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Problem-Based Research Paper:

Fall Prevention in Elderly and Confused Patients

Madison McClafferty 

Department of Nursing, Delaware Technical Community College 

NUR340-501 Nursing Research

Tammy Layer 

October 1, 2022
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The issue on fall prevention is an important one when it comes to maintain patient safety.

Falls are especially prevalent in the elderly and/or confused patients and can result in injuries,

prolonged hospitalization, a decrease in their life quality, and even death (Szewieczek et al.,

2016). Although there are current practices that many hospitals use to prevent falls, they still

happen every day meaning that they do not fully prevent falls. In every accredited hospital, The

Joint Commission is an accreditation organization that “seeks to continuously improve health

care for the public…by evaluating health care organizations” which makes sure that all hospitals

are providing safe care to all patients (The Joint Commission, n.d.).

Within The Joint Commission and their research, they create Sentinel Event Alerts that

each hospital must use these Alerts to implement safe and effective care for all patients. A

Sentinel Event Alert on falls was released meaning that its occurrence happens so frequently that

there needs to be addressed and there was one that was released named “Preventing Falls and

Fall-Related Injuries in Health Care Facilities” (Sentinel Event Alert, 2015). Although much

research and reduction of falls have occurred throughout the years at hospitals, there still is not

enough reduction in patient falls.

Statement of the Problem

In my current workplace, we care mainly for confused or elderly patients meaning that

we use many fall prevention tactics that have been shown in research, but that does not mean that

every unit or hospital uses the same fall prevention methods that we do. From the classes and

education that I receive on my unit, I know how important it is to prevent falls and the adverse

effects that result in them, but other units or hospitals do not receive the same education as we

do, which is why this was an issue I wanted to research. As I conduct this research, my research
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question is if the current practices and teaching effective in preventing falls that could lead to

patient harms or sentinel events.

Literature Review and Analysis

According to the World Health Organization, falls during hospitalizations are a huge

cause of traumatic deaths for patients and there are about 600,000 falls every year that lead to

death (World Health Organization, 2021). A study published as “Fall Prevention in Hospitals and

Nursing Homes” in the Sigma Global Nursing Excellence Journal, focused on creating a practice

guideline in which all nursing staff would be able to search for fall preventions and to use in their

practice. The concern of the Sigma study was that were no current guidelines or practices that

nursing staff would be able to use to safely prevent their patients from sustaining falls.

The research that was conducted by this study prior to their own research, they found that

the most updated fall prevention guideline was created in 2018, so the overall intention of this

guideline was to create an updated version for nursing staff to use to prevent falls. A systematic

review was the method used for the Sigma fall prevention study and used information “on the

topic of fall prevention, an assessment of the study quality, the preparation of meta-analyses to

summarize the results, and the application of the GRADE (Grading of Recommendations

Assessment, Development and Evaluation) approach to grade the scientific literature” (Schoberer

et al., 2022). Using the GRADE method, the researchers were able to grade the evidence that was

found based on certain bias or if the results were inconsistent. Although this article has strong

use of evidence grading, there are still some limitations such as using “no recommendation”

when not choosing certain research which could be seen as it having inconsistent results rather

than not enough information to be used in the study results.

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In another scholarly article named “Risk Factors for Fall Occurrence in Hospitalized

Adult Patients: A Case-control Study”, it uses a quantitative methodology to summarize data

from what patients had experienced in a recent hospital fall. The researchers used a sample of

about 300 patients who had experienced a fall in the last 72 hours that the study was being

conducted. Overall, the data was collected from patient interviews, charted information in the

electronic medical record, and using the Morse Fall scale to determine the patient’s risk for falls.

From the collected data, the researchers imputed it into Microsoft Excel to start the analysis

process.

The data collection is reliable and valid as it was done by experts in the Nursing field and

used verified data from the medical record which can ultimately be used in legal cases. The

results of the study showed that the patients with the most risk factors related to hospital falls

were elderly patients with a mean age of 58.4 years old and an 86.2% chance of falls for patients

who had a nursing diagnosis of falls for confused patients (Severo et al., 2018). Some limitations

for the study were that the data was only used from one hospital in Brazil’s patient population

and only their electronic medical record.

Using the patient’s perspective is another way that research can be used to not only

compare current fall prevention strategies but create new ones. In the study “The Patients’

Perspective of Sustaining a Fall in Hospital: A Qualitative Study”, the researchers used patient

perspectives from after they sustained a fall. The main purpose of this qualitative study was that

using the patient’s perspective and experiences there can be a better plan developed to prevent

patient falls.

In this study, it uses a specific methodology called Van Manen’s approach. The approach

focuses on a “description of personal experiences, conversational interview, and close

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observation” in their data collection (Fuster Guillen, 2019). In Van Manen’s approach it uses the

interviews that were conducted of the participants and discovers themes between the interviews.

The researchers chose this type of methodology as they stated that there was little research on

how the patient felt before, during, and after their falls.

There were three common themes that were identified from comparing what was spoken

in each interview and they were the patients “feeling safe, realizing the risk, and recovering

independence and identity” (Gettens et al., 2017). Some other themes that were discovered

throughout comparing the interviews were that patients felt responsible for the fall and were

worried about aftermath, patients pretending to be fully well and not needed fall precautions, and

patients finally realizing that they need the help of staff or assistive devices while ambulating to

prevent falls. Using the methodology of taking information from a patient’s personal experience

on a fall creates bias of the study which is the main limitation of this risk factor study. Also, it is

hard to use patients personal bias and thoughts rather than data to bring about change in a

hospital setting as hospitals are very data and number based.

