Background: Little is known about hospitalized older adults' perceptions regarding fall prevention interventions received during hospitalization and fall prevention discharge instruction
Trang 1Original Article
Patient perceptions and experiences with falls during hospitalization and
after discharge
a
University of Michigan, School of Nursing, Ann Arbor, MI 48109, USA
b
St Joseph Mercy-Ann Arbor, Ann Arbor, MI 48106, USA
a b s t r a c t
a r t i c l e i n f o
Article history:
Received 5 November 2015
Revised 19 January 2016
Accepted 28 January 2016
Available online xxxx
Keywords:
Falls
Fall prevention
Discharge instructions
Older adults
Perceptions
Aims: The aim of this study was to describe hospitalized older adults' (N 60 years) perceptions about (1) their fall risks while hospitalized; (2) fall prevention interventions received while hospitalized; and (3) fall prevention discharge instructions
Background: Little is known about hospitalized older adults' perceptions regarding fall prevention interventions received during hospitalization and fall prevention discharge instructions
Methods: This is a prospective, exploratory study using qualitative methods
Results: This paper reports qualitativefindings of patients' perspectives on fall prevention interventions during hospitalization and at discharge Eight major themes supported by multiple minor themes emerged: overall per-ceptions of falling; overall perper-ceptions of fall prevention interventions while hospitalized;“telling” fall preven-tion;“doing” fall prevention; effectiveness of fall prevention strategies; personal fall prevention strategies; fall-related discharge instructions; and most effective fall-fall-related discharge instructions
Conclusions: Findings suggest healthcare providers need to more fully engage patients and families in under-standing fall prevention interventions and factors contributing to falls during hospitalization and at discharge
© 2016 Elsevier Inc All rights reserved
Falls are a significant problem for older adults, particularly for those
who are hospitalized (Clyburn & Heydemann, 2011; Milisen et al.,
2013) Falls are among the most frequently reported patient safety
inci-dents, accounting for approximately 40% of all adverse events in
hospi-tals (Miake-Lye, Hempel, Ganz, & Shekelle, 2013; Oliver, 2008)
Moreover, up to 50% of inpatient falls result in some sort of injury
(e.g., fracture, trauma, and death) (Oliver, Healey, & Haines, 2010;
Tinetti & Kumar, 2010) Falls can also contribute to patient anxiety,
loss of confidence in mobility and activities, social isolation, prolonged
hos-pital stay, discharge to long-term care facilities, and increased healthcare
cost (Miake-Lye et al., 2013; Oliver, 2008; Tinetti & Kumar, 2010)
Efforts to reduce falls in hospitals have largely focused on conducting
routine fall risks assessments followed by implementing general fall
prevention interventions for those at risk (Oliver, 2008; Oliver et al.,
2010) In addition to these system- and clinician-driven efforts, fall
pre-vention must involve other members within the context of care,
includ-ing patients and their families Perceptions (e.g., beliefs and awareness)
about an individual's health are essential to engage people in
under-standing their health risks, as well as, in adopting behaviors to reduce
those risks (Garces et al., 2012; Mullins, Abdulhalim, & Lavallee, 2012;
Shubert, Smith, Prizer, & Ory, 2014) However, minimal research has ad-dressed hospitalized older adults' perceptions about their fall risks, in-terventions they received to prevent falls, and discharge instructions
to reduce falls Therefore, it is imperative to understand older adults' perceptions of falls and fall prevention interventions to fully engage them in the adoption of behaviors that will reduce falls during hospital-ization and after discharge to more effectively address this national pa-tient safety issue
The specific aims of this exploratory study were to describe hospitalized older adults' (≥60 years) perceptions about (1) their fall risks while hospi-talized; (2) interventions they received to prevent falls while hospihospi-talized; and (3) the instructions received at discharge to prevent falls at home
1 Background Previous studies have explored perceptions regarding falls and fall prevention, but most have focused on community-dwelling older adults rather than those who are hospitalized (Boyd & Stevens, 2009; Calhoun
et al., 2011; Faes et al., 2010; Høst et al., 2011; Karlsson, Vonschewelov, Karlsson, Cöster, & Rosengen, 2013; Laing, Silver, York, & Phelan, 2011; McInnes, Seers, & Tutton, 2011; McMahon, Talley, & Wyman, 2011; Roe
et al., 2009) Findings from these studies demonstrate that older adults: (1) believe falling to be a normal part of the aging process (Høst et al., 2011; McInnes et al., 2011); (2) consider falls embarrassing and have
Applied Nursing Research 31 (2016) 79–85
⁎ Corresponding author at: University of Michigan, School of Nursing, 400 N Ingalls,
Suite 4170, Ann Arbor, MI 48109, USA.
