Survey Assesses Patients’ Confidence, Fall Risk

Sep 01, 2015

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Patient perception a key element in preventing falls in hospitals

Article in American Journal of Critical Care finds patients deemed at risk for falls may not follow prevention strategies depending on their perceptions of personal risk

ALISO VIEJO, Calif. — Sept. 1, 2015 — Falls are the most common adverse event among hospitalized patients, and a study published in the September issue of the American Journal of Critical Care (AJCC) examines an often overlooked element to preventing falls in hospitals: patient perceptions of their personal risk. 

The article, “Perceptions Related to Falls and Fall Prevention Among Hospitalized Adults,” discusses the results of an inpatient survey about fall-related attitudes. 

The 38-item survey included the patients’ ratings of their confidence to act without falling and their degree of concern about falling. The patients also answered questions about potential consequences of their falling while hospitalized and their intention to ask for assistance before taking an action that is deemed high risk for falls. 

The study found acutely ill patients’ intentions to engage in fall prevention behaviors during hospitalization decrease when they are not afraid of falling, do not perceive adverse consequences if they do fall, and have increased confidence that they can perform high-risk behaviors without help and without falling.

Principal investigator Renee Samples Twibell, RN, PhD, CNE, is an associate professor in the School of Nursing at Ball State University and a nurse researcher at Indiana University Health Ball Memorial Hospital, both in Muncie, Indiana. 

“Strategies to prevent falls have limited success without patients’ participation,” Twibell said. “Our findings suggest that fear of falling is a key perception for nurses to assess as they develop fall-prevention plans.”

A total of 158 patients in acute care units at Ball Memorial Hospital participated in the study. 

Even though all study participants had been assessed by nurses as being at risk for falls, more than half reported they were not at all likely or were slightly likely to fall during hospitalization and were confident that they could get out of bed without help and without falling. 

Other findings from the study include the following:

  • More than 75 percent of participants reported they would call for assistance before getting out of bed to walk to the bathroom, walk around in their hospital room or walk outside the room. However, 10 percent indicated that they would not call for help for any mobility-related activities.
  • Approximately 80 percent of patients surveyed said they would reach for items on the bedside table without help and were confident they could do so without falling.
  • Nearly half of the respondents were most concerned with walking outside their hospital room.
  • Participants reported that even if they fell, they would still be able to cope alone (69 percent), be independent (60 percent) and be active (65 percent).   

At the bedside, nurses caring for acutely ill patients can put this research into practice by incorporating fall-related perceptions as they assess each patient’s risk factors. They can then integrate that information into a fall-prevention plan and tailor communications about falls to fit a patient’s perception.

The research team suggests directions for future studies and calls for new strategies to shape the perceptions of patients at risk for falls and to engage acutely ill, alert patients in staying safe during hospitalization.

The American Association of Critical-Care Nurses, which publishes AJCC, supported this research project with an AACN-Philips Healthcare clinical outcomes grant. Additional research and clinical practice resources on fall prevention are available at

To access the article and its full-text PDF, visit the AJCC website at

About the American Journal of Critical Care: The American Journal of Critical Care (AJCC), a bimonthly scientific journal published by the American Association of Critical-Care Nurses, provides leading-edge clinical research that focuses on evidence-based practice applications. Established in 1992, it includes clinical and research studies, case reports, editorials and commentaries. AJCC enjoys a circulation of more than 101,000 acute and critical care nurses and can be accessed at

About the American Association of Critical-Care Nurses: Founded in 1969 and based in Aliso Viejo, California, the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN represents the interests of more than 500,000 acute and critical care nurses and includes more than 225 chapters worldwide. The organization's vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution.

American Association of Critical-Care Nurses
101 Columbia
Aliso Viejo, CA 92656-4109

Phone: (949) 362-2000
Fax: (949) 362-2020