The effect of nurses' training on the implementation of preventive measures for falls in hospitalized elderly patients

Document Type : Original Article


1 Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran

2 Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran

3 Department of Biostatistics and Epidemiology, Faculty of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran

4 School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran

5 Department of Community Health Nursing, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran & French Institute of Research and High Education (IFRES-INT), Paris, France


Objectives: This study aimed to assess the impact of nurses' training on the implementation of preventive measures for falls in hospitalized elderly individuals.
Methods: A quasi-experimental study was conducted, involving 64 nurses employed at Ganjavian Hospital in Dezful, Iran. Convenience sampling was used to select the participants between April 15th and July 15th, 2020. The nurses were then randomly assigned to either the intervention or control group. Initially, a checklist was utilized to assess both groups' fall prevention activities for older patients. Subsequently, the intervention group received workshop training, while no specific intervention was provided to the control group. After a two-week period, the fall prevention behaviors were reassessed in both groups. Data analysis was performed using SPSS software version 16, employing independent t-tests, paired t-tests, chi-square tests, and analysis of covariance.
Results: Prior to training, the mean score for nurses' fall prevention behaviors was 12.31±4.12. Following the training, the mean score significantly increased to 26.78±3.41 (p<0.001). Furthermore, after controlling for underlying characteristics such as ward and job experience, as well as baseline values, significant changes in mean scores between the control and intervention groups were identified (p<0.001).
Conclusion: Workshop training sessions tailored to nurses' needs can effectively enhance their implementation of fall prevention behaviors for elderly patients. Therefore, it is recommended to conduct similar comprehensive training interventions for nurses to mitigate falls and their associated complications among hospitalized elderly individuals.


