Forum 2020; 47:457-468. [PMID: 32555560 DOI: 10.1188/20.onf.457-468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To explore perspectives of hospitalized adults with cancer regarding engagement in fall prevention plans. The primary aim was to discover new knowledge about patients' perspectives and improve the design of fall prevention strategies. A secondary aim was to compare fall-related perspectives of patients who had and who had not fallen. PARTICIPANTS & SETTING 30 inpatients with cancer at a teaching hospital in a statewide academic health system in the midwestern United States. METHODOLOGIC APPROACH A descriptive exploratory approach framed qualitative data collection through interviews with inpatients. Data were analyzed thematically. FINDINGS Themes reflected six perspectives related to engagement in fall prevention. A need to go to the bathroom triggered a two-step process in which participants decided whether to ask staff for assistance to mobilize and to wait for assistance to arrive. If necessary, participants would disengage from fall prevention plans and move to the bathroom without assistance to avoid incontinence, preserve privacy, and maintain independence in toileting. Factors influencing decisions were assessments of mobilization capacity and views of nurses' behaviors. IMPLICATIONS FOR NURSING Nurses can foster patient engagement in fall prevention by developing trusting, authentic relationships with at-risk patients, involving patients in assessing their own fall risk, and tailoring toileting plans to ensure continence.
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Affiliation(s)
| | | | - Lori Delaney
- Indiana University Health Ball Memorial Hospital
| | | | | | - Gena Coers
- Indiana University Health Ball Memorial Hospital
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Dolan H, Taylor-Piliae R. Embarrassment experienced by older adults in relation to accidental falls: A concept analysis. Geriatr Nurs 2020; 41:769-775. [PMID: 32522426 DOI: 10.1016/j.gerinurse.2020.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022]
Abstract
Embarrassment is commonly felt by older adults experiencing a fall, and embarrassment may cause older adults to adopt maladaptive behaviors by not implementing fall prevention strategies. Clarifying the concept of embarrassment for nursing and defining the concept as it relates to accidental falls and fall prevention among older adults was conducted using Walker and Avant's eight-step concept analysis process. The proposed definition of embarrassment experienced by older adults in relation to accidental falls is: The feeling of physical discomfort and exposure in a social situation due to the loss of control and self-esteem, as well as the inconsistency between one's personal identity as an independent and dignified person and the accidental fall or near fall behavior that threatens independence and dignity leading to emotional distress. Nurses recognizing older adults' potential fall-related embarrassment may increase older adults' adherence to fall prevention strategies and improve health outcomes.
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Affiliation(s)
- Hanne Dolan
- The University of Arizona, College of Nursing, 1305 N Martin Ave, Tucson, AZ 85721-0203, United States.
| | - Ruth Taylor-Piliae
- The University of Arizona, College of Nursing, 1305 N Martin Ave, Tucson, AZ 85721-0203, United States
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Heng H, Jazayeri D, Shaw L, Kiegaldie D, Hill AM, Morris ME. Hospital falls prevention with patient education: a scoping review. BMC Geriatr 2020; 20:140. [PMID: 32293298 PMCID: PMC7161005 DOI: 10.1186/s12877-020-01515-w] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/12/2020] [Indexed: 12/28/2022] Open
Abstract
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.
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Affiliation(s)
- Hazel Heng
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Australia
| | - Dana Jazayeri
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Australia
| | - Louise Shaw
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Australia
| | - Debra Kiegaldie
- Healthscope and Faculty of Health Science, Youth & Community Studies, Holmesglen Institute, Melbourne, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Meg E Morris
- Victorian Rehabilitation Centre, ARCH Healthscope and La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Australia.
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Selecting a theoretical framework to guide a research study of older adults' perceptions and experiences of falling in the hospital. Appl Nurs Res 2019; 47:38-40. [DOI: 10.1016/j.apnr.2019.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 04/24/2019] [Indexed: 11/18/2022]
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