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Falls Prevention


Patient falls are one of the most reported incidents in hospitals. These falls occur in health care institutions and at residential homes. Statistics also show that one in three of these falls lead to injuries and hospitalisation. Consequently, the essay seeks to discuss the issue of falls and their prevention in health care institutions. An evaluation of the prevalence and risk factors for falls shows that these incidences can be prevented. This prevention was evident from the author’s reflection of her clinical practicum of an elderly patient who sustained a fractured neck of femur. Further critical reflection using the Gibbs reflection cycle confirmed that nurses could have prevented the fall and injury to the patient. Three recommendations for future professional development for nurses were identified. These were: to train nurses to detect patient falls and care for fall-related injuries; develop nursing practices for fall prevention; and provide an institutional framework for fall prevention.

Keywords: falls, Gibbs reflection cycle, injury, hip fracture, nursing practice, training.

Falls Prevention

Patient falls are one of the most reported incidents in hospitals. These incidents comprise of falls within the hospital and outside the hospital such as an aged care institution or home. Incident reports from the Australian Institute of Health and Welfare (AIHW) (2012) show that majority of hospital falls occur from tripping, slipping and stumbling (64 percent). This is followed by falls involving wheelchairs, stairs, beds, pedestrian conveyances, chairs, scaffolding, and falling from buildings. Unspecified falls account for 29 percent of falls and comprise of falls in bathtubs, from toilets or bumping into objects. Most of these falls occur in aged care facilities, bathrooms, bedrooms, outdoor areas, service areas (such as stores and restaurants), public streets or roads and farms (AIHW, 2012). Thirty percent of these falls lead to serious injuries and hospitalization. Follow-up care is also required for the older population especially for orthopaedic, surgical and rehabilitative care. The issue with these falls is that they can be prevented. This prevention is especially necessary for older people aged 65 and above because the impact of the falls may be detrimental to their health and physical independence. This essay first discusses the prevalence of falls in the Australian population. It also discusses existing nursing practices and standards on the same. The discussion will lead to a critical reflection of the health issue using the Gibb’s reflective cycle. Thereafter, recommendations will be presented based on the reflection and literature as well as strategies proposed for implementing the recommended changes.

The prevalence of hospitalised falls has significantly increased over the years. According to AIHW (2012), twenty-three percent of hospitalizations between 2001 and 2002 were attributed to falls. These falls increased to 78,600 annually by 2009 among Australians aged 65 years and above. Annual records show that one in three elderly people in Australia experience a fall. This trend is higher among females between 70 years and 95 years compared to elderly males. A geographical distribution of falls shows that New South Wales, Australian Capital Territory and Victoria have higher incidences of hospitalized fall injuries among the elderly aged 65+ compared to Australia’s average rate. AIHW (2012) also reports that seventy percent of falls occur in an aged care residence or home. Moreover, hospital care provided to patient falls is 1.2 million days for an average of 15.8 days for every fall injury.

Falls occur when patients engage in activities such as walking, working, resting and sports (AIHW, 2012). In most instances, the causes of falls are slippery floors, stairs, use of medication, lack of balance, inappropriate shoes and lack of muscle strength or sedentary behaviour. Physiological reasons include age, feet problem, gait disturbance, poor reflex, use of short steps, and calcium blockers. Patient falls have a significant impact on the patient and the health care system. Carroll, Dykes and Hurley (2010) agree that incidents of patient falls are a problem in hospitals. This is because falls increase the risk of injury by 30 percent and have negative impacts on the patient’s wellbeing and independence (Logghe et al., 2010). The most common injury is fracturing of the neck of femur which occurs in 40.5 percent of patients followed by injuries to the abdomen, lumbar spine, pelvis, knee, head, thorax and the shoulder or upper arm (AIHW, 2012). Falls also have significant impacts on family members who may need to provide care to the incapacitated patient. In addition, family members may be required to bear the hospitalisation costs of the patient as well as the costs of follow-up procedures such as rehabilitation (Dykes et al., 2009). Another impact is the burden on the health care system. Forty-five percent of falls occur in health service institutions such as hospitals (AIHW, 2012). These falls increase hospitalization expenses since 87 percent of fall patients require surgical interventions (such as repair of wounds and hemiarthroplasty of the femur), orthopaedic procedures, imaging (such as computerised tomography) and non-invasive interventions such as occupational therapy (AIHW, 2012). These procedures and specialists needed to perform them increase the total and average health care costs for fall injuries in Australia (Watson, Clapperton & Mitchell, 2010).

