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Background and Relevance of the Topic

Falls are considered a major cause of disability as well as morbidity in aged individuals. More than one in three elderlies aged more than 65 years’ experience fall every year (Alghnam et al., 2020). Gap in understanding and evidence-based knowledge is considered one of the major barriers of meeting patient’s requirement. Some of the evidence-based interventions that enrolled nurse or nurse practitioners need to perform include physical assistance, patient positioning and bed-position management. Appropriate maintenance of the above-mentioned activities requires good understanding and knowledge on fall injuries and fall prevention in elderlies.  

Therefore, the main objective of this study is to develop a literature review obtaining data from primary research articles (e.g. RCT, Cohort study and meta-analysis) to investigate the importance and impact of educational training program on knowledge expansion concerning fall prevention.        

Fall injuries in this aspect are one of the most adverse as well as costly issues within healthcare centres (Alghnam et al., 2020). In healthcare centres, inappropriate care and assistance due to ignorance, poor knowledge and adherence to safe clinical practice guideline increases risk of fall and fall associated complications. To date, no single option is there to resolve the issue; however, as per current evidences and understanding, nutritional guidelines, adherence to physical activities and physiotherapy is considered effective in increasing bone and muscle strength of patient that further reduces risk of fall injury (Shaw, Kiegaldie & Farlie, 2020).

Methodology is not an option, rather an evidence-based tool that complements the research question and/or helps in fulfilling the research objective. As it is to critically discuss and develop a literature review, Medline, CINAHL and PubMed databases are used to search most relevant articles. The main reason for choosing CINAHL and Medline is that they are great source for research in medical science. Boolean operator search strategy including ‘and’, ‘or’ are utilized along with some key words including ‘fall’, ‘injury’, ‘older’, ‘aged’, ‘nurse’ etc. A total of 427 records are identified. Focusing on exclusion criteria a total of duplicate records were exempted. All searches on e-database/journal were restricted to full-text article and published in English language. Studies identified in time of the search were primarily assessed for their significance utilizing information delivered in the title, aim and abstract. After assessing and screening all eligibility records, a total of 15 full text and peer-reviewed articles are chosen.

The 15 chosen peer-reviewed articles from e-database, which specifically explored the role of training and/or education program on increasing attachment and involvement of adherence to patient care and more knowledge and perception on prevention of falls and associated damage or harm in aged individuals. Key themes that have been identified in the obtained literatures are:

Methods

In the study of Kempegowda et al. (2018) the researchers stated to examine the retention of the knowledge regrading fall management in the hospital care setting and it was reported that after 6 week of the intervention implementation there was improvement in the knowledge of the nurses. This study finding was also supported by the study of Toye et al. (2017) also supported the introduction of the knowledge-based program to improve the patient falls in the hospital care setting and the study findings reported that the knowledge-based program improved the staff activities associated with the documentation, detection, and managing of delirium to inter-professional roles and communication (Melin, 2018, Teresi et al., 2013). Ott (2018) also supported impact of the educational session on the fall prevention for the community based physical therapy patients as in this current study the researchers reported about knowledge improvement by the implementation of fall prevention educational session. In another study by Maloney et al. (2011) the researchers also described the effectiveness of the educational intervention for improving the fall incidents in the hospital care setting. In this study, the researchers performed comparative analysis between the face to face and web-based program and study result reported about significant results in case of both of the interventions.

The study of Park, (2021), in this aspect, specifically reflected on impact of education and interaction of patients’ falls and injury. In this study, the researcher included 57 elderly patients and 58 nurses. The study result reported that the introduction of the interaction-based training program improved the fall prevention behaviours and the knowledge among the intervention group nurses and the patients as well. The fear of falling of the patients was also reduced in the post intervention condition. McKenzie et al. (2017) also supported the interactive training program for the fall prevention education as in their study they had reported to utilize the interactive learning for the health care professionals. The role of interaction during the training program was also identified in the study of Colon-Emeric et al. (2017) as in this study the authors stated that interaction between the staff related to the fall prevention can reduce the fall incidents in the nursing home-based care.

