Udén G, Ehnfors M, Sjöström K
Centre of Caring Sciences, Lund University, Sweden.
J Adv Nurs. 1999 Jan;29(1):145-52. doi: 10.1046/j.1365-2648.1999.00874.x.
The consequences of falls among hospital patients are a great problem, for the patient, the family and society, and cost billions of dollars. In Sweden, almost one-third of all hip fractures occur in the hospital population. Despite this, very few prevention strategies have been developed and tested. In this study, a risk assessment and recording programme in relation to the risk of falling among patients in a geriatric department at a Swedish hospital was implemented. The records of all patients admitted to a geriatric unit during one year, and a stratified random sample of patient records, constituting the control group from the year before, were reviewed. No recording of assessments regarding the patients' risk of falling, and no preventive nursing interventions, were found in the records of the control group. The study group, however, increased the recording of risk assessment to 96%. Only implemented nursing interventions were found in the patients' records, despite the fact that Swedish law makes it obligatory for the registered nurse to record both the planning and implementation of nursing care. In the study group there were explicit descriptions of problems of concern for nursing regarding the patients' risk of falling in less than one-third of the records, the nursing care plans were rare, and the evaluations were not satisfactory. Nursing interventions consisted mostly of information or education, promotion of patient participation, and structuring of the environment. There was no agreement on any standard-care plan. Recording of falls was found more often in the study group than in the control group (probably due to more careful recording), but the proportion of injuries in relation to falls was higher in the control group. The results of this study may be used as a baseline for developing a nursing strategy and documentation relating to falls.
医院患者跌倒的后果对患者、家庭和社会来说都是一个大问题，并且造成了数十亿美元的损失。在瑞典，所有髋部骨折中几乎有三分之一发生在住院患者中。尽管如此，很少有预防策略得到开发和测试。在本研究中，瑞典一家医院的老年科实施了一项与患者跌倒风险相关的风险评估和记录计划。回顾了某一年入住老年病房的所有患者的记录，以及构成前一年对照组的分层随机抽样患者记录。在对照组的记录中，未发现有关患者跌倒风险评估的记录，也未发现预防性护理干预措施。然而，研究组将风险评估记录增加到了96%。尽管瑞典法律规定注册护士有义务记录护理计划和护理实施情况，但在患者记录中仅发现了已实施的护理干预措施。在研究组中，不到三分之一的记录中明确描述了护理人员对患者跌倒风险的关注问题，护理计划很少，评估也不尽人意。护理干预措施主要包括信息或教育、促进患者参与以及环境构建。没有达成任何标准护理计划。研究组中跌倒记录比对照组更常见（可能是由于记录更仔细），但对照组中跌倒相关损伤的比例更高。本研究结果可作为制定与跌倒相关的护理策略和记录的基线。