E-mail address: mmontie@med.umich.edu (M Montie).
http://dx.doi.org/10.1016/j.apnr.2016.01.009
Contents lists available atScienceDirect
Applied Nursing Research
j o u r n a l h o m e p a g e :w w w e l s e v i e r c o m / l o c a t e / a p n r
Trang 2a fear of falling (Boyd & Stevens, 2009; Roe et al., 2009); and (3) restrict
or stop normal activities to prevent falling (Roe et al., 2009) Findings
from these studies have also been used to guide development, testing,
and implementation of community-based fall prevention programs
(Baker, Gottschalk, & Bianco, 2007; Tinetti et al., 2008)
In contrast tofindings from community settings, little is known
about perceptions of hospitalized older adults regarding their fall risks,
despite patient education being frequently used to prevent falls (Ang,
Mordiffi, & Wong, 2011).Carroll, Dykes, and Hurley (2010)interviewed
nine patients who had fallen while hospitalized and found that most
were not aware of their risk of falling; those who were aware received
inconsistent messages from nurses regarding their fall risks Patients
stated that they“wanted to be informed of why they were at risk and
what specific activities the nurse wanted them to do to reduce their
risk for falling, and the role of the healthcare team in their fall
preven-tion.” (Carroll et al., 2010; page 240) Similarly,findings byRogers
(2013) demonstrated that adult inpatients had little information
about their fall risks
Falls are among the most frequently occurring post-discharge adverse
events (Tsilimingras & Bates, 2008), and the incidence of falls in the
post-discharge period is more than in the general community population
(Davenport et al., 2009) The significance of discharge instruction has
been demonstrated when older adults are equipped with knowledge
re-garding self-care following hospital discharge (Bobay, Jerofke, Weiss, &
Yakusheva, 2010; Foust, Vuckovic, & Henriquez, 2012; Maloney &
Weiss, 2008) However, only one study of 333 subjects, conducted in
Australia, examined older adults' perceptions about fall prevention
strat-egies after discharge and found that many had little knowledge about
ap-propriate strategies to prevent falls at home (Hill et al., 2011)
Understanding patients' perceptions about fall risks and
interven-tions to prevent falls is critical to advance the knowledge of preventing
falls during and following hospitalization This study provides insights
about this important area from the perspective of the patients
2 Method
This prospective exploratory study was conducted in a 450-bed
com-munity hospital located in Michigan Informants were recruited from two
adult medical–surgical units Approval of the Institutional Review Board
from the University of Michigan and the study site was obtained
2.1 Design
A prospective exploratory design using qualitative methods was
conducted to meet the study aims To solicit participant perceptions,
two semi-structured interview guides were developed with
open-ended questions and probes The guides were designed to be delivered
verbally Thefirst interview guide was delivered face-to-face while
in-formants were hospitalized to elicit information about their perceptions
regarding falls prior to hospitalization, risk for falling in the hospital, and
fall prevention interventions they received while hospitalized The
sec-ond interview guide was delivered over the telephone after informants
were discharged to their homes to obtain additional information about
fall prevention interventions used in the hospital, and instructions that
they received at discharge to prevent falls at home
2.2 Sample
To be eligible for the study, potential informants had to meet the
fol-lowing inclusion criteria: (1) 60 years of age or older; (2) hospitalized
on the study unit for at least 48 hours; (3) at risk for falls as defined
by nursing staff via the Morse Score within 24 hours prior to the
inter-view; (4) have a working phone number at home; (5) be medically
sta-ble; and (6) speak English Informants were excluded if they were
acutely confused (e.g., delirious) as determined by the Confusion
Assessment Method (CAM) screening tool, which was administered prior to seeking informed consent
