Managing and keeping control: A qualitative synthesis of nursing and care staff strategies to prevent older people from falling.

AIM: To better understand formal care providers' role in fall prevention. DESIGN: Qualitative synthesis as part of an integrative review. DATA SOURCES: Fifteen electronic databases were consulted with the time limit being December 2017. Studies included were qualitative primary studies on formal care providers and fall prevention of people over 65 years of age in health care facilities. 17 studies were included. REVIEW METHODS: Qualitative researchers carried out a critical appraisal and abstraction of the studies retained. Primary studies were imported into Nvivo 12 software; grounded theory procedures of constant comparison, microanalysis, coding, development of memos and diagrams were completed concurrently in a continuous growing process of data conceptualization. Analysis was iterative; it started with open coding and ended with the development of an integrative memo. FINDINGS: Primary studies were synthesized with the emerging core category of "Managing and keeping control" and described by the emerging strategies of risk management, risk control and articulation work. These three categories account for the formal care providers' role in fall prevention in health care facilities. CONCLUSION: Fall prevention is not given by a series of means and instruments; it is rather built in the interactions between formal care providers and the material and social world. The interactive character of prevention implies that outcomes cannot always be anticipated. IMPACT: Although falls are one of the most researched clinical problems in nursing, the role played by nursing and care staff is dispersed and scantily documented. Formal care providers alternate risk management with risk control strategies to prevent older people from falling in health care facilities, they also resort to the articulation of the health care team as a complementary strategy. This review shows the dynamic character of fall prevention, which is something that has tended to go unnoticed in the literature and in policy.

[The care in the prevention of falls in elderly people: Meta-summary of qualitative articles]. / El cuidado en la prevención de caídas en personas mayores: metaresumen de artículos cualitativos.

OBJECTIVE: To summarize the qualitative evidence on the role of care providers in the prevention of falls of persons over 65 years of age in centres and in the community. DESIGN: Meta-summary of qualitative evidence following the aggregation method. DATA SOURCES: Extensive manual search of 16 databases (CINAHL, Pubmed/Medline, Embase, PsycInfo, Cochrane Library, PeDRO, Opengrey (Reports), Cuiden, Cuidatge, Enfispo, Medes, Lilacs, Teseo, Dissertation and Thesis Global and Ibecs), in English, French, Spanish and Portuguese; no time limit. SELECTION OF STUDIES: Selection and blind critical appraisal by pairs. A first relevance and relevance screening and a second critical appraisal screening were carried out. A total of 4170 articles were located; 41 qualitative articles were critically appraised and 31 were selected. DATA EXTRACTION: Data regarding author, year, study design, location, participants (number, age, sex and occupation), study methods and findings were extracted. RESULTS: The analysis revealed four major themes: precipitating factors, preventive models, feelings and decision-making process. It also highlights the difficult act of ethical balance, the role of the institution in prevention and the fragmentation of care, as keys to successful implementation. CONCLUSIONS: The findings show the complexity of fall prevention and the need to incorporate care providers' opinions in preventive models.

Situating Preventive Action in a Moral and Clinical Context: A Qualitative Synthesis on Fall Prevention.

The prevention of falls is an integral part of the safety culture of health institutions with mandatory fall prevention programs set within health care facilities. Care providers are key in identifying the risks of falls and in implementing strategic actions to prevent them. With the aim to better understand practices of fall prevention, we conducted a synthesis of qualitative evidence on care providers' practices to prevent older people from falling in health care facilities. This synthesis is part of an integrative review of the role of care providers in fall prevention of adults aged 65 years and above. Primary studies were synthesized with the emerging core category of "a complex decision" and described by four emerging conditions that make that decision complex: (a) permanent threat of a fall, (b) continuous flow of information, (c) lack of control, and (d) ethical dilemmas and moral issues over the course of action. The present synthesis shows that before implementing preventive actions, care providers consider the conditions in which they are immersed, in this way situating their preventive actions in a clinical and a moral context.

"Falls prevention among older people and care providers: protocol for an integrative review".

AIM: To review the evidence about the role of care providers in fall prevention in older adults aged ≥ 65 years, this includes their views, strategies, and approaches on falls prevention and effectiveness of nursing interventions. BACKGROUND: Some fall prevention programmes are successfully implemented and led by nurses and it is acknowledged the vital role they play in developing plans for fall prevention. Nevertheless, there has not been a systematic review of the literature that describes this role and care providers' views on fall's prevention initiatives. DESIGN: A convergent synthesis of qualitative, quantitative, and mixed methods studies. The eligibility criteria will be based on participants, interventions/exposure, comparisons, and outcomes for quantitative studies and on population, the phenomena of interest and the context, for qualitative studies. To extract data and assess study qualities members of the research team will work in pairs according to their expertise. The review will follow the guidelines for integrative reviews and the proposed methods will adhere to the PRISMA statement checklist complemented by the ENTREQ framework. As qualitative synthesis are emergent, all procedures and changes in procedure will be documented. DISCUSSION: The review has a constructivist drive as studies that combine methods ought to be paradigmatic driven. Review questions are broad to allow issues emerge and have purposefully left the design flexible to allow for adjustments as the review progresses. The review seeks to highlight the roles that care providers play in fall prevention and their views on fall's prevention initiatives.

