Restriction lift date: 2029-12-31
Fall prevention in older people in long-term care facilities: a mixed-methods study investigating effective staff education to prevent falls in older residents
Loading...
Files
Date
2024
Authors
Albasha, Neah Mohammad A.
Journal Title
Journal ISSN
Volume Title
Publisher
University College Cork
Published Version
Abstract
Background: More than 50% of older residents in long-term care facilities(LTCFs)fall each year, associated with adverse psychological and physical consequences. In intervention studies, some fall prevention activities reduced morbidity, but challenges remain in clinical practice. Fall prevention can be enhanced by LTCF staff knowledge and skills and by identifying barriers and facilitators to success. This thesis aimed to explore LTCF staff education needs (i.e. knowledge gaps) and selfidentified learning needs, and to identify the most common implementation strategies used in fall prevention studies.
Methods: To synthesise the evidence on implementation strategies and outcomes(categorised using the Expert Recommendations for Implementing Change(ERIC)Taxonomy and Implementation Outcomes Framework), and on clinical outcomes of fall prevention interventions, a systematic search of six electronic and eight grey literature databases from 2001 to 2021 was conducted, updated to 2023. Using an exploratory, parallel, mixed methods design, staff in 14 LCTFs(varying in
size and provider type) in southwest Ireland were invited to complete a survey, a hybrid of two previously developed questionnaires. Staff knowledge, attitudes, and confidence in fall prevention, along with previous training and future education preferences, were evaluated. Suggestions were sought on how to prioritise fall prevention activities and current practices regarding fall incidents. Staff in five of the LTCFs were invited to participate in online interviews, using a semi-structured guide to explore barriers and facilitators of fall prevention activities, and staff perceptions of their learning needs. Survey analysis included descriptive statistics and content analysis, mapping categories to the refined theoretical domains framework(TDF) and an existing fall prevention guideline, and reflective thematic analysis using Braun and Clarke's method. The two data sets were then triangulated to compare/contrast findings and determine whether educational needs reflected inadequate training and/or their perceived learning needs.
Results: The SR identified 39 implementation strategies for fall prevention used in 27 studies but highlighted poor reporting, limited assessment and no clear pattern in implementation strategies within positive studies, requiring improvement. In total, there were 155 survey participants across 13 LTCFs, predominantly HCAs and nurses, with a response rate of 15%. Overall, 60% of LTCF staff, mainly senior nurses, had high levels of knowledge about fall prevention, but role-specific knowledge gaps involved exercise, medication review, antipsychotic drug usage and toileting issues. Respondents had high confidence in delivering fall prevention interventions (90%); greater experience in healthcare was associated with greater
knowledge and confidence. The most common fall prevention activities suggested were environmental reviews and modifications, staff education, resident monitoring, using alarm/call systems and protective equipment, while fall prevention activities targeting resident-related risk factors (e.g., assessing risk factors) were less recognised. Staff also used a standardised approach to respond to falls, implementing comprehensive post-fall control measures.
Concurrently, 17 LTCF staff members from 4 sites participated in online 1:1 interviews (n=7) or small group interviews (n=10). Analysis identified six main themes, leading to the conclusion that integrating fall prevention into daily routines is feasible and practical through rapid-cycle audits, falls champions, informal communication, and staff collaboration. Half of participants had received fall prevention training, but many welcomed further education, especially in-service,multidisciplinary training tailored to staff roles and local contexts.
Triangulation of the data revealed that there were both knowledge gaps and selfidentified learning needs in topics such as fall risk assessment, manual handling techniques, medication review, while practice- based learning was preferred.
Conclusion:The most common strategy used in falls prevention studies is education, but LTCF staff have both educational and learning needs. This thesis provided insights into
fall prevention education, and identified required curriculum elements, and emphasised the importance of tailoring multidisciplinary fall prevention education to staff preferences and educational needs. Future fall prevention education programmes should consider the greatest knowledge gaps, as well as self-identified learning needs and staff preferences for delivery, along with the nursing home’s culture, to most effectively integrate fall prevention activities into practice.
Description
Keywords
Fall prevention , Older person , Long-term care , Staff
Citation
Albasha, N. M. A. 2024. Fall prevention in older people in long-term care facilities: a mixed-methods study investigating effective staff education to prevent falls in older residents PhD Thesis, University College Cork.