Falls are nurse-sensitive outcome which reflect the quality of nursing care. Nurses, therefore, have a major role to play in efforts to decrease fall rates. The objective of this project is to increase nurses' knowledge on the proper use of the CVVM as an attempt to effectively decrease fall rates. Pretest, post test, and course evaluation data were collected from 30 nurses. A descriptive analysis of the data was performed. Overall, the pretest evaluation showed that nurses had an average score of 43% in the combined assessment of their knowledge on fall prevention strategies, their use of the CVVM, and their knowledge about the hospital's policy on patient monitoring. The nurses' post test average score in the combined assessment of these measures increased to 89% after the educational training which included presentations, hands-on-training, and provision of reference materials and cheat cards on fall prevention strategies and the use of the CVVM surveillance system. Inadequate training, lack of knowledge on the utilization of CVVM surveillance, inadequate use of system resources, and noncompliance with hospital policies were the primary drivers of fall rates in this hospital. Main recommendations include training and periodic retraining of staff on fall prevention strategies; leadership involvement to ensure nurses' compliance with the use of CVVM technology and hospital policy on patient monitoring; provision of CVVM reference materials; and nursing responsibilities in patient monitoring. Social change implications of this project include that nurses are better equipped through training to prevent falls, therefore, lowering patient morbidity and mortality rates.

In Sweden fall-related injuries among the elderly lead to over a thousand deaths and close to 300.0000 hospital visitations annually. Fall related injuries can in many cases lead to serious head injuries along with other fractures. The elderly are more prone to fall and sustain an injury because of conditions such as osteoporosis and weak muscles. Researchers at KTH from the Division of Neuronic Engineering have developed a special floor that absorbs energy from an impact which can reduce the severity of injury when a person falls. There has been research done on the floor focusing on hip fractures which have shown good results. The floor has been set up in an elderly home in Stureby, Stockholm, Sweden, however further testing is needed to fully develop the floor to its maximum capacity. One goal of this master thesis was to investigate certain obstacles with the floor which arose during testing in Stureby. One of the challenges was that the floor had greater rolling resistance since it is softer than a normal concrete floor. The experiment was done by using a dynamo meter to measure the force needed to move a test wagon with a fixed weight and different sizes of wheels. Another goal of this thesis was to investigate head impacts on the KTH floor. That was done in a helmet testing lab at Mips helmet company. There a dummy head was dropped from various heights and the acceleration was measured. The 1st principle strain of the brain was calculated from the collected data. Other companies have created similar floors so it was a part of the thesis to compare the KTH floor with its competitors. The results from the rolling resistance showed that by increasing the width and diameter of the wheels there was less force needed to move the test wagon. Further tests are needed to investigate the problem regarding the indentation issues seen on the floor set up in Stureby. Some research has already begun with different types of linoleum and glue. In the head impact studies, the KTH floor showed the best results of all tested floors when dropped from 60 cm. However, when dropped from 100 cm a competitor floor showed better results in the resultant translational acceleration.

No description available.

