Marta Aranda-Gallardo

Instruments for assessing the risk of falls in acute hospitalized patients: a systematic review protocol

AIM The purpose of this article is to present the research protocol of a systematic review about fall risk assessment tools in acute hospitalized patients. BACKGROUND Various risk assessment tools for falls have been developed, but with uncertainties derived from validation in heterogeneous environments and variations in their sensitivity, specificity and predictive validity. DESIGN Systematic review and meta-analysis. METHODS Two independent reviewers will extract data in a blinded process. Quality of studies will be assessed using various standardized instruments. A meta-analysis will be performed if applicable. For all studies, sensitivity, specificity, positive and negative predictive values, together with the positive and negative likelihood ratios and Youden index will be calculated. The diagnostic odds ratio of the studies and the hierarchical summary Relative Operating Characteristic curve and bivariate model will be applied. Calculations will be made from random effects models. Forest-plot diagrams for sensitivity and specificity and likelihood ratios, in addition to Cochranes Q test and the I(2) statistic, will be calculated. Funding of the review was confirmed in December 2010. DISCUSSION The results of this review will help to clarify some uncertainties provoked by earlier research findings and enable informed choice of a validated, reproducible instrument for assessing the risk of falls by hospital patients, so that preventive action may be taken to minimize this risk.

Design and validation of the INICIARE instrument, for the assessment of dependency level in acutely ill hospitalised patients

AIMS AND OBJECTIVES The aim of this study was to establish the validity and reliability of an instrument (Inventario del NIvel de Cuidados mediante IndicAdores de clasificación de Resultados de Enfermería) used to assess the dependency level in acutely hospitalised patients. This instrument is novel, and it is based on the Nursing Outcomes Classification. BACKGROUND Multiple existing instruments for needs assessment have been poorly validated and based predominately on interventions. Standardised Nursing Languages offer an ideal framework to develop nursing sensitive instruments. DESIGN A cross-sectional validation study in two acute care hospitals in Spain. METHODS This study was implemented in two phases. First, the research team developed the instrument to be validated. In the second phase, the validation process was performed by experts, and the data analysis was conducted to establish the psychometric properties of the instrument. RESULTS Seven hundred and sixty-one patient ratings performed by nurses were collected during the course of the research study. Data analysis yielded a Cronbachs alpha of 0·91. An exploratory factorial analysis identified three factors (Physiological, Instrumental and Cognitive-behavioural), which explained 74% of the variance. CONCLUSIONS Inventario del NIvel de Cuidados mediante IndicAdores de clasificación de Resultados de Enfermería was demonstrated to be a valid and reliable instrument based on its use in acutely hospitalised patients to assess the level of dependency. RELEVANCE TO CLINICAL PRACTICE Inventario del NIvel de Cuidados mediante IndicAdores de clasificación de Resultados de Enfermería can be used as an assessment tool in hospitalised patients during the nursing process throughout the entire hospitalisation period. It contributes information to support decisions on nursing diagnoses, interventions and outcomes. It also enables data codification in large databases.

Adaptación transcultural del instrumento «STRATIFY» para la valoración del riesgo de caídas

AIMS To adapt to Spanish language the STRATIFY tool for clinical use in the Spanish-speaking World. METHOD A multicenter, 2 care settings cross-sectional study cultural adaptation study in acute care hospitals and nursing homes was performed in Andalusia during 2014. The adaptation process was divided into 4 stages: translation, back-translation, equivalence between the 2 back-translations and piloting of the Spanish version, thus obtaining the final version. The validity of appearance, content validity and the time required to complete the scale were taken into account. For analysis, the median, central tendency and dispersion of scores, the interquartile range, and the interquartile deviation for the possible variability in responses it was calculated. RESULTS Content validity measured by content validity index reached a profit of 1. For the validity aspect the clarity and comprehensibility of the questions were taken into account. Of the 5 questions of the instrument, 2 had a small disagreement solved with the introduction of an explanatory phrase to achieve conceptual equivalence. Median both questions were equal or superior to 5. The average time for completion of the scale was less than 3 minutes. CONCLUSION The process of adaptation to Spanish of STRATIFY has led to a semantic version and culturally equivalent to the original for easy filling and understanding for use in the Spanish-speaking world.

Characteristics, consequences and prevention of falls in institutionalised older adults in the province of Malaga (Spain): a prospective, cohort, multicentre study

Objectives Falls are an important adverse event among institutionalised persons. It is in this clinical setting where falls occur more frequently than in any other, despite the measures commonly taken to prevent them. This study aimed to determine the characteristics of a typical institutionalised elderly patient who suffers a fall and to describe the physical harms resulting from this event. We then examined the association between falls and the preventive measures used. Methods This was a prospective cohort study in 37 nursing homes in Spain. The participants were all the nursing home residents institutionalised in these centres from May 2014 to July 2016. Participants were followed up for 9 months. During this period, two observations were made to evaluate the preventive measures taken and to record the occurrence of falls. Results 896 residents were recruited, of whom 647 completed the study. During this period, 411 falls took place, affecting 213 residents. The injuries caused by the falls were mostly minor or moderate. They took place more frequently among women and provoked 22 fractures (5.35%). The most commonly used fall prevention measure was bed rails (53.53% of cases), followed by physical restraint (16.79%). The latter measure was associated with a higher incidence of injuries not requiring stitches (OR=2.06, 95% CI 1.01 to 4.22, P=0.054) and of injuries that did require stitches (OR=3.51, 95% CI 1.36 to 9.01, P=0.014) as a consequence of falls. Bed rails protected against night-time falls. Conclusions Falls are a very common adverse event in nursing homes. The prevention of falls is most commonly addressed by methods to restrain movement. The use of physical restraints is associated with a greater occurrence of injuries caused by a fall.