Examining the role of communication disability in the hospital falls of patients with stroke
- Publication Type:
- Thesis
- Issue Date:
- 2024
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People with stroke are at a high risk of falls during their inpatient hospital admission and falls can result in several adverse consequences to both the patient and the health service. People with communication disability may have unique risk factors that may contribute to their falls in hospital. The aim of this thesis was to gain an in depth understanding of the: (a) relationship between falls in inpatient rehabilitation and communication disability following stroke, (b) context, nature, and outcomes of falls for patients with communication disability following stroke, (c) potential strategies that may reduce the risk of falls for patients with communication disability following stroke.
Existing literature, including hospital falls policies, were reviewed using a systematic review with meta-analysis and qualitative synthesis. Medical records and incident reports of falls in patients with communication disability following stroke and health professional focus groups were analysed descriptively and with a content thematic analysis. Finally, a meta-synthesis combined the studies using a content thematic analysis to present clinical implications. The Generic Reference Model patient safety framework guided data collection, analysis, and the reporting of the studies.
Communication disability is not well represented in the literature and in policies concerning hospital falls. However, communication disability following stroke has multiple impacts on the management of falls in hospital. The results of the medical record and incident report reviews indicated that difficulties following simple instructions were a risk factor for a fall. Additionally, difficulties gaining attention and communicating basic needs were contributing factors for falls. The most common type of fall was an unwitnessed roll from bed and patients often fell when taking a risk or attempting to address an unmet basic need. Communication disability made it difficult for health professionals to understand the circumstances of some unwitnessed falls and assess for injury following a fall. Health professionals suggested falls prevention for these patients should include family members, tailored education programs and improved documentation of the functional impacts of communication disability. Health professionals should consider the functional implications of a patient’s communication disability when considering falls risks and potential contributing factors for falls. Hospital managers should consider communication disability when developing and updating falls prevention policies and procedures to support the provision of safer, more effective care for these patients. There is an urgent need for research into which strategies may be effective for patients with communication disability after stroke.
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