The patients’ perspective of sustaining a fall in hospital: A qualitative study

Gettens, Stephanie; Fulbrook, Paul; Jessup, Melanie; Choy, Nancy Low

doi:10.1111/jocn.14075

Cited by 25 publications

(43 citation statements)

References 27 publications

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“…Some patients initiate risky decisions about mobility based on their own judgements, without always seeking help from nurses or other health professionals [25]. Others report feeling secure by virtue of being in a hospital environment, even though they are actually at high risk of falling [11,22,26]. Although risk taking is not always problematic, it becomes dangerous when excessive, poorly considered or not in a supported environment [22].…”

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confidence: 99%

Hospital falls prevention with patient education: a scoping review

et al. 2020

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Background: Hospital falls remain a frequent and debilitating problem worldwide. Most hospital falls prevention strategies have targeted clinician education, environmental modifications, assistive devices, hospital systems and medication reviews. The role that patients can play in preventing falls whilst in hospital has received less attention. This critical review scopes patient falls education interventions for hospitals. The quality of the educational designs under-pinning patient falls education programmes was also evaluated. The outcomes of patient-centred falls prevention programs were considered for a range of hospital settings and diagnoses. Methods: The Arksey and O'Malley (2005) framework for scoping reviews was adapted using Joanna Briggs Institute and PRISMA-ScR guidelines. Eight databases, including grey literature, were searched from January 2008 until February 2020. Two reviewers independently screened the articles and data were extracted and summarised thematically. The quality of falls prevention education programs for patients was also appraised using a modified quality metric tool. Results: Forty-three articles were included in the final analysis. The interventions included: (i) direct face-to-face patient education about falls risks and mitigation; (ii) educational tools; (iii) patient-focussed consumer materials such as pamphlets, brochures and handouts; and (iv) hospital systems, policies and procedures to assist patients to prevent falls. The included studies assessed falls or education related outcomes before and after patient falls prevention education. Few studies reported incorporating education design principles or educational theories. When reported, most educational programs were of low to moderate quality from an educational design perspective. Conclusions: There is emerging evidence that hospital falls prevention interventions that incorporate patient education can reduce falls and associated injuries such as bruising, lacerations or fractures. The design, mode of delivery and quality of educational design influence outcomes. Well-designed education programs can improve knowledge and self-perception of risk, empowering patients to reduce their risk of falling whilst in hospital.

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confidence: 99%

Hospital falls prevention with patient education: a scoping review

et al. 2020

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“…Few existing studies have examined patients’ subjective perceptions of falls in hospitals. A study conducted on patients with various diseases in a tertiary referral hospital [ 28 ] identified the following themes: 1) patients’ feelings of safety during hospitalisation, 2) realizing the risk of falling after the fall, 3) regaining their independence and identity including consideration of strategic ways to mitigate the risk of falling. Similarly, a small sample study ( n = 5) with patients in rehabilitation wards [ 29 ] derived the following themes: 1) patients’ perceptions about the causes of their fall, 2) their thoughts about changes in the way they move around the hospital after the fall, 3) decreased confidence and negative attitudes toward rehabilitation, and 4) changes in the role of staff.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have investigated the experience of falls in hospitals from patients’ perspectives [ 28 , 29 ]. Furthermore, to the best of our knowledge, no study has focused on the perspective of patients with stroke undergoing rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

Patients’ thoughts on their falls in a rehabilitation hospital: a qualitative study of patients with stroke

