Thesis (Ph. M.)--University of Wisconsin, 1933. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 93-95).

Thesis (M.Eng.)--University of Louisville, 2007. / Title and description from thesis home page (viewed May 9, 2007). Department of Mechanical Engineering. Vita. "May 2007." Includes bibliographical references (p. 107-111).

Falls, with and without injury, in acute care hospitals are quite common but can be prevented if appropriate interventions are in place to address this issue. It is imperative that nurses assess fall risks of all patients admitted to the hospital and advocate for appropriate interventions to prevent falls in those who are found to be at risk. The purpose of this project was to recommend changes to the current fall prevention protocol in the project facility, an acute care hospital, based on best practices identified in a systematic review of the literature. At the time of the project, the hospital had a high rate of falls. The clinical practice question addressed by this project focused on the evidence-based fall prevention interventions that have resulted in a decreased fall rate among patients on medical-surgical units in an acute inpatient hospital setting. This doctoral project was informed by Kolcaba's theory of caring, and the major source of evidence was a systematic review of the literature focusing on fall prevention. Findings indicated that identification of fall risk factors and implementation of multifactorial fall prevention interventions, such as fall prevention teams, unit fall team champions and use of a fall risk scale, can reduce falls on medical surgical units in acute care hospitals. It was recommended that a multidisciplinary fall prevention team be developed in conjunction with unit fall team champions and that a fall risk scale be used to bridge the practice gap. If implemented, these changes may benefit patients, nurses, and the organization as a whole through decreased falls, lengths of stay, and health care costs.

No description available.

Falls due to slipping are a serious occupational concern. Slipping is estimated to cause 40-50% of all fall-related injuries. In 2011, falls resulted in 22% of injuries requiring days away from work. Epidemiological data indicates that older and obese adults experience more falls than young, non-obese individuals. An increasingly heavier and older workforce may be exacerbating the problem of slip-induced falls in the workplace. The purpose of this study was to examine the effects of obesity and age on slip severity and fall outcome following an unexpected slip. Four groups of participants (young obese, young non-obese, older obese, older non-obese) were exposed to an unexpected slip perturbation. Slip severity (slip distance, slip duration, average slip velocity and peak slip velocity) and slip outcome (fall or recovery) were compared between groups. Obese individuals experienced 8.25% faster slips than non-obese individuals in terms of average slip velocity (p=0.022). Obesity did not affect slip distance, slip duration or peak slip velocity. Obese individuals also experienced more falls; 33.3% of obese individuals fell compared to 8.6% of non-obese (p=0.005). Obese individuals were 8.24 times more likely to experience a fall than non-obese individuals, when adjusting for age, gender and gait speed. No age effects were found for slip severity or slip outcome. This study revealed that obese participants experienced faster slips and more falls than their non-obese counterparts. These results, along with epidemiological data reporting higher fall rates among the obese, indicate that obesity may be a significant risk factor for experiencing slip-induced fall. / Master of Science

Slips, trips, and falls are the costliest source of disabling injuries in the workplace, costing $18.6 billion annually. The purpose of this study was to investigate the effects of mental fatigue on gait variables associated with the risk of slipping and tripping. The study also investigated the efficacy of a 10-minute rest break in mitigating the effect of mental fatigue on those variables. Twenty healthy young adults (10 males and 10 females) participated and completed two experimental sessions. The order of sessions was counter-balanced for each participant. During the mental fatigue session, participants completed a computerized mentally fatiguing task for 90 minutes and performed a set of gait trials every 15 minutes throughout the task. During the control session, participants watched an emotionally neutral documentary in place of the mentally fatiguing task. After 90 minutes of the task or documentary, participants took a 10- minute break and then completed one last set of gait trials. Risk of slipping was inferred from the required coefficient of friction, heel contact velocity, and heel contact angle. Risk of tripping was inferred from minimum toe clearance and obstacle clearance. The results showed no increase in slip or trip risk. Rest breaks appeared to decrease levels of self-reported mental fatigue. However, they did not appear to have any mitigating effect on any of the gait variables that were measured. / Master of Science / Slips, trips, and falls are the costliest source of disabling injuries in the workplace, costing $18.6 billion annually. The purpose of this study was to measure the effect of mental fatigue on the risk of falling. In this study, twenty healthy young adults (10 males and 10 females) completed two sessions. In the first session, the participants completed multiple walking sessions while performing a mentally fatiguing task. In the second session, the participants identical walking sessions, with the exception that instead of performing a mentally fatiguing task, they were watching a documentary. The study also aimed to study whether a 10-minute rest break could reduce the effect of mental fatigue on the participants' risk of falling. The results showed that mental fatigue had no effect on slip or trip risk. The rest break was successful at decreasing the self-reported mental fatigue rating but had no effect on the risk of slipping or tripping.