[Fall prevention in older people and their families: a qualitative synthesis]. / La prevención de las caídas de las personas mayores y sus familiares: una síntesis cualitativa.

OBJECTIVE: To analyse and synthesize the evidence on fall prevention of people older than 65 years and their family care providers METHOD: Qualitative synthesis, which is a part of a convergent systematic integrative review. Forty-one qualitative studies were retained for full text scrutiny. Nine studies on family care providers were selected for this synthesis. RESULTS: Care providing, and kinship relationships mediated family care providers' interventions to prevent falls in older people. The fall of the dependent relative constitutes a turning point in these relationships. Family care providers are vulnerable to having a fall themselves and therefore receivers of preventive interventions. CONCLUSIONS: Taking into account the context of care and family relations will improve the effectiveness of preventive interventions and will facilitate adherence. Fall prevention policy and programmes must pay better attention to the health and wellbeing of family care providers.

[Active-Murcia program: secondary analysis, with a gender perspective, on the quality of life of participating women.] / Programa Activa-Murcia: análisis secundario, con perspectiva de género, sobre la calidad de vida en mujeres participantes.

OBJECTIVE: Nowadays sedentarism has become a public health issue, as a matter of gender and age. Older women are more sedentary, which affects their Quality of life. The aim of this study was to evaluate the Activa-Murcia Program impact over the Quality of life in women participating in it. METHODS: Longitudinal retrospective descriptive study within a gender perspective was carried out, including women who had participated in the Activa-Murcia Program. A SF-36 Survey of Quality of Life has been evaluated, scoring age range in three different stages and the enviroment in which they live. An analysis of repeated measurements was carried aout using ANOVA, and the Bonferroni Test was used for the pairwise analysis. RESULTS: The sample included 1,140 women. "Overall health" dimension improved up to 3 points, except in women over 60. Score highed inversely proportional to their age in the following dimensions: "Vitality" in 9.9, 6.2 and 3.9; "Mental health" in 7.7, 5.6 and 3.7; "Declared health evolution" in 11.2, 8.6. and 7.6. Women between 30-44 years old living in rural areas and those over 60 living in urban areas did not improve in "Social functions". Dealing with "Emotional Role", women between 30-44 and women between 45-59 in urban areas improved (p<0.05). There was a statistical asociation between being highly aged and improving less in "Vitality", "Emotional Role" and "Mental health". CONCLUSIONS: As women were getting older improve less in the dimensions of quality of life; so that could show, among others, an empowerment deficit.

OBJETIVO: El sedentarismo es un problema de Salud Pública, influenciado por brechas de género y edad. Las mujeres mayores son más sedentarias, lo que repercute en su calidad de vida. El objetivo general de este trabajo fue evaluar el impacto del Programa Activa-Murcia sobre la calidad de Vida de las participantes en dicho programa. METODOS: Se realizó un análisis secundario con perspectiva de género de un estudio descriptivo longitudinal retrospectivo de una cohorte de mujeres que habían participado en el Programa Activa-Murcia, evaluándose las dimensiones del Cuestionario de Calidad de Vida SF-36 y las puntuaciones según tres franjas etarias y el ámbito en el que vivían. Se realizó un análisis de medidas repetidas mediante ANOVA, y para el análisis por pares se utilizó el Test de Bonferroni. RESULTADOS: La muestra la componían 1.140 mujeres. La dimensión "Salud General" mejoró alrededor de 3 puntos, excepto en las mayores de 60 años. Aumentaron las puntuaciones de forma inversamente proporcional a la edad en siguientes dimensiones: "Vitalidad", en 9,9, 6,2 y 3,9 puntos; "Salud Mental", en 7,7, 5,6 y 3,7 puntos; y "Evolución Declarada de Salud", en 11,2, 8,6 y 7,6 puntos. Las mujeres entre 30-44 años rurales y las mayores de 60 años urbanas no mejoraron en "Función Social". Sobre el "Rol Emocional", las mujeres entre 30-44 años y las mujeres entre 45-59 años de zona urbana mejoraban (p<0,05). Existió asociación estadísticamente significativa entre tener mayor edad y mejorar menos en "Vitalidad", "Rol Emocional" y "Salud Mental". CONCLUSIONES: Las mujeres mayores mejoran menos en las dimensiones de la calidad de vida, lo que podría indicar, entre otros motivos, un déficit de empoderamiento.