Clinical Nursing Judgment Related to Reducing the Incidence of Falls by Elderly Patients

Abstract

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.

Falls prevention revisited: a call for a new approach

“…There is substantial evidence that they do. As noted by Turkoski et al. (1997), nurses expressed self‐doubt and blame following a patient fall that was sufficient to drive them from the profession.…”

Fall risk assessment: A prospective investigation of nurses’ clinical judgement and risk assessment tools in predicting patient falls

“…suggest that nurses’ clinical judgements about patients’ fall risk may aid the development of fall prevention protocols. Further research is warranted to build on limited knowledge in this area 16 …”

Side Rail Use and Bed‐Related Fall Outcomes Among Nursing Home Residents

“…2 In numerous studies of falls and injuries, researchers have noted a significant incidence of falls and injuries with side rail use, [3][4][5][6][7][8][9][10][11] and several editorials and reviews of the falls literature discourage their use. [12][13][14][15][16][17] It is well recognized by physicians and nurses working in British geriatric facilities that side rails lack any known benefit in fall prevention, 18 and their prevalence is modest, only 8.4% (56/668) in one study. 19 A study conducted in a New Zealand hospital found a decease in falls and injuries after a policy to reduce side rail use.…”