Patient falls: acute care nurses' experiences.

AIM: To describe the findings from a qualitative study exploring acute care nurses' experiences with patient falls. BACKGROUND: Patient falls continue to be a problem in acute care settings for nurses at the point of care. Despite the growing body of knowledge related to risk factors and interventions for fall prevention, minimal attention has been given to nurses' perspectives of patient falls. DESIGN: A qualitative descriptive design was used. METHOD: Focus group discussions were conducted with nurses working on a cross-section of inpatient acute care settings. Audio-taped sessions were transcribed and analysed thematically. RESULTS: Nurses described their experience of falls as 'knowing the patient as safe', an ongoing affirmation that the patient was free from harm. In this focused, narrowly defined and highly specific knowing, nurses employed the key strategies of assessment, monitoring and communicating. Variable conditions influenced whether these strategies were effective in giving nurses the knowledge they needed to keep the patient safe. When strategies failed to provide nurses with knowledge of their patients as safe and patients fell, this created considerable stress for nurses and prompted them to use a range of coping strategies. CONCLUSION: Knowing the patient as safe has the potential to resolve the tension between patient safety and independence. The critical, often taken for granted, activities used by nurses in this knowing must be expanded to include the meaning falls have for patients and attend to factors beyond nurses control such as environmental redesign and staffing. RELEVANCE TO CLINICAL PRACTICE: Nurses play an important role in fall prevention through knowing the patient as safe but must be supported through the use of a multi-faceted approach extending from the individual nurse to the institutional level.

Spartanburg Fall Risk Assessment Tool: a simple three-step process.

The purpose of this study was to develop a valid, reliable, and user-friendly fall risk assessment tool that is a sensitive predictor for falls in the acute care population. Fall risk factors were determined from extensive review of evidence-based studies available from a PubMed search. Previous falls, medications, and gait were found to be the top three risk factors for predicting a true risk for falls in multiple health care settings. The Spartanburg Fall Risk Assessment Tool (SFRAT) is unique from other fall risk assessment tools in combining intrinsic, patient-related factors, with a direct measure of the patient's functional status. Interrater reliability of the SFRAT using Cohen's kappa was .9008, which reflects almost perfect agreement. The predictability analysis found the SFRAT to be 100% sensitive for falls (27/27) with no false negatives. Specificity was 28% (48/172) with 124 false positives. These false positives may actually reflect patients who were at true risk for fall but were prevented from falling due to effective interventions instituted by the staff providing their care. The SFRAT fall risk assessment is a simple, reliable tool easily incorporated by nurses into their direct care routine.