Effective fall-risk communication both among staff and between staff and family members is vital for ensuring the safety of residents in long-term care (LTC) settings. This study uses focus group methodology to investigate how information about falls is identified, communicated, and responded to by licensed staff (registered nurses/registered practical nurses) and unlicensed staff (personal support workers) in four LTC facilities. The authors report on the major themes that emerged throughout the focus groups relating to falls management and report on similarities and differences in the communication processes between the two sampled groups. Results highlight communication of the resident’s fall risk, reporting procedures to staff and family members, care plan communication and adherence information, a falls quality improvement knowledge deficit, and barriers to falls quality improvement. Recommendations toward improved communication networks among diverse LTC staff to enhance fall-reduction efforts in LTC settings are provided.
AGS Clinical Practice Committee. (2000). AGS position statement: Regulation and quality of care standards in nursing facilities. Journal of the American Geriatrics Society, 48, 1519-1520.
2.
Ayres, L., Kavanaugh, K., & Knafl, K.A. ( 2003). Within-case and across-case approaches to qualitative data analysis. Qualitative Health Research, 13, 871-883.
3.
Becker, C., Kron, M., Lindemann, U., Sturm, E., Eichner, B., & Walter-Jung, B. (2003). Effectiveness of a multifaceted intervention on falls in nursing home residents. Journal of the American Geriatrics Society, 51, 306-313.
4.
Berlowitz, D.R., Young, G.J., Hickey, E.C., Saliba, D., Mittman, B.S., Czarnowski, E., . . . Moscowitz, M.A. (2003). Quality improvement implementation in the nursing home. Health Services Research, 38, 65-83.
5.
Bouwen, A., De Lepeleire, J., & Buntinx, F. ( 2008). Rate of accidental falls in institutionalised older people with and without cognitive impairment halved as a result of a staff-oriented intervention. Age and Ageing, 37, 306-310.
6.
Capezuti, E., Taylor, J.A., Brown, H., Ouslander, J.G., & Strothers, H. ( 2007). Challenges to implementing an APN-facilitated falls prevention project. Applied Nursing Research, 20, 2-9.
7.
Capezuti, E., Wagner, L.M., Brush, B.L., Boltz, M., Renz, S., & Talerico, K.A. (2007). Consequences of an intervention to reduce restrictive siderail use in nursing homes. Journal of the American Geriatrics Society, 55, 334-341.
8.
Colon-Emeric, C., Schenck, A., Gorospe, J., McArdle, J., Dobson, L., DePorter, C., & McConnell, E. ( 2006). Translating evidence-based falls presention into clinical practice in nursing facilities: Results and lessons from a quality improvement collaborative. Journal of the American Geriatrics Society , 54, 1414-1418.
9.
Donabedian, A. ( 1966). Evaluating the quality of medical care. Milbank Memorial Fund Quarterly, 44, 166-206.
10.
Duggleby, W. ( 2005). What about focus group interaction data? Qualitative Health Research, 15, 832-840.
11.
Gurwitz, J.H., Sanchez-Cross, M.T., Eckler, M., & Matulis, J. ( 1994). The epidemiology of adverse and unexpected events in the long-term care setting. Journal of the American Geriatrics Society, 42, 33-38.
12.
Holmes, D., Teresi, J.A., Ramirez, M., Ellis, J., Eimicke, J., Kong, J., . . . Silver, S. ( 2007). An evaluation of a monitoring system intervention. Clinical Nursing Research, 16, 317-335.
13.
Jensen, J., Lundin-Olsson, L., Nyberg, L., & Gustafson, Y. ( 2002). Fall and injury prevention in older people living in residential care facilities. Annals of Internal Medicine, 136, 733-741.
14.
Kevern, J., & Webb, C. ( 2001). Focus groups as a tool for critical social research in nurse education. Nurse Education Today, 21, 323-333.
15.
Krueger, R.A. ( 1994). Focus groups: A practical guide for applied research (2nd ed.). Thousand Oaks, CA : Sage.
16.
Lake, E.T., & Cheung, R.B. ( 2006). Are patient falls and pressure ulcers sensitive to nurse staffing? Western Journal of Nursing Research, 28, 654-677.