The purpose of this study was (1) to trace the contributions of the newspaper to the civic improvement and economic growth of Wichita Falls; (2) to trace the contributions of the publishers; and (3) to trace the development of the Wichita Falls Times from 1907, when it began as a daily, to 1976, when it sold to Harte-Hanks Communications Inc.

Title from PDF of title page (University of Missouri--Columbia, viewed on March 10, 2010). The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file. Thesis advisor: Dr. Mihail Popescu. Includes bibliographical references.

Introduction. Patient falls occur frequently in the acute hospital setting and are one of the most common adverse events experienced by hospitalised patients. In-hospital falls have negative outcomes for patients, causing injuries in up to half of those who fall. Falls in hospital create additional costs for health services due to increased length of stay (LOS), and greater health resource use. In contrast to much research focused on in-hospital falls worldwide, little is known about the rate, contributing factors and outcomes of inpatient falls in the state sector in South African hospitals. At the research hospital, a Falls Policy has been in place since 2013. The chosen falls risk screening tool, the Morse Falls Scale (MFS), had not been locally validated, and therefore its ability to accurately discriminate between patients who fall and patients who do not fall was unknown. A focused analysis of local falls incident reporting, and a description of contributory factors and consequences of falls, could better inform and target falls and fall injury prevention. Furthermore, this research may assist in service development and refining the Falls Policy. Methodology. The aim of this study was to obtain broad-based data on the magnitude of patient falls, and to identify factors contributing to falls. The aim was achieved in two parts, the first was a retrospective record review design. Predictive risk factors for falls were explored by comparing two patient groups, a Fall-Group and a Non-fall Group. In the FallGroup, further objectives related to describing circumstances surrounding fall events, including activities patients were performing at the time of the fall, the time of day and day of week the fall occurred, locations of fall events, and the clinical consequences sustained as a result of the fall. The use of the existing falls risk screening tool, the MFS, as well as its predictive accuracy to correctly identify patients at increased risk of falling was investigated. Second, a survey of nurses at the research hospital was undertaken to examine nurses' knowledge, attitudes and beliefs around the Falls Policy and current falls prevention practices. Results. There were 171 reported fall events during the ten-month period, representing 11.77% of adverse events and a falls rate of 0.73 per 1000 patient occupied bed days (POBD) during this time. Significant predictive risk factors for falling were a longer LOS and having a greater number of comorbid conditions. While the mean age of the sample was 50.0 years (SD=17.3 years), the Fall Group was significantly older than the Non-fall Group (p = .004). There were significantly more deaths in the Fall Group (p = .001), and this group had a longer average LOS (p < .001) compared to the Non-fall Group. The only sub-scale from the MFS that was significantly associated with falls was walking status. Minor-moderate clinical consequences were experienced as a result of the fall in 97% of cases (n=124). This study demonstrated that the MFS in use in the hospital has a low predictive accuracy of 55% at the current cut-off score of 50. At this score, the MFS has a sensitivity of 35.9% and a specificity of 75.4%. While an initial MFS was found in each of the cases, there was only evidence of a repeat MFS in 13 participants (9.7%) in the Fall Group. The nursing survey showed 70% of respondents had not had training on the Falls Policy (n=93) and only 37% (n=49) reported receiving regular feedback on fall rates. Receptiveness of most (66%, n=91) nurses to more training in falls prevention is encouraging. Discussion. The fall rate of 0.73 falls per POBD was lower than expected when compared to international studies. At the research hospital, when the Falls Policy was introduced in 2013, a fall was not defined in the policy and as highlighted in the nursing survey, there still appears to be lack of clarity on the fall definition. The MFS had a low predictive accuracy at the current cut-off score. The low sensitivity and specificity of the MFS in this setting may be due to the MFS not being updated regularly as per the Falls Policy. A further reason for the MFS poor predictive value may be the younger age group found in this sample when compared to international studies where the scale has performed better. Recommendations. The poor predictive value of the current risk screening tool found in this study is concerning. Therefore, further investigation into whether the MFS performs better if it is updated more frequently, and if completed in full, as per the Falls Policy, is recommended. Alternatively, the hospital should consider all patients with multiple comorbidities and those with longer length of stays at high risk, and provide interventions to minimise risk as per the Falls Policy. Future research into factors contributing to fall events and falls prevention should follow a prospective design and be supported at management as well as ward level. Further investigation into the most appropriate way to reduce harm from falls is recommended at the research site. Conclusion. This descriptive study provides a starting point for the hospital to examine the Falls Policy and falls prevention strategies currently in use. It is hoped that the study will contribute to local awareness-raising and capacity-building and help the hospital evaluate current practice and set a baseline for improvement.

