Introduction
In addition to people in health care establishments having various illnesses, many patients experience falls. Falls are common among people from 65 years old, with at least one in three individuals falling every year (Patton et al., 2021). Patton et al. (2021) state that due to the increasing number of the older population, compared to other age groups, fall rates are expected to grow as well. Therefore, more awareness needs to be brought to fall prevention to enhance the safety and well-being of elderly patients within health care institutions. The development of a successful fall prevention strategy requires an analysis of the reasons behind falls, the most vulnerable groups of patients, responsible staff members, issues, and existing practices.
Fall Prevention
Causes and Consequences
To begin with, one needs to understand the causes and consequences of falls. Patton et al. (2021) mention that experiences of falls are due to a combination of biological, environmental, and behavioral factors. Some of those factors include health status, presence of chronic illnesses, and medication intake (Patton et al., 2021). While most of the patients tend to report falling to their health care providers, only 60% of them receive information on preventing future falls (Patton et al., 2021). Tucker et al. (2019) state that more than 20% of falls result in painful injuries that extend the length of stay. Although few injuries can lead to death, many of them are associated with a higher cost of stay and loss of functional independence (Patton et al., 2021). Moreover, patients, who have severe damages due to falling, require additional care from medical staff, affecting their daily productivity (Patton et al., 2021). Fall prevention is significant to maintain the treatment process of patients in health care organizations, ensure their safety, and evade work overload.
Gender Differences
To develop a fall prevention strategy, one needs to consider differences between patients’ perceptions of interventions. Patton et al. (2021) suggest that gender-related factors can affect the risk of falling since men seem to fall more often than women. However, men are less likely to seek medical care after a fall and are reluctant to engage in discussions (Patton et al., 2021). Therefore, fall prevention strategies for women and men may need to differ. For example, women tend to have more interest in varying ways to prevent falls, such as wearing proper shoes and taking vitamins to avert osteoporosis (Patton et al., 2021). On the other hand, men are drawn to calculating risks of falling and prefer written guidelines with explanations from medical staff (Patton et al., 2021). While some studies concentrate on fall experiences, Patton et al. (2021) focus on expectations on prevention. Multiple patients’ preferences need to be considered in fall prevention, and those related to gender can be a starting point.
Vulnerable Groups
Although falls and subsequent injuries are common among older patients, some are more vulnerable than others. Tucker et al. (2019) examine fall prevention for oncology patients who have been identified as at a higher risk due to complications of cancer. However, patients are often unaware that they are subject to falling, even if they have such experiences (Tucker et al., 2019). Moreover, fall prevention strategies are difficult to sustain and need modifications, as their initial effects recede with time (Tucker et al., 2019). Some barriers to fall prevention include not feeling well, dizziness, overestimating one’s abilities, lack of patience, and desire to be independent (Tucker et al., 2019). Tucker et al. (2019) also highlight the importance of tailored interventions that would meet a patient’s needs to prevent falls. The study of fall experiences among people with cancer shows that prevention strategies need to meet each patient’s expectations and treatment plans.
Responsible Staff Members
A crucial part of fall prevention is determining responsible medical staff members. Porter et al. (2018) suggest that successful fall prevention depends on interprofessional work. However, Tucker et al. (2019) emphasize the importance of nursing for hospitalized patients and analyze the roles of registered nurses (RNs) and nursing assistants (NAs). RNs and NAs are involved in answering bed alarms and keeping clear paths for patients, as well as sharing information about risks and engaging patients and their families in preventing falls (Tucker et al., 2019). RNs and NAs, who apply evidence-based practice (EBP), also routinely track and report falls to identify changes and assess the effectiveness of prevention interventions (Tucker et al., 2019). Overall, the nursing staff is meant to ensure patient safety and recognize areas for improvement to avoid injuries.
Main Issues
While nurses are significant in fall prevention, cooperation between several healthcare professionals is required for the prolonged safety of patients. Porter et al. (2018) state that one of the weaknesses of many evidence-based falls prevention programs (EBFPPs) is a lack of sustainability. The sustainability of EBP in preventing falls depends on communication within the health care team and organizational practices (Porter et al., 2018). Communication in EBFPPs revolves around gathering information about fall risk and sharing and discussing that information to develop fall prevention strategies (Porter et al., 2018). Porter et al. (2018) have determined that nurses are responsible for collecting data, and although they do so correctly, the data transmission is insufficient. Nurses often expect other healthcare professionals to design and enact fall prevention strategies without directly informing them about such expectations (Porter et al., 2018). At the same time, nurses are anticipated to be the most active participants of fall prevention, as they spend more time with patients (Porter et al., 2018). EBFPPs’ effectiveness can fade over time due to a lack of communication and not transparent distribution of duties.
