Associations between patient symptoms and falls in an acute care hospital: A cross-sectional study.

AIM AND OBJECTIVES: To describe associations between patient fall risk and common symptoms among hospitalised inpatients. BACKGROUND: Predictors of falls have been identified in a variety of populations and settings, but the role of inpatients' symptom experience has not been adequately evaluated. DESIGN: Cross-sectional. METHODS: Participants included 614 medical and elective surgical patients in an acute hospital in Norway. Patient falls during hospitalisation were assessed by self-report and incident reports. Pain intensity and the occurrence and distress of 15 other symptoms were assessed by self-report. RESULTS: Patient falls were associated with male sex and having more comorbidities. Medical patients were more likely to fall than elective surgical patients. In logistic regression analyses, higher symptom counts were associated with increased risk of fall, with each additional symptom conferring a 15% increase in fall risk. Symptom distress related to concentration difficulties, lack of energy, sleep problems, nausea, vomiting and diarrhoea was associated with increased risk of fall, even after adjusting for the influence of age, sex and comorbidities (odds ratios ranged 2.3-4.8). Severe pain, as well as symptom distress related to drowsiness, itching, dizziness or swelling of arms/legs, was also associated with patient falls, although these associations were attenuated after accounting for age, sex and comorbidities. Overall, symptom distress was more strongly associated with fall risk than symptom occurrence. CONCLUSIONS: Symptom burden and distress may help identify hospital patients at risk for fall. Additional research is needed to determine whether symptoms are useful for assessing fall risk among hospital patients and other high-risk populations. If symptoms are useful indicators of fall risk, they should be considered for inclusion in standardised risk assessments. RELEVANCE TO CLINICAL PRACTICE: Clinicians ought to pay particular attention to increased fall risk among patients reporting many symptoms and those experiencing distress from concentration difficulties, fatigue, sleep problems, nausea, vomiting and diarrhoea.

Supplementing the Braden scale for pressure ulcer risk among medical inpatients: the contribution of self-reported symptoms and standard laboratory tests.

AIMS AND OBJECTIVES: To evaluate medical inpatients' symptom experience and selected laboratory blood results as indicators of their pressure ulcer risk as measured by the Braden scale. BACKGROUND: Pressure ulcers reduce quality of life and increase treatment costs. The prevalence of pressure ulcers is 6-23% in hospital populations, but literature suggests that most pressure ulcers are avoidable. DESIGN: Prospective, cross-sectional survey. METHODS: Three hundred and twenty-eight patients admitted to medical wards in an acute hospital in Oslo, Norway consented to participate. Data were collected on 10 days between 2012-2014 by registered nurses and nursing students. Pressure ulcer risk was assessed using the Braden scale, and scores <19 indicated pressure ulcer risk. Skin examinations were categorised as normal or stages I-IV using established definitions. Comorbidities were collected by self-report. Self-reported symptom occurrence and distress were measured with 15 items from the Memorial Symptom Assessment Scale, and pain was assessed using two numeric rating scales. Admission laboratory data were collected from medical records. RESULTS: Prevalence of pressure ulcers was 11·9, and 20·4% of patients were identified as being at risk for developing pressure ulcers. Multivariable analysis showed that pressure ulcer risk was positively associated with age ≥80 years, vomiting, severe pain at rest, urination problems, shortness of breath and low albumin and was negatively associated with nervousness. CONCLUSION: Our study indicates that using patient-reported symptoms and standard laboratory results as supplemental indicators of pressure ulcer risk may improve identification of vulnerable patients, but replication of these findings in other study samples is needed. RELEVANCE TO CLINICAL PRACTICE: Nurses play a key role in preventing pressure ulcers during hospitalisation. A better understanding of the underlying mechanisms may improve the quality of care. Knowledge about symptoms associated with pressure ulcer risk may contribute to a faster clinical judgment of patients at risk.

Pain and concomitant symptoms in medical and elective surgical inpatients: a point prevalence survey.

AIMS AND OBJECTIVES: This study (1) reports the prevalence of severe pain and other symptoms among both medical and elective surgical patients and (2) examines the co-occurrence of severe pain and other symptoms and symptom-related distress. BACKGROUND: As symptom burden can interfere with patients' rehabilitation, daily activities and quality of life, detection and optimal management of pain and other symptoms is important for good nursing care. DESIGN: Cross-sectional point prevalence survey. METHODS: Data were collected by self-report on 10 predetermined screening days from medical and surgical patients admitted to a local hospital in Oslo, Norway. Patients rated their average level of pain on movement during the last 24 hours on a 0-10 numeric rating scale (severe pain defined as ≥7). The occurrence of other symptoms and symptom distress were measured with 15 items from the Memorial Symptom Assessment Scale. Data on comorbidities were also collected. RESULTS: A total of 602 patients participated in the study (response rate = 71%). Medical patients had a higher incidence of symptoms than surgical patients and reported more symptom distress. Surgical patients reported higher levels of pain than medical patients, but the prevalence of severe pain did not differ between the two groups. In analyses adjusted for age, sex and comorbidities, severe pain among medical patients was associated with severe distress due to concentration difficulties, vomiting, itching and swelling, while severe pain among surgical patients was associated with the occurrence of drowsiness. CONCLUSION: Associations between severe pain and other symptoms differ for medical and elective surgical patients. RELEVANCE TO CLINICAL PRACTICE: Knowledge of concurrent symptoms and comorbidities in medical and surgical patients experiencing severe pain may help nurses to better tailor management of the patients' symptoms and improve quality of care.