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Orts-Cortés MI, Cabañero-Martínez MJ, Meseguer-Liza C, Arredondo-González CP, de la Cuesta-Benjumea C, Abad-Corpa E. Effectiveness of nursing interventions in the prevention of falls in older adults in the community and in health care settings: A systematic review and meta-analysis of RCT. Enferm Clin (Engl Ed) 2024; 34:4-13. [PMID: 38185371 DOI: 10.1016/j.enfcle.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/09/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To estimate the effectiveness of fall prevention programs in people aged 65 years and older involving nursing professionals. METHODS We included available full-text randomized clinical trials on nurse-led prevention of falls in the community in people over 65 years of age and reporting the incidence of such falls. An extensive search was performed in 14 databases covering the period 2016-2018 for publications in English, French, Portuguese and Spanish. The quality of the papers was assessed independently and blindly by reviewers working in pairs using the risk of bias dominios of the Cochrane Collaboration. The hazard ratio was used as a measure of the effect size of the incidence of falls. A random-effects model was assumed for statistical analyses. The influence of moderator variables of the studies on the effect sizes was performed using ANOVAs and its 95% CI for each moderator category. RESULTS A total of 31 randomized clinical trials were selected with 25,551 participants. The most frequent type of intervention was education (57.1%), followed by multifactorial models (37.1%). The probability of falling was significantly reduced by 13% in the intervention groups compared to the control groups (RR+=0.87). Multifactorial (RR+=0.89) and education-based (RR=+0.84) interventions significantly reduced the probability of falls by 11% and 16%, respectively. CONCLUSIONS Discarding publication bias prevention programs carried out by nurses produce a significant 10% reduction in falls. Education-based and multifactorial interventions are the most effective when conducted by nurses.
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Affiliation(s)
- María Isabel Orts-Cortés
- Department of Nursing, University of Alicante, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Nursing and Healthcare Research Unit (Investén-ISCIII), CIBER of Frailty and Healthy Aging (CIBERFES) Instituto de Salud Carlos III, Madrid, Spain
| | - María José Cabañero-Martínez
- Department of Nursing, University of Alicante, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Cristóbal Meseguer-Liza
- Adjunct Professor of Nursing, University of Murcia, Nurse Murcia Health Service, Murcia, Spain
| | | | | | - Eva Abad-Corpa
- University of Murcia, Nurse, Murcia Health Service, IMIB-Arrixaca. Murcia, Nursing and Healthcare Research Unit (Investén-ISCIII), CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
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Del Castillo M, Mosteiro MA, Navarro J, Rivas ME, Gianella M, Ahumada M. [Incidence, circumstances and consequences of falls in subjects with stroke: One year of follow-up]. Rehabilitacion (Madr) 2023; 57:100809. [PMID: 37399639 DOI: 10.1016/j.rh.2023.100809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 01/25/2023] [Accepted: 04/01/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Falls are among the most frequent complications following stroke (CVA), and have a negative impact on rehabilitation. OBJECTIVES To study the incidence, circumstances, and consequences of falls in stroke patients up to 12months after starting outpatient kinetic treatment. MATERIALS AND METHODS Prospective design, case series. Consecutive sampling. Patients admitted to the day hospital between June 2019 and May 2020. Included: adults with a diagnosis of first supratentorial stroke and functional ambulatory category score ≥3. EXCLUSION CRITERIA other condition affecting locomotion. MAIN VARIABLES number of falls, circumstances, and consequences. Clinical, demographic, and functional characteristics were measured. RESULTS Twenty-one subjects were included, 13 suffered at least one fall. The subjects reported 41 falls: 15 were to the most affected side, 35 inside the home, 28 without the indicated equipment, they were alone when the event occurred on 29 occasions, and in two situations medical assistance was required. There were statistically significant differences (P<.05) in functional performance (balance, gait velocity) between those who fell and those who did not. No significant differences were found between gait endurance and falls. CONCLUSION More than half suffered a fall, alone, to the weaker side, and without the appropriate equipment. With this information the incidence could be reduced by preventive measures.
