Modeling of adult patient falls and the repercussions to Nursing as a second victim

Abstract

Objective: analyze the falls of adult hospitalized patients and their repercussions on the Nursing worker as the second victim. Method: an exploratory, descriptive and qualitative study conducted in two stages - identification of falls with moderate to severe damage and the modeling of falls using the software Functional Resonance Analysis Method; and analysis of the repercussions on the worker as the second victim by means of semi-structured interviews submitted to Content Analysis, with 21 Nursing workers. Results: a total of 447 falls of adult patients were identified, 12 of which with moderate to severe damage, occurred in the absence of the companion, while using sleep inducing, hypotensive or muscle strength altering medications. The modeling identified 22 functions related to the Standard Operating Procedure, to the fall prevention protocol and to the post-event actions. Of these, eight presented variability in their execution. In the second step, the categories “The complexity of care to prevent falls” and “Feelings of the second victim” emerged. Conclusion: falls are complex phenomena and prevention requires involvement of the patient, family and multi-professional team. The professionals involved are second victims and experience feelings of guilt, fear, anguish and helplessness. This study can contribute to the multi-professional spirit and to the early approach to second victims.

Falls Suffered by Hospitalized Adult Patients: Support to the Nursing Team as the Second Victim

“…The second victim phenomenon occurs widely and more frequently in places with patients who require more care and with the occurrence of death. However, patients who suffered severe injuries, where the care provided had a direct impact on the outcome of these patients, led to feelings of guilt, a fact that demonstrates the importance of structuring programs that support second victims (9,20).…”

“…Among the feelings experienced by the second victim are guilt stemming from the harm done to the patient, fear for the loss of reputation, and distress over the charge of uncleared or unaddressed situations are all part of the second victim's experiences (9,20,22).…”

“…Nursing teams who are directly involved in the care of a patient who has fallen experience feelings such as guilt, distress, and helplessness. These feelings stem from a self-judgment that leads to devaluation by patients, who are instructed on fall prevention care and do not adhere to the measures, and from the understanding that falls are a reflection of a work process that is solely the responsibility of the nursing team (9), when, in fact, it should be the reason for multiprofessional care, considering that it is an event that requires a multimodal approach. This happens because the implementation of collaborative practices results in better outcomes for patients and safer care, based on the promotion of trust relationships between healthcare teams (10) and, consequently, on the promotion of healthcare staff safety.…”

Ocorrências de quedas em unidades clínico-cirúrgicas e o grau de complexidade do cuidado

“…Ademais, afeta negativamente a imagem das instituições, expõe processos de trabalho, onera o sistema de saúde, aumenta o tempo de internação e pode trazer complicações éticas e legais (Tahir et al, 2018) tanto à instituição, quanto ao seu corpo funcional. Especificamente relacionado às quedas, os desfechos graves aos pacientes podem ainda repercutir sobremaneira nos profissionais de Enfermagem, tanto na vida privada quanto profissional desses trabalhadores (Quadros et al, 2022).…”

“…Deste modo, estratégias de intervenção multifatorial mostram uma redução nas taxas de quedas, uma vez que os guidelines, de maneira isolada, não comportam as várias estratégias necessárias para reduzir a ocorrência das quedas (Damoiseaux-Volman et al, 2021). Além disso, a mitigação dos danos demonstra a necessidade da abordagem multimodal pela complexidade representada por esse incidente de segurança, a fim de contribuir com essa abordagem é necessário mobilizar pacientes, familiares e profissionais para aumentar a adesão aos protocolos e incidir em medidas de prevenção às quedas (Quadros et al, 2022).…”