Falls – Safety in Nursing
A fall may be described as an unexpected dropping or coming into contact with a lower position such as ground or floor experienced by an individual. In nursing, falls and their prevention thereof is a major area of focus as the impact of these occurrences can be dire to the health of the participant. Patients, owing to their medical condition may be highly susceptible to falls resulting in fatal injuries or even death. The risk of falling may be exacerbated by intrinsic and extrinsic factors. Intrinsic elements responsible for such falls may be cognitive, posture, vision impairment, body balance problems and effects of contraindicated drugs or medication. Extrinsic factors on the other hand include slippery or irregular surfaces, restraint devices, unfitting or inappropriate footwear, use of wrong support devices and poor lighting among others (Micelle, 2008).
Assessment of the intrinsic and extrinsic risk factors to patients may employ noting parameters such as age. It is commonly evident that advancement in age is more often than not associated with mobility impairment. This may result in unexpected tripping and falls in the elderly. The problem is compounded further by medical conditions that the make frail the elderly patients. It is therefore important that nurses both in general practice and nursing homes note the relationship between age and level of susceptibility to falls. The history of falls in a patient is also an important assessment parameter. If a patient has a history of regular falls particularly as a result of intrinsic factors, the nursing professional needs to accord such a patient extra attention to minimize risk of injuries that may result from falls in future (Chang, et al. 2004).
Other common considerations of assessment are functional disabilities and the accompanied use of support devices. A medical dimension employed in assessing the patient’s susceptibility to a fall, involves analyzing conditions that are highly linked to falls. These include dementia, Parkinson’s syndrome, diabetes, depression and arthritis. Use of medication that increases the risk of osteoporosis should also be carefully studied to ascertain the risk level on the patient. Drugs such as anticoagulants are known to have such effects. Cognitive impairment resulting from brain damage either from physical accidents or disease condition should be assessed to determine its apparent effect on the patient. Deleterious effects on the brain have been associated with causing body imbalance which may make a patient vulnerable to a fall as a result. Other problems linked to the cognitive impairment include visual impairment which indirectly reduces one’s judgment based on visual inability to determine distances and surface texture and hence the probability of falling over (Gray-Miceli, Johnson & Strump, 2005).
Assessment of the environment in which the patient operates is important in an effort to curtail the risk of falling. The most important elements to be considered in this include an inspection of the floor surfaces. A patient whether with intrinsic impairments or not may be at risk of falling if the floor surface on which he/she is walking is uneven in texture. It is the role of the nursing professional to ensure the floor surfaces on which the patient walks is free of spills, wet or increasingly slippery as to cause a fall. Once assessment is done, the nurse is to ensure measures are taken to reduce the chance of a fall by the patient. The clothing worn by the patients should be assessed to ensure it does not raise a risk of tripping. Unfitting clothes given to a patient may inhibit or make their movements inconsistent, increasing the risk of falling. Clothes that are too long for a patient need not be given to such a patient as they make locomotion a challenge. Strapped clothes may also be a risk factor as the straps may be too long and get tangled with other objects in the environment leading to loss of balance by the patient wearing them. Any new patient ought therefore to have their garments fitted in accordance with the body sizes to avoid any risks posed by unfitting clothing (ECRI Institute, 2006).
Another important environmental component that requires consideration in assessment of fall risk factors is the lighting. Light is an integral part of day to day running of life both for the patients and the nurses. Darkness reduces the visual ability of an individual however good their eye sight may be. Poor lighting is one of the leading causes of falling accidents. For a patient to move freely within the environment provided, adequate lighting is of paramount importance. If the patient suffers from reduced visual ability, he/she may need extra attention in terms of lighting. The assessment of lighting systems in an environment need to be carried out by qualified personnel as in normal circumstances, a non-professional may inaccurately judge the lighting to be adequate when it is not. Excessive lighting is also dangerous as it results in glares. This could damage an individual’s eyes resulting in impaired vision. The illumination systems should be performing optimally at all times and where necessary back-up systems of lighting with a similar lighting quality should be employed. This would in turn greatly reduce falling incidences among the patients (Gray-Miceli, Johnson & Strump, 2005).
Locomotion aids make another important ingredient in successful patient environment. The furniture the patient uses needs assessment to ascertain its durability and functionality. The incidences of falling may be greatly reduced if efforts are made to ensure that table tops, chairs, wooden walking sticks, grab rails and beds are in good condition. Any other supportive aids such as intravenous poles should be closely observed to ensure they are in good condition at all times.
According to Vieira, Heritage and Costa (2011), the leading causes of patient falls particularly in hospital settings in geriatric cases were carpet floors, confusion, old age, cognitive impairment, vertigo, medications such as tranquilizers and anticonvulsants, being an amputee, history of falls and the urge for assistance. Other possible causes would be visual and hearing impairments, postural hypotension, urinary incontinence, wrong bed heights, use of bed rails and the apparent fear of falling. Their study revealed that falls in geriatric formations range from 15% to 54% in hospital settings. It however concluded that there were no unique characteristic among geriatric patients’ falls and thus the precautions taken in other settings could be applied here as well.
