Paper interpretation - Effect of structured nurse-patient conversation on preventing falls among patients in an acute care hospital: A mixed study

Falls are a serious public health problem globally, particularly in acute care hospitals, where hospitalized patients are at high risk for falls and may experience adverse outcomes such as prolonged hospital stays. Multifactorial fall prevention programs can reduce the risk of falls and related injuries, but successful implementation requires active patient participation.

Kathrin Weber and others from the University of Basel in Switzerland published an article titled "Effect of structured nurse-patient conversation on preventing falls among patients in an acute care hospital: A mixed study" in the International Journal of Nursing Sciences. The article explores the effect of combining structured nurse-patient conversations with fall prevention information leaflets on preventing falls among patients in acute care hospitals.

The study was conducted from September 2020 to April 2021 in the neurology ward of a Swiss university hospital using a mixed study design. The intervention consisted of a falls information leaflet and a structured nurse-patient dialog, and nurses were trained in the use of communication aids to systematically engage patients in falls risk management.

The Falls Information Leaflet is an educational tool developed based on the literature that was designed and tested for readability by patients and nurses in 2019. Its content is divided into three modules: first, it emphasizes the importance of patients' active participation in fall prevention and encourages them to collaborate with their healthcare provider; second, it provides specific instructions for safe activities and illustrates correct walking postures; and third, it is a personalized risk assessment checklist with a blank area for patients to record their individual safety needs. Patients received the leaflet upon admission to the group and were required to complete reading it before the nurse-patient conversation.

Structured nurse-patient conversations are led by registered nurses, who receive specific training on how to use leaflets to guide patients to understand risks, use communication techniques such as open-ended questioning to guide behavior change, and follow a standardized process for discussion. The conversation takes place as early as possible after the patient is admitted to the hospital, and the core components include: interpreting the patient's fall risk level based on the risk assessment tool in the electronic health record; discussing preventive measures on a case-by-case basis, combining the patient's checklist of risk factors in the flyer with the need to document them; the nurse providing evidence-supported recommendations that are negotiated and agreed upon by the patient; and, finally, confirming the patient's understanding and collecting feedback.

During monthly reflection meetings, nurses share experiences and adjust details. Patient risk information was also shared in conjunction with the hospital's multifactorial falls prevention program, introduced in 2013, in interdisciplinary collaboration with physical therapists and pharmacists. Ethical aspects followed the principle of voluntary participation, excluding patients with cognitive or language impairment and ensuring that the intervention was applicable to those with communication skills.

In terms of effectiveness, 56 patients achieved post-intervention satisfaction scores of 5.3±1.01 out of 6, perceived engagement of 5.2±1.1, and 21 nurses expressed willingness to continue using the tool , with a significant increase in confidence after completing 5 conversations. However, implementation faced challenges such as heavy daily workload, difficulty in reserving time for focused conversations, and environmental distractions affecting the quality of communication, suggesting the need to optimize the simplicity of the tool and explore interdisciplinary collaboration to enhance sustainability.

The study highlights that structured conversations combined with information leaflets promote patient engagement, are consistent with a patient-centered care framework, and are less costly. The findings are consistent with international guidelines and confirm the need for patient education in falls prevention. However, the time and environmental pressures faced by nurses highlight the challenges of balancing multiple tasks in clinical practice, suggesting the need for multidisciplinary collaboration to enhance the sustainability of interventions. The study also noted that although there was no significant reduction in fall rates, improved patient confidence may influence behavior over time, and larger samples and long-term follow-up are needed to validate the effects in the future.