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Albasha N, Curtin C, McCullagh R, Cornally N, Timmons S. Staff perspectives on fall prevention activities in long-term care facilities for older residents: "Brief but often" staff education is key. PLoS One 2024; 19:e0310139. [PMID: 39250475 PMCID: PMC11383231 DOI: 10.1371/journal.pone.0310139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 08/25/2024] [Indexed: 09/11/2024] Open
Abstract
INTRODUCTION Falls are a serious health problem in long-term care facilities (LTCFs), affecting more than 50% of residents. A key role of LTCF staff is to assess fall risks and implement fall prevention activities. Understanding the barriers and facilitators is key to successful implementation. METHODS This descriptive qualitative study involving four LTCF facilities (varied provider types and sizes) in southwest Ireland. We recruited a convenience sample of 17 LTCF staff, who participated in semi-structured online 1:1 interviews (n = 7) or small group interviews (n = 10). The data were analysed using Braun and Clarke's reflective thematic analysis. RESULTS The participants included two directors of nursing, three therapists, one ward manager, one general practitioner, five nurses and five healthcare assistants. Six main themes were identified, reflecting factors that influenced fall prevention: a need for sufficient staff and appropriate skill mix; fall policy, documentation and leadership; equipment and safe environments; person-centred care; staff knowledge, skills and awareness in falls prevention; and staff communication and collaborative working. A wide range of approaches that supported LTCF staff to overcome barriers were identified, including audits and feedback, falls champions, fall prevention leaders, daily communication (e.g., safety pauses) and staff collaboration. Formal multidisciplinary meetings and identification systems to highlight residents at high risk of falling were not considered helpful. Staff suggested that education should be briefer, ongoing and practice-based ("brief but often") to promote ownership and responsibility. CONCLUSION LTCF staff identified several approaches to prevent falls in LTCFs as part of usual care, rather than lengthy, formal meetings and training. The potential role of families in fall prevention was under-appreciated and should be investigated further.
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Affiliation(s)
- Neah Albasha
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork City, Ireland
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Catriona Curtin
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork City, Ireland
| | - Ruth McCullagh
- Discipline of Physiotherapy, School of Clinical Therapies, University College Cork, Cork City, Ireland
| | - Nicola Cornally
- School of Nursing and Midwifery, University College Cork, Cork City, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork City, Ireland
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Albasha N, Curtin C, McCullagh R, Cornally N, Timmons S. Staff's insights into fall prevention solutions in long-term care facilities: a cross-sectional study. BMC Geriatr 2023; 23:738. [PMID: 37957577 PMCID: PMC10644547 DOI: 10.1186/s12877-023-04435-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
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.
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Affiliation(s)
- Neah Albasha
- Center for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
- Rehabilitation Department, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
| | - Catriona Curtin
- Center for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Ruth McCullagh
- Discipline of Physiotherapy, School of Clinical Therapies, University College Cork, Cork, Ireland
| | - Nicola Cornally
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Suzanne Timmons
- Center for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
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Albasha N, McCullagh R, Cornally N, Timmons S. Staff knowledge, attitudes and confidence levels for fall preventions in older person long-term care facilities: a cross-sectional study. BMC Geriatr 2023; 23:595. [PMID: 37749541 PMCID: PMC10521420 DOI: 10.1186/s12877-023-04323-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/15/2023] [Indexed: 09/27/2023] Open
Abstract
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.
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Affiliation(s)
- Neah Albasha
- Center for Gerontology and Rehabilitation, School of Medicine, St Finbarr's Hospital, University College Cork, Block 13, Douglas Road, The Bungalow, Cork, Ireland.
- Rehabilitation Department, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
| | - Ruth McCullagh
- Discipline of Physiotherapy, School of Clinical Therapies, University College Cork, Cork, Ireland
| | - Nicola Cornally
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Suzanne Timmons
- Center for Gerontology and Rehabilitation, School of Medicine, St Finbarr's Hospital, University College Cork, Block 13, Douglas Road, The Bungalow, Cork, Ireland
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Möller U O, Fänge A M, J K, D S, F F, Hansson E E. Modern technology against falls - A description of the MoTFall project. Health Informatics J 2021; 27:14604582211011514. [PMID: 34006139 DOI: 10.1177/14604582211011514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To meet future challenges from an older and physically less active population innovative solutions are needed. Modern Technology against Falls (MoTFall) aims to prevent falls, increase physical activity and improve self-rated health among older people by means of an information and communication technology based system. The project has developed technology-based solutions, focusing on person-centred care. A participatory research design was applied in the development of a mobile application, a wearable inertial movement measurement unit (IMMU), called the Snubblometer ('snubbla' is 'stumble' in Swedish) and a web-based education programme for health care professionals. The mobile application includes a fall risk index, exercises and information related to falls prevention. By linking the app to the IMMU, person-centred interventions can be developed and implemented in various health care settings and with different target populations. The IMMU has shown good validity and reliability for measuring postural sway and high sensitivity and specificity for measuring a near fall. The education programme is directed at non-graduate health care professionals in nursing homes and home care. The technical solutions have potential for use in research and in clinical practice.
