My thoughts are that there was nothing challenging about walking in rehab, there were no perturbations, no stepping over any obstacles. With nothing challenging you'll never be able to recover from any potential fall. I never fell while in the hospital so I never got any practice on how to fall when on my own. A glaring mistake in my rehab.
Patients’ thoughts on their falls in a rehabilitation hospital: a qualitative study of patients with stroke
BMC Geriatrics volume 21, Article number: 713 (2021)
Abstract
Background
Patients with stroke in rehabilitation wards are at an increased risk of falling. Although patients’ participation in establishing medical safety is considered crucial, there is limited evidence on their perspectives of falls. This study aims to comprehensively elucidate the subjective falling experience of patients with stroke who have been admitted to rehabilitation wards.
Methods
Twenty-three consecutive patients with stroke (44 to 90 years) who experienced a fall during hospitalisation were interviewed within 1 week after the fall, and thematic analysis was used to analyse the data.
Results
Five themes surrounding fall events were extracted from the narratives: ‘Psychological background before the action’, ‘Support for the action’, ‘Direct causes of the fall’, ‘Patients’ awareness after the fall’, and ‘Changes in attitudes and behaviours after the fall’. ‘Psychological background before the action’ comprised hastiness or hesitation to call for help. Participants often took an action based on ‘Support for the action’ derived from their past experiences of moving safely, their confidence, and/or motivation to challenge themselves to move. ‘Direct causes of the fall’ consisted of unfamiliar actions, training fatigue, the surrounding environment, reduced physical function due to paralysis, lack of attention, overconfidence in their ability, and insufficient prediction of falls. ‘Patients’ awareness after the fall’ consisted of re-affirming difficult movements, the need for rehabilitation, a reduced ability to move, an increased risk of falling, the need for attention while moving, a fear of falling, and a lack of lessons learned from falling. Finally, patients demonstrated ‘Changes in attitudes and behaviours after the fall’ such as embodying a positive attitude to cope with the risk of falling or behavioural changes to reduce the risk of falling.
Conclusions
Comprehensive information on patients’ perspectives before and after the fall was elucidated, uncovering many aspects including the psychological background for why patients engaged in risky behaviours resulting in falls, presence of positive thinking, and behaviour after the fall. By incorporating the patients’ views on fall incidences and their assessment, we can develop appropriate prevention strategies against falls.
Introduction
Fall prevention in a hospital is an important issue in patient safety [1]. Falls are the most common incidents that occur in hospitals, accounting for approximately 30% of all incidents [2]. Falls can lead to physical complications such as fractures and trauma [3, 4], and are associated with high anxiety, depression, and low self-confidence [5], resulting in longer hospital stays and higher financial costs [6, 7]. The World Health Organization states that the increase in falls is a priority issue in aging countries and that ‘Fall prevention is a challenge to the ageing population’ in hospitals and facilities as well as in the community [8].
Patient participation is recognized as an important approach to ensure medical safety. The World Health Organization encourages patients and their families to actively participate in medical care to prevent adverse events and stay safe while in the hospital [9]. Educating patients by providing knowledge and sharing preventive strategies has been attempted to engage them in fall prevention practices at hospitals [10,11,12,13]. However, little attempt has been made to involve patients deeply in the process of fall assessment [14]. Looking back on patients’ thoughts and behaviours regarding their falls may help us understand the backgrounds, causes, and consequences of the fall.
Patients with stroke, in particular, are at a high risk of experiencing falls [15,16,17,18,19] because of multiple intrinsic risk factors, such as functional deterioration in motor, sensory, and cognitive abilities [16, 20, 21]. Higher fall rates have been especially reported among patients admitted to rehabilitation wards [18, 22,23,24]. The overall purpose of rehabilitation is to facilitate patients to independently engage in daily life activities again. However, increased physical activity can also increase the risk of falling [25]. Therefore, there is always a trade-off between independence and safety [26, 27]. Thus, there is a constant risk of falling at rehabilitation wards, and it is an important challenge to minimize this risk for patients recovering from a stroke while helping them regain their independence.
Few studies have investigated the experience of falls in hospitals from patients’ perspectives [28, 29]. Furthermore, to the best of our knowledge, no study has focused on the perspective of patients with stroke undergoing rehabilitation. Therefore, this study aimed to elucidate the subjective perspectives toward falling among patients with stroke admitted to rehabilitation wards.
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