The Gibb’s reflective cycle was used to help the author to reflect on the problem of patient falls. The author experienced first-hand the hospitalisation of a patient whose neck of femur had fractured from a fall. The patient was a 75-year old Caucasian woman who had fallen in the hospital bathroom. As part of the clinical practicum, the author was requested to assist a nurse who was collecting the patient’s data. The author collected data on the patient’s age, gender, duration of hospital stay, access to the hospital bathroom, and the existence of grab bars and mobility aides. Data on the patient’s medical condition(s) was collected such as medication, balancing problems, diet and exercise. The information helped the author to determine whether physiological factors contributed to the fall and resulting hip injury.

The patient revealed that she felt that nurses were too busy to attend to her and thought she could walk to the bathroom without losing her balance. She said that she fell because she lost her balance as she was coming out of the bathroom. Further examination of her physical status showed that the patient had low body weight which affected her bone mass and grip strength. She also had difficulties walking and early stages of osteoporosis. The patient also showed signs of disturbed gait, low reflex and low muscle strength. She also did not engage in any strength training exercises.

To enhance the reflection, the author examined literature on falls and hip injuries. This would help the author to compare the patient’s symptoms with the literature. Findings from the comparison showed that the patient’s health information coincided with demographic data on elderly patients who have sustained falls. For instance, statistics showed higher falls among women than men aged between 65 years and 80 years. These findings confirmed that the patient’s age and gender increased her risk of falling. On the location of fall, the patient said that she fell in the bathroom inside her home. AIHW (2012) concur that 20 percent of falls occur in the bathroom compared to 10 percent of falls in the bedroom or other indoor living areas. In addition, the Institute reports that hip fractures are one of the most common injuries resulting from falls in older people between 80 and 94 years (pp.7-9).

Literature on the epidemiology and pathology of fall-related hip injuries revealed similar symptoms as the patient. For instance, the patient exhibited similar physiological symptoms as those articulated by Marks, Allegrante, MacKenzie and Lane (2003). The authors observed that falls in elderly people occur due to medication, calcium blockers, gait disturbance, poor reflex, impaired balance and feet problems. Their pathogenesis of hip injuries revealed low bone mass, osteoporosis, poor strength training exercise, poor muscle timing, low joint mobility, and ageing. This pathogenesis was similar to the patient’s symptoms. In addition, the patient showed similar etiology outlined by Rubenstein (2006) as low body weight, low bone mass, low grip strength and age.

On further investigation, the author observed that the patient’s fall and hip injury could have been prevented. Research shows that hip fractures can be reduced by preventing falls. The first prevention is to encourage patients to exercise regularly. This is because exercise had been shown to improve leg strength and balance which then prevents the risk of falls (Logghe et al., 2013). Secondly, patients should be warned when taking medication which causes dizziness. They should be informed about the risk of falls due to the effects of their medication. Thirdly, aged care facilities, homes and hospitals should eliminate the safety hazards which cause patients to fall. This may include removing slippery surfaces such as floors, adding railings to stairways and adding grab bars in the bathroom for support (Mark et al., 2003). Fourthly, nurses should encourage elderly patients to receive osteoporosis screening regularly and receive treatment for the condition. In addition, they need to work closely with family members and nutritionists to ensure that the patient has sufficient calcium and vitamin D intake (Centres for Disease Control and Prevention, 2013). Lastly, nurses may be required to use hip protectors to elderly people who are at high risk of falling and hip injury. The hip protector would be worn by the patient and protect the neck of femur in case of a fall (Feder, Cryer, Donovan & Carter, 2000).

