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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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Patterns and predictors of fall injury transitions among Korean older adult fallers: a 2-year longitudinal study. Sci Rep 2022; 12:22188. [PMID: 36564434 PMCID: PMC9789049 DOI: 10.1038/s41598-022-26665-2] [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: 08/28/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
This study was conducted to identify fall injury patterns, the transition from the baseline to follow-up, and the factors associated with the identified fall injury patterns using data obtained from the Korean Frailty and Aging Cohort Study. The participants were 566 community-dwelling older adults with fall experience. Three fall injury patterns were identified as the baseline and follow-up periods. The probability that the participant in the "fracture injury" pattern at Time 1 transitioned to the "fracture injury" pattern at Time 2 was 0.098. The factors associated with the "bruising and/or sprain injury" pattern were education level (relative risk ratio [RRR] = 0.55, p = 0.012), alcohol consumption (RRR = 0.50, p = 0.034), and balancing in tandem position (RRR = 2.77, p < 0.001). In the "fracture injury" pattern, male (RRR = 0.22, p = 0.038), frailty score (RRR = 0.58, p = 0.042), "bruising injury" (RRR = 0.23, p = 0.007), and "sprain injury" (RRR = 0.20, p = 0.007) at the baseline were significant factors. The findings indicate that previous fall experiences, higher alcohol consumption, lower frailty scores, and poor balance levels are associated with fall injury patterns. These patterns should be considered when developing prevention interventions.
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Organizational Factors Associated with Evidence-Based Practice Knowledge, Attitudes, and Implementation among Nurses in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148407. [PMID: 35886258 PMCID: PMC9324115 DOI: 10.3390/ijerph19148407] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022]
Abstract
Evidence-based practice (EBP) is crucial in keeping nurses aware of the current knowledge and improving clinical decision-making. The integration of nurses’ EBP competencies and organizational support has been suggested to create an effective arena in implementing EBP. The purpose of the study was to examine organizational factors influencing nurses’ EBP knowledge, attitudes, and implementation and identify staff nurses’ perceptions of EBP nursing leadership and hospital supports in Saudi Arabia. Data were collected from a convenience sample of staff nurses (N = 227) working in four hospitals using a cross-sectional, correlational descriptive design. Level of education (p < 0.05), EBP training (p < 0.05), unit type (ICU (p < 0.001) and ER (p < 0.01)), perceived nursing leadership (p < 0.001), and work environment (p < 0.05) supports were found significantly associated with nurses’ knowledge. Magnet recognition (p < 0.01) and knowledge (p < 0.001) had significant influence on nurses’ attitudes. Unit type (ER) (p < 0.05), knowledge (p < 0.001), and attitudes (p < 0.001) were associated with implementation. Encouragement to attend EBP trainings from nursing leadership was perceived by most nurses (51.1%). Nurses reported their hospitals support EBP through training (68.2%). Findings support the need for healthcare systems to create a culture that facilitates EBP implementation to enhance nurses’ EBP competencies and improve patients’ outcomes. Nursing managers may consider preparing nurses through education.
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Ojo EO, Thiamwong L. Effects of Nurse-Led Fall Prevention Programs for Older Adults: A Systematic Review. PACIFIC RIM INTERNATIONAL JOURNAL OF NURSING RESEARCH 2022; 26:417-431. [PMID: 36051891 PMCID: PMC9432804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Falls among older adults are preventable events and fall prevention programs led by nursing staff are promising and viable programs for preventing falls. This systematic review aimed to gain insight into the effects of nurse-led fall prevention programs for older adults. The Preferred Reporting Items for Systemic Reviews and Meta-Analysis was used as a guideline in reporting this literature search conducted through CINAHL, MEDLINE, Eric, Science Direct, and Google Scholar databases. The Johns Hopkins Nursing Evidence-Based Practice was used to determine the level of evidence and quality rating of the articles, while data extraction was done by a matrix review method. The review included six randomized controlled trials, two non-randomized controlled trials, and three quasi-experimental designs. Six studies directed their education component of the intervention on the nursing staff, while three focused on the older participants. Nurses' roles were patient assessment, patient education, administration of exercise programs, and follow-up post interventions. Fall rates and fall incidents were reduced in five studies, while three studies changed patients' behavior. Fall prevention programs with education components specific for older adults and nursing staff resulted in positive outcomes. Nursing staff make a significant contribution to improving patients' outcomes, and a fall prevention program that focuses on reducing injurious fall rates and enhancing participants' behavior could maximize its effects.
