US and Dutch nurse experiences with fall prevention technology within nursing home environment and workflow: A qualitative study

Abstract

Falls remain a major geriatric problem, and the search for new solutions continues. We investigated how existing fall prevention technology was experienced within nursing home nurses' environment and workflow. Our NIH-funded study in an American nursing home was followed by a cultural learning exchange with a Dutch nursing home. We constructed two case reports from interview and observational data and compared the magnitude of falls, safety cultures, and technology characteristics and effectiveness. Falls were a high-magnitude problem at the US site, with a collectively vigilant safety culture attending to non-directional audible alarms; falls were a low-magnitude problem at the NL site which employed customizable, infrared sensors that directed text alerts to assigned staff members' mobile devices in patient-centered care culture. Across cases, 1) a coordinated communication system was essential in facilitating effective fall prevention alert response, and 2) nursing home safety culture is tightly associated with the chosen technological system.

Alarming and/or Alerting Device Effectiveness in Reducing Falls in Long-Term Care (LTC) Facilities? A Systematic Review

“…‘Increased staff burden’ [15,18,22,29] as a barrier was mentioned in 4 out of 61 occurrences (6.6%). Learning new equipment and systems costs time and money [15,22,29].…”

“…‘Increased staff burden’ [15,18,22,29] as a barrier was mentioned in 4 out of 61 occurrences (6.6%). Learning new equipment and systems costs time and money [15,22,29]. Resources available to long-term care providers are constrained, which can cause issues with large-scale implementation when it comes to an already overburdened staff [22,29].…”

“…Resources available to long-term care providers are constrained, which can cause issues with large-scale implementation when it comes to an already overburdened staff [22,29]. Nurses tend to focus on tasks perceived as more important, as opposed to expending the time to respond to alarms [15,29]. Dealing with common equipment malfunctions also causes increased nursing workload and causes their time to be capitalized by alarm needs as opposed to other important resident needs [18].…”

Alarming and/or Alerting Device Effectiveness in Reducing Falls in Long-Term Care (LTC) Facilities? A Systematic Review

“…‘Increased staff burden’ [15,18,22,29] as a barrier was mentioned in 4 out of 61 occurrences (6.6%). Learning new equipment and systems costs time and money [15,22,29].…”

“…‘Increased staff burden’ [15,18,22,29] as a barrier was mentioned in 4 out of 61 occurrences (6.6%). Learning new equipment and systems costs time and money [15,22,29]. Resources available to long-term care providers are constrained, which can cause issues with large-scale implementation when it comes to an already overburdened staff [22,29].…”

“…Resources available to long-term care providers are constrained, which can cause issues with large-scale implementation when it comes to an already overburdened staff [22,29]. Nurses tend to focus on tasks perceived as more important, as opposed to expending the time to respond to alarms [15,29]. Dealing with common equipment malfunctions also causes increased nursing workload and causes their time to be capitalized by alarm needs as opposed to other important resident needs [18].…”

Mobilisation Alarm Use in Hospitals and Alignment With Person‐Centred Practice: A Qualitative Study

“…Residential care settings are perhaps ahead of hospitals in how they involve care recipients and their families in dignity of risk decisions involving alarms. Research has demonstrated falls can be effectively managed by instilling a culture where alarms are used in a considered way, individualised to the resident's behaviour with agreements recorded about residents and families accepting the trade-off between safety and freedom of movement and privacy (Vandenberg et al 2017). Whilst some examples were provided in our study where patients were involved in choosing fall prevention options that best reflected their values, there appeared to be a lack of any formal processes to ensure this person-centred approach was prioritised in the fast-paced hospital setting.…”

Staff perspectives on fall prevention activities in long-term care facilities for older residents: "Brief but often" staff education is key

“…Our findings indicated that sensor mats are perceived as helpful for maintaining staff awareness of falls risk, but significant disadvantages include increasing resident agitation and interfering with other residents’ care. Over-using sensors may lead to falls; staff education can support their proper use, and staff performance may be improved if unnecessary alarms are de-implemented [ 49 ]. Additionally, our findings revealed that using identification systems for residents “at high risk of falling” was unhelpful in LTCFs (where most are high-risk or are well-known to staff) and contrary to promoting residents’ dignity (privacy).…”

Alarming and/or Alerting Device Effectiveness in Reducing Falls in Long-Term Care (LTC) Facilities? A Systematic Review