Furthermore, organizational practices in health care institutions affect the sustainability of fall prevention programs. For instance, the nursing staff is often unable to answer bed alarms promptly and attend to patients due to staff shortage compared to the number of those who need help (Porter et al., 2018). Moreover, fall prevention needs to be based on interprofessional teamwork, but the non-nursing staff is sometimes unaware of certain practices, such as hospital fall data or strategies applied in varying units (Porter et al., 2018). For example, while some units have specific hourly patient rounds to determine patients’ baseline activity level, others keep a list of high fall risk patients next to the unit clerk (Porter et al., 2018). Therefore, existing organizational problems need to be considered to not interfere with EBFPPs.
Example
When analyzing fall prevention, one should assess strategies successfully applied before. For instance, Mazza et al. (2021) examine the effectiveness of an EBFPP called A Matter of Balance (MOB). Although the study focuses on community-dwelling older people, MOB can be applied in health care institutions since it aims to decrease the fear of falling and encourage exercise for better balance (Mazza et al., 2021). Patton et al. (2021) state that women often worry about falling alone and not getting up and emphasize the importance of socialization in fall prevention. EBFPPs that include physical activities are helpful in reducing the risk of falls, and MOB consists of several sessions that focus on gentle exercises and group discussions (Mazza et al., 2021). MOB is shown to improve participants’ health status, reduce fear, and decrease the number of falls, including those that cause injuries (Mazza et al., 2021). EBFPPs like MOB can assist in fall prevention and enhance patients’ well-being.
Recommendations
Upon the reviewed articles, one can indicate several recommendations for fall prevention. Porter et al. (2018) propose implementation of risk assessments, modified toileting practices, the use of bed alarms, surveillance, and encouragements for medical staff to examine data trends. However, the listed interventions are necessary but also insufficient (Porter et al., 2018). As nurses are found to be most responsible for preventing falls, in addition to documenting, they have to report fall incidents to senior leaders, who need to be dedicated to fall prevention (Porter et al., 2018). Tucker et al. (2019) suggest that RNs and NAs need more decision support in EBP and that leaders should promote active evaluation of fall risks and planning intervention. Mazza et al. (2021) advise data collection to identify gaps and emphasize the importance of implementing exercises for fall prevention in older people. Most of the recommendations are quite common but critical and require action from all health care providers.
Furthermore, one needs to recognize the importance of communication and patient engagement. As mentioned above, one of the issues in sustaining the effectiveness of EBFPPs is poor communication between health care professionals. Porter et al. (2018) state that regular communication about fall prevention needs to become a daily routine. Tucker et al. (2019) suggest ongoing training for the interprofessional teams to improve discussions of risks and strategies. Research also emphasizes the significance of involving patients and their families in fall prevention. The medical staff needs to be trained to communicate with patients to enhance decision-making and foster family participation (Tucker et al., 2019; Porter et al., 2018). For instance, nurses should improve their listening skills, show empathy, ask questions, and learn to make conclusions (Tucker et al., 2019). Fall prevention depends on a joint effort from healthcare professionals who consider patient needs.
Article Summary
The mentioned above articles present varying studies but have some common aspects. Patton et al. (2021) examine the experiences of falls among older men and women and suggest their preferences in fall prevention interventions that can be used to develop strategies. Tucker et al. (2019) focus more on the fall experiences of patients with cancer and responses from nursing professionals to determine existing barriers. Porter et al. (2018) explore the main issues that health care professionals encounter in EBFPPs and recommend ways to sustain the effectiveness of fall prevention. Mazza et al. (2021) analyze an EBFPP that can be used for older people as it lessens falls and improves health. While the articles focus on different elements of fall prevention, their findings are connected.
Conclusion
To summarize, fall prevention in health care institutions is significant to reduce injuries among older people and evade prolonged stay and extensive costs. A strategy should consider patients’ experiences of falls and preferences in fall prevention, so health care professionals have to engage more with patients and their families. While EBFPPs require interprofessional teams, nurses are usually most responsible for fall prevention. However, sustaining the efficacy of an EBFPP is challenging and demands active communication within the medical staff, continuous training, and attention to data trends.
References
Mazza, N. Z., Bailey, E., Lanou, A. J., & Miller, N. (2021). A statewide approach to falls prevention: Widespread implementation of A Matter of Balance in North Carolina, 2014–2019. Journal of Applied Gerontology, 40(11), 1447-1454. Web.
Patton, S., Vincenzo, J., & Lefler, L. (2021). Gender differences in older pdults’ perceptions of falls and fall prevention. Health Promotion Practice 0(0), 1-8. Web.
Porter, R. B., Cullen, L., Farrington, M., Matthews, G., & Tucker, S. (2018). Exploring clinicians’ perceptions about sustaining an evidence-based fall prevention program. The American Journal of Nursing, 118(5), 24-33. Web.
Tucker, S., Sheikholeslami, D., Farrington, M., Picone, D., Johnson, J., Matthews, G., & Cullen, L. (2019). Patient, nurse, and organizational factors that influence evidence‐based fall prevention for hospitalized oncology patients: An exploratory study. Worldviews on Evidence‐Based Nursing, 16(2), 111-120. Web.