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Affiliation(s)
- Eunice Oladepe Ojo
- Correspondence to: Eunice Oladepe Ojo, DNP, RN, CV-BC, PCCN, DNP Graduate (Nurse Executive), College of Nursing, University of Central Florida, Orlando, FL, 32826, USA.
| | - Ladda Thiamwong
- Department of Nursing Systems, College of Nursing University of Central Florida Orlando, FL, 32826, USA
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Jung H, Lee HY, Park HA. Comparisons of Fall Prevention Activities Using Electronic Nursing Records: A Case-Control Study. J Patient Saf 2022; 18:145-151. [PMID: 35344975 PMCID: PMC9359761 DOI: 10.1097/pts.0000000000000930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to compare the current fall prevention nursing practices with the evidence-based practices recommended in clinical practice guidelines according to the risk of falling and specific risk factors. METHODS The standardized nursing statements of 12,277 patients were extracted from electronic nursing records and classified into groups according to the risk of falling and individual patients' specific risk factors. The mean frequencies of the fall prevention practices in 10 categories derived from clinical practice guidelines were compared among the groups. We additionally analyzed the differences in the mean frequencies of tailored fall prevention practices according to individual patients' specific risk factors. RESULTS The nurses documented more fall prevention practices for patients at a high risk of falling and nonfallers than for patients at a low risk of falling and fallers. Specifically, the difference in nursing practices related to environmental modifications was largest between patients at a high risk of falling and those at a low risk of falling. There were also large differences in the nursing practices related to mental status, dizziness/vertigo, and mobility limitations between fallers and nonfallers. There was more documentation of tailored fall prevention practices related to mobility limitations for patient with mild lower limb weakness than for those with good power and balance. In contrast, patients with severe lower limb weakness had received fewer fall prevention practices related to mobility limitations. CONCLUSIONS The present findings emphasize that individual risk-specific nursing interventions in addition to universal precautions are crucial for preventing falls among patients.
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Affiliation(s)
- Hyesil Jung
- From the Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam
| | - Ho-Young Lee
- From the Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Innab AM. Nurses’ perceptions of fall risk factors and fall prevention strategies in acute care settings in Saudi Arabia. Nurs Open 2022; 9:1362-1369. [PMID: 35099122 PMCID: PMC8859041 DOI: 10.1002/nop2.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/20/2021] [Accepted: 01/09/2022] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Adnan M. Innab
- Nursing Administration and Education Department College of Nursing King Saud University Riyadh Kingdom of Saudi Arabia
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Ayhan Oncu Y, Seren Intepeler S. Nurses' view of implementation evidence-based fall prevention interventions: A qualitative study. J Nurs Manag 2021; 30:234-242. [PMID: 34591345 DOI: 10.1111/jonm.13480] [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: 06/22/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 11/30/2022]
Abstract
AIM The purpose of this descriptive qualitative study was to evaluate nurses' views of implementation evidence-based fall prevention interventions. METHODS The study was conducted with participation of nurses who worked in a training and research hospital after evidence-based fall prevention interventions had been implemented. Interviews were done with 17 nurses who participated in all training courses. RESULTS The evaluation of the interventions was examined, and three themes were extracted through analysis: 'effectiveness of training programme', 'barriers' and 'suggestions'. CONCLUSION Nurses emphasized that evidence-based fall prevention interventions are usable in hospital, but team collaboration and administrative support are required for better outcomes. IMPLICATIONS FOR NURSING MANAGEMENT The study result shows that fall prevention interventions should be introduced to all health care professionals, through the use of various training methods. Training should be given to patients and their caregivers, and barriers that nurses stated like understaffing, lack of materials and tools that ensure patient safety and internet (research/scientific information) access restriction should be reduced.
