Patients' and staff's views of falls occurring on rehabilitation wards: An action research study to explore the voices of experience

Turner, Nicholas (2012) Patients' and staff's views of falls occurring on rehabilitation wards: An action research study to explore the voices of experience. Doctoral thesis, Northumbria University.

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Abstract

Background - Falls are a major cause of disability and the leading cause of mortality due to injury in people over 75 years living in the UK. Falling in hospital is a significant problem, with falls rates almost three times higher than community-dwelling populations. Interventions effective in the community are not necessarily transferable to an in-patient setting.

Aims - The primary aim of the research was to facilitate changes to in-patient rehabilitation services for older people, with a focus on improving falls prevention by exploring patients’ experiences and collaborating with NHS staff.

Method - This qualitative action research study had two cycles. In the first cycle, semi-structured interviews were conducted to gain an understanding of the experiences of in-patients who had fallen. In the second cycle, ward staff participated in educational focus group sessions.

Findings - The adherence to patient safety and risk management after a fall formed a priority for ward staff which affected the promotion of patients’ independent functioning. The consequences of falling, particularly psycho-social issues such as low self-efficacy and reduced confidence, and restrictions to mobility due to fear were reinforced by the actions of the staff. This resulted in a change in the expected pathway of patients receiving rehabilitation, which prevented them from achieving optimal functioning. Staff identified that inadequate staffing levels affected the rehabilitation ethos. This was compounded by poor relationships and team-working practices.

Discussion/Conclusion - The patients’ and staff’s voices of experience demonstrated a range of attitudes, beliefs and behaviours that were either in harmony (resonance) or opposition (dissonance) to each other. Increasing the resonance offered opportunities for service improvement. This study was unique in its focus on two areas of falls research where there is a lack of evidence: patients’ experiences of falling in hospital and interprofessional collaboration for service improvement for in-patient falls prevention. Recommendations to improve Trust practice included greater involvement of patients in decision-making and falls management; adherence to effective team-working practices; and engaging in opportunities to enhance professional learning through falls documentation and monitoring.

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