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Affiliation(s)
| | | | | | - Smedberg D
- Lund University, Skåne University Hospital, Sweden
| | - Falkvall F
- Research Institutes of Sweden (RISE), Security and Transport/Measurement Technology, Sweden
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Garrido S, Markwell H, Andreallo F, Hatcher D. Benefits, Challenges and Solutions for Implementing Personalised Music Playlist Programs in Residential Aged Care in Australia. J Multidiscip Healthc 2021; 14:1193-1204. [PMID: 34079277 PMCID: PMC8164704 DOI: 10.2147/jmdh.s293764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/15/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Residential aged care facilities face the immense challenge of adapting to the increasingly high needs of their residents, while delivering personalised, holistic care. There is considerable evidence that music can provide an affordable, accessible way to reduce changes in behaviour associated with dementia, in order to meet these standards of care. However, a number of barriers exist to the effective implementation of music programs in long-term aged care facilities. METHODS This study involved focus groups with 17 participants including staff in residential aged care facilities and family caregivers to investigate the benefits of music programs, as well as the challenges and possible solutions to them. A general inductive approach was taken to data analysis. RESULTS A number of benefits of music programs were identified, including improvements to the wellbeing of both residents of aged care facilities and their caregivers. However, an ingrained culture within residential aged care of focusing on physical care rather than thinking holistically about wellbeing was identified as a significant barrier. DISCUSSION These findings revealed that education is a key component of changing ingrained cultures of task-driven care at both a managerial level and in care staff, so that attention can be given to psychological and emotional needs as well as the physical.
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Morris ME, Haines T, Hill AM, Cameron ID, Jones C, Jazayeri D, Mitra B, Kiegaldie D, Shorr RI, McPhail SM. Divesting from a Scored Hospital Fall Risk Assessment Tool (FRAT): A Cluster Randomized Non-Inferiority Trial. J Am Geriatr Soc 2021; 69:2598-2604. [PMID: 33834490 PMCID: PMC8518986 DOI: 10.1111/jgs.17125] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/21/2021] [Accepted: 02/26/2021] [Indexed: 12/26/2022]
Abstract
Background/Objectives We investigated the impact of ceasing routine falls risk assessment tool (FRAT) completion and instead used clinical reasoning to select fall mitigation strategies. Design Two‐group, multi‐site cluster‐randomized active‐control non‐inferiority trial. Setting Hospital wards. Participants Adult inpatients admitted to participating hospitals (n = 10 hospitals, 123,176 bed days). Intervention Hospitals were randomly assigned (1:1) to a usual care control group that continued to use a historical FRAT to assign falls risk scores and accompanying mitigation strategies, or an experimental group whereby clinicians did not assign risk scores and instead used clinical reasoning to select fall mitigation strategies using a decision support list. Measurements The primary measure was between‐group difference in mean fall rates (falls/1000 bed days). Falls were identified from incident reports supplemented by hand searches of medical records over three consecutive months at each hospital. The incidence rate ratio (IRR) of monthly falls rates in control versus experimental hospitals was also estimated. Results The experimental clinical reasoning approach was non‐inferior to the usual care FRAT that assigned fall risk ratings when compared to a‐priori stakeholder derived and sensitivity non‐inferiority margins. The mean fall rates were 3.84 falls/1000 bed days for the FRAT continuing sites and 3.11 falls/1000 bed days for experimental sites. After adjusting for historical fall rates at each hospital, the IRR (95%CI) was 0.78 (0.64, 0.95), where IRR < 1.00 indicated fewer falls among the experimental group. There were 4 and 3 serious events in the control and experimental groups, respectively. Conclusion Replacing a FRAT scoring system with clinical reasoning did not lead to inferior fall outcomes in the short term and may even reduce fall incidence.
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Affiliation(s)
- Meg E Morris
- Healthscope ARCH, Victorian Rehabilitation Centre, Glen Waverley, Victoria, Australia.,La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Melbourne, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Anne Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, Kolling Institute, University of Sydney, St. Leonards, New South Wales, Australia
| | | | - Dana Jazayeri
- Healthscope ARCH, Victorian Rehabilitation Centre, Glen Waverley, Victoria, Australia.,La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Melbourne, Australia
| | - Biswadev Mitra
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Debra Kiegaldie
- Holmesglen Institute, Melbourne, Victoria, Australia.,Eastern Clinical School, Monash University, Melbourne, Australia
| | - Ronald I Shorr
- Geriatric Research Education and Clinical Center (GRECC), Malcom Randall VAMC, Gainesville, Florida, USA and Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Clinical Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia
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