Impact of Fall Prevention on Nurses and Care of Fall Risk Patients

Abstract

Results of this study identify unintended consequences of fall prevention message on nurses and older adult patients. Further research is needed understand how nurse care for fall risk patients.

Nursing practice with hospitalised older people: Safety and harm

“…The review yielded 23 articles that represented one mixed methods (Strumpf & Evans, ), seven quantitative (Farina‐Lopez, Estevez‐Guerra, Polo‐Luque, Pogranyiva, & Penelo, ; Janelli, Stamps, & Delles, ; Liukkonen & Laitinen, ; McCabe, Alvarez, McNulty, & Fitzpatrick, ; Myers, Nikoletti, & Hill, ; Suen et al, ; Werner, ) and 15 qualitative studies (Bok, Pierce, Gies, & Steiner, ; Boltz, Capezuti, & Shabbat, ; Brown, Williams, Woodby, Davis, & Allman, ; Chuang & Huang, ; Dahlke, Hall, & Baumbusch, ; Dahlke & Phinney, ; Goethals, Dierckx de Casterlé, & Gastmans, ; King, Pecanac, Krupp, Liebzeit, & Mahoney, ; Kneafsey, Clifford, & Greenfield, ; Lai, ; Lee, Chan, Tam, & Yeung, ; Ludwick, O'Toole, & Meehan, ; Nolan, ; Quinn, ; Schofield, Tolson, & Fleming, ). Nine were conducted in the United States, three in the United Kingdom, three in Hong Kong, two in Canada and one each in Spain, Taiwan, Belgium, Finland, Australia and Israel.…”

“…In 2 of the studies, nursing staff in the United States (US) (Janelli et al, ) and the United Kingdom (UK) (Schofield et al, ) discussed using chemical restraints to keep their older patients from harms that were defined as falling or removing medical equipment (e.g., catheters, intravenous lines). Studies from Taiwan (Chuang & Huang, ), Spain (Farina‐Lopez et al, ), the United States (King et al, ; Ludwick et al, ; McCabe et al, ; Quinn, ; Strumpf & Evans, ), Hong Kong (Lai, ; Lee et al, ; Suen et al, ), Finland (Liukkonen & Laitinen, ), Australia (Myers et al, ) and Israel (Werner, ) all reported nurses' use of physical restraints to keep their older patients safe. Four of the studies identified that once physical restraints had been applied to an older patient, nursing teams were reticent to remove them, even if the reason for using the restraint was no longer present (Chuang & Huang, ; Goethals et al, ; Ludwick et al, ; Suen et al, ).…”

“…Management that supported nursing teams in balancing older patients' fear of falling, families' beliefs that the older person should stay in bed, and workload were more likely to focus on improving older patients' mobility. King et al's () grounded theory study exploring US nurses' experiences with fall prevention programmes revealed how messaging from hospital administration to achieve zero falls could contribute to increased use of physical restraints. When managers on high fall units emphasised the importance of no falls, nurses developed a fear of falls and limited older patients' activities even though they recognised this practice was not in the best interest of their patients.…”

“…In five of these studies, nurses reported the acute care context as a challenging environment to manage the safety needs of older people (Chuang & Huang, 2007;Dahlke & Phinney, 2008;Dahlke et al, 2017;Lai, 2007;Ludwick et al, 2010) leading nurses to frame the use of restraints as a relief to their concerns of older patients' safety (Chuang & Huang, 2007;Lai, 2007). Additionally, some of the more recent studies discussed how no falls policies, administrative practices to reinforce no falls, and individual nurse characteristics (such as risk tolerance) influenced restraint use (King et al, 2018;Lai, 2007) and how nurses defined safety (Dahlke et al, 2017;Schofield et al, 2012). These will be explained in the themes of restraining and reducing mobility.…”

Nursing students’ experience with fall risk assessment in older adults

“…Hospitalized older adults are especially vulnerable to functional decline due to age-related changes in cardiovascular and musculoskeletal systems. Decreased ambulation due to illness, staffing issues, and nurses' fear of patients falling can result in increased functional decline and an increased risk for falling while in the hospital (King, Steege, Winsor, & VanDenbergh, 2016) and after discharge to the community (King, Pecanac, Krupp, Liebzeit, & Mahoney, 2016).…”