The evidence regarding the efficacy of specific fall prevention programs has been mixed.
Member checking was used during focused interviews. At the end of interviews, participants were shown a decisional matrix which identified categories and asked to provide feedback on missing properties or dimensions and suggest any alternative explanations for interactions among categories. Staff RN notifications occur in the form of a patient safety net (PSN) report and an additional two-page explanation of the fall event. Nurses described increasing intensity of the message as receiving more e-mails from midlevel and senior-level nurse administrators about patient falls, and increasing discussion about patient falls during shift report and unit staff meetings. Nurses often internalized the investigation as personal and felt blamed for the fall event, frightened that they would get into trouble, and defeated.“She was tearing up, ‘I promise I set the bed exit alarm, I promise, I promise’. Nurse characteristics that seemed to have a protective effect were being confident in clinical decision making, having a formal (care team leader or charge nurse) or informal (seen as an expert on the unit) leadership role on the unit, and years of experience as a nurse. New Haven, Connecticut Both hospitals are designated as teaching hospitals and have a nurse to patient ratio of 1:4.Several recruitment strategies were used, including announcing the study at unit meetings (staff meetings and unit council meetings), e-mail invitations, and flyers placed in nursing staff mailboxes. A systematic reviewRisk factors and risk assessment tools for falls in hospital in-patients: A systematic reviewNonpayment for performance? It makes us feel bad” (Interview 10).Monthly meetings that included only senior-level and midlevel nursing administration often led to midlevel managers feeling blamed that their units were not meeting the goal and could jeopardize the hospital Magnet status designation.“And we met, there was a lot of push ‘falls aren’t okay’ and we met for about an hour and a half and it was pretty negative. The study was initiated on July, 2013 and completed on December, 2014.
The tone delivered to high-fall units was often blame and shame and targeted individual staff involved in patient falls. Maintaining strength was achieved by getting patients up and out of bed at least to a chair and walking early and often. Twenty-seven registered nurses and certified nursing assistants participated in in-depth interviews. The increase in time demands to notify, document, and investigate, interrupted the nurses’ workflow, putting them even further behind in care duties for all of his/her patients.“It increases workload when you have a fall and you have to do all those things, the PSN, the phone, and the huddle” (Interview 13).“You’re already feeling bad that your patient fell. If you have any questions, please submit a message to Falls are a common and devastating complication of hospital care, particularly in elderly patients. Search for other works by this author on: Containing patients was used as a strategy when nurses wanted to get fall risk patients out of bed, but were unable to provide constant surveillance as directed by nurse managers. Criticism among nursing staff contributed to low morale.“You’re afraid of a fall happening so they you’re really hard on your NAs too because you’re like everybody’s got to run” (Interview 10).In addition, nurses described frustration in not being able to do the right thing for the patient (getting them up to walk) for fear that a fall would occur. Being identified as a high-fall unit occurred if the unit had more than 2 falls monthly, whereas low-fall units had occasional falls, every 3–6 months. This sense of feeling overwhelmed took a physical and emotional toll on nurses. Prisons and COVID-19: A Desperate Call for Gerontological Expertise in Correctional Healthcare Everyone is so afraid of getting into trouble” (Interview 3).The overwhelming nature of fall investigations and the intensity of messages to reduce falls left nurses concerned that they would lose their job or their unit manager or CNS would be fired if falls continued to occur. The study sites differed in the number of patient days for people older than 65 years and in bed capacity. A lot of people felt that was shaming us or blaming us” (Interview 21).Ultimately, fear of falls resulted in nurses being fearful to care for fall risk patients.
Nurses were acknowledged for their efforts to get patients up to walk by receiving individual recognition from unit leadership (nurse managers, CNS, and charge nurses).
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