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Affiliation(s)
- M Del Castillo
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLEINI), Buenos Aires, Argentina
| | - M A Mosteiro
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLEINI), Buenos Aires, Argentina.
| | - J Navarro
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLEINI), Buenos Aires, Argentina
| | - M E Rivas
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLEINI), Buenos Aires, Argentina
| | - M Gianella
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLEINI), Buenos Aires, Argentina
| | - M Ahumada
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLEINI), Buenos Aires, Argentina
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Bustamante-Troncoso C, Herrera-López LM, Sánchez H, Pérez JC, Márquez-Doren F, Leiva S. [Effect of a multidimensional intervention for prevention of falls in the eldery]. Aten Primaria 2020; 52:722-730. [PMID: 31740074 PMCID: PMC8054286 DOI: 10.1016/j.aprim.2019.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/30/2019] [Accepted: 07/29/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the effect of a multidimensional intervention on the perception and management of risk factors and frequency of falls in independent elderly people living in the community. DESIGN Randomised clinical trial. SETTING Family health centre, primary care. PARTICIPANTS Independent elderly people living in the community. INTERVENTION For intervention group (IG) a multidimensional intervention, consisting of home visits and telephone follow-up was carried out for 5 months (n=77), and those assigned to the control group (CG, n=77) received usual care in the family health centre. MAIN MEASUREMENTS Perception of risk of falls, number of risk factors and number of falls in the study period. RESULTS In both groups there were increases in the perception of risk factors for falling associated with walking (IG: P<.001 and CG: P<.001). Belonging to the IG was significantly associated with a decrease in the risk factors associated with surfaces (r=0.25) and shoes (r=0.24), as well as an increase in the perception of risk of falls associated with walking (r=0.21) and the presence of objects or furniture (r=0.36). In the IG, 5 participants (7.9%) suffered at least one fall in the 5-month period and 18 (27.7%) patients in the CG (P=.004). CONCLUSIONS The multidimensional intervention was effective in reducing the frequency of falls and in the management of extrinsic risk factors associated with surfaces, lighting, and support devices.
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Affiliation(s)
| | | | - Hugo Sánchez
- Servicio de Salud Metropolitano Sur, Santiago de Chile, Chile
| | - J Carola Pérez
- Facultad de Psicología, Universidad del Desarrollo, Santiago de Chile, Chile
| | | | - Sara Leiva
- Centro de Salud Familiar Félix de Amesti, Departamento de Salud Municipalidad de Macul, Santiago de Chile, Chile
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Alcañiz-Mesas AI, García-González M, Zúñiga-Blanco L, Del Barrio-Pintado MB, Íñigo-Cruces L, Folguera-Arnau M, Albornos-Muñoz L, Melián-Correa E. Implementation experience of a guideline on fall prevention in Centres Committed to Excellence in Care®. Enferm Clin (Engl Ed) 2020; 30:185-197. [PMID: 32439314 DOI: 10.1016/j.enfcli.2020.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/07/2019] [Accepted: 03/10/2020] [Indexed: 11/19/2022]
Abstract
AIM To describe the progress of implementing the «Preventing falls» Guideline of the Best Practice Spotlight Organization (BPSO®) Programme and fall outcomes in Centres Committed to Excellence in Care (CCEC®). METHOD A Quasi-experimental study pre-post test from a multicentric approach carried out between 2012-2018. The study is focused on patients aged 65 or older, discharged from guideline implementation units, analysing sociodemographic variables (sex, age, hospitalization days; fall risk assessment on admission and patient in risk; fall prevention plan; incidence of falls. Data was compared from CCEC® programme indicators measured over the periods: baseline (T1), candidate during the first three years (T2), and sustainability (T3). Descriptive and inferential analysis was performed. RESULTS 31,486 patients were evaluated in 7 centres (T1=465; T2=14,255; T3=16,766). Of the patients, 51.87% were men and average age was 79.06 years. Hospitalization was 8.15 days. Fall risk assessment on admission was performed in 81.96% of patients (T1=44.30%, T2=81.11%, T3=83.73%) and 52.31% patients had high risk. A prevention falls plan was registered in 47.75% of patients (T1=24.73%, T2=42.43%, T3=52.90%). Four hundred and twenty-three falls were recorded, 62.17% without injuries. CONCLUSIONS Despite the differences between hospitals, such as structural characteristics, strategies, assessment tools and data progression pace; adherence to recommendations is proving successful, improving widely. Guideline implementation has allowed fall problems to be addressed, producing positive changes in the process and encouraging the implementation and sustainability of evidence-based nursing practice.