Eighteen informants were enrolled in the study, withfifteen com-pleting the post-discharge interview We were unable to reach one in-formant using the telephone number they provided during thefirst interview; the other two were not discharged to their homes Ten infor-mants were male, andfive were female The mean age was 72 years (SD = 10.86) Informants were contacted by telephone within 3 days after discharge to set up a time for the post-discharge interview All post-discharge interviews were conducted within 8 days after dis-charge, with the majority completed within 4 days
2.3 Data collection procedures The list of potential informants was provided by a clinical nurse spe-cialist and nurse manager of the study units to the investigative team each day for review After validation that potential informants met study inclusion criteria, they were approached in their hospital rooms Ten eligible informants declined to participate If a potential informant was not diagnosed with delirium in accordance with the CAM, written informed consent was obtained prior to any study procedures A trained research assistant who was a part of the research team conducted in-hospital and post-discharge interviews The in-in-hospital interview was conducted in the patient's hospital room without the presence of healthcare providers or other patients and was audio recorded During the hospital interviews, informants were asked about their perspectives concerning their risk for falling while in the hospital, and interventions they received during hospitalization to prevent falls Interviews were
45 minutes or less At the end of the interview, informants provided a home telephone number for contact following discharge
After informants were discharged from the hospital, they were contacted within 3 days via telephone to schedule an interview about their perceptions on interventions they received in the hospital to pre-vent falls, as well as, discharge instructions they received about preven-tion of falls at home All post-discharge interviews were conducted within 8 days after discharge via telephone, were audio recorded, and lasted no more than 45 minutes
2.4 Data analysis All of the interviews were transcribed verbatim and reviewed for transcription accuracy Transcribed interviews were analyzed using the constant comparative methods of Glaser and Strauss (Corbin & Strauss, 1990; Glaser & Strauss, 1967) To ensure appropriate, rigorous, and robust data analysis, three members of the investigative team with expertise in qualitative analysis individually performed initial coding (e.g., minor themes) Minor themes were then compared, discussed, and agreed upon Individually, the three investigators organized the minor themes into major themes Major themes were then compared and discussed until a consensus was reached
3 Results Qualitative data analysis revealed eight major themes: (1) overall per-ceptions of falling; (2) overall perper-ceptions of fall prevention interventions while hospitalized; (3)“telling” fall prevention; (4) “doing” fall preven-tion; (5) effectiveness of fall prevention strategies; (6) personal fall pre-vention strategies; (7) fall-related discharge instructions; and (8) most effective fall-related discharge instructions Multiple minor themes sup-port each of these major themes, and are discussed below
3.1 Overall perceptions of falling The major theme, overall perceptions of falling, is supported by three minor themes, including past fall experiences, fall risks, and fear of fall-related injuries
80 C Shuman et al / Applied Nursing Research 31 (2016) 79–85
Trang 33.1.1 Past fall experiences
Most informants perceived that they had indeed experienced one or
more falls prior to their current hospitalization Not only did informants
experience one or more falls, but that they also perceived the reasons
for these falls:
“…Because I have a lack of balance…I lost balance…”
“…Dehydration and low blood pressure…”
Other reasons noted by informants that contributed to their falls
in-cluded other health conditions (e.g brain tumor, herniated disc), not
pay-ing attention to their surroundpay-ings, and medications they were takpay-ing
3.1.2 Fall risks
It is noteworthy that despite being currently designated as fall risks
by healthcare providers, as well as having experienced prior falls, most
informants stated that they did not believe they were at risk for falling
while in the hospital:
“…No, because there is enough people around when I get up go to the
bathroom They all helped me…”
“…I′m not necessarily concerned about falling because the hospital
staff…they have a belt on me So, I′m not worried about that…”
The majority of the informants felt safe due to the presence of