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Affiliation(s)
- Yasemin Ayhan Oncu
- Faculty of Health Sciences, Nursing Department, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
| | - Seyda Seren Intepeler
- Nursing Faculty, Nursing Management Department, Dokuz Eylul University, Izmir, Turkey
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DiGerolamo KA, Chen-Lim ML. An Educational Intervention to Improve Staff Collaboration and Enhance Knowledge of Fall Risk Factors and Prevention Guidelines. J Pediatr Nurs 2021; 57:43-49. [PMID: 33221696 DOI: 10.1016/j.pedn.2020.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Magnet®-designated hospitals are seeking to reduce the frequency of falls that lead to injury, which is considered a hospital-acquired condition. Patients with cancer are at high risk to fall, due to multiple factors. Synthesis of the literature supports team efforts and shared learning sessions for patient-care staff as part of the fall prevention process. The purpose was to improve collaboration between Registered Nurses (RNs) and Senior Nurse Aides (SNAs), as well as to enhance their knowledge of fall risk factors and evidence-based prevention guidelines for pediatric oncology patients. METHODS An evidence-based practice project was implemented using a quality improvement pilot based on the Magnet® framework. Oncology RNs and SNAs at a large pediatric hospital were invited to attend one of five educational sessions. Pre-and post-session learning was assessed based on an adapted fall risk knowledge assessment tool. FINDINGS Thirty participants attended an educational session with 27 (25 RNs and 2 SNAs) matched pre- and post-session assessments. Median post-session assessment scores were statistically significantly higher than pre-session scores (Z = -3.11, p = 0.001). Overall knowledge scores increased for 63% of participants. DISCUSSION An educational intervention focused on pediatric oncology nursing enhanced knowledge of patient-care roles and fall prevention efforts, leading to improved fall outcomes. APPLICATION TO PRACTICE Ensuring that RNs and SNAs fully embrace their shared role in harm prevention is vital when considering the complexity of delivering nursing care in our current healthcare environment.
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Affiliation(s)
- Kimberly A DiGerolamo
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd. Philadelphia, PA 19104, United States of America.
| | - Mei Lin Chen-Lim
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd. Philadelphia, PA 19104, United States of America
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Improving Prediction of Fall Risk Using Electronic Health Record Data With Various Types and Sources at Multiple Times. Comput Inform Nurs 2019; 38:157-164. [PMID: 31498252 DOI: 10.1097/cin.0000000000000561] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Inpatient falls are among the most common adverse events threatening patient safety. Although many studies have developed predictive models for fall risk, there are some drawbacks. First, most previous studies have relied on an incident-reporting system alone to identify fall events. Thus, it has been found that falls are more likely to be underreported. Second, there has been a controversy on how to select accurate representative values for patient status data across multiple times and various data sources in electronic health records. Given this background, this study used nurses' progress notes as a complementary data source to detect fall events. In addition, we developed criteria including coverage, currency, and granularity in order to integrate electronic health records data documented at multiple times in various data types and sources. Based on this methodology, we developed three models, logistic regression, Cox proportional hazard regression, and decision tree, to predict risk of patient falls and evaluate the predictive performance of these models by comparing the results to results from the Hendrich II Fall Risk Model. The findings of this study will be used in a clinical decision support system to predict risk of falling and provide evidence-based tailored recommendations in the future.
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The Cumulative Complexity Model and Repeat Falls: A Quality Improvement Project. Prof Case Manag 2018; 23:190-203. [PMID: 29846349 DOI: 10.1097/ncm.0000000000000279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE OF PROJECT The purpose of this article is to demonstrate the effectiveness of the Cumulative Complexity Model as a framework to build an Excel tool and a Pareto tool that will enable inpatient case managers to predict the increased risk for and prevent repeat falls. The Excel tool is based on work explained in a previous article by and uses a macro to analyze the factors causing the repeat falls and then calculate the probability of it happening again. This enables the case manager to identify trends in how the patient is transitioning toward goals of care and identify problems before they become barriers to the smooth transition to other levels of care. Thus, the case manager will save the facility money by avoiding unneeded days of care and avoiding the costs that result from rendering medical care for the patient who has fallen. PRIMARY PRACTICE SETTINGS In July 2015, a group of nurses at a small Veterans Health Administration Hospital in the Northwest collaborated to find ways to reverse a trend of increasing falls and repeat falls. METHODOLOGY AND SAMPLE A retrospective chart review of all falls and repeat falls (N = 73) that happened between January 2013 and July 2015 was used to generate a list of top 11 contributing variables that enabled evaluation of the data. A bundle of 3 interventions was instituted in October 2015: (1) development of a dedicated charge nurse/resource nurse, (2) use of a standardized method of rounding, and (3) use of a noncontact patient monitoring system ("virtual nurses"). Falls pre- and postimplementation (N = 109) were analyzed using linear and logistic regression analyses. Data were entered into an Excel sheet and analyzed to identify the major contributing factors to falls and repeat falls and to identify trends. These data were also evaluated to find out whether length of stay and nurse workload contributed to falls. RESULTS Fifteen months after implementation of the aforementioned interventions, falls on the unit went down from 30 aggregate falls in 2015 to 17 aggregate falls in 2016. Repeat falls in 2015 went from 9 repeat falls after admission to the unit down to 2 repeat falls in 2016. Each additional extrinsic variable that was present added an additional 1.43 to the odds ratio (OR) for a fall. Similarly, each additional intrinsic variable present added 2.08 to the OR for a fall. The linear regression of length of stay and falls demonstrated that 17.5% of falls correlated with length of stay, F(1,36) = 7.63, p = .009, R = .175, adjusted R = .152. Workload correlated with work 17% of the time, as measured by using ward days of care, F(1,100) = 20.84, p = .00001, R = .17, adjusted R = .16. IMPLICATIONS FOR CASE MANAGERS Two examples of the how to use these tools are located in the "Discussion" section of the article.
