The prevention of falls is an integral part of the safety culture of health institutions with mandatory fall prevention programs set within health care facilities. Care providers are key in identifying the risks of falls and in implementing strategic actions to prevent them. With the aim to better understand practices of fall prevention, we conducted a synthesis of qualitative evidence on care providers’ practices to prevent older people from falling in health care facilities. This synthesis is part of an integrative review of the role of care providers in fall prevention of adults aged 65 years and above. Primary studies were synthesized with the emerging core category of “a complex decision” and described by four emerging conditions that make that decision complex: (a) permanent threat of a fall, (b) continuous flow of information, (c) lack of control, and (d) ethical dilemmas and moral issues over the course of action. The present synthesis shows that before implementing preventive actions, care providers consider the conditions in which they are immersed, in this way situating their preventive actions in a clinical and a moral context.
The review has a constructivist drive as studies that combine methods ought to be paradigmatic driven. Review questions are broad to allow issues emerge and have purposefully left the design flexible to allow for adjustments as the review progresses. The review seeks to highlight the roles that care providers play in fall prevention and their views on fall's prevention initiatives.
Aim: To better understand formal care providers' role in fall prevention.Design: Qualitative synthesis as part of an integrative review.Data sources: Fifteen electronic databases were consulted with the time limit being December 2017. Studies included were qualitative primary studies on formal care providers and fall prevention of people over 65 years of age in health care facilities.17 studies were included.Review Methods: Qualitative researchers carried out a critical appraisal and abstraction of the studies retained. Primary studies were imported into Nvivo 12 software; grounded theory procedures of constant comparison, microanalysis, coding, development of memos and diagrams were completed concurrently in a continuous growing process of data conceptualization. Analysis was iterative; it started with open coding and ended with the development of an integrative memo.Findings: Primary studies were synthesized with the emerging core category of "Managing and keeping control" and described by the emerging strategies of risk management, risk control and articulation work. These three categories account for the formal care providers' role in fall prevention in health care facilities. Conclusion:Fall prevention is not given by a series of means and instruments; it is rather built in the interactions between formal care providers and the material and social world. The interactive character of prevention implies that outcomes cannot always be anticipated. Impact:• Although falls are one of the most researched clinical problems in nursing, the role played by nursing and care staff is dispersed and scantily documented.• Formal care providers alternate risk management with risk control strategies to prevent older people from falling in health care facilities, they also resort to the articulation of the health care team as a complementary strategy.• This review shows the dynamic character of fall prevention, which is something that has tended to go unnoticed in the literature and in policy. | 3009 DE LA CUESTA-BENJUMEA ET AL. 1 | INTRODUC TI ON Falls are the most severe problem affecting older people, and are associated with mortality, morbidity and loss of function; moreover falls are the leading cause for hospital admissions (European Innovation Partnership on Active & Healthy Ageing, 2013). Adults over 65 are more likely to suffer falls with fatal consequences and are more likely to need long-term assistance and admission to health care facilities. (World Health Organization [WHO], 2018).Falling is a serious threat to patient safety (Cameron et al., 2010) and is the most common accident reported in hospitals (Morse, 2002), incidence rates range from 5.71 to 18.0 falls per 1,000 bed days. (Cameron et al., 2018). The number of falls within health care facilities is three times those occurring in the community (Panel on Prevention of Falls in Older Persons, American Geriatrics Society, & British Geriatrics Society, 2011). Studies reported an incidence rate of 1.7 falls per person-year in nursing facilities, compared with 0...
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