“…‘Increased staff burden’ [15,18,22,29] as a barrier was mentioned in 4 out of 61 occurrences (6.6%). Learning new equipment and systems costs time and money [15,22,29].…”

“…‘Increased staff burden’ [15,18,22,29] as a barrier was mentioned in 4 out of 61 occurrences (6.6%). Learning new equipment and systems costs time and money [15,22,29]. Resources available to long-term care providers are constrained, which can cause issues with large-scale implementation when it comes to an already overburdened staff [22,29].…”

“…Resources available to long-term care providers are constrained, which can cause issues with large-scale implementation when it comes to an already overburdened staff [22,29]. Nurses tend to focus on tasks perceived as more important, as opposed to expending the time to respond to alarms [15,29]. Dealing with common equipment malfunctions also causes increased nursing workload and causes their time to be capitalized by alarm needs as opposed to other important resident needs [18].…”

Mobilisation Alarm Use in Hospitals and Alignment With Person‐Centred Practice: A Qualitative Study

“…Residential care settings are perhaps ahead of hospitals in how they involve care recipients and their families in dignity of risk decisions involving alarms. Research has demonstrated falls can be effectively managed by instilling a culture where alarms are used in a considered way, individualised to the resident's behaviour with agreements recorded about residents and families accepting the trade-off between safety and freedom of movement and privacy (Vandenberg et al 2017). Whilst some examples were provided in our study where patients were involved in choosing fall prevention options that best reflected their values, there appeared to be a lack of any formal processes to ensure this person-centred approach was prioritised in the fast-paced hospital setting.…”

Staff perspectives on fall prevention activities in long-term care facilities for older residents: "Brief but often" staff education is key

“…Our findings indicated that sensor mats are perceived as helpful for maintaining staff awareness of falls risk, but significant disadvantages include increasing resident agitation and interfering with other residents’ care. Over-using sensors may lead to falls; staff education can support their proper use, and staff performance may be improved if unnecessary alarms are de-implemented [ 49 ]. Additionally, our findings revealed that using identification systems for residents “at high risk of falling” was unhelpful in LTCFs (where most are high-risk or are well-known to staff) and contrary to promoting residents’ dignity (privacy).…”

Alarming and/or Alerting Device Effectiveness in Reducing Falls in Long-Term Care (LTC) Facilities? A Systematic Review

“…‘Increased staff burden’ [15,18,22,29] as a barrier was mentioned in 4 out of 61 occurrences (6.6%). Learning new equipment and systems costs time and money [15,22,29].…”

“…‘Increased staff burden’ [15,18,22,29] as a barrier was mentioned in 4 out of 61 occurrences (6.6%). Learning new equipment and systems costs time and money [15,22,29]. Resources available to long-term care providers are constrained, which can cause issues with large-scale implementation when it comes to an already overburdened staff [22,29].…”

“…Resources available to long-term care providers are constrained, which can cause issues with large-scale implementation when it comes to an already overburdened staff [22,29]. Nurses tend to focus on tasks perceived as more important, as opposed to expending the time to respond to alarms [15,29]. Dealing with common equipment malfunctions also causes increased nursing workload and causes their time to be capitalized by alarm needs as opposed to other important resident needs [18].…”

Mobilisation Alarm Use in Hospitals and Alignment With Person‐Centred Practice: A Qualitative Study

“…Residential care settings are perhaps ahead of hospitals in how they involve care recipients and their families in dignity of risk decisions involving alarms. Research has demonstrated falls can be effectively managed by instilling a culture where alarms are used in a considered way, individualised to the resident's behaviour with agreements recorded about residents and families accepting the trade-off between safety and freedom of movement and privacy (Vandenberg et al 2017). Whilst some examples were provided in our study where patients were involved in choosing fall prevention options that best reflected their values, there appeared to be a lack of any formal processes to ensure this person-centred approach was prioritised in the fast-paced hospital setting.…”

Staff perspectives on fall prevention activities in long-term care facilities for older residents: "Brief but often" staff education is key

“…Our findings indicated that sensor mats are perceived as helpful for maintaining staff awareness of falls risk, but significant disadvantages include increasing resident agitation and interfering with other residents’ care. Over-using sensors may lead to falls; staff education can support their proper use, and staff performance may be improved if unnecessary alarms are de-implemented [ 49 ]. Additionally, our findings revealed that using identification systems for residents “at high risk of falling” was unhelpful in LTCFs (where most are high-risk or are well-known to staff) and contrary to promoting residents’ dignity (privacy).…”