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Shuman CJ, Liu X, Aebersold ML, Tschannen D, Banaszak-Holl J, Titler MG. Associations among unit leadership and unit climates for implementation in acute care: a cross-sectional study. Implement Sci 2018; 13:62. [PMID: 29695302 PMCID: PMC5918552 DOI: 10.1186/s13012-018-0753-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/19/2018] [Indexed: 11/17/2022] Open
Abstract
Background Nurse managers have a pivotal role in fostering unit climates supportive of implementing evidence-based practices (EBPs) in care delivery. EBP leadership behaviors and competencies of nurse managers and their impact on practice climates are widely overlooked in implementation science. The purpose of this study was to examine the contributions of nurse manager EBP leadership behaviors and nurse manager EBP competencies in explaining unit climates for EBP implementation in adult medical-surgical units. Methods A multi-site, multi-unit cross-sectional research design was used to recruit the sample of 24 nurse managers and 553 randomly selected staff nurses from 24 adult medical-surgical units from 7 acute care hospitals in the Northeast and Midwestern USA. Staff nurse perceptions of nurse manager EBP leadership behaviors and unit climates for EBP implementation were measured using the Implementation Leadership Scale and Implementation Climate Scale, respectively. EBP competencies of nurse managers were measured using the Nurse Manager EBP Competency Scale. Participants were emailed a link to an electronic questionnaire and asked to respond within 1 month. The contributions of nurse manager EBP leadership behaviors and competencies in explaining unit climates for EBP implementation were estimated using mixed-effects models controlling for nurse education and years of experience on current unit and accounting for the variability across hospitals and units. Significance level was set at α < .05. Results Two hundred sixty-four staff nurses and 22 nurse managers were included in the final sample, representing 22 units in 7 hospitals. Nurse manager EBP leadership behaviors (p < .001) and EBP competency (p = .008) explained 52.4% of marginal variance in unit climate for EBP implementation. Leadership behaviors uniquely explained 45.2% variance. The variance accounted for by the random intercepts for hospitals and units (p < .001) and years of nursing experience in current unit (p < .05) were significant but level of nursing education was not. Conclusion Nurse managers are significantly related to unit climates for EBP implementation primarily through their leadership behaviors. Future implementation studies should consider the leadership of nurse managers in creating climates supportive of EBP implementation. Electronic supplementary material The online version of this article (10.1186/s13012-018-0753-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Clayton J Shuman
- School of Nursing, University of Michigan, 400 N. Ingalls, Room 4162, Ann Arbor, MI, 48109, USA.
| | - Xuefeng Liu
- School of Nursing, University of Michigan, 400 N. Ingalls, Room 4162, Ann Arbor, MI, 48109, USA
| | - Michelle L Aebersold
- School of Nursing, University of Michigan, 400 N. Ingalls, Room 4162, Ann Arbor, MI, 48109, USA
| | - Dana Tschannen
- School of Nursing, University of Michigan, 400 N. Ingalls, Room 4162, Ann Arbor, MI, 48109, USA
| | - Jane Banaszak-Holl
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.,Institute of Gerontology at Michigan Medicine, 300 N. Ingalls, Ann Arbor, MI, 48109, USA
| | - Marita G Titler
- School of Nursing, University of Michigan, 400 N. Ingalls, Room 4162, Ann Arbor, MI, 48109, USA
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