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Open Access The Safety of Safety Research: The Case of Patient Fall Research La fiabilité de la recherche sur la sécurité : le cas de l'évaluation des risques de chute

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Abstract:

Most fall intervention programs consist of 2 components: fall risk prediction instruments to identify the patient who is likely to fall, and fall intervention strategies to prevent the patient from falling or to protect the patient from injury should a fall occur. While critical to the effectiveness of a fall intervention program, many of the fall risk prediction instruments have been criticized for their failure to accurately identify the fall-prone patient. In this article, in the context of the validity assessments conducted on the Morse Fall Scale, the research conducted in the past 2 decades on fall risk assessment is critiqued. Some fall prediction research is based upon invalid assumptions and/or errors in design, both in the development of risk scales and in the evaluation of these instruments. Many of these instruments have been constructed with inappropriate reliance on face validity, have been evaluated inadequately, or have been tested in the clinical setting using an invalid design. Finally, improper use of fall scales in the clinical area may increase the risk of injury to the patient. The author concludes that much nursing research on patient falls does not contribute to improved patient safety.

French
La plupart des programmes de prévention des chutes comportent deux volets : d'une part, des instruments de prédiction du risque de chute chez les patients et, d'autre part, des stratégies visant à empêcher les chutes ou à prévenir les blessures en cas de chute. Malgré leur rôle essentiel, un grand nombre de ces instruments ont fait l'objet de critiques parce qu'ils ne permettent pas d'identifier avec précision les patients sujets aux chutes. Le présent article examine, à la lumière des essais sur la validité touchant l'échelle de Morse [Morse Fall Scale], les recherches menées au cours des vingt dernières années sur l'évaluation du risque de chute. Certains travaux en la matière s'appuient sur des hypothèses erronées ou des erreurs de conception, tant en ce qui concerne la mise au point des échelles de risque que leur évaluation. Bon nombre de ces instruments ont été élaborés uniquement en fonction de leur validité apparente et n'ont pas bénéficié d'une évaluation adéquate ou, s'ils ont été mis à l'essai en milieu clinique, d'un plan expérimental valide. Enfin, l'usage à mauvais escient des échelles d'évaluation du risque de chute peut accroître le risque de chute chez les patients. L'auteure conclut qu'une grande part de la recherche menée en sciences infirmières sur ce thème ne contribue pas à améliorer la sécurité des patients.

Keywords: COCHRANE CRITERIA; FALL INTERVENTION; FALL PREDICTION; MORSE FALL SCALE; PATIENT FALL RISK ASSESSMENT

Document Type: Research Article

Publication date: June 1, 2006

More about this publication?
  • CJNR is a peer-reviewed, quarterly journal published by the McGill University School of Nursing since 1969. With world-wide circulation, CJNR's primary mandate is to publish original nursing research that develops basic knowledge for the discipline and examines the application of the knowledge in practice. Research related to education and history is also welcomed, as are methodological, theoretical, and review papers that advance nursing science. Letters or commentaries about published articles are encouraged. Learn more.
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