An in depth analysis on the falls’ etiology found that out of the numerous risk factors that affected particularly the elderly, the factors that could be pointed as having the strongest influence on these falls were decreased muscle strength, previous falls, visual impairment , depression, medical side effects and balance problems. Another major factor responsible for these falls and hitherto ignored by previous studies was the attitudinal aspect. The authors argue that any study that fails to consider the attitudinal element would register poor results in predicting the number of patients who would fall in hospital settings. To raise the validity bar for this study, the cognitively impaired patients were left out of the study as they presumed to lack the ability to make sound judgment about their surroundings which could be responsible for the high number of falls. Nevertheless, the study recommends management of the patients through provision of high quality care as the most effective way to tackle the challenge of injuries resulting from falls both at home and hospital settings (Schonwetter, Sehwan, Kirby, Martin & Henderson, 2010).
Another study carried out in a metropolitan hospital in Australia identified bed unit and transferring of patients as being responsible for the highest number of falls. The act of moving the patients was highlighted as high risk activity which could put the patients at risk of falling. The study indicated that up to 80% of the falls took place in the rooms occupied by the patients making the bed unit the most high risk area for falls. The second identified cause of these falls was the bathroom and toilet especially when patients attempted to walk on their own after toileting or showering. The study also revealed that most of the falls were not witnessed as they occurred. The study therefore recommended that patient be made to understand the need to seek help when necessary since in another part it showed that assisted patients recorded minimal falls.in these cases, the nurse or the patient were either using inappropriate aids and it was recommended that nurses and their patients learn to use specific mobilizing aids as authorized by specialists however complex they may appear (Johnson, George & Duong Thuy, 2011).
On noting that patients susceptible to falls were not seeking help from nurses, a method to encourage response was crafted in order to decrease patient falls. Combining call bell response with staff awareness resulted in improved response to patient calls. The challenge had been the emotional dilemma patients experienced in regarding to themselves as bothers. The call bell worked as it only involved pressing of a button to attract attention. More employment of such methods in hospitals could therefore reduce the number of falls (Digby, Bloomer & Howard, 2011).
Sicknesses such as cancer have also been identified to increase the susceptibility of patients to falls. This has been attributed to the side effects arising from such processes as chemotherapy. Variations exist in the patients based on gender, functional state, age and the effect of hormone and radiation based therapies. More research however needs t o be carried out to understand if there are specific oncology based risk factors that make such patients susceptible (Allan-Gibbs, 2010).
To reduce or prevent falls, the nurses should employ strategies focused on the patient and the environment. These include using of standardized fall-risk tools and any other useful assessment tools to determine the risk of falling. The findings should then be communicated with stakeholders concerned. In the discussion with these stakeholders, the nurses should aim at reviewing discouraging the use of any substances such as medications that increase susceptibility to falling. The stakeholders could involve family members and caregivers if the patient is receiving home based care. Other efforts would involve constant practicing to improve on mobility and balance maintenance. The risk assessment and any interventions adopted should be communicated in case the patient is being transferred to another setting. If possible, upon discharge the home-based care giver should be provided with information including written material for reference purposes on the most appropriate ways to reduce falling risks in such patients. Referring the patient to professionally run exercise groups or facilities for rehabilitation could effectively promote quick recovery or improvement in the patient’s overall condition (Rubenstein, & Josephson, 2006).
Another intervention strategy entails instituting safety precautions to reduce the risk of falls. This may entail employing measures such as using low-rise bedstead, soft floor carpets to minimize injury in highly susceptible patients, ensuring quick access to call lights and close observation on the patients as they walk around. Reducing the number of physical barriers in the pathways used by the patients as well as use of non skid shoes or flat soft sole shoes has been identified to be of great help. Other basic safety precautions that are helpful include using personal sensor alarms, regulating the times for toileting and locating the washroom facilities in easily accessible areas. The use of specific glasses to aid in walking and increasing mobility program durations as well as teaching theoretically what the patients should do is effective (ECRI Institute, 2006).
Constant changes in the environment according to emerging demands in patients are an appropriate intervention strategy. Routine check on the patient care surroundings forms the basis for instituting the necessary corrective changes. The empirical checklists may be used as the basis to inform what change is the most appropriate for a particular situation. By interacting with experts such as risk assessment managers and housekeeping department evaluation strategies to improve the environment safety can be easily drafted. This may include considering the patients with more specific needs who would require extra safety measures (ECRI Institute, 2006).
Intervention may also include training of staff on handling the patients. The patients who are likely to experience falls such as those with impaired judgment, osteoporosis and/or hip fractures may need more specialized attention and thus the nursing staff need to receive training and instructions from experts on what to do in case of a fall by such a patient.
The expected outcomes from these interventions are that; patient falls will be avoided and safety will be maintained. In case of a fall, the patient will not develop any serious complications and furthermore, they will know the risks associated with falling. Through information acquired, the patients will be enlightened on how to avoid falls when discharged. It will also be possible to effectively assess and treat any adverse problems arising from a fall. At the same time, the nursing staff will have the knowledge and skills to identify, treat and /or manage patients at risk of falling or those who have suffered a fall. It will also be possible for the nurses to incorporate into their practice a deeper understanding of assessment procedures and other management approaches to reduce or prevent falls within the hospital setting. With adequate skills, the nursing staff will be in a position to educate the patients ready for discharge on the best strategies to avoid future falls while also appreciating the patients’ experience of falling with reference to their functional, emotional and physical status.
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