<p>Air pollution and a general concern for lack of physical activity in North America have motivated governments to encourage non-motorized modes of transportation. A key infrastructure component for these forms of transportation is sidewalks. The City of Saskatoon has identified the need to formalize sidewalk management policies to demonstrate diligence for community protection regarding sidewalk safety. Prioritization of sidewalk maintenance and rehabilitation actions must be objective and minimize risk to the community. Most research on prioritization of pedestrian facilities involved new construction projects. This research proposes a decision model that prioritizes a given list of existing unsafe sidewalk locations needing maintenance or rehabilitation using a direct measure of pedestrian safety, namely, quality-adjusted life years lost per year. </p><p>A decision model was developed for prioritizing a given list of unsafe sidewalk locations, aiding maintenance and rehabilitation decisions by providing the associated risk to pedestrian safety. The model used data mostly from high quality sources that had already been collected and validated. Probabilities and estimations were used to produce value-added decision policy.</p> <p>The decision analysis framework applied probability and multi-attribute utility theories. This study differed from other research due to the inclusion of age and gender groups. Total average daily population of the city was estimated. This population was distributed to sidewalk locations using probabilities for trip purposes and a locations ability to attract people relative to the city total. Then trip injury events were predicted. Age and gender distribution and trip injury type estimations were used to determine the impact of those injuries on quality of life.</p><p>There exist much observable high quality data that can be used as indicators of unknown or unobserved events. A decision policy was developed that prioritizes unsafe sidewalk locations based on the direct safety impact on pedestrians. Results showed that quality-adjusted life years lost per year sufficiently prioritized a given list of unsafe sidewalk locations. It was demonstrated that the use of conditional probabilities (n=594) allowed for the ability to abstract data representing a different source population to another. Average daily population confined and distributed within the city boundary minimized problems of accuracy. Gender-age distribution was important for differentiating the risk at unsafe sidewalk locations. Concepts from this research provide for possible extension to the development of sidewalk service levels and sidewalk priority maps and for risk assessment of other public services.</p>

<p>Air pollution and a general concern for lack of physical activity in North America have motivated governments to encourage non-motorized modes of transportation. A key infrastructure component for these forms of transportation is sidewalks. The City of Saskatoon has identified the need to formalize sidewalk management policies to demonstrate diligence for community protection regarding sidewalk safety. Prioritization of sidewalk maintenance and rehabilitation actions must be objective and minimize risk to the community. Most research on prioritization of pedestrian facilities involved new construction projects. This research proposes a decision model that prioritizes a given list of existing unsafe sidewalk locations needing maintenance or rehabilitation using a direct measure of pedestrian safety, namely, quality-adjusted life years lost per year. </p><p>A decision model was developed for prioritizing a given list of unsafe sidewalk locations, aiding maintenance and rehabilitation decisions by providing the associated risk to pedestrian safety. The model used data mostly from high quality sources that had already been collected and validated. Probabilities and estimations were used to produce value-added decision policy.</p> <p>The decision analysis framework applied probability and multi-attribute utility theories. This study differed from other research due to the inclusion of age and gender groups. Total average daily population of the city was estimated. This population was distributed to sidewalk locations using probabilities for trip purposes and a locations ability to attract people relative to the city total. Then trip injury events were predicted. Age and gender distribution and trip injury type estimations were used to determine the impact of those injuries on quality of life.</p><p>There exist much observable high quality data that can be used as indicators of unknown or unobserved events. A decision policy was developed that prioritizes unsafe sidewalk locations based on the direct safety impact on pedestrians. Results showed that quality-adjusted life years lost per year sufficiently prioritized a given list of unsafe sidewalk locations. It was demonstrated that the use of conditional probabilities (n=594) allowed for the ability to abstract data representing a different source population to another. Average daily population confined and distributed within the city boundary minimized problems of accuracy. Gender-age distribution was important for differentiating the risk at unsafe sidewalk locations. Concepts from this research provide for possible extension to the development of sidewalk service levels and sidewalk priority maps and for risk assessment of other public services.</p>