healthcare providers and the healthcare they received, which led
them to trust their healthcare providers (e.g., nurses)
3.1.3 Fear of fall-related injuries
Despite the apparent trust the informants had with their healthcare
providers, they were concerned about potential injuries that could
re-sult from a fall while they were hospitalized:
“…I guess break a bone I have osteoporosis…”
“…That I will break hip and be in the hospital as I were in the midst of
having the cancer, and I live alone, so it′s very hard for me…”
As in other issues with the elderly, their fear of falling is one of
sev-eral issues that is compounded by other health conditions and living
ar-rangements experienced by older adults
3.2 Overall perceptions of fall prevention interventions while hospitalized
Interviews conducted during and after discharge asked the
infor-mants to share their perceptions about what was done to prevent falls
while they were hospitalized These interviews resulted in four minor
themes, described below, to support this major theme, overall
percep-tions of fall prevention intervenpercep-tions while hospitalized
3.2.1 Non-acknowledgement of fall prevention interventions
Initially, informants stated that healthcare providers had not had
conversations with them about falls:
“I don′t think they′ve talked about falling, but they′ve taught [me] how
to get into the bed and out of the bed They trained me how to do it,
which I assume is to prevent falling…”
“…Uh, I don′t know if they have actually told me anything about falling.”
However, as the conversation proceeded, informants started
discussing fall prevention interventions performed by healthcare
pro-viders and their satisfaction with these interventions
3.2.2 Tailored fall prevention interventions
A number of informants shared that the fall prevention strategies they received during hospitalization were specific to their healthcare needs:
“…Well, I think they were designed specifically for my problems, which was herniated discs, and the surgery that I had…”
“I would say the reminder [was specific to me], like I am a bare-footed person all the time around the house and everything, a reminder of put-ting socks on every time I got up was beneficial to me…”
3.2.3 General fall prevention interventions Other informants, however, perceived that all patients received the same general fall prevention interventions:
“Yes, I think they [all patients] were told the same things…”
“I don′t think they [fall prevention strategies] were specifically for me, they were pretty general…”
3.2.4 Overall satisfaction of fall prevention interventions Informants shared thoughts on whether their healthcare providers could have contributed more to their fall prevention:
“…No, they are pretty thorough Yeah, they are pretty much focusing on your problems and your situation, and try to give you the best…”
“…I′m pretty sure that the people that [are] working in the hospital are pretty good at instructing their patients And I know me and probably a lot of other patients tend to be a little stubborn, or we press the call but-ton, and they′re busy, and they can′t come right away, so we decide to get up and try something on our own…”
Although informants initially expressed that they did not receive in-formation to prevent falls while they were hospitalized, as the inter-views proceeded, and with use of interview probes, informants were able to give examples of healthcare providers' actions that were utilized
to prevent them from falling Some informants thought the interven-tions were specific to their needs, while others thought the interven-tions were more general and the same for all patients The kinds of fall prevention interventions that were received during hospitalization are further described in the following two major themes:“telling” fall pre-vention and“doing” fall prevention
3.3.“Telling” fall prevention Informants described what their healthcare providers were“telling” them in regard to how they could reduce their risk of falling while hos-pitalized They discussed three fall prevention areas: (1) reminders; (2) clearing obstacles; and (3) general assistance
3.3.1 Reminders Informants stated that their healthcare providers discussed some general reminders in regard to fall prevention:
“They said do not get up by myself…They just say go slow and made sure that at least one of them [nurse] is in the room, and they took good care of me…”
“…Always reminding me to put my slippers on, or my socks on.”
