Educators’ perspectives about how older hospital patients can engage in a falls prevention education programme: a qualitative process evaluation

Abstract

ObjectivesFalls are the most frequent adverse event reported in hospitals. Patient and staff education delivered by trained educators significantly reduced falls and injurious falls in an older rehabilitation population. The purpose of the study was to explore the educators’ perspectives of delivering the education and to conceptualise how the programme worked to prevent falls among older patients who received the education.DesignA qualitative exploratory study.MethodsData were gathered from three sources: conducting a focus group and an interview (n=10 educators), written educator notes and reflective researcher field notes based on interactions with the educators during the primary study. The educators delivered the programme on eight rehabilitation wards for periods of between 10 and 40 weeks. They provided older patients with individualised education to engage in falls prevention and provided staff with education to support patient actions. Data were thematically analysed and presented using a conceptual framework.ResultsFalls prevention education led to mutual understanding between staff and patients which assisted patients to engage in falls prevention behaviours. Mutual understanding was derived from the following observations: the educators perceived that they could facilitate an effective three-way interaction between staff actions, patient actions and the ward environment which led to behaviour change on the wards. This included engaging with staff and patients, and assisting them to reconcile differing perspectives about falls prevention behaviours.ConclusionsIndividualised falls prevention education effectively provides patients who receive it with the capability and motivation to develop and undertake behavioural strategies that reduce their falls, if supported by staff and the ward environment.

‘It promoted a positive culture around falls prevention’: staff response to a patient education programme—a qualitative evaluation

“…Ward staff may have been able to give more detailed feedback if we had been able to interview them immediately following the trial. However, our findings from this study were supported by our previous two studies,22 23 even though we gave staff no information about patients' or educators' feedback about the programme. The main participants were nursing and allied health staff.…”

“…34 The staff perspectives concurred with the educators' perspectives about how the programme worked. Educators perceived that their education facilitated staff and patients developing a mutual understanding, whereby staff encouraged patients to engage in strategies that reduced their risk of falls 23. Staff also independently provided the same feedback as the educators regarding the importance of the educator role, namely that the educator was a health professional who could act as an independent advocate, yet was also viewed as part of the ward team 23…”

“…We then analysed patients' feedback and also gathered information from the educators about the study,22 23 prior to seeking feedback from staff who had worked on the wards during the trial. Ward staff may have been able to give more detailed feedback if we had been able to interview them immediately following the trial.…”

“…The focus group guide was developed based on the constructs of the Health Belief Model,19 20 since this was the framework for the Safe Recovery patient education programme 1516 The guide also incorporated findings from an earlier focus group that had interviewed the educators who delivered the programme on the wards 23. Questions explored three main topics: the patient–staff interaction regarding falls prevention, staff perceptions about how the education impacted on them while it was being delivered to patients on the wards and how staff felt the education impacted ward falls prevention efforts overall.…”

“…These results suggested that delivering the education as a ward level intervention also caused a ward level change which was effective in reducing falls. Although educators reported that staff were mainly supportive of the education,23 staff perspectives about what changes might have occurred on the wards during the intervention period had not been explored. Additionally, patients and educators perceived that staff communication and response to the programme formed a potential barrier to patients engaging in falls prevention strategies 22…”