The incidence of falls among elderly patients has been and continues to be a major challenge for nurses. Falls add physical injury and mental stress to patients' existing health problems, are a deterrent to rehabilitation, and increase healthcare costs. This study describes the variables that nurses identify as influencing their clinical decision making and the nursing behaviors associated with preventing patient falls. The study was grounded in the theory that discretionary nursing behaviors are related to nursing expertise, and the study was guided by the assumption that such behaviors are proactive and anticipatory. An analysis of interviews of registered nurses (n = 14) working on a geriatric rehabilitation unit in a medical center in Ohio focused on the zones of association and the contextual meanings of language used by the nurses when discussing patient falls. Four themes emerged: the reasons for patient falls, identifying patients who are likely to fall, preventing falls, and nurses' feelings when patients fall.

1. Multiple falls and injuries are more prevalent among elderly over the age of 75 and are the second leading cause of accidental death in the elderly. The risk for falling is noted to be significantly greater in the hospitalized elderly. 2. Review of retrospective quality improvement chart audits revealed that peak fall times were associated with the patient's need for toileting, rest, and obtaining nutrition and hydration. 3. The MetroHealth Falls Prevention Program is based on simple proactive measures to prevent falls in the elderly. 4. An effective falls prevention program has several implications for gerontological nursing practice, including less restraint use, increased patient autonomy, and decreased loss of self-esteem. There is also a sense of increased nursing control over patient safety and time management, as well as implications for further nursing research.

The purpose of this study was to compare patients receiving neurodevelopmental therapy (NDT) to patients receiving a traditional approach. The study took place on two separate medical rehabilitation units, each using just one approach. Patients were assigned to each unit based upon bed availability. The charts of 43 cerebral vascular accident (CVA) patients who received the traditional approach and of 37 CVA patients who received NDT were audited for demographic, functional, and disposition data. No significant differences at admission were found between the two groups, except that the NDT group had higher scores in dressing (p = .04) and toileting (p = .02). At discharge, the NDT group had higher functioning scores on toileting only (p = .03). Length of stay was almost identical between the two groups. Eighty-six percent of the NDT sample were discharged home compared to 78% of the traditional sample, but this was not statistically significant. Thus, the NDT approach does not appear to be superior to the traditional approach. These results imply that there needs to be more careful study of rehabilitation approaches before committing to one specific approach in the nursing care of CVA patients.