3.3.2 Clearing obstacles Informants explained that their healthcare providers had also en-gaged them in conversations about clearing obstacles:
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Trang 4“…[They make sure the] floor is clear of obstacles, and they make sure
that, if you have any cause for them [obstacles] to think you might fall,
they won′t let you move, unless there′s somebody with you…”
“…obstacles that may, you know, be in your way, remove them or slide
them over from where your walking path would be ”
3.3.3 General assistance
Informants also described general assistance that was inclusive of
fall prevention For example, they commented on assistance with
am-bulation and mobility:
“Well they told him all those techniques…how to get into the bed and
not fall back…or how to hold on to the walker How to turn, not twist
All of the things that you need to know in order to successfully move
around without damaging yourself”
“…I know this afternoon, they want to put me in a chair, and that I will
be getting a lot of help for that…”
3.4.“Doing” fall prevention
After informants clarified what healthcare providers were “telling” them
about fall prevention while they were hospitalized, they then discussed
what their healthcare providers were“doing” with regard to fall prevention
Informants indicated that healthcare providers were“doing” several things,
such as teaching fall prevention and providing physical assistance
3.4.1 Teaching
Informants explained that their healthcare providers gave them a
great deal of instruction regarding fall prevention:
“…They teach me move slowly, you can raise up, and so I get my chest
up and swing my feet a little bit slowly…”
“Well, they teach me how to stand and lean…Just get my balance, so I
don′t fall And they give me a lot of support and encouragement…”
3.4.2 Physical assistance
Informants also indicated that they received physical assistance for
fall prevention This included a variety of activities, such as assistance
with mobility (e.g., utilization of a walker), belt security, and
chair/sit-ting assistance
“…Well, when I walked, they had a belt around me, and somebody back
of me, following along, with a grip of the belt…”
“…Well, they′ve been very kind about lifting me out of the chair on the
commode, and rolling me in there, rolling me up to the sink, so I can
wash my face.”
3.5 Effectiveness of fall prevention strategies
Informants went on to share their perceptions about the
effective-ness of the fall prevention interventions on the basis of their personal
conditions and own experiences
“I guess my walker will be the most effective…”
“Well, I think they make sure that in the room or wherever I
am, that there are as few obstacles as possible And that they try
to make sure that there′s help available very quickly as you need it…”
In many cases, informants' personal perceptions of the most effec-tive fall prevention strategies were the same strategies that had been provided by healthcare providers in the hospital
3.6 Personal fall prevention strategies Patients' perceptions about ways to reduce their own risk of falling are important, since they depict how patients view themselves as at risk for falls The study informants remarked that they thought becom-ing more proactive and acquirbecom-ing better awareness of their surround-ings would assist them in reducing their own risks for falls
3.6.1 Being proactive Informants stated that one way in which they thought they could lessen their fall risks was by becoming more proactive, by paying more attention to their fall risks, and by following the advice of their healthcare providers:
“…Uh, probably the biggest thing would be to pay attention…And un-derstand the seriousness of it [falling]…”
“…I think people have to be better judges of what they can really do…”
3.6.2 Acquiring awareness of surroundings Informants also stated that another way to reduce their risks for fall-ing was to become more aware of their surroundfall-ings:
“…I can see certain things, like design of furniture, design of doorways, design of height of furniture…I feel a lot of attention should be applied for older people…”
“…if you got throw rugs, you don′t want those around because you could stumble over them.”
3.7 Fall-related discharge instructions During the post-discharge interviews, informants shared informa-tion they received at discharge that focused on preventing falls at home This major theme, fall-related discharge instructions, is
support-ed by two minor themes describsupport-ed below
3.7.1 Initial perceptions of fall-related discharge instructions Informants discussed discharge directions, specifically with regard
to fall prevention:
“…There wasn′t any discussion of that… You know frankly, I didn′t think about that.”
“I don′t believe I was told anything.”
