Children's falls inside the inpatient setting: A qualitative study of parent perceptions and the implications for falls prevention messaging.

PURPOSE: To explore how parents understand their children's falls during hospitalization and how they perceive hospital interventions and messaging related to fall risk and prevention. DESIGN AND METHODS: Semi-structured interviews were conducted to explore parent-caregiver descriptions of their children's falls during hospitalization. Prospective purposive sampling was used to identify eligible participants. Interviews were conducted with the parent-caregiver who was present at the time of the fall event. Themes were coded both inductively and deductively using a constant comparative method. RESULTS: Twelve parent-child groupings participated. Three themes emerged: parental knowledge of risk, parent sense of threat to the identity of the child, and age differences in perception of level of controllability of risk. CONCLUSIONS: Falls prevention education is usually delivered as a straightforward presentation of generic factual information about risk factors, with the assumption that families need more information. Findings from this study challenge this approach. This study indicates that parent-caregivers have fairly high levels of knowledge about children's fall risks; parent-caregiver beliefs about the controllability of falls may differ based on age of the child; finally, as has been found in previous studies of adult falls, parent-caregivers may perceive hospital falls prevention measures as a source of potential threat to their child''s already vulnerable social identity. PRACTICE IMPLICATIONS: Involving the parent-caregiver in the fall risk assessment and collaborative development of falls prevention interventions may increase family alliance with health advice and reduce the incidence of falls in hospitalized children.

An Educational Intervention to Improve Staff Collaboration and Enhance Knowledge of Fall Risk Factors and Prevention Guidelines.

BACKGROUND: Magnet®-designated hospitals are seeking to reduce the frequency of falls that lead to injury, which is considered a hospital-acquired condition. Patients with cancer are at high risk to fall, due to multiple factors. Synthesis of the literature supports team efforts and shared learning sessions for patient-care staff as part of the fall prevention process. The purpose was to improve collaboration between Registered Nurses (RNs) and Senior Nurse Aides (SNAs), as well as to enhance their knowledge of fall risk factors and evidence-based prevention guidelines for pediatric oncology patients. METHODS: An evidence-based practice project was implemented using a quality improvement pilot based on the Magnet® framework. Oncology RNs and SNAs at a large pediatric hospital were invited to attend one of five educational sessions. Pre-and post-session learning was assessed based on an adapted fall risk knowledge assessment tool. FINDINGS: Thirty participants attended an educational session with 27 (25 RNs and 2 SNAs) matched pre- and post-session assessments. Median post-session assessment scores were statistically significantly higher than pre-session scores (Z =  -3.11, p = 0.001). Overall knowledge scores increased for 63% of participants. DISCUSSION: An educational intervention focused on pediatric oncology nursing enhanced knowledge of patient-care roles and fall prevention efforts, leading to improved fall outcomes. APPLICATION TO PRACTICE: Ensuring that RNs and SNAs fully embrace their shared role in harm prevention is vital when considering the complexity of delivering nursing care in our current healthcare environment.

Enhancing Evidence-Based Practice Integration Into Clinical Practice: Using Policy as a Tool for Culture Change in a Large Urban Academic Medical Center.

PURPOSE: This article describes how a large urban medical center was able to enhance the integration of evidence-based practice in the clinical environment by reconfiguring its approach to policy and procedures documentation. PROJECT DESCRIPTION: Leaders at a large urban medical center observed that numerous nursing practice documents lacked a base of evidence. No standard process existed for building staff awareness of the evidence-based underlying practice, and there was uneven knowledge of evidence-based practice in the milieu. To address the problem, a team of Clinical Nurse Specialists developed a novel policy establishing procedures for document review, formal structures for policy assignment, and rigorous standards for the development and sharing of evidence tables. OUTCOME: The proportion of nursing guidance documents connected to evidence tables increased from 45% to 77% in the first year and a half following implementation. The change has enabled streamlining and consolidation of nursing practice guidance documents and has led to significant increases in engagement with clinical inquiry at the bedside. CONCLUSION: A policy specifically requiring evidence to be incorporated into nursing practice guidance documents can help enhance the understanding and uptake of evidence-based practice in a complex clinical environment. Clinical Nurse Specialists played a vital role in facilitating this organizational culture change.