Knowledge and performance among nurses before and after a training programme on patient falls

Nagwa Younes Abou El Enein, Azza Saad Abd El Ghany, Ashraf Ahmad Zaghloul

Department of Health Administration and Behavioural Sciences, High Institute of Public Health, University of Alexandria, Alexandria, Egypt.
Health Insurance Organization, Alexandria, Egypt.

DOI: 10.4236/ojn.2012.24053                

Abstract

Background: Patient falls in hospitals are common and affect approximately 2% to 17% of patients during their hospital stay. Patient falls are a nursingsensitive quality indicator in the delivery of inpatient services. Objective: To assess the effect of educational training program on nurses’ knowledge and performance regarding prevention of fall at one of the health insurance organization hospitals in Alexandria. Setting: The study was conducted at 284 bed general hospital affiliated with the Health Insurance Organization in Alexandria. Design: A quasi-experimental design was followed. Participants: The study sample included all nurses of different ranks working at four departments namely, orthopedic, medical, surgical, ICU unit. Results: There was a significant difference regarding all factors under study before and after the educational programme except for two individual factors, old age (p = 0.84), overall poor health status (p = 0.38), and two health factors, uses aids (p = 0.50), treatment by heparin (p = 1.00), and two environmental factors, poor lighting (p = 0.34), loose cords or wires (p = 0.30) and bells (p = 0.30), and one miscellaneous factor, patient education (p = 0.85) and tidy environment(p = 0.85). All departments showed posttest performance improvement, the total performance median for departments regarding environmental factor (p = 0.04) and health education (p = 0.001). Conclusion: Education programmes should be regularly, updated in view of changing knowledge and work practices.

