Fall prevention in hospitals and nursing homes: Clinical practice guideline.

BACKGROUND: Falls and their consequences are particularly common in older adults in hospitals and long-term care (LTC) facilities. AIM: To avoid falls and their consequences, and provide nurses with an overview of all relevant research literature on fall prevention, and a practice guideline on fall prevention in older adults was developed. METHODS: The development process included a systematic literature review to identify systematic reviews and primary studies 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. The guideline panel and an external multidisciplinary team graded the recommendations using the Delphi method. In addition, the panel and team formulated expert opinions. RESULTS: A total of 79 randomized controlled trials on fall prevention were identified, which formed the basis of the recommendations. Strongly recommended measures for both settings included multifactorial interventions, professionally supported body exercise interventions, and education and counselling interventions. The panel and team did not recommend the use of a specific assessment tool for fall risk assessment, low-floor beds in hospitals, or body exercise interventions in frail residents. LINKING EVIDENCE TO ACTION: During the development of this guideline, particular attention was paid to collecting evidence-based knowledge relevant to practice. By applying the recommendations, the outlined nursing care is justified, enabling healthcare personnel to achieve the overriding goal of providing optimal care to persons at risk of falling. Evidence for several fall prevention interventions was graded as very low. Sound intervention studies are necessary to strengthen the confidence in the evidence for low-floor beds, alarm sensor systems, medication review, and staff education in hospitals.

The participant's perspective: learning from an aggression management training course for nurses. Insights from a qualitative interview study.

BACKGROUND: Aggression management training for nurses is an important part of a comprehensive strategy to reduce patient and visitor aggression in healthcare. Although training is commonplace, few scientific studies examine its benefits. AIM: To explore and describe, from a nurse's perspective, the learning gained from attending aggression management training. DESIGN AND METHODS: This was a descriptive qualitative interview study. We conducted semi-structured individual interviews with seven nurses before (September/October 2012) and after they attended aggression management training (January/February 2013). Interview transcripts were content-analysed qualitatively. ETHICAL ISSUES: The study plan was reviewed by the responsible ethics committees. Participants gave written informed consent. FINDINGS: Aggression management training did not change nurses' attitude. Coping emotionally with the management of patient and visitor aggression remained a challenge. Nurses' theoretical knowledge increased, but they did not necessarily acquire new strategies for managing patient/visitor aggression. Instead, the course refreshed or activated existing knowledge of prevention, intervention and de-escalation strategies. The training increased nurses' environmental and situational awareness for early signs of patient and visitor. They also acquired some strategies for emotional self-management. Nurses became more confident in dealing with (potentially) aggressive situations. While the training influenced nurses' individual clinical practice, learning was rarely shared within teams. CONCLUSIONS: Aggression management training increases skills, knowledge and confidence in dealing with patient or visitor aggression, but the emotional management remains a challenge. Future research should investigate how aggression management training courses can strengthen nurses' ability to emotionally cope with patient and visitor aggression. More knowledge is needed on how the theoretical and practical knowledge gained from the training may be disseminated more effectively within teams and thus contributed to the creation of low-conflict ward cultures.