No / Falls are the most common safety incident reported by acute hospitals. NICE recommends multifactorial falls risk assessment and tailored interventions, but implementation is variable. Determine how and in what contexts multifactorial falls risk assessment and tailored interventions are used in acute NHS hospitals in England. Design: Realist review and multi-site case study. (1) Systematic searches to identify stakeholders’ theories, tested using empirical data from primary studies. Review of falls prevention policies of acute Trusts. (2) Theory testing and refinement through observation, staff interviews (N=50), patient and carer interviews (N=31), and record review (N=60). Setting: Three Trusts, one orthopaedic and one older person ward in each. Results: Seventy-eight studies were used for theory construction and 50 for theory testing. Four theories were explored: (1) Leadership: Wards had falls link practitioners but authority to allocate resources for falls prevention resided with senior nurses. (2) Shared Responsibility: A key falls prevention strategy was patient supervision. This fell to nursing staff, constraining the extent to which responsibility for falls prevention could be shared. (3) Facilitation: Assessments were consistently documented but workload pressures could reduce this to a tick-box exercise. Assessment items varied. While individual patient risk factors were identified, patients were categorised as high or low risk to determine who should receive supervision. (4) Patient Participation: Nursing staff lacked time to explain to patients their falls risks or how to prevent themselves from falling, although other staff could do so. Sensitive communication could prevent patients taking actions that increase their risk of falling. Limitations: Within the realist review, we completed synthesis for only two theories. We could not access patient records before observations, preventing assessment of whether care plans were enacted. Conclusions: (1) Leadership: There should be a clear distinction between senior nurses’ roles and falls link practitioners in relation to falls prevention; (2) Shared Responsibility: Trusts should consider how processes and systems, including the electronic health record, can be revised to better support a multidisciplinary approach, and alternatives to patient supervision should be considered; (3) Facilitation: Trusts should consider how to reduce documentation burden and avoid tick-box responses, and ensure items included in the falls risk assessment tools align with guidance. Falls risk assessment tools and falls care plans should be presented as tools to support practice, rather than something to be audited; (4) Patient Participation: Trusts should consider how they can ensure patients receive individualised information about risks and preventing falls and provide staff with guidance on brief but sensitive ways to talk with patients to reduce the likelihood of actions that increase their risk of falling. Future work: (1) Development and evaluation of interventions to support multidisciplinary teams to undertake, and involve patients in, multifactorial falls risk assessment and selection and delivery of tailored interventions; (2) Mixed method and economic evaluations of patient supervision; (3) Evaluation of engagement support workers, volunteers, and/or carers to support falls prevention. Research should include those with cognitive impairment and patients who do not speak English. / This project was funded by the National Institute for Health Research (NIHR) Health and Social Care Delivery Research programme and will be published in the Health and Social Care Delivery Research Journal.