17.
Lane, C.J., Bronskill, S.E., Sykora, K., Dhalla, I.A., Anderson, G.M., Mamdani, M.M., . . . Rochon, P.A. ( 2004). Potentially inappropriate prescribing in Ontario community-dwelling older adults and nursing home residents. Journal of the American Geriatrics Society, 52, 861-866.
18.
McGilton, K.S., McGillis Hall, L., Wodchis, W.P., & Petroz, U. ( 2007). Supervisory support, job stress, and job satisfaction among long-term care nursing staff. Journal of Nursing Administration , 37, 1-6.
19.
Moore, K., & Haralambous, B. (2007). Barriers to reducing the use of restraints in residential elder care facilities. Journal of Advanced Nursing, 58, 532-540.
20.
Neyens, J.C.L., Dijcks, B.P.J., Twisk, J., Schols, J.M.G.A., van Haastregt, J.C.M., van den Heuvel, W.J.A., & de Witte, L.P. (2009). A multifactorial intervention for the prevention of falls in psychogeriatric nursing home patients, a randomized controlled trial (RCT). Age and Ageing, 38, 194-199.
21.
Phillips, V.L., Yarmo Roberts, D., & Hunsaker, A.E. (2008). Certified nursing aides’ and care assistants’ views on falls: Insight for creation and implementation of fall prevention programs. Journal of the American Medical Directors Association, 9, 168-172.
22.
Rapp, M.P. ( 2003). Opportunities for advance practice nurses in the nursing facility. Journal of the American Medical Directors Association , 4, 337-343.
23.
Rask, K., Parmelee, P.A., Taylor, J.A., Green, D., Brown, H., Hawley, J., . . . Ouslander, J.G. (2007). Implementation and evaluation of a nursing home fall management program. Journal of the American Geriatrics Society, 55, 342-349.
24.
Ray, W.A., Taylor, J.A., Meador, K.G., Thapa, P.B., Brown, A., Kajihara, H.K., . . . Griffin, M.R. ( 1997). A randomized trial of a consultation service to reduce falls in nursing homes. Journal of the American Medical Association , 278, 557-596.
25.
Rubenstein, L.Z., & Josephson, K.R. (2002). The epidemiology of falls and syncope. Clinics in Geriatric Medicine, 18, 141-158.
26.
Scott, V., Donaldson, M., & Gallagher, E. ( 2003, September). A review of the literature on best practices in falls prevention for residents of long-term care facilities. Long Term Care Falls Review. Retrieved from http://www.injuryresearch.bc.ca/Publications/Final%20LTC%20Lit%20review.pdf
27.
Scott, V., Votova, K., Scanlan, A., & Close, J. ( 2007). Multifactorial and functional mobility assessment tools for fall risk among older adults in community, home-support, long and acute care settings. Age and Ageing, 36, 130-139.
28.
Stevens, J. ( 1996). Applied multivariate statistics for the social sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum.
29.
Taylor, J.A. ( 2002). The Vanderbilt fall prevention program for long-term care: Eight years of field experience with nursing home staff. Journal of the American Medical Directors Association, 3, 180-185.
30.
Taylor, J.A., Parmelee, P.A., Brown, H., Strothers, H.S., Capezuti, E., & Ouslander, J.G. (2007). A model qualtiy improvement program for the management of falls in nursing homes. Journal of the American Medical Directors Association, 8, S26-S36.
31.
Wagner, L.M., Capezuti, E., Clark, P.C., Parmelee, P.A., & Ouslander, J.G. (2008). Use of a falls incident reporting system to improve medical record care process documentation in nursing homes. Quality and Safety in Health Care, 17, 104-108.
32.
Wagner, L.M., Capezuti, E., & Rice, J. ( 2009). Nurses’ perceptions of safety culture in long term care settings. Journal of Nursing Scholarship, 41, 184-192.
33.
Wagner, L.M., Capezuti, E., Taylor, J.A., Sattin, R.W., & Ouslander, J.G. (2005). Impact of a falls menu-driven incident reporting system on documentation and quality improvement in nursing homes. The Gerontologist, 45, 835-842.