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Affiliation(s)
- Ana Isabel Alcañiz-Mesas
- Unidad de Oncología y Hematología, Complejo Hospitalario Universitario de Albacete. Gerencia de Atención Integrada de Albacete, Albacete, España
| | - Milagros García-González
- Servicio de Medicina Interna, Hospital de Mendaro. Organización Sanitaria Integrada Debabarrena, Mendaro, Gipuzkoa, España
| | - Lucía Zúñiga-Blanco
- Unidad de Medicina Interna, Hospital de Medina del Campo. Gerencia de Atención Especializada Área Este Valladolid, Medina del Campo, Valladolid, España
| | - M Begoña Del Barrio-Pintado
- Área de Gestión Clínica, Medicina Interna Unidad 3.(a) C. Hospital Valle de Nalón, Langreo, Asturias, España
| | - Lidia Íñigo-Cruces
- Unidad de Medicina Interna, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - Mercè Folguera-Arnau
- Área de Calidad, Dirección de Enfermería y Continuidad Asistencial, Hospital Universitari de Santa María, Lleida, España
| | - Laura Albornos-Muñoz
- Unidad de Investigación en Cuidados de Salud (Investén-isciii), REDISSEC, Instituto de Salud Carlos III, Madrid, España.
| | - Esther Melián-Correa
- Servicio de Medicina Preventiva, Hospital Dr. José Molina Orosa. Área de Salud de Lanzarote, Gerencia de Servicios Sanitarios, Arrecife, Lanzarote, España
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Altemir M, Arteaga A. A protocol to prevent and deal with aggressive behavior against health workers. Enferm Clin (Engl Ed) 2018; 28:125-32. [PMID: 29107451 DOI: 10.1016/j.enfcli.2017.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 08/21/2017] [Accepted: 09/04/2017] [Indexed: 11/23/2022]
Abstract
Violence against health workers is a highly prevalent phenomenon with serious psychological and labour consequences among professionals. This paper aims, first, to find out the main studies undertaken to date to describe and analyse the phenomenon, as well as to present different initiatives and protocols of action carried out. The second objective is to offer a procedure of action both to prevent aggression and to intervene in the event of receiving an aggression at work. After a bibliographic search in PubMed, Scopus and SciELO databases, the impact of the aggressions suffered by health professionals, the contexts in which aggressions are more frequent, their main consequences and different strategies and protocols conducted in Spain are reviewed. Given that rigorous reviews supporting such procedures are lacking in scientific journals, different action guidelines for professionals to prevent and to deal with hostile behaviour based on available evidence are developed and proposed. Finally, an easily consultable and applicable action procedure for health workers attacked in the workplace is presented.
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Gabari Gambarte MI, Sáenz Mendía R. [Keys to preventing accidents in children in the school context]. Gac Sanit 2016; 32:405-410. [PMID: 27816229 DOI: 10.1016/j.gaceta.2016.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/21/2016] [Accepted: 07/26/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To learn about children's perception of the causes and prevention strategies involved in school accidents. METHOD The sample included 584 school children aged 8-9 years from Navarra. A mixed design was chosen by questionnaire with three open-response questions and one multiple-choice assessment. Analysis was performed in two phases: 1) qualitative development of categories and dimensions of the responses of narrative content, and 2) quantitative variables for recoding correlational analysis. RESULTS 22 categories emerged, which make up three perceptual dimensions: 1) attribution of causality (5), 2) identification of mechanisms of avoidance (11), and 3) development of coping strategies (6). The correlation intra-variables portray varying degrees: on the one hand, moderate positive numbers (r>0.5) in allocating and identifying causality avoidance mechanisms and, on the other hand, high positive correlation values (r>0.7) referred to developing coping strategies. DISCUSSION Children are able to identify accidents as a health problem. They question the multiplicity of elements involved and relate the origin and kind of accident to prevention and support mechanisms.