An article posted in the Age and Ageing Journal by Oxford Medicine named

“Interventions to Reduce Falls in Hospitals: A Systematic Review and Meta-analysis” and it

focuses on prevention interventions that can be done to prevent falls. In total, this article summed

up 43 conducted studies to create evidence and compared it to the current interventions that are

being used. Current interventions such as call bell use and bed exit alarms are not full proof in

preventing falls as the research states.

Mobility status, patient education, environmental modifications, and medications given

can contribute to patient falls. From their research they discovered that there were about 30% of

hospital falls that resulted in injury to patients meaning that the interventions that we currently
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use in the hospital are not being used well enough (Barker et al., 2022). There are some

implications of the article based on fall interventions as there were some of the 43 studies that

were included that could have some a risk of bias. Although there were three people who acted

as reviewers who evaluated if there were any risk for bias in each study, that does not always

guarantee that some sort of bias slipped into the study.

Lastly, an article named “The Perceived Knowledge of Fall Prevention in Nursing

Working in Acute Care Hospitals in China and the United States” focuses on the nurse’s

perspective rather than the patient’s perspective in fall prevention. Not only does it rely on

patients to be educated on their fall prevention interventions, but it is also even more apparent

that nurses must know how to safely prevent falls. Without nursing staff having deep knowledge

on the interventions, more falls will occur. In this study, the methodology used was a cross

sectional survey that used 17 items to measure the amount of fall prevention knowledge the

nurses have.

To measure fall prevention knowledge, a questionnaire was produced by the researchers

and given to nurses which asked questions that were the basis of knowledge relating to fall

prevention. It is imperative to measure how educated nurses are on this subject as they “are on

the frontline and are mainly responsible for the assessment of the risk of falls and health

education of the patients” (Wang et al., 2021). Afterall, how will patients be educated on fall

prevention and understand the interventions if their nurse does not have the knowledge to

educate their patents and that is why it is important.

The results of the study showed that nurses had an extensive knowledge of most fall

prevention education although there were still some items that nurses were not as familiar with
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meaning that more education needed to be done. A limitation of this includes that many of the

staff could lie on the questionnaire which result in a bias and skewed results. These results are

key in fall prevention as knowing what nurses do and do not know will allow us to educate staff

to safely prevent falls.

Recommendations

In my opinion, the most important aspect in preventing falls is the education component.

It is hard to educate your patients on preventing falls or even knowing which interventions to use

to prevent falls if the nursing staff has not received proper education on how to do so. The study

that is based off the knowledge that nurses have on fall interventions is the most beneficial in

understanding fall prevention. Although the quantitative research is helpful in fall prevention and

knowing the numbers behind it, fall prevention is much more than just numbers and the

percentage of patients who are at risk for falls, but nurses knowing the risks and what can cause a

fall is just as important.

A title of a study that I created and would suggest is “Education of Fall Prevention

Interventions to Reduce Hospital Falls: A Qualitative Study”. In this study, the methodology

that would be used are questionnaires, nurse interviews, or multiple-choice exams to measure

how much knowledge nursing staff has on fall prevention interventions. Knowing the amount of

knowledge that the staff has will allow the hospital educators to teach their staff interventions

that ensure not only physical, but mental safety interventions. To protect human rights in the

process of the studies, it is important to keep the study subjects anonymous and ensure that the

interventions that are being used will not harm any participant or patients. The overall

implications to nursing practice are to always ensure the safety of patients and that starts with

education. Preventing falls not only prevents patient injuries, but it can prevent patient death.
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References

Fuster Guillen, D. E. (2019). Qualitative Research: Hermeneutical Phenomenological Method.

Propósitos y Representaciones, 7(1), 201. https://doi.org/10.20511/pyr2019.v7n1.267

Gettens, S., Fulbrook, P., Jessup, M., & Low Choy, N. (2017). The patients’ perspective of

sustaining a fall in hospital: A qualitative study. Journal of Clinical Nursing, 27(3-4), 743–

752. https://doi.org/10.1111/jocn.14075

Joint Commission FAQs. The Joint Commission. (n.d.). Retrieved October 1, 2022, from

https://www.jointcommission.org/about-us/facts-about-the-joint-commission/joint-

commission-faqs/

Sentinel Event Alert 55 Preventing Falls and fall related injuries in health care facilities. The

Joint Commission. (2015, September 28). Retrieved October 1, 2022, from

https://www.jointcommission.org/resources/patient-safety-topics/sentinel-event/sentinel-

event-alert-newsletters/sentinel-event-alert-55-preventing-falls-and-fall-related-injuries-in-

health-care-facilities/#.Ywa85uxKg0p

Severo, I. M., Kuchenbecker, R. de, Vieira, D. F., Lucena, A. de, & Almeida, M. de. (2018).

Risk factors for fall occurrence in hospitalized adult patients: A case-control study. Revista

Latino-Americana De Enfermagem, 26. https://doi.org/10.1590/1518-8345.2460.3016

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Szewieczek, J., Mazur, K., & Wilczyński, K. (2016). Geriatric falls in the context of a hospital

fall prevention program: Delirium, low body mass index, and other risk factors. Clinical

Interventions in Aging, Volume 11, 1253–1261. https://doi.org/10.2147/cia.s115755

Wang, L., Zhang, L., Roe, E., Decker, S., Howard, G., Luth, A., Marks, K., & Whitman, B.

(2021). The perceived knowledge of fall prevention in nurses working in acute care

hospitals in China and the United States. Journal of Patient Safety, 18(2).

https://doi.org/10.1097/pts.0000000000000873

World Health Organization. (2021, April 26). Falls. World Health Organization. Retrieved

October 1, 2022, from https://www.who.int/news-room/fact-sheets/detail/falls