Investigating Falls Risk Awareness in Hospitals Using the Self-Awareness of Falls Risk Measure (SAFRM): Empirical Research Quantitative

Aim: The overarching aim of this study was to explore patients' falls risk awareness in hospitals using section A of the validated Self Awareness of Falls Risk Measure (SAFRM).

Design: Descriptive cross-sectional study design.

Setting: Three rural/regional hospitals in the State of Victoria, Australia.

Methods: Using a purposive sampling strategy, patients were eligible to participate if aged ≥ 40 years, English-speaking, and have ambulatory capacity prior to hospital admission. Participants were excluded from the study if they returned a Standardised Mini-Mental State Examination (SMMSE) score < 18. Falls risk awareness data was collected from both patient and health professionals using section A of the SAFRM. Patient demographic data was collected from patient medical records.

Results: A total of 77 patients (72.9 years ±11.2) and 58 health professionals were recruited. Patients had a significant difference in falls risk awareness when compared to their clinician (z = -2.08, p = 0.038). Regression analyses showed that patients were more likely to overestimate their falls risk if they used anticoagulant medication and if their highest education level was less than or equal year 11. An exploratory factor analysis (EFA) revealed a three-factor solution from section A of the SAFRM, which were labelled Physical Activity Awareness, Cognitive Awareness and Balance Awareness.

Conclusions: There was a significant difference in patients' falls risk awareness compared to a health professional. The independent associations of variables with falls risk awareness, such as age, education level and medication use, further our understanding of the differences in falls risk awareness. The findings also establish that the 15-item section A SAFRM is a reliable and feasible falls risk perception measure for use in hospitals, with future research recommended to evaluate the proposed three-factor model with the addition of tailored hospital falls education.

Implications for the profession and/or patient care: The findings from this study establish a significant difference in patients' falls risk awareness compared to their health professional. Section A of the SAFRM is a reliable tool for nurses and other health professionals to establish the presence of a falls risk disparity. The ability to empirically measure this disparity and to determine an under- or overestimation of falls risk is a useful addition to clinical practice. The SAFRM facilitates a person-centred approach to falls prevention by providing opportunities for the clinician to collaborate with the patient and tailor fall prevention strategies.

Impact: Problem: Inpatient falls in hospital settings.

Main findings: There was a significant difference in patients' falls risk awareness compared to a health professional. Section A of the Self-Awareness of Falls Risk measure is a reliable and feasible tool to identify under- or overestimation of falls risk perception in hospitals. Patients were more likely to overestimate their falls risk if they used anticoagulant medication and if their highest education level was less than year 11. The findings for a three factor-model Physical Activity Awareness, Cognitive Awareness and Balance Awareness could inform future hospital falls education.

Impact: Registered nurses, health professionals, inpatients. Reporting Method: STROBE checklist for cross-sectional studies. Patient or Public Contribution: This study involved the collection of data from patient participants and registered nurses.