Effectiveness of a Nurse-Led Fall Prevention Program in Reducing Fall Incidence Among Elderly Patients in a Hospital Ward: A Randomized Controlled Trial

Falls Prevention Program Details 1. Frequency and Duration of Supervised Balance and Strength Exercises: The supervised balance and strength exercises will be conducted twice daily for 10 minutes each session during the patient’s inpatient admission. The sessions will be held once in the morning and once in the afternoon to allow for optimal patient engagement without causing fatigue. 2. Examples of Balance and Strength Exercises: Balance Exercises: Nurses who have undergone the study-specific training (as described in the Nurse Training Description) will supervise the balance and strength exercises. Heel-to-toe walk: walking in a straight line with one foot directly in front of the other, mimicking a tightrope walk. Single-leg stands: standing on one foot for a set time (e.g., 10-15 seconds) and switching to the other foot. Side leg raises: lifting one leg to the side while holding onto a stable surface for support. Strength Exercises: Sit-to-stand: Moving from a seated to a standing position without using hands for support. Chair squats: Squatting down to just above a chair seat and standing back up. Heel raises: lifting the heels off the ground while standing to strengthen the calf muscles. 3. Examples of Prevention Strategies for Participants (Education Component): The CDC STEADI (Stopping Elderly Accidents, Deaths & Injuries) brochure is a concise and well-designed resource for older adults, covering key aspects of fall prevention.(https://www.cdc.gov/steadi/pdf/STEADI-Brochure-WhatYouCanDo-508.pdf) The American Academy of Orthopaedic Surgeons (AAOS) brochure offers comprehensive information on fall risks, prevention strategies, and home safety tips.(https://orthoinfo.aaos.org/globalassets/pdfs/aaosfallprevention.pdf) These are exactly the type of publicly available brochures that would be valuable additions to a falls prevention program. When using them in your program, you'll want to clearly cite the source in your materials. If you are modifying them in any way, be sure to get appropriate permissions if necessary. Environment safety: Advise participants to remove trip hazards such as loose rugs, use non-slip mats in bathrooms, and ensure good lighting throughout their living areas. Assistive devices: Educate participants on the correct use of walking aids such as canes or walkers. Footwear: Encourage the use of well-fitting, non-slip shoes, and discourage walking in socks or slippers that may increase the risk of slipping. Medication review: Advise participants to speak with their healthcare provider about reviewing medications that may contribute to dizziness or instability. 4. Anticipated Duration of the Education Component: The education component will consist of a once-off education session delivered over a 20-minute period. During this session, participants will receive verbal instructions along with written brochures outlining key prevention strategies and exercises to perform at home. This session will also include demonstrations of the exercises and time for questions. 5. Fall Risk Assessment Description: The fall risk assessment will involve evaluating the participant’s balance, gait, and strength using tools like the Timed Up and Go Test (TUG) and Berg Balance Scale. Nurses will assess the patient’s mobility, use of assistive devices, and environmental hazards. This assessment will take approximately 10-15 minutes each day and will be recorded in the patient’s care plan to monitor progress and make adjustments to the intervention as needed. 6. Program Duration: The falls prevention program will be delivered over a 6-month period, starting from the first participant's enrolment. Each participant will be enrolled for the duration of their inpatient stay, and follow-up may continue for one month after discharge to assess outcomes and adherence. 7. Strategies to Monitor Adherence: Education session attendance checklists will be maintained to ensure participants attend the prevention strategy discussions. Audit of environmental modifications (e.g., removal of trip hazards, installation of safety equipment) will be conducted during inpatient stays. Exercise logs will be used for participants to document their completion of supervised and independent exercises. Nurses will check and encourage adherence during daily interactions. Nurse Training Description Training for Nurses: Nurses involved in the program will undergo a comprehensive training session before the program's first participant enrolment. This training will last one week and will cover: Proper administration of fall risk assessments (e.g., TUG and Berg Balance Scale). Demonstration and supervision of balance and strength exercises. Effective communication techniques for patient education on fall prevention strategies. Documentation procedures to monitor adherence and participant progress. Clinical supervisors and physiotherapists with expertise in fall prevention and rehabilitation will deliver the training. Ongoing supervision will be provided, and nurses will have access to resources and refresher courses throughout the program to ensure consistency and competency.