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Affiliation(s)
- M Inés Gabari Gambarte
- Departamento de Psicología y Pedagogía, Universidad Pública de Navarra, Pamplona, España.
| | - Raquel Sáenz Mendía
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, España
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Malveiro J, de Jesus SN, Viseo J, Pechorro P, Pacheco E, Lima-Rodríguez JS, Lima-Serrano M. [Prevention of drink driving at academic festivals: «Tú decides» project]. Enferm Clin 2015; 25:305-11. [PMID: 26481955 DOI: 10.1016/j.enfcli.2015.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/05/2015] [Accepted: 07/27/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Alcohol consumption among university students has reached worrying levels, its effects on driving being highly dangerous. This aspect emphasizes the need to develop prevention programs, intended to raise subjects' awareness about the effects of alcohol on driving. The aim of the present research is to evaluate the effectiveness of the intervention program «Tú decides», implemented at the Algarve University during several students festivals, between 2010-2014. METHOD Quasi-experimental study, pre-post test without control group. A total of 5,079 participants were inquired. They were asked, at two different moments, before and after the measurement of the blood alcohol level and giving an information session with technical recommendations to prevent driving under alcohol effects. One factor ANOVA test used, in order to perform a mean comparison, as well as the Chi-square statistics, to perform a proportion comparison (p<.05). RESULTS It was found that the intention to drive was lower at the second moment (42.1%) (χ(2)=2078.71; p=.000). This intention was influenced by blood alcohol level different levels (χ(2)=338.252; p=.000), gender (χ(2)=35.718; p=.000), age (χ(2)=62.805; p=.000) and professional situation of the participants (χ(2)=27.397; p=.001). CONCLUSIONS We can affirm that the main objective of this intervention was achieved, since the participants followed the technical recommendations based on the blood alcohol level results.
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Martínez Pérez JE, Sánchez Martínez FI, Abellán Perpiñán JM, Pinto Prades JL. [Monetary value of the human costs of road traffic injuries in Spain]. Gac Sanit 2015; 29 Suppl 1:76-8. [PMID: 26342412 DOI: 10.1016/j.gaceta.2015.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/30/2015] [Accepted: 02/02/2015] [Indexed: 11/23/2022]
Abstract
Cost-benefit analyses in the field of road safety compute human costs as a key component of total costs. The present article presents two studies promoted by the Directorate-General for Traffic aimed at obtaining official values for the costs associated with fatal and non-fatal traffic injuries in Spain. We combined the contingent valuation approach and the (modified) standard gamble technique in two surveys administered to large representative samples (n1=2,020, n2=2,000) of the Spanish population. The monetary value of preventing a fatality was estimated to be 1.4 million euros. Values of 219,000 and 6,100 euros were obtained for minor and severe non-fatal injuries, respectively. These figures are comparable to those observed in neighboring countries.
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Pérez-Juan E, Maqueda-Palau M, Romero-Grilo C, Muñoz-Moles Y. [Procedure adverse events: nursing care in central venous catheter fracture]. Enferm Clin 2014; 24:148-53. [PMID: 24439203 DOI: 10.1016/j.enfcli.2013.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/25/2013] [Accepted: 11/25/2013] [Indexed: 11/22/2022]
Abstract
In a intensive care unit (ICU) there are many factors that can lead to the occurrence of adverse events. A high percentage of these events are associated with the administration of drugs. Diagnostic tests, such as computed tomography, is common in critically ill patients and technique can be performed with injection of contrast agent to enhance the visualization of soft tissue. The contrast is a medication and the nurse is responsible for its proper administration. The management of the critically ill patient is complex. ICU team and radiology shares responsibility for the care and safety of the patient safety during the transfer and performing tests with contrast. The World Health Organisation patient safety strategies, recommends analysing errors and learning from them. Therefore, it was decided to investigate the causes of the category E severity adverse events that occurred in a patient who was admitted to the ICU for septic shock of abdominal origin. An abdominal computed tomography was performed with contrast which was injected through a central venous catheter. The contrast did not appear in the image. What happened? Causal analysis helped to understand what triggered the event. A care plan and an algorithm were drafted to prevent it from happening again, with the following objectives: improving knowledge, skills and promoting positive attitudes towards patient safety, working at primary, secondary and tertiary care levels.
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