Recommendations for future professional development for nurses are to receive training on how to detect patient falls and care for fall-related injuries, design nursing practices for fall prevention and provide an institutional framework for fall prevention in the hospital. Firstly, nurses should be trained to detect and care for fall-related injuries. This training would focus on creating a nurse-patient partnership where the patient acknowledges the activities which reduce falls and the nurse understands his/her role in helping patients accept their injury (Anderson et al., 2012). One strategy to achieve this would be to ask patients what they can do to prevent a fall. Such a discussion would inform the patient of the need to be more thoughtful about his abilities such as carelessness or denying the risk of falling (Carroll, Dykes & Hurley, 2010). The benefit of this strategy is that it makes patient aware of his risk of falling, activities for reducing falls and the nurse’s role in fall prevention. It also encourages open communication and information flow between the nurse and the patients.

Secondly, the hospital should design nursing practices for fall prevention. Nursing activities need to recognize the patient’s need for assistance (such as when getting out of bed or walking). One strategy is to train nurses to inform to the patients to call for help whenever they need it and not feel that seeking assistance is a bother (Carroll, Dykes & Hurley, 2010). Their responsibility is to make patients feel comfortable to ask for help, not appear to be too busy and provide prompt responses to the patients. Another strategy is to define a plan of care which assesses the patient’s mental status, gait, diet and comorbidities. An assessment of the patient’s diet, for instance, would reveal whether there is a need to supplement calcium and/or vitamin D intake (Annweiler et al., 2010).Supplementation of Vitamin D at 700IU per day would reduce fall rates because it improves muscle strength and balance (Bischoff-Ferrari et al., 2009). The final strategy is to develop group exercise programs such as Tai Chi and home-based exercise which aim to improve the patient’s strength and balance (Gillespie & Handoll, 2009; Logghe et al., 2010). The third recommendation is to develop an institution’s framework for fall prevention. The framework would focus on creating a team of physicians, occupational therapists and nurses to collaborate on fall prevention at organisational, staff and patient level (Quigley et al., 2012). Organizational level collaboration would include modifying the environment (such as using floor mats and non-cluttered spaces), using safety equipment (such as anti-tippers in wheelchairs) and making architectural changes such as eliminating uneven floor surfaces and reengineering bathrooms (Krauss et al., 2008). At the staff level, the team would be trained on communication and importance of patient debriefing. At patient level, the team would incorporate the use of hip protectors, adherence to medication (such as vitamin D supplements), endurance and strength exercises, and assistive mobility aides (Quigley et al., 2012).

The essay has discussed the problem surrounding falls and their prevention in health care institutions. It has determined that falls and subsequent injuries can be prevented. This is based on critical reflection of the author’s clinical practicum using the Gibbs reflection cycle. The reflection revealed that the patient’s fall could have been prevented by hospital nurses. Three recommendations for future professional development for nurses were identified. These were: to train nurses to detect patient falls and care for fall-related injuries; develop nursing practices for fall prevention; and provide an institutional framework for fall prevention. The critical reflection and literature analysis revealed to the author the need for greater patient care to ensure that hospital falls were prevented.


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Annweiler, C., Montero-Odasso, M., Schott, A., Berrut, G., Fantino, B., & Beauchet, O. (2010). Fall prevention and vitamin D in the elderly: An overview of the key role of the non-bone effects. Journal of NeuroEngineering and Rehabilitation, 7, 50-63.

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Logghe, I., Verhagen, A., Rademaker, A., Bierma-Zeinstra, S., Rossum, E., Faber, M., & Koes, B. (2010). The effects of Tai Chi on fall prevention, fear of falling and balance in older people: A meta-analysis. Preventive Medicine, 51, 222-227.

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Quigley, P., Bulat, T., Kurtzman, E., Olney, R., Powell-Cope, G., & Rubenstein, L. (2010). Fall prevention and injury protection for nursing home students. Journal of American Medical Directors Association, 11, 284-293.