BackgroundUnassisted falls are more likely to result in injury than assisted falls. However, little is known about risk factors for falling unassisted. Furthermore, rural hospitals, which care for a high proportion of older adults, are underrepresented in research on hospital falls. This study identified risk factors for unassisted and injurious falls in rural hospitals.MethodsSeventeen hospitals reported 353 falls over 2 years. We categorized falls by type (assisted vs. unassisted) and outcome (injurious vs. non-injurious). We used multivariate logistic regression to determine factors that predicted fall type and outcome.ResultsWith all other factors being equal, the odds of falling unassisted were 2.55 times greater for a patient aged ≥65 than < 65 (95% confidence interval [CI] = 1.30–5.03), 3.70 times greater for a patient with cognitive impairment than without (95% CI = 2.06–6.63), and 6.97 times greater if a gait belt was not identified as an intervention for a patient than if it was identified (95% CI = 3.75–12.94). With all other factors being equal, the odds of an injurious fall were 2.55 times greater for a patient aged ≥65 than < 65 (95% CI = 1.32–4.94), 2.48 times greater if a fall occurred in the bathroom vs. other locations (95% CI = 1.41–4.36), and 3.65 times greater if the fall occurred when hands-on assistance was provided without a gait belt, compared to hands-on assistance with a gait belt (95% CI = 1.34–9.97).ConclusionsMany factors associated with unassisted or injurious falls in rural hospitals were consistent with research conducted in larger facilities. A novel finding is that identifying a gait belt as an intervention decreased the odds of patients falling unassisted. Additionally, using a gait belt during an assisted fall decreased the odds of injury. We expanded upon other research that found an association between assistance during falls and injury by discovering that the manner in which a fall is assisted is an important consideration for risk mitigation.

Hospital type was a significant predictor of fall rates. However, shifting the paradigm for fall risk reduction from a nursing-centric approach to one in which teams implement evidence-based practices and learn from data may decrease fall risk regardless of hospital type.

This exploratory study of patients in Pennsylvania (PA) and Virginia (VA) hospitals in 1998-1999 measures the segregation of care for Black patients receiving inpatient care for specific medical and surgical conditions. It also examined inpatient mortality risk for Black patients and the impact of treatment in heavily segregated hospitals on mortality for Blacks and non-Blacks. Segregation of hospital care was found across both states but was more pronounced in PA. Blacks did not experience higher mortality rates than non-Blacks either before or after controls for clinical risk factors in either state and for certain admission types had lower mortality. Both Black and non-Black surgical, heart failure, and lung disease patients treated in VA hospitals with more Black patients had poorer outcomes. Future research should examine how access, patient choice, hospital organization, processes of care, and factors related to nursing care might influence hospital outcomes for patients from different racial backgrounds.

The deposition of agricultural pesticides in the homes of agricultural workers and residents of agricultural communities is a major environmental health concern. The effectiveness of home cleaning activities in removing pesticides from home surfaces has not been tested. An intervention study was conducted to assess the effectiveness of cleaning windowsills, floors and carpets in a sample of 10 farmworker homes. Baseline measures of organophosphorus (OP) pesticide residues were obtained, a standardized cleaning intervention was applied and follow-up measures of pesticide residues were obtained within 24-48 hours after the cleaning and 12 months later. House dust was analyzed for six OP pesticides. All homes had detectable baseline levels of OP pesticides on floors and windowsills. Cleaning of linoleum floors was ineffective in removing total pesticide residues and cleaning effectiveness varied among the pesticides. The cleaning of total OP pesticides on the windowsills was effective (median decrease was 0.0029 microg/cm(2), 1-sided p-value = 0.01). Steam cleaning carpets essentially reduced the amounts to non-detectable levels. In 12 months the levels in carpets had accumulated to one-third of the baseline levels. These results provide evidence that cleaning practices can reduce the amount of pesticides in agricultural homes; however the type of surface being cleaned and the pesticides present in the home may influence results.

This phenomenological study aimed to describe nursing care of Latinos in the emergency department to determine how care is planned relative to the patient's ethnicity, including linguistic abilities. Unstructured interviews were conducted with 15 registered nurses from four hospitals in the Northwest. Interpreters play a pivotal role in nurses' practices. Nurses' skills with working with interpreters, interpreter availability, engagement, and accuracy enhance or impede effective care. Linguistic differences challenge effective care provision. Culturally competent care requires secure avenues of accurate communication. Administrators must provide nurses with resources that promote culturally competent care, including training with interpreters to facilitate effective communication.