Main Subjects

  1. Shali M, Joolaee S, Hooshmand A, Haghani H, Masoumi H. The relationship between incidence of patient falls and nurses’ professional commitment. Hayat. 2016;22(1):27-37
  2. Callis N. Falls prevention: Identification of predictive fall risk factors. Appl Nurs Res. 2016;29:53-8. doi: 10.1016/j.apnr.2015.05.007 PMID: 26856489
  3. de Groot GCL, Al-Fattal A, Sandven I. Falls in hospital: a case-control study. Scand J Caring Sci. 2020;34(2):332-339. doi: 10.1111/scs.12733 PMID: 31294860; PMCID: PMC7328684
  4. Cameron ID, Dyer SM, Panagoda CE, Murray GR, Hill KD, Cumming RG,et al. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev. 2018;9(9):CD005465. doi: 10.1002/14651858.CD005465.pub4 PMID: 30191554; PMCID: PMC6148705
  5. Najafpour Z, Godarzi Z, Arab M, Yaseri M. Risk Factors for Falls in Hospital In-Patients: A Prospective Nested Case Control Study. Int J Health Policy Manag. 2019;8(5):300-306. doi: 10.15171/ijhpm.2019.11 PMID: 31204446; PMCID: PMC6571495
  6. Iwamoto J, Saeki K, Kobayashi M, Yamagami Y, Yoshida O, Kurumatani N, et al. Lower Incidence of In-Hospital Falls in Patients Hospitalized in Window Beds Than Nonwindow Beds. J Am Med Dir Assoc. 2020;21(4):476-480. doi: 10.1016/j.jamda.2019.07.006. PMID: 31447262
  7. Bouldin EL, Andresen EM, Dunton NE, Simon M, Waters TM, Liu M, et al. Falls among adult patients hospitalized in the United States: prevalence and trends. J Patient Saf. 2013;9(1):13-7. doi: 10.1097/PTS.0b013e3182699b64. PMID: 23143749; PMCID: PMC3572247
  8. World Health Organization. Ageing, and L.C. Unit, WHO global report on falls prevention in older age. 2008: World Health Organization.
  9. Joolaee S, Shali M, Harati Khalilabad T, Haghani H, Vaezi A, Sepehrinia M. Association of the incidence of patient falls and work environment of nurses. Iran J Nurs. 2018;31(114):38-48
  10. Bursiek AA, Hopkins MR, Breitkopf DM, Grubbs PL, Joswiak ME, Klipfel JM, et al. Use of High-Fidelity Simulation to Enhance Interdisciplinary Collaboration and Reduce Patient Falls. J Patient Saf. 2020;16(3):245-250. doi: 10.1097/PTS.0000000000000277 PMID: 28272294
  11. Dykes PC, Burns Z, Adelman J, Benneyan J, Bogaisky M, Carter E, et al. Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries: A Nonrandomized Controlled Trial. JAMA Netw Open. 2020;3(11):e2025889. doi: 10.1001/jamanetworkopen.2020.25889 PMID: 33201236; PMCID: PMC7672520
  12. Tricco AC, Thomas SM, Veroniki AA, Hamid JS, Cogo E, Strifler L, et al. Comparisons of interventions for preventing falls in older adults: a systematic review and meta-analysis. JAMA. 2017; 318(17):1687-1699. doi:10.1001/jama.2017.15006. Erratum in: JAMA. 2021;325(16):1682. PMID: 29114830; PMCID: PMC5818787
  13. Stel VS, Smit JH, Pluijm SM, Lips P. Consequences of falling in older men and women and risk factors for health service use and functional decline. Age Ageing. 2004;33(1):58-65. doi: 10.1093/ageing/afh028. PMID: 14695865
  14. Christiansen TL, Lipsitz S, Scanlan M, Yu SP, Lindros ME, Leung WY, et al. Patient Activation Related to Fall Prevention: A Multisite Study. Jt Comm J Qual Patient Saf. 2020;46(3):129-135. doi: 10.1016/j.jcjq.2019.11.010 PMID: 31948814
  15. Allen L, Bulat T, Uphold CR, Johnson T, Winkler SL. Using a post fall assessment simulation to examine nurse thought processes. J Nurs Prof Dev. 2020;36(5):266-270. doi: 10.1097/NND.0000000000000662 PMID: 32890180
  16. Park JH, Son JT. Structural analysis of variables related to fall prevention behavior of registered nurses in small-to-medium sized hospitals. J Korean Acad Fundam Nurs. 2018; 25(4): 269-281
  17. Lake ET, Friese CR. Variations in nursing practice environments: relation to staffing and hospital characteristics. Nurs Res. 2006; 55 (1):1-9
  18. Kim KS, Kim JA, Choi YK, Kim YJ, Song MS, Kim ES. Validity and reliability assessment of the performance measures based on the nursing process for prevention and management of pressure ulcers, falls and pain. J Korean Clin Nurs Res. 2010;16(3):5-23
  19. Kuhlenschmidt ML, Reeber C, Wallace C, Chen Y, Barnholtz-Sloan J, Mazanec SR. Tailoring Education to Perceived Fall Risk in Hospitalized Patients With Cancer: A Randomized, Controlled Trial. Clin J Oncol Nurs. 2016;20(1):84-9. doi: 10.1188/16.CJON.84-89. PMID: 26800411
  20. Gray-Miceli D, Mazzia L, Crane G. Advanced Practice Nurse-Led Statewide Collaborative to Reduce Falls in Hospitals. J Nurs Care Qual. 2017;32(2):120-125. doi: 10.1097/NCQ.0000000000000213 PMID: 27479516
  21. Dong B, Ding Q. Aging in China: a challenge or an opportunity? J Am Med Dir Assoc. 2009;10(7):456-8. doi: 10.1016/j.jamda.2009.06.007 PMID: 19716060
  22. Liu H, Shen J, Xiao LD. Effectiveness of an educational intervention on improving knowledge level of Chinese registered nurses on prevention of falls in hospitalized older people--a randomized controlled trial. Nurs Educ Today. 2012;32(6):695-702. doi: 10.1016/j.nedt.2011.09.009 PMID: 22051103
  23. Wu B, Mao ZF, Zhong R. Long-term care arrangements in rural China: review of recent developments. J Am Med Dir Assoc. 2009; 10(7):472-7. doi: 10.1016/j.jamda.2009.07.008 PMID: 19716063
  24. Verghese J. Person-Centered Fall Risk Awareness Perspectives: Clinical Correlates and Fall Risk. J Am Geriatr Soc. 2016; 64 (12): 2528-2532. doi:10.1111/jgs.14375 PMID: 27801936; PMCID: PMC5173409
  25. Rajendran S. Impact of home modification education on fall prevention in home-based older adults. 2010: State University of New York at Buffalo.
  26. Sinuraya E. Nurses’ Fall Knowledge and Fall Prevention Practices for Hospitalized Elderly in Medan, Indonesia. 2016, Prince of Songkla University.
  27. Aguwa H. Nursing Education to Prevent Resident Falls in Long-Term Care. 2019.
  28. Leverenz MD, J Lape. Education on fall prevention to improve self-efficacy of nursing staff in long term care: a pilot study. Internet J Allied Health Sci Pract. 2018;16(3):6.
  29. Bowden V, Bradas C, McNett M. Impact of level of nurse experience on falls in medical surgical units. J Nurs Manag. 2019; 27 (4):833-839. doi: 10.1111/jonm.12742 PMID: 30565782
  30. Lee IK, Choi JY. Factors associated with nurses' activities for hospital fall prevention. Korean J Rehabil Nurs. 2013;16(1): 55-62.
  31. Koh SL, Hafizah N, Lee JY, Loo YL, Muthu R. Impact of a fall prevention programme in acute hospital settings in Singapore. Singapore Med J. 2009;50(4):425-32. PMID: 19421690
  32. Lee NJ, Kim JH. Perception of patient safety culture and safety care activity among nurses in small-medium sized general hospitals. J Korean Acad Nurs Adm. 2011;17(4):462-473.
  33. Weinberg J, Proske D, Szerszen A, Lefkovic K, Cline C, El-Sayegh S, et al. An inpatient fall prevention initiative in a tertiary care hospital. Jt Comm J Qual Patient Saf. 2011;37(7):317-25. doi: 10.1016/s1553-7250(11)37040-7 PMID: 21819030
  34. Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, et al. Changing provider behavior: an overview of systematic reviews of interventions. Med Care. 2001;39(8 Suppl 2):II2-45. PMID: 11583120
  35. Oliver D, Healey F, Haines TP. Preventing falls and fall-related injuries in hospitals. Clin Geriatr Med. 2010;26(4):645-92. doi: 10.1016/j.cger.2010.06.005 PMID: 20934615