Meyer et al. (2012) identified the direct role of the nurses in the process of fall prevention in the hospital care setting as in this current study, the researchers mentioned about the judgmental roles of the nurses by using the risk assessment tool. Therefore, in this study the researchers reported that use of the fall risk assessment tool did not report about the significant outcomes after relying on the nurses’ judgemental role. In another study by Johnson et al. (2015) the researchers supported the importance of fall screening for preventing the fall incidents in the hospital care setting. Colon-Emeric et al. (2013) also stated about the role of nurses in reducing the communication gaps, practice interaction strategies and collecting the feedback and the study reported about the role of nurses in the process of decision making as well.

Findings

Cabilan (2014) identified the importance of hospital environment and quality of care in the fall prevention of the elderly people in the hospital care setting. McCarty et al. (2018) also identified the importance of the promoting the quality of care by lowering falls in the community hospital emergency rooms. The study of Lopez-Jeng and Eberth (2020) stated about the role of the safety culture of the particular hospital through interdisciplinary approach for improving the safety environment.

As a part of the limitation of the current study, it can be reported that the individual quality of the research articles was not assessed by the researchers by using the critical appraisal tool. The researchers also did not consider the bias present in the individual studies and irrespective of that the studies were selected for this current review and hence, it can be considered as a limitation of the current review. The researchers also did not consider the generalization of the selected study results and thus it can be considered as the third limitation of the study.

The study findings are mostly aligned with the previous study findings as in the study of Salmond and Echevarria (2017) the researchers also reported about the role of the nurses and their education program for reducing the fall incidents in the hospital care setting. On the contrary to the current findings, the study of Woo, Milworm and Dowding (2017) identified the communication skills of the nurses for preventing the fall related incidents in the hospital care setting. On the contrary to this, the study of Evripidou et al. (2019) also supported the current study findings by mentioning importance of the knowledge level of the nurses working in the hospital care setting for reducing the fall incidents. Backhaus et al. (2017) in their study supported the environment of the hospital care setting for improving the fall incident prevention as the researchers stated that the nurse assistants can help the patients in reducing the fall cases and fear of falling among the nursing home residents. Oxelmark et al. (2018) also stated that for reducing the fall incidents in the hospital care setting it is important to support and foster the nurse patient relationship. Cameron et al. (2018) also supported the role of hospital environment in improving the fall incidents by introducing the fall screening and related processes in the hospital care setting as well. On the contrary to this, the study of Lawton et al. (2017) contradicted the above findings as in this study the researchers reported about the patient involvement in improving the patient fall incidents in the hospital care setting.

Theme 1: Improvement of Fall knowledge

Conclusion

Hence, it can be concluded that the issue of the fall incidents in the hospital care setting among the elder population is a common problem. Some of the evidence-based interventions that enrolled nurse or nurse practitioners need to perform include physical assistance, patient positioning and bed-position management. In healthcare centres, inappropriate care and assistance due to ignorance, poor knowledge and adherence to safe clinical practice guideline increases risk of fall and fall associated complications. The current study used a systematic review-based study design to understand the importance of the fall prevention in the hospital care setting. Medline, CINAHL and PubMed databases are used to search most relevant articles. The main reason for choosing CINAHL and Medline is that they are great source for research in medical science. The 15 chosen peer-reviewed articles from e-database, which specifically explored the role of training and/or education program on increasing attachment and involvement of adherence to patient care and more knowledge. The researchers reported about the generation of the 4 different study themes and they are mainly- “Theme 1: Improvement of fall knowledge”, “Theme 2: Interaction and the goal of this initiative is to ‘promote fall prevention via interaction.”, “Theme 3: Role of Nurses”, and “Theme 4: Hospital Environment and Quality of Care”. In spite of that, the study has a few limitations such as lack of critical appraisal, not considering the individual bias of the study and lack of generalization of the individual study results. However, considering the importance of the issue identified in the study the researchers can use the study findings as the evidenced based practice in the hospital care setting for improving the fall related incidents among the elderly people.