et al. 2021

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Background Patients with stroke in rehabilitation wards are at an increased risk of falling. Although patients’ participation in establishing medical safety is considered crucial, there is limited evidence on their perspectives of falls. This study aims to comprehensively elucidate the subjective falling experience of patients with stroke who have been admitted to rehabilitation wards. Methods Twenty-three consecutive patients with stroke (44 to 90 years) who experienced a fall during hospitalisation were interviewed within 1 week after the fall, and thematic analysis was used to analyse the data. Results Five themes surrounding fall events were extracted from the narratives: ‘Psychological background before the action’, ‘Support for the action’, ‘Direct causes of the fall’, ‘Patients’ awareness after the fall’, and ‘Changes in attitudes and behaviours after the fall’. ‘Psychological background before the action’ comprised hastiness or hesitation to call for help. Participants often took an action based on ‘Support for the action’ derived from their past experiences of moving safely, their confidence, and/or motivation to challenge themselves to move. ‘Direct causes of the fall’ consisted of unfamiliar actions, training fatigue, the surrounding environment, reduced physical function due to paralysis, lack of attention, overconfidence in their ability, and insufficient prediction of falls. ‘Patients’ awareness after the fall’ consisted of re-affirming difficult movements, the need for rehabilitation, a reduced ability to move, an increased risk of falling, the need for attention while moving, a fear of falling, and a lack of lessons learned from falling. Finally, patients demonstrated ‘Changes in attitudes and behaviours after the fall’ such as embodying a positive attitude to cope with the risk of falling or behavioural changes to reduce the risk of falling. Conclusions Comprehensive information on patients’ perspectives before and after the fall was elucidated, uncovering many aspects including the psychological background for why patients engaged in risky behaviours resulting in falls, presence of positive thinking, and behaviour after the fall. By incorporating the patients’ views on fall incidences and their assessment, we can develop appropriate prevention strategies against falls.

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“…Accessibility to healthcare professionals generates feelings of safety (Gettens et al, 2018; Lovink et al, 2015). There are studies reporting a worse perception of safety when the healthcare professional is absent (Mollon, 2014) because patients think that no professionals will be available to help them if something goes wrong during their care (Stenhouse, 2013).…”

Section: Discussionmentioning

confidence: 99%

Feeling safe or unsafe in prehospital emergency care: A qualitative study of the experiences of patients, carers and healthcare professionals

Péculo‐Carrasco

Sola

Casal‐Sánchez

et al. 2020

Journal of Clinical Nursing

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Aims and objectives: To determine the feelings of safety among patients taken to hospital after requesting urgent care, based on their experiences and those of their carers and prehospital emergency care professionals. Background: Little research has been performed into the perception of safety in prehospital emergency care settings worldwide, from either the perspective of the patients or from that of healthcare professionals. Design: Exploratory qualitative study using focus groups in Spain. Methods: The participants were patients that requested care through the emergency telephone service, their carers and the professionals of the emergency care teams. The structured sampling design was based on an intentional, nonprobability selection following pragmatic criteria. Seven groups of patients/carers and two groups of professionals were formed (65 participants). The recordings were fully transcribed before their validation and codes were assigned to ensure anonymity. The ATLAS.ti software was used for the analysis. The authors took into account the COREQ checklist for qualitative studies. Findings: Neither group provided a clear definition of the meaning of feeling safe. It appeared easier to give examples that had a positive or negative influence on their perception of feeling safe. During the analysis of the discourse, six categories were detected after grouping the related codes. Conclusions: For most of the patients' feeling of being safe or very safe arose from the perception of calmness, trust and protection. Defining the perception of safety was not easy. The factors with the greatest effect on feeling safe were related to Information and communication, Person-centred care and Professional competency, without losing sight of other factors such as Accessibility and response times of the emergency teams, Equipment and Healthcare setting.

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The patients’ perspective of sustaining a fall in hospital: A qualitative study

Abstract: By understanding the patient's perspective of falling, nurses and other health professionals conducting risk assessment can tailor their discussions and interventions to the patient's perceptions and needs.

Cited by 25 publications

References 27 publications

Hospital falls prevention with patient education: a scoping review

Hospital falls prevention with patient education: a scoping review

Patients’ thoughts on their falls in a rehabilitation hospital: a qualitative study of patients with stroke

Feeling safe or unsafe in prehospital emergency care: A qualitative study of the experiences of patients, carers and healthcare professionals

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