Development of a fall prevention program adapted to the individual risks of elderly persons in facilities

本研究的目的是透过相互行动研究，提高护理人员的护理技巧和动机，以发展一套适合长期照护机构中老年患者个体风险的预防跌倒计划。该计划综合了七项基于证据的实践研究，包括员工教育、通过焦点小组访谈识别与设施中预防跌倒相关的问题、评估个人风险、实施适应风险的护理、就跌倒相关问题进行咨询、以及在发生跌倒时修改护理。预防跌倒项目被证明是有效的，特别是在减少受伤方面。干预病房每1000个住院日的跌倒率由7.6降至5.0，而对照组病房则由4.8降至4.3。干预病房受伤人数比例由干预前6个月的22.6%显著降低至干预后6个月的9.7%，受伤人数由13人减少至3人。没有人受到该计划的伤害。这个过程从对一个不可预测的过程的期待和焦虑，到通过角色冲突获得成就感。赋予权力被认为是一种驱动力。工作人员的变革动因是病人和家属对令人满意的护理的反应，以及认识到需要与其他医务人员合作。另一方面，预防跌倒团队成员的变革动因是对能够识别个人风险并具有潜在护理技能的工作人员的认可。总之，通过提高护理人员的护理技能和积极性，预防跌倒项目在长期护理机构的老年人中是可以接受的。

The aim of this study was to develop a fall-prevention program adapted to the individual risks of elderly patients in a long-term care facility by increasing the caregiving skills and motivation of staff members through mutual action research. The program, developed through the synthesis of seven evidence-based practice studies, consisted of staff education, identification of problems related to fall prevention in the facility by the use of focus group interview, assessment of individual risks, implementation of care adapted to the risks, consultation about fall-related problems, and modification of care in case of falls. The fall-prevention program was shown to be effective, especially in reducing injuries. The fall rate per 1, 000 residential days was reduced from 7.6 to 5.0 in the intervention ward, while it went from 4.8 to 4.3 in the control ward. The percentage of injured persons in the intervention ward was significantly reduced from 22.6% during the 6 months before the intervention period to 9.7% during the 6-month intervention period, and the number of injuries was reduced from 13 to 3. No one was harmed by the program. The process went from expectation and anxiety regarding an unpredictable process to feeling of achievement through role conflicts. Empowerment was considered a driving force. The change agents for staff members were the response of patients and family members to satisfactory care, and the recognition of the need for cooperation with other medical staff members. On the other hand, the change agent for the fall prevention team members was recognition of staff members who could identify individual risks and had potential care skills. In conclusion, the fall-prevention program was shown to be acceptable for use among elderly individuals in a long-term care facility by increasing the caregiving skills and motivation of staff members.