Falls are common for older adults, with significant consequences, including injuries and even death as well as healthcare costs. However, few studies have looked at environmental factors, such as lighting, equipment, and slippery floor surfaces, as potential risk factors for falls by nursing home residents. This study explores the risk factors associated with resident falls in a nursing home using a focus group.
This study explored nursing staff perspectives of person, environment, and interactive circumstances surrounding nursing home falls.
Researchers used purposive sampling to recruit participants from the two nursing homes with the highest and lowest fall rates and licensed as well as unlicensed staff within the mid-Atlantic region. They conducted two focus groups per facility: one with licensed nurses and one with geriatric nursing assistants. Thematic and content analysis revealed three themes and 11 categories. The researchers audiotaped each focus group, which lasted no longer than 2 hours. Participants received $10 from the study budget and were allowed to count their participation as work time, paid by the corporation.
All four focus group interviews were transcribed and verified against the original audio recording for accuracy. Researchers organized and managed the data using Atlas.ti version 5.0 for the thematic analysis and NVivo version 7.0 for the content analysis. Researchers also applied thematic analysis to the data to identify the overarching themes and included in-depth open and axial coding.
The three categories under the person theme were: change in residents’ health status, decline in residents’ abilities, and residents’ behaviors and personality characteristics. There were five nursing home environment categories: design safety, limited space, obstacles, equipment misuse and malfunction, and staff and organization of care. The three interactions leading to falls categories were: reasons for falls, time of falls, and high-risk activities. The results indicate that interactions between person and environment factors are significant contributors to resident falls.
Some of the limitations of this study include: the possibility of bias from using a nonprobability purposive sample, having only 3 participants in one of the groups, and the lack of representation of night shift staff. Thus, it is possible the results do not account for the full range of experiences and factors associated with fall events in nursing homes. More data would allow for interfacility and licensed-versus-unlicensed nursing staff comparisons that were not possible in this study because of time constraints and study resources.