Background: Fall injuries are a costly problem for society, with costs ranging up to 14 billion a year. In addition to economic loss accidental falls also creates human value losses and reduced quality of life for its victims. In order to prevent the occurrence of injury related to accidental falls healthcare providers utilize various scientifically developed risk assessment tools, one of them being Downton Fall Risk Index. Method: Empirical, quantitative cross-sectional study. Objective: The purpose of the extended essay was to describe the categories in Downton Fall Risk Index that have a bearing on patients' risk of falling while in hospital and in municipal care, and to illustrate how nurses can use the fall risk assessment tool. Results: Of the 708 participants a total of 73% had a high risk of falling according to Downton Fall Risk Index, of the patients being treated at a hospital 66% had high risk of falling and of the patients being treated in municipal care 87% had high risk of falling. Downton Fall Risk Index indicates that the medication was by far the largest category and included 576 patients (81%), followed by sensory impairment in 474 patients (67%). 335 patients (47%) had fallen previously. Discussion: Previous studies show that among patients being treated in hospitals, between 1.3 to 2.1% will fall. Downton Fall Risk Index indicates that 66% of the group of patients are at high risk of falling. This may be due to the fact that Downton Fall Risk Index focuses too much on medication. It is the nurse’s responsibility to coordinate work around the patient in order to minimize the risk of falling. For example, contact an occupational therapist or an ophthalmologist who can undertake specific actions to reduce patients' risk of falling. Nurses should also use appropriate risk assessment tools to identify risk factors in the patient and then use these to formulate a nursing diagnosis. Conclusion: Downton Fall Risk Index is too sensitive to be used on hospitalized patients, the instrument works better in patients being treated in municipal care. It is important that the nurse can use scientifically designed tool for ensuring good health care for the patient, tools such as the fall risk assessment tool. / Bakgrund: Fallskador är ett dyrt problem för samhället med kostnader som sträcker sig upp mot 14 miljarder kronor om året i Sverige. Förutom ekonomiska förluster skapar fall även humanvärdesförluster och försämrad livskvalitet för den drabbade. För att förhindra uppkomsten av fallskador används inom sjukvården olika vetenskapligt framtagna fallriskbedömningsinstrument, ett av dessa är Downton Fall Risk Index. Metod: Empirisk, kvantitativ tvärsnittsstudie. Syfte: Syftet med fördjupningsarbetet är att beskriva vilka kategorier i Downton Fall Risk Index som har betydelse för patienters fallrisk vid vistelse på sjukhus och vid kommunal vård, samt att belysa hur sjuksköterskan kan använda Fallriskbedömningsinstrument. Resultat: Av de 708 medverkande hade totalt 73% hög risk att falla enligt Downton Fall Risk Index, på sjukhus hade 66% av patienterna hög risk att falla och i kommunal vård hade 87% av patienterna hög risk att falla. Downton Fall Risk Index anger att medicinering var den klart största kategorin och inkluderade 576 av patienterna (81%), därefter kom sensorisk funktionsnedsättning med 474 patienter (67%). 335 patienter (47%) hade fallit tidigare. Diskussion: Tidigare studier visar att på sjukhus faller mellan 1,3-2,1% av patienterna. Downton Fall Risk Index anger att 66% av samma patientgrupp har hög risk för fall. Detta kan bero på att Downton Fall Risk Index fokuserar för mycket på medicinering. Det är sjuksköterskans uppgift att samordna arbetet runt patienten så att fallrisken minimeras. Till exempel ska sjuksköterskan kontakta arbetsterapeuter eller ögonläkare som kan utföra punktinsatser för att minska patientens fallrisk. Sjuksköterskan ska även använda fallriskbedömningsinstrument för att identifiera riskfaktorer hos patienten och sedan använda dessa för att utforma en omvårdnadsdiagnos. Slutsats: Downton Fall Risk Index är alldeles för känsligt för att kunna användas på patienter inneliggande på sjukhus, instrumentet fungerar bättre på patienter inneliggande i kommunal vård. Det är viktigt att sjuksköterskan kan använda vetenskapligt utformade verktyg för att säkerställa en god omvårdnad för patienten, verktyg såsom Fallriskbedömningsinstrument.