References

Alghnam, S., Alsayyari, A. S., Towhari, J. A., Alsayer, R. M., Almohaimeed, M. Y., Aldebasi, M. H., & Albabtin, I. T. (2020). Epidemiological characteristics of fall injuries and their related outcome in Riyadh, Saudi Arabia: A descriptive study from a Level-I trauma center. Journal of family & community medicine, 27(2), 114–119. https://doi.org/10.4103/jfcm.JFCM_245_19

Backhaus, R., van Rossum, E., Verbeek, H., Halfens, R. J., Tan, F. E., Capezuti, E., & Hamers, J. P. (2017). Work environment characteristics associated with quality of care in Dutch nursing homes: A cross-sectional study. International Journal of Nursing Studies, 66, 15-22. https://www.sciencedirect.com/science/article/pii/S0020748916302383 

Cabilan, C. J. (2014). Falls risk assessment and falls prevention strategies in private oncology and neurosurgical setting: a best practice implementation project. JBI Evidence Synthesis, 12(10), 218-233. doi: 10.11124/jbisrir-2014-1878

Theme 2: Interaction And The Goal Of This Initiative Is To ‘Promote Fall Prevention Via Interaction

Cameron, I. D., Dyer, S. M., Panagoda, C. E., Murray, G. R., Hill, K. D., Cumming, R. G., & Kerse, N. (2018). Interventions for preventing falls in older people in care facilities and hospitals. Cochrane database of systematic reviews, (9). https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005465.pub4/abstract 

Colón-Emeric, C. S., Corazzini, K., McConnell, E. S., Pan, W., Toles, M., Hall, R., Cary, M. P., Jr, Batchelor-Murphy, M., Yap, T., Anderson, A. L., Burd, A., Amarasekara, S., & Anderson, R. A. (2017). Effect of Promoting High-Quality Staff Interactions on Fall Prevention in Nursing Homes: A Cluster-Randomized Trial. JAMA internal medicine, 177(11), 1634–1641. https://doi.org/10.1001/jamainternmed.2017.5073

Colon-Emeric, C. S., McConnell, E., Pinheiro, S. O., Corazzini, K., Porter, K., Earp, K. M., Landerman, L., Beales, J., Lipscomb, J., Hancock, K., & Anderson, R. A. (2013). CONNECT for better fall prevention in nursing homes: results from a pilot intervention study. Journal of the American Geriatrics Society, 61(12), 2150–2159. https://doi.org/10.1111/jgs.12550

Evripidou, M., Charalambous, A., Middleton, N., & Papastavrou, E. (2019). Nurses’ knowledge and attitudes about dementia care: Systematic literature review. Perspectives in psychiatric care, 55(1), 48-60. https://onlinelibrary.wiley.com/doi/abs/10.1111/ppc.12291  

Johnson, M., Kelly, L., Siric, K., Tran, D. T., & Overs, B. (2015). Improving falls risk screening and prevention using an e-learning approach. Journal of nursing management, 23(7), 910–919. https://doi.org/10.1111/jonm.12234

Kempegowda, P., Chandan, J. S., Hutton, R., Brown, L., Madden, W., Webb, J., Doyle, A., & Treml, J. (2018). Focused educational intervention improves but may not sustain knowledge regarding falls management. BMJ open quality, 7(3), e000222. https://doi.org/10.1136/bmjoq-2017-000222

Lawton, R., O'Hara, J. K., Sheard, L., Armitage, G., Cocks, K., Buckley, H., ... & Wright, J. (2017). Can patient involvement improve patient safety? A cluster randomised control trial of the Patient Reporting and Action for a Safe Environment (PRASE) intervention. BMJ Quality & Safety, 26(8), 622-631. https://qualitysafety.bmj.com/content/26/8/622.short 

Lopez-Jeng, C., & Eberth, S. D. (2020). Improving hospital safety culture for falls prevention through interdisciplinary health education. Health promotion practice, 21(6), 918-925. https://doi.org/10.1177/1524839919840337.