Over half of the informants did not initially perceive that they had received discharge instructions about fall prevention However, further interview probes with these informants revealed that they had indeed received discharge instructions regarding fall prevention
3.7.2 Verbal and written discharge instructions Informants elaborated that healthcare providers not only verbally delivered fall prevention instructions about the physical environment and mobility, but also provided a fall prevention pamphlet and other written information
82 C Shuman et al / Applied Nursing Research 31 (2016) 79–85
Trang 53.7.3 Physical environment
Informants stated that conversations at discharge included specific
fall prevention concerning physical environment:
“I was interviewed by the case manager, and she was very interested in
the layout of my home, as far as entrances, exits, um that had something
to do with falling…”
“…In the bathroom, always have a rubber mat in the tub, and some rug
that′s for a bathtub, water resistant, a rug outside of the tub, so when
you step out, your risk for falling would be reduced by that too…”
3.7.4 Mobility
Mobility discussions were also expressed by the informants:
“…They went through a lot of suggestions…They′ve offered a pretend
car and they showed you ways to get in and out…”
“…First of all, I′m not supposed to make fast moves, fast turns, sharp
turns I was supposed to move very slowly I was not supposed to do it
on my own I should be using a walker or be with someone…”
3.7.5 Written discharge instructions
Informants shared that they also received written information
(e.g., pamphlets) regarding fall prevention:
“…There were sheets, there were copies that were given me to discuss
some of this stuff [fall prevention]…”
“…They gave me, you know, a lot of, you know, books and pamphlets,
and lists and that And that was very, very helpful…”
Although informants initially responded that they had not received
discharge instructions, they were able to share that they did receive
both verbal and written information about prevention of falls at home
Informants also shared their perceptions about the effectiveness of the
discharge instructions as described below
3.8 Most effective fall-related discharge instructions
According to informants, the most effective fall prevention
instruc-tions included both physical and environmental strategies
3.8.1.“Physical” fall preventions
Informants discussed several fall prevention instructions that aided
them physically:
“The three-point stance I always have three points of… before you
move, get balance as much as possible, don′t try to stretch out, or reach,
or do more than you can…”
“You know they taught you how to sit up They said don′t twist, or roll
Just getting yourself in a sitting position those few days after surgery
was work And they were very helpful with that…”
Informants reported not only that they received adequate
instruc-tion, but also that they were“shown” how to physically prevent falls
3.8.2.“Environmental” fall preventions
Informants also stated the fall prevention instructions at hospital
discharge included environmental advice:
“…Clear the area of debris…And um keep everything organized and structured and you′d have no problems of walking around…”
“…Watch out for area rugs that are sticking out the corner Either nail them down or remove them from the room, if it′s an area rug that has tilted upwards…”
Informants acknowledged that the fall prevention instructions they received at discharge addressed both physical and environmental ef-fects Informants were eager to discuss these fall prevention strategies, and most informants stated that the information they had received re-garding fall prevention was helpful
4 Discussion Findings from this exploratory study revealed that most informants had fallen one or more times prior to hospitalization, and that most knew what had contributed to their falling (e.g., loss of balance) These reasons suggest a similarity to other studies that have reported balance as a contributing factor for falls in older adults (Carroll et al., 2010; Huang et al., 2012; Talbot, Musiol, Witham, & Metter, 2005; Zecevic, Salmoni, Speechley, & Vandervoort, 2006) Despite acknowl-edgement of experiencing a fall, informants were not aware that they were at risk for falls while hospitalized Informants did, however, freely express their fear of falling and potential injuries (e.g., broken bone, bro-ken hip) while they were hospitalized Thesefindings are similar to other studies in which patients have a fear of falling during hospitaliza-tion because they are frail and have poor funchospitaliza-tional reserve (Mackintosh, Hill, Dodd, Goldie, & Culham, 2006; Oliver et al., 2010) Although informants did indeed receive fall prevention tions while hospitalized, they initially did not perceive these interven-tions as such After further discussion (e.g., probing), informants commented on various conversations and actions that their healthcare providers initiated regarding fall prevention Examples include what their healthcare providers were“telling” them (e.g., reminders, clearing obstacles, and general assistance), and what healthcare providers were