Keywords

Patient Falls; Nurse Knowledge; Performance; Quasi-Experimental Design

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Dykes, P.C., Carroll, D.L., Hurley, A.C., Benoit, A. and Middleton, B. (2009) Why do patients in acute care hospitals fall? Can falls be prevented? Journal of Nursing Administration, 39, 299-304.
[2]	Al-Aama, T. (2011) Falls in the elderly: Spectrum and prevention. Canadian Family Physician, 57, 771-776.
[3]	Blank, W.A., Freiberger, E., Siegrist, M., Landendoerfer, P., Linde, K., Schuster, T., Pfeifer, K., Schneider, A. and Halle, M. (2003) An interdisciplinary intervention to prevent falls in community-dwelling elderly persons: Protocol of a cluster-randomized trial [PreFalls]. BMC Geriatrics, 11.
[4]	Dykes, P.C., Carroll, D.L., Hurley, A., Lipsitz, S., Benoit, A., Chang, F., Meltzer, S., Tsurikova, R., Zuyov, L. and Middleton, B. (2010) Fall prevention in acute care hospitals: A randomized trial. JAMA, 304, 1912-1918.
[5]	Mahoney, J.E. (1998) Immobility and falls. Clinics in Geriatric Medicine, 14, 699-726.
[6]	Krauss, M.J., Nguyen, S.L., Dunagan, W.C., et al. (2007) Circumstances of patient falls and injuries in 9 hospitals in a Midwestern healthcare system. Infection Control and Hospital Epidemiology, 28, 544-550. HUdoi:10.1086/513725U
[7]	Lake, E.T., Shang, J., Klaus, S. and Dunton, N.E. (2010) Patient falls: Association with hospital Magnet status and nursing unit staffing. Research in Nursing & Health, 33, 413-425. HUdoi:10.1002/nur.20399U
[8]	Batchelor, F., Hill, K., Mackintosh, S. and Said, C. (2010) What works in falls prevention after stroke? A systematic review and meta-analysis, Stroke, 41, 1715-1722. HUdoi:10.1161/STROKEAHA.109.570390U
[9]	Halfon, P., Eggli, Y., Van Melle, G. and Vagnair, A. (2001) Risk of falls for hospitalized patients: A predictive model based on routinely available data. Journal of Clinical Epidemiology, 54, 1258-66. HUdoi:10.1016/S0895-4356(01)00406-1U
[10]	Fischer, I.D., Krauss, M.J., Dunagan, W.C., Birge, S., Hitcho, E., Johnson, S., Costantinou, E. and Fraser, V.J. (2005) Patterns and predictors of inpatient falls and fall-related injuries in a large academic hospital. Infection Control and Hospital Epidemiology, 26, 822-827. HUdoi:10.1086/502500U
[11]	Hitcho, E.B., Krauss, M.J., Birge, S., Claiborne Dunagan, W., Fischer, I., Johnson, S., Nast, P.A., Costantinou, E. and Fraser, V.J. (2004) Characteristics and circumstances of falls in a hospital setting: A prospective study. Journal of General Internal Medicine, 19, 732-739. HUdoi:10.1111/j.1525-1497.2004.30387.xUH PMid:15209586 PMCid:1492485
[12]	Oliver, D., Hopper, A. and Seed, P. (2000) Do hospital fall prevention programs work? A systematic review. Journal of the American Geriatrics Society, 48, 1679- 1689.
[13]	Heung, M., Adamowski, T., Segal, J.H. and Malani, P.N. (2010) A successful approach to fall prevention in an outpatient hemodialysis center. Clinical Journal of the American Society of Nephrology, 5, 1775-1779. HUdoi:10.2215/CJN.01610210U
[14]	Logan, P.A., Coupland, C.A., Gladman, J.R., Sahota, O., Stoner-Hobbs, V., Robertson, K., Tomlinson, V., Ward, M., Sach, T. and Avery, A.J. (2010) Community falls prevention for people who call an emergency ambulance after a fall: Randomised controlled trial. BMJ, 340, c2102. HUdoi:10.1136/bmj.c2102U
[15]	Hignett, S. and Masud, T. (2006) A review of environmental hazards associated with in-patient falls. Ergonomics, 49, 605-616.
[16]	Morse, J.M., Black, C., Oberle, K. and Donahue, P. (1989) A prospective study to identify the fall-prone patient. Social Science & Medicine, 28, 81-86. HUdoi:10.1016/0277-9536(89)90309-2U
[17]	Boswell, D.J., Ramsey, J., Smith, M.A. and Wagers, B. (2001) The cost-effectiveness of a patient-sitter program in an acute care hospital: A test of the impact of sitters on the incidence of falls and patient satisfaction. Quality Management in Health Care, 10, 10-16.
[18]	McFarlane-Kolb, H. (2004) Falls risk assessment, multitargeted interventions and the impact on hospital falls. International Journal of Nursing Practice, 10, 199-206. HUdoi:10.1111/j.1440-172X.2004.00482.xU
[19]	Reiling, J. (2006) Safe design of healthcare facilities. Qual Saf Health Care, 15, i34-i40. HUdoi:10.1136/qshc.2006.019422U
[20]	Tzeng, H.M. and Yin, C.Y. (2006) The staff-working height and the designing-regulation height for patient beds as possible causes of patient falls. Nursing Economics, 24, 323-327, 279.
[21]	Tzeng, H.M. and Yin, C.Y. (2008) Heights of occupied patient beds: A possible risk factor for inpatient falls. Journal of Clinical Nursing, 17, 1503-1509. HUdoi:10.1111/j.1365-2702.2007.02086.xU
[22]	Hurley, A.C., Dykes, P.C., Carroll, D.L., Dykes, J.S. and Middleton, B. (2009) Fall TIP: Validation of icons to communicate fall risk status and tailored interventions to prevent patient falls. Studies in health technology and informatics, 146, 455-459.
[23]	Koh, S.L., Hafizah, N., Lee, J.Y., Loo, Y.L. and Muthu, R. (2009) Impact of a fall prevention programme in acute hospital settings in Singapore. Singapore Medical Journal, 50, 425-432.
[24]	Koh, S.S., Manias, E., Hutchinson, A.M., Donath, S. and Johnston, L. (2008) Nurses’ perceived barriers to the implementation of a fall prevention clinical practice guideline in Singapore hospitals. BMC Health Services Research, 8, 105.
[25]	Oliver, D., Hopper, A. and Seed, P. (2000) Do hospital fall prevention programs work? A systematic review. Journal of the American Geriatrics Society, 48, 1679-1689.
[26]	Hendrich, A., Nyhuis, A., Kippenbrock, T. and Soja, M.E. (1995) Hospital falls: Development of predictive model for clinical practice. Applied Nursing Research, 8, 129-139. HUdoi:10.1016/S0897-1897(95)80592-3U
[27]	Rao, S.S. (2005) Prevention of falls in older patients. American Family Physician, 72, 81-88.