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To explore why there is variation in implementation of multifactorial falls prevention practices that are recommended to reduce falls risks for older patients in hospital.
Mixed method, realist evaluation.
Three older persons and three orthopaedic wards in acute hospitals in England.
Healthcare professionals, including nurses, therapists and doctors (n=40), and patients aged 65 and over, and carers (n=31).
We examined mechanisms hypothesised to underpin the implementation of multifactorial falls risk assessment and multidomain, personalised prevention plans.
We developed an explanation detailing that how contextual factors supported or constrained implementation of recommended falls prevention practices.
Nurses led delivery of falls risk assessment and prevention planning using their organisation’s electronic health records (EHR) to guide and document these practices. Implementation of recommended practices was influenced by (1) organisational EHR systems that differed in falls risk assessment items they included, (2) competing priorities on nurse time that could reduce falls risk assessment to a tick box exercise, encourage ‘blanket’ rather than tailored interventions and that constrained nurse time with patients to personalise prevention plans and (3) established but not recommended falls prevention practices, such as risk screening, that focused multidisciplinary communication on patients screened as at high risk of falls and that emphasised nursing, rather than Multidisciplinary Team (MDT), responsibility for preventing falls through constant patient supervision.
To promote consistent delivery of multifactorial falls prevention practices, and to help ease the nursing burden, organisations should consider how electronic systems and established ward-based practices can be reconfigured to support greater multidisciplinary staff and patient and carer involvement in modification of individual falls risks.
To explore nurses' experiences of the adoption, implementation, and use of digital technologies during the Covid-19 pandemic in the UK.
A qualitative descriptive study.
A qualitative study using two data sources: qualitative responses from 55 respondents to an online survey, and data from in-depth interviews with 21 individuals. The NASSS framework was used to guide data collection and analysis. Data were analysed using framework analysis.
Respondents reported using a variety of technologies including video conferencing applications, telemonitoring, systems to support care management and telecommunication systems. The analysis identified a range of reasons why technology had been introduced into services, and a recognition of its value in a situation where otherwise care may not have been able to continue. During the pandemic nurses were expected to change their work practices very rapidly, and we identified situations where organisational infrastructure either supported this effectively or created additional burdens for the nurses' work.
Nurses had to adapt to new ways of working rapidly, with digital technology being one of the primary means through which communication and care were delivered. The Covid-19 pandemic provided a unique set of circumstances where layers of governance and many of the existing barriers to technology introduction were reduced.
It is important to learn from these experiences, to understand how to sustain innovations that have proved to be successful, as well as the factors that enable nurses to work effectively in this new environment.
This study adheres to the guidance for publishing qualitative research in informatics.
A public contributor was involved from the beginning of the study conceptualization. They had input into the study approach, were part of the team that acquired the funding for the study and gave input at various stages into the processes for data collection, analysis and writing up the findings. The public contributor is a co-author on this paper and has been involved in the writing and editing of this report.
This work aimed to explore barriers to pessary self-management and co-create strategies to address these.
Participatory Action Research.
In October 2024, eight pessary-using women living in the United Kingdom participated in cooperative inquiry, discussion and co-creation of strategies in two virtual workshops.
Pessary using women who participated in this research identified challenges affecting willingness to self-manage a pessary and proposed solutions to address these and better support women. Pessary practitioners should assess physical capabilities, consider softer, more malleable pessaries, and explore the possibility of a pessary applicator. Peer support was seen as empowering, enabling self-advocacy and improved care; therefore, establishing peer networks was prioritised. Major barriers included difficulty navigating services and limited access to a full range of pessaries, leading some women to buy devices online without medical oversight, creating a two-tier system based on ability to pay. The group called for improved, standardised pessary care, and for self-management to be reframed to avoid women feeling ‘fobbed off’ through better follow-up, positive language, and compassionate care.
The group identified strategies to address barriers to pessary self-management which require further exploration. Pessary practitioners have a responsibility to listen to these voices and take steps to improve care for women in the future.