Falls and fall related injuries are a major health issue to the elderly population of Sweden. The number of accidents in the community caused by falls is increasing. It is mainly the elderly who need to be hospitalized after a fall. Patients with stroke, cognitive disorders, or hip fracture, have a particularly high risk of falling. A common consequence of falls is femur fractures. To prevent and reduce the occurrences of falls in hospitals, an individual care plan aimed at the patient, is required, as well as an individual and feasible nursing intervention. It also require that health professionals use their knowledge and the patient’s and the hospital's resources, to implement the care plan. Since 2008 SKL runs a national effort to reduce preventable harm and improve patient safety, where fall related injuries are an area of focus. Aim: The aim with this study is to examine and describe health professionals' attitudes towards falls and fall prevention, and whether the nursing staff considers themselves to be proficient in falls and fall prevention. Method: This was a quantitative study and Mann Whitney U test were conducted in order to analyse and summarize the answers from the questionnaires. Results: The respondents have a positive attitude towards fall prevention. The perception among the nursing staff is that they feel well trained in fall prevention, and have sufficient knowledge in fall prevention. Conclusion: The conclusion of this study is that nurses and nursing staff take falls among patients very seriously and have a positive attitude towards fall prevention. They also consider themselves to have a good knowledge about falls and fall prevention. / Fall och fallskador är ett stort folkhälsoproblem för den äldre befolkningen i Sverige. Antalet olyckor i samhället orsakade av fall ökar. Det är de äldre som oftast behöver sjukhusvård efter fallolyckor. Patienter med stroke, kognitiva störningar eller höftfrakturer har en särskilt hög risk att råka ut för fall och fallskador. En vanligt förekommande konsekvens av fall är höftfrakturer. För att förebygga och minska att fall sker krävs en individuell vårdplan för patienten och individuella och genomförbara omvårdnadsåtgärder. Det krävs att vårdpersonal använder sina kunskaper och patientens och sjukhusets resurser för att genomföra vårdplanen. Sedan 2008 driver SKL en nationell satsning för att minska antalet vårdskador och öka patientsäkerheten. Ett område som omfattas av denna nationella satsning är fall och skador till följd av fall. Syfte: Syftet med den här studien är att undersöka och beskriva vårdpersonalens attityder till fall och fallprevention och om vårdpersonal anser sig ha goda kunskaper om fall och fallprevention. Metod: Studien har använt sig av en kvantitativ metod i form av en enkätundersökning. Beskrivande statistik och Mann Whitney U test användes för att bearbeta enkätsvaren. Resultat: Resultatet visar att vårdpersonal till övervägande del har en positiv uppfattning till fallprevention och ser allvarligt på fallskador. Enkäten visar att vårdpersonalen upplever och känner att de är välutbildade i fallprevention och har kunskaper för att ge och skapa en god fallprevention i sitt arbete. Slutsats: Slutsatsen i denna studie är att vårdpersonal tar fall och fallskador på allvar och har en positiv uppfattning till fallprevention. De anser sig också ha goda kunskaper inom fall och fallprevention.

Introduction: Injuries due to accidents are an underlying cause for a large proportion of the number of health care visits in Sweden every year. According to statistics from the National Board of Health and Welfare in Sweden (socialstyrelsen.se) between 1308,25 and 1405,66 health care visits per 100.000 residents are generated each year for the period 2001-2014 due to accidents, and falling is the largest underlying category. Falling can in turn be studied through a number of subcategories, where fall from equipment on playground is one of them, and this is the subcategory studied in this paper. Statistics from the National Board of Health and Welfare show an increase of the number of health care visits per 100.000 residents in Sweden due to this category during the period 2001-2014, despite the fact that since 1999 there are European standards with the purpose of raising the safety of playgrounds. The statistics also show that in Sweden there are large regional differences in injury prevalence for this category of accidents, which is the reason why this became the focus of this study.   One of the reasons this is an important area for injury prevention work is that it’s a shared societal responsibility, another reason is that the studied population has the largest statistical life expectancy left, so injuries that affect their health can also affect the future wellbeing of the society.  The municipalities’ work regarding this area is dictated by European Standards to ensure the safety of playgrounds. Beyond the specifications for the equipment itself, the standards dictate that a series of inspections of varying degrees are preformed throughout the year to ensure the standards are met.   