Why nurses help falling patients despite the risks

An all too common scenario.

Joe opens his eyes and appears out the window of his hospital room. He all the time got up early. Even on the age of 82, he cannot shake the habits he learned in his youth.

“I’m feeling dizzy again,” Joe thinks as he sits up in bed. Medication sometimes makes me feel this fashion. Joe presses the indicator light for a nurse to assist him into the toilet. The nurses reminded him to do that so he would not fall.

Then he thinks again. “I can do it myself. I don’t desire to disturb the nurses. They should help patients who actually need it. Joe walks to the sting of the bed. His walker is not nearby, but he must get to the toilet urgently. Still dazed, Joe holds on to the bed for a moment to maintain from falling forward. After some time, he manages to rise up and go to the toilet. As he enters the room, the dizziness returns and his legs suddenly feel weak. As Joe begins to fall, fear grips him…

Nurse Smith begins her rounds and is happy to see Joe. He all the time gets up early to greet her with a smile and a joke. When she opens the door to his room, she sees him walking into the toilet without his walker. She moves quickly towards him, but he suddenly rocks forward. She knows he’ll fall. Reacting immediately, she grabs his torso to forestall him from falling to the toilet floor. Joe grabs her arms to regular himself, putting most of his weight on her back and shoulders. Despite his smaller size, he successfully helps Joe to the bathroom, then calls for help and a wheelchair.

Nurse Smith is relieved that Joe is protected. “He could have hit his head on the bathroom,” he thinks. Nevertheless, he now experiences severe pain in his lower back.

This vignette, although contrived, could appear familiar to many nurses because it captures common elements of assisted fall scenarios that occur in hospitals across the country. On this scenario, Joe, who feels in a position to accomplish that despite his advanced age and health, decides that he can go to the toilet without waiting for help or using mobility aids. Nurse Smith reacts quickly, using her body to interrupt or minimize the results of Joe’s fall, slowing his fall and helping him reach the bathroom. At this point, he only considers the danger of wounding the patient and injuring himself in the method.

Aspects increasing the likelihood of assisted falls.

Situations equivalent to the one described above often result in accidents at work amongst employees. Previous research has shown that although there isn’t a protected solution to help a falling patient, medical staff, including nurses, still do it. To raised understand why nurses help falling patients (even when it might lead to injury), we first need to know what results in assisted falls. In our November 2023 article “What medical staff who’ve experienced falls in assisted patients can teach us: consequences of falls and risk of injuries”, we described the outcomes of our quality improvement project, which aimed to discover common aspects and characteristics of assisted falls. We also checked out nurses’ experiences with assisted falls and why they decide to intervene with falling patients.

What motivates nurses to assist falling patients?

We conducted this work as a part of the Department of Veterans Affairs’ Patient Safety Investigation Center in Tampa, Florida. In our interviews with nurses, they described several vital the explanation why that they had helped falling patients prior to now and, in some cases, would help falling patients in the longer term. Essentially the most often mentioned reasons included:

1. The nurse may judge that the patient can be seriously injured and even die if she doesn’t slow the patient’s fall or break his fall.
2. Nurses could have the misunderstanding that there are protected ways to support falls because they’ve received training or education in using “ergonomic techniques” to slow or stop a patient’s fall (equivalent to positioning themselves near the patient to avoid reaching, using their body to support the patient, keeping the back straight or controlling the patient’s descent).
3. The nurse may judge that the falling patient weighs lower than herself and will feel that she will safely slow the patient’s fall or break his fall.

Nurses feel they’ve an “obligation to assist” falling patients.

No matter why nurses help specific patients with falls, all nurses we interviewed felt that they had an “obligation to assist.” As medical anthropologists working in a VA patient safety center, we wanted to higher understand nurses’ “duty to assist” and its importance not just for patient safety, but in addition for occupational health and safety. For a number of the nurses we interviewed, a way of duty to the patient gave the impression to be an ethical obligation, a core personal value, and/or a general instinct to guard others.

Understanding the “duty to assist” as a mental model.

The “duty to assist” is an example of the psychological concept of a “mental model.” A mental model is one’s internal understanding of “cause” and “effect”. These are personal algorithms that help people make decisions and solve problems. For instance, nurses’ training and education, facility and unit safety culture, past experiences, and private values ​​may contribute to their approach to patient care and safety.

It was instructive to learn from the nurses we talked to that they often do that participation the “duty to assist” mental model – the overriding desire to guard patients from harm, even on the expense of their very own safety. This was true even for nurses who had been injured prior to now while assisting with falls and who personally understood the risks. For instance, there was a standard belief that if a nurse had not helped a falling patient (cause), the patient might have been seriously injured and even died (effect).

The “duty to assist” mental model is a big contributing factor to assisted falls and requires additional reflection. Furthermore, patients also make decisions based on their very own mental models. For instance, in our vignette, Joe is working from a “self-efficacy” mental model when he decides that he doesn’t must call a nurse or use a walker. Like many patients, Joe desires to act independently, even when it risks his safety. Nurse Smith makes a split-second decision based on her “duty to assist” mental model, which tells her that Joe is falling (cause) and due to this fact Joe can be hurt (effect), believing that if she uses ergonomic techniques to securely break the autumn (cause), Joe can be protected (effect). Her false belief that she may help Joe safely through the use of ergonomic techniques may create a false sense that helping Joe with a fall isn’t a risk.

Minimize the danger of patient and staff injury through fall injury prevention strategies.

Many nurses have difficulty reconciling the concept of ​​a “duty to assist” with the truth that helping falling patients isn’t protected. Mental models, including the “duty to assist,” are difficult to alter. For that reason, we imagine that minimizing the danger of injury to patients and staff within the event of a fall is critical. Concentrate on stopping injuries when falling strategies equivalent to environmental protection is one solution to achieve this goal.

It’s imperative for nurses to know that there isn’t a protected solution to help a falling patient, even when ergonomic techniques are used, even when the patient weighs lower than the nurse, and even when the nurse has previously safely helped a falling patient. Finally, we imagine that further research into the aspects and effects of assisted falls is warranted. Evidence suggests that helping with falls reduces the danger of patient injury but increases the danger of staff injury – an uncomfortable trade-off that raises vital ethical questions.

We invite you to contemplate a number of the questions that arise from our work: What shapes morality and ethics in nursing, and the way do these concepts influence reasoning, problem solving, and decision-making in practice? Could a greater understanding of those constructs help health care organizations develop policies and procedures which are sensitive to shared causal beliefs?

Margeaux Chavez, MA, MPH, CPH, and Sarah E. Bradley, PhD, MPH, CPH, are health systems qualitative researchers working for the Department of Veterans Affairs, Veterans Health Administration.