“doing” to assist them (e.g., teaching and physical assistance) In subse-quent conversations, informants stated that they were not only satisfied with these fall prevention interventions (e.g.,“…they were very thor-ough” and “…are pretty good at instructing patients…”), but also that some felt they received fall prevention interventions tailored to them (e.g.,“…designed specifically for me…”) The acknowledgement of tai-lored fall prevention interventions is congruent with recommendations that these interventions should be tailored to patient-specific fall risk factors (Cameron et al., 2012; Coussement et al., 2008; Hempel et al., 2013; Kenny et al., 2011; Oliver et al., 2010) Informants felt that these actions (e.g., fall prevention interventions) were effective
Likewise, informants did not initially perceive that they had received fall prevention interventions at discharge After further probing, infor-mants reported that they had not only received verbal discharge fall prevention instructions with regard to the physical environment and mobility, but they had also received written information about preventing falls (e.g., sheets, books, and pamphlets)
In addition, informants discussed their perceptions regarding the most effective fall prevention discharge instructions that they received These perceptions included both physical (e.g., three-point stance and body positioning), and environmental strategies (e.g., clearing areas of debris and rug placement) These perceptions parallel the work ofHill
et al (2011), as these strategies were also identified by patients as post-discharge fall prevention strategies
It is important to note that informants initially did not perceive that they were at risk for falls or received interventions to prevent falls dur-ing hospitalization and at discharge However with further probdur-ing, and
as the interviews progressed, the informants clarified their perceptions and described fall prevention interventions they received These initial
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C Shuman et al / Applied Nursing Research 31 (2016) 79–85
Trang 6perceptions by informants suggest that patients may not be mindful of
their risk for falls, and perceive that the healthcare team will keep
them safe Additionally, these initial perceptions about their fall risks
and interventions they received to prevent falls suggest that healthcare
providers' level and type of engagement with patients and families
re-garding understanding their fall risks, and interventions to prevent
falls has significant room for improvement
4.1 Limitations
Our study consisted of a single hospital setting, which only accounts
for patients' perspectives from that site Althoughfindings may not be
generalizable beyond the current setting, we do acknowledge the
value of replicating this study at multiple sites, since patient perceptions
of fall interventions are important for fall prevention Further research is
needed in multiple sites to support thesefindings
4.2 Implications for research
This study should be replicated as a multi-site study representing
different geographic regions of the country Future research should
also include interviews of family members in addition to patients, as
well as the healthcare providers delivering care Preventing falls in
hos-pitals is a collaborative mission that requires the participation of
pa-tients and family members Thus, further research is needed to
understand how healthcare providers can more effectively engage
pa-tients and family members in prevention of falls during hospitalization
and following discharge
4.3 Implications for clinical practice
There are several implications for practice from this study First,
nurses and other healthcare providers in hospital settings need to do
more than impart information, but rather have conversations with
hos-pitalized patients and their families about why they are at risk for
fall-ing, and define the specific fall risk factors they have that may
contribute to a fall or injury from a fall Second, having repeated
conver-sations with patients and family members about what they can
contrib-ute (e.g., paying more attention; heeding advice of the healthcare team)
to prevent falls is also warranted Lastly, nurses should explain to
pa-tients and family members that fall prevention is a collaborative
pro-cess, which necessitates the active participation of patients and their
family members in understanding their risks for falling and
interven-tions to prevent falling
5 Conclusion
This exploratory study revealed that informants received fall
pre-vention interpre-ventions while hospitalized and at hospital discharge,
even though they did not perceive these as such initially Further
discus-sion and probing with informants led to this realization, as depicted by
informant accounts of detailed descriptions of actions, instructions, and
written and verbal fall prevention interventions Undoubtedly,
commu-nication and level of engagement influenced patient perceptions These
findings suggest that healthcare providers need to more fully engage
and provide clarity to patients and family members regarding fall risks
and fall prevention With appropriate patient and caregiver
engage-ment, fall prevention interventions can be effectively implemented,
without patient misconceptions
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