Interactions that support older inpatients with cognitive impairments to engage with falls prevention in hospitals: An ethnographic study

Abstract

Aims

To explore the nature of interactions that enable older inpatients with cognitive impairments to engage with hospital staff on falls prevention.

Design

Ethnographic study.

Methods

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.

Results

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.

Conclusions

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.

Implications for Profession and Patient Care

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.

Reporting Method

The paper adheres to EQUATOR guidelines, Standards for Reporting Qualitative Research.

Patient or Public Contribution

Patient/public contributors were involved in study design, evaluation and data analysis. They co-authored this manuscript.