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Open Access Research article

The nursing staff's opinion of falls among older persons with dementia. a cross-sectional study

Solveig Struksnes1*, Margareta Bachrach-Lindström2, Marie Louise Hall-Lord34, Randi Slaasletten1 and Inger Johansson34

Author Affiliations

1 Associate professor, Center of Care Research, Department of Health, Care and Nursing, Gjövik University College, 2815 Gjövik, Norway

2 Associate Professor, Faculty of Health Sciences, Department of Medicine and Care, Division of Nursing Science, Linköping University, 58183 Linköping, Sweden

3 Professor in Nursing, Center of Care Research, Department of Health, Care and Nursing, Gjövik University College, 2815 Gjövik, Norway

4 Faculty of Social and Life Sciences, Karlstad University, 65188 Karlstad, Sweden

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BMC Nursing 2011, 10:13  doi:10.1186/1472-6955-10-13

Published: 20 June 2011

Abstract

The aim of this study was to describe the nursing staff's opinion of caring for older persons with dementia with the focus on causes of falls, fall-preventing interventions, routines of documentation and report and the nursing staff's experiences and reactions when fall incidents occur. A further aim was to compare these areas between registered nurses (RNs) and enrolled nurses (ENs) and staff with ≤5 and >5 years of employment in the care units in question.

Background

Falls are common among older people and persons with dementia constitute an additional risk group.

Methods

The study had a cross-sectional design and included nursing staff (n = 63, response rate 66%) working in four special care units for older persons with dementia. Data collection was conducted with a questionnaire consisting of 64 questions.

Results

The respondents reported that the individuals' mental and physical impairment constitute the most frequent causes of falls. The findings also revealed a lack of, or uncertainty about, routines of documentation and reporting fall-risk and fall-preventing interventions. Respondents who had been employed in the care units more than five years reported to a higher degree that colours and material on floors caused falls. RNs considered the residents' autonomy and freedom of movement as a cause of falls to a significantly higher degree than ENs. RNs also reported a significantly longer time than ENs before fall incidents were discovered, and they used conversation and closeness as fall-preventing interventions to a significantly higher degree than ENs.

Conclusions

Individual factors were the most common causes to falls according to the nursing staff. RNs used closeness and dialog as interventions to a significantly higher degree to prevent falls than ENs. Caring of for older people with dementia consisted of a comprehensive on-going assessment by the nursing staff to balance the residents' autonomy-versus-control to minimise fall-risk. This ethical dilemma should initiate development of feasible routines of systematic risk-assessment, report and documentation.

Keywords:
Dementia; falls; nursing home; nursing care; older persons