Aim: The aim of this study is to examine if there are any identifiable and differing factors in the way that municipalities work with playgrounds and playground safety, both practically and theoretically, based on if they are located in a region with high injury prevalence or in a region with low injury prevalence of this type of injury.   Method: The study was designed as a qualitative interview study where representatives of 11 different municipalities were interviewed with the purpose to map out how they worked with playgrounds and playground safety within their municipality. The data collected was then analysed using thematically/ phenomenological content analysis to see if any differing factors between the two groups could be detected.   Results: No major unambiguous differences were discovered between the two compared groups included in the study, but certain tendencies could be found in the material. Four themes were uncovered, enabling factors for the practical work, hindering factors for the practical work, enabling factors for the theoretical work and hindering factors for the theoretical work. These themes in turn produce a number of categories and subcategories. The results show a wider range of both hindering and enabling factors of both the practical and theoretical work in the municipalities from regions with high injury prevalence, compared to the municipalities from regions with low injury prevalence.   Conclusion: The result indicates that there are differences in how the municipalities from regions with low injury prevalence work regarding playground safety compared to municipalities from regions with high injury prevalence. However, further research will be required to fully uncover and explore which these factors are. / Inledning: Skador till följd av olyckor ligger bakom en ansenlig andel av vårdtillfällen i Sverige varje år. Enligt Patientregistret (Socialstyrelsen.se) uppgår dessa skador till mellan 1308,25 till 1405,66 vårdtillfällen per 100 000 invånare och år, under åren 2001–2014. Den olyckstyp som är orsaken till att högst antal personen uppsöker vård är fallolyckor.  Fallolyckor delas i sin tur in i flera underkategorier, varav en är fall från lekredskap på lekplats, vilket är vad denna studie kom att fokusera på. Orsaken till att denna kategori är intressant är att det i statistiken i Patientregistret går att se en ökning av antalet vårdtillfällen per 100 000 invånare för åren 2001–2014, detta trots att det sedan 1999 finns europeiska standarder med syfte att höja säkerheten på lekplatser. I statistiken går också att utläsa att det finns stora regionala variationer i skadeprevalensen för denna olyckskategori i Sverige, vilket är huvudområdet för denna studie.   Något som gör detta till ett viktigt område för skadeprevention är dels att det är ett samhällsansvar, ansvaret för barnens hälsa och välmående kan inte läggas varken på barnen själva eller uteslutande på deras föräldrar; dels på grund av att skador i denna population kan få stora effekter på sikt då barn är den grupp som statistiskt sett har flest levnadsår kvar och i framtiden kommer bära ansvaret för det gemensamma samhället. Kommunerna idag är ålagda enligt de europeiska standarderna att se till att lekplatser följer vissa standarder för att lekplatserna ska anses säkra. Utöver de specifikationer som finns för själva utrustningen så utförs uppdraget genom att ett antal inspektioner och besiktningar görs för att säkerställa att standarden på lekplatserna löpande efterses.   Syfte: Målet med studien är således att undersöka och försöka kartlägga om det finns skillnader i arbetssätt, både praktiskt och teoretiskt, mellan kommuner som ligger i län med hög skadeprevalens inom denna olyckskategori jämfört med kommuner som ligger i län med låg dito som kan förklara skillnaderna i fallskadeprevalens mellan de båda grupperna.   Metod: Studien utfördes som en kvalitativ intervjustudie där representanter för totalt 11 kommuner intervjuades kring hur de inom den egna kommunen arbetade med lekplatser och lekplatssäkerhet. Insamlade data analyserades sedan med tematisk/ fenomenologisk innehållsanalys för att se om några skillnader kunde upptäckas.   Resultat: Inga större, konkreta skillnader kunde upptäckas mellan de två grupperna som jämfördes i studien, däremot kunde vissa tendenser skönjas. Fyra teman vaskades fram genom analysen, vilka var goda förutsättningar för det praktiska arbetet, faktorer som hindrar det praktiska arbetet, goda förutsättningar för det teoretiska arbetet samt faktorer som hindrar det teoretiska arbetet. Dessa teman är i sin tur indelade i ett antal kategorier och underkategorier. Resultatet visar att bland kommuner som ligger i län med hög skadeprevalens är en större spridning på hindrande och underlättande faktorer för såväl det praktiska som det teoretiska arbetet med lekplatssäkerhet, jämfört med kommuner från län med låg skadeprevalens.   Slutsats: Resultatet indikerar att det finns faktorer kring arbetet med lekplatssäkerhet som skiljer sig åt i hur kommuner från län med hög skadeprevalens arbetar kring lekplatssäkerhet, kontra kommuner från län med låg skadeprevalens. Dock krävs vidare forskning för att se en tydlig kartläggning av dessa faktorer.