To support women's willingness to self-manage their pessary, pessary practitioners should consider and support women to overcome physical and emotional barriers; improve information provision; maximise social support; boost women's perceived self-efficacy; reframe pessary self-management and ensure robust, accessible follow-up is in place. This will ensure pessary-using women are supported to make an informed decision about pessary self-management. This research offers pessary practitioners insight into barriers women perceive to pessary self-management and guidance as to how women can be supported to self-manage their pessary.
Only 21% of women are willing to self-manage their pessary. Therefore, this research aimed to co-create strategies to better support women to self-manage their pessary and overcome barriers to willingness. Women reported individual, societal and service factors which affect willingness to self-manage a pessary. These research findings should be translated into clinical practice and care delivery for pessary using women in both a community and hospital setting.
COREQ (COnsolidated criteria for REporting Qualitative research) Checklist.
Patients and members of the public were involved in research prioritization, study design, data analysis, interpretation of findings and dissemination.
Study not registered.
To identify the factors influencing professionals’ implementation of the National Institute for Health and Care Excellence (NICE) guidelines on self-harm.
A rapid review evidence synthesis
Five electronic databases (ASSIA, CINAHL, EMBASE, MEDLINE, PsycINFO) and five indexing databases (Science Citation Index Expanded (SCIE), Social Sciences Citation Index (SSCI), Arts and Humanities Citation Index (AHCI), Emerging Sources Citation Index (ESCI) and Conference Proceedings Citation Index (CPCI)), using the Web of Science platform, were searched in December 2023 and repeated in July 2024.
We included quantitative and qualitative studies that investigated professionals’ knowledge and implementation of NICE guidelines on self-harm, that were in English language and published between 2004 and July 2024.
One reviewer used standardised methods to search, screen, select, quality assess and synthesise the included studies, to accelerate the review. Quality assessment was conducted using the Mixed Methods Appraisal Tool. Data were extracted and synthesised thematically using NICE guidance implementation priorities.
The review included 10 studies. Six were conducted in accident and emergency (A&E) settings, two in general practice, one in a burns and plastic surgery hospital department and one involved cross-sectoral health professionals. Key findings indicate that awareness and implementation of self-harm guidelines is low among health professionals. Systemic barriers include lack of staff training, negative staff attitudes towards people who self-harm and lack of resources.
There is a need to develop and implement regular training on self-harm, incorporating NICE guidance and measures, to integrate knowledge and mobilise practice changes. Further research into the implementation of NICE guidelines in children who self-harm is needed, and in a wider variety of health and social care settings. The absence of studies from the social care sector into professionals’ awareness and implementation of NICE guidelines on self-harm is a key limitation.
To explore the nature of interactions that enable older inpatients with cognitive impairments to engage with hospital staff on falls prevention.
Ethnographic study.
Ethnographic observations on orthopaedic and older person wards in English hospitals (251.25 h) and semi-structured qualitative interviews with 50 staff, 28 patients and three carers. Findings were analysed using a framework approach.
Interactions were often informal and personalised. Staff qualities that supported engagement in falls prevention included the ability to empathise and negotiate, taking patient perspectives into account. Although registered nurses had limited time for this, families/carers and other staff, including engagement workers, did so and passed information to nurses.
Some older inpatients with cognitive impairments engaged with staff on falls prevention. Engagement enabled them to express their needs and collaborate, to an extent, on falls prevention activities. To support this, we recommend wider adoption in hospitals of engagement workers and developing the relational skills that underpin engagement in training programmes for patient-facing staff.
Interactions that support cognitively impaired inpatients to engage in falls prevention can involve not only nurses, but also families/carers and non-nursing staff, with potential to reduce pressures on busy nurses and improve patient safety.
The paper adheres to EQUATOR guidelines, Standards for Reporting Qualitative Research.
Patient/public contributors were involved in study design, evaluation and data analysis. They co-authored this manuscript.
FreshRSS 