Blog Article
Globally, approximately 30-50% of people living in nursing or residential care homes fall each year. This is a global public health problem and the second leading cause of death from unintentional injury. Falls have an impact on quality of life and morbidity and preventing them is gold standard care. When falls do occur, putting in place safe strategies to help the person rise are required. Structured risk assessment and use of a ‘lifting’ cushion are one of the strategies used.
The aim of this research, led by Professor Fiona Cowdell and Professor Judith Dyson, was to evaluate the impact of the lifting cushion on managing falls. Their study also assessed barriers and facilitators to staff using a lifting cushion in 18 care homes in Birmingham.
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What methods were used?
The study involved two phases, including:
- Capturing quantitative pre and post cushion implementation data with comparison of means testing and
- Theoretically underpinned qualitative semi-structured interviews to explore barriers and facilitators to cushion implementation with inductive and deductive data analysis.
What was discovered?
Researchers found that the lifting cushion was poorly adopted in Birmingham care homes, being used in only 6% of falls. Barriers to cushion use included i) a lack of confidence in assessing safety to lift a resident, partly because staff were not allowed devices (telephones and iPads) in the workplace which meant they were unable to access the relevant app’ to allow this assessment, ii) a belief that the cushion might be frightening for older people with dementia, iii) those tasked with implementation had low levels of drive and enthusiasm and iv) staff were worried the cushion was not very stable. Facilitators included i) positive experience of the training, ii) the cushion being easy to use, iii) staff found it easy to use and iv) when senior staff supported its use.
What can be done?
This is one of the first implementation studies in care homes. There is very little research about the adoption of evidence into practice in this environment.
The implementation of evidence into practice requires a considered approach where not only are barriers and facilitators considered (as in this case) but they are addressed or enhanced (respectively). This was out with the scope of this study. The authors recommend more implementation research in care homes to establish what approaches and strategies are best suited to this environment.
For carers wanting to use the cushion, recommendations included i) the provision of devices to allow use of the risk to rise assessment app, ii) staff train on cushion use in front of residents (an approach that appeared to allay resident fears of the cushion and iii) “positive deviants”, staff with experience, passion and a real enthusiasm for improving resident care after a fall are tasked with implementation of the device.
Find out more about the Centre for Social Care, Health and Related Research