Maloney, S., Haas, R., Keating, J. L., Molloy, E., Jolly, B., Sims, J., Morgan, P., & Haines, T. (2011). Effectiveness of Web-based versus face-to-face delivery of education in prescription of falls-prevention exercise to health professionals: randomized trial. Journal of medical Internet research, 13(4), e116. https://doi.org/10.2196/jmir.1680

McCarty, C. A., Woehrle, T. A., Waring, S. C., Taran, A. M., & Kitch, L. A. (2018). Implementation of the MEDFRAT to Promote Quality Care and Decrease Falls in Community Hospital Emergency Rooms. Journal of emergency nursing, 44(3), 280–284. https://doi.org/10.1016/j.jen.2017.10.007

McKenzie, G., Lasater, K., Delander, G. E., Neal, M. B., Morgove, M., & Eckstrom, E. (2017). Falls prevention education: Interprofessional training to enhance collaborative practice. Gerontology & geriatrics education, 38(2), 232–243. https://doi.org/10.1080/02701960.2015.1127809

Melin C. M. (2018). Reducing falls in the inpatient hospital setting. International journal of evidence-based healthcare, 16(1), 25–31. https://doi.org/10.1097/XEB.0000000000000115

Meyer, G., Köpke, S., Haastert, B., & Mühlhauser, I. (2012). Comparison of a fall risk assessment tool with nurses' judgement alone: a cluster-randomised controlled trial. Age and ageing, 38(4), 417–423. https://doi.org/10.1093/ageing/afp049

Ott L. D. (2018). The impact of implementing a fall prevention educational session for community-dwelling physical therapy patients. Nursing open, 5(4), 567–574. https://doi.org/10.1002/nop2.165

Oxelmark, L., Ulin, K., Chaboyer, W., Bucknall, T., & Ringdal, M. (2018). Registered Nurses’ experiences of patient participation in hospital care: supporting and hindering factors patient participation in care. Scandinavian journal of caring sciences, 32(2), 612-621. https://onlinelibrary.wiley.com/doi/abs/10.1111/scs.12486 

Park B. M. (2021). Development and Effect of a Fall Prevention Program Based on King's Theory of Goal Attainment in Long-Term Care Hospitals: An Experimental Study. Healthcare (Basel, Switzerland), 9(6), 715. https://doi.org/10.3390/healthcare9060715

Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic nursing, 36(1), 12. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5266427/ 

Shaw, L., Kiegaldie, D., & Farlie, M. K. (2020). Education interventions for health professionals on falls prevention in health care settings: a 10-year scoping review. BMC geriatrics, 20(1), 460. https://doi.org/10.1186/s12877-020-01819-x

Singh, I., & Okeke, J. (2016). Reducing inpatient falls in a 100% single room elderly care environment: evaluation of the impact of a systematic nurse training programme on falls risk assessment (FRA). BMJ Open Quality, 5(1), u210921-w4741. https://bmjopenquality.bmj.com/content/5/1/u210921.w4741.short

Teresi, J. A., Ramirez, M., Remler, D., Ellis, J., Boratgis, G., Silver, S., Lindsey, M., Kong, J., Eimicke, J. P., & Dichter, E. (2013). Comparative effectiveness of implementing evidence-based education and best practices in nursing homes: effects on falls, quality-of-life and societal costs. International journal of nursing studies, 50(4), 448–463. https://doi.org/10.1016/j.ijnurstu.2011.07.003

Toye, C., Kitchen, S., Hill, A., Edwards, D., Sin, M., & Maher, S. (2017). Piloting staff education in Australia to reduce falls in older hospital patients experiencing delirium. Nursing & health sciences, 19(1), 51–58. https://doi.org/10.1111/nhs.12300

Woo, K., Milworm, G., & Dowding, D. (2017). Characteristics of quality improvement champions in nursing homes: a systematic review with implications for evidence?based practice. Worldviews on Evidence?Based Nursing, 14(6), 440-446.

https://sigmapubs.onlinelibrary.wiley.com/doi/abs/10.1111/wvn.12262

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