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 hours) 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.
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Patient or Public Contribution: Patient/public contributors were involved in study design, evaluation and data analysis. They co-authored this manuscript.

Impact/What does this paper contribute to the wider global clinical community?
• Older hospital inpatients with cognitive impairments are more vulnerable to harm from falls but little is known about engaging them in falls prevention.
• Using empirical data from a study in English hospitals, the paper evidences interactions that support these patients to engage with staff and the relational skills involved. Although nurses had limited time for this, other clinical and non-clinical staff did so and passed information to nurses to inform patient care.
• The research can benefit cognitively impaired inpatients at risk of falling and their families/carers, as well as nurses and other hospital staff involved in falls prevention.