Speaker for Nursing Conferences 2019- Akiko Hiyama

Title: Hierarchical organization of nurse decisions and priorities for fall prevention

Akiko Hiyama

Sapporo City University, Japan


Hiyama studied Nursing at the Japanese Red Cross Hokkaido College of Nursing, Japan and graduated as MS in 2010. I received PhD degree in 2016 at the Sapporo City University.


The purpose of this study was to clarify the decisions and priorities of experienced nurses for fall prevention. The subjects were ward nurses with either 10 or more years of ward nursing experience or 2 years of experience or less. We conducted a mail-in questionnaire survey using anonymous survey forms. After describing the general purpose of the survey (fall prevention) to the subjects, we had them rate the importance of evaluation criteria of patients’ fall risk on a 9-point scale, as well as had them rate the importance of nursing practices for fall prevention for each evaluation criterion. All questions were constructed using the results of our past research. We analyzed the data using Microsoft Excel, designating responses of 1, 3, 5, 7, and 9 as  “minimally important,” “slightly important,” “important,” “very important,” and “exceedingly important” in the answers; inverse numbers of 1/3, 1/5, 1/7, and 1/9 were assigned to “not minimally important,” “not slightly important, ”not important,” “not very important” and “not exceedingly important.” By calculating weights, we were able to evaluate the relative importance of each evaluation criterion. We then conducted a hierarchical analysis, exploring the difference in ratings between subjects with 2 years of ward experience or less (n = 19) and subjects with 10 years or more years of clinical experience (n = 20).
“Action in the absence of concentration” was considered the most important evaluation criterion by 27% of the less than 2 years or less, whereas only 20% of the subjects in the 10 years or more group rated it as most important. “Habitual behavior in unstable activity” was rated as most important by 23% of the 2 years or less group but by 28% of the 10 years or more group. Among subjects with 10 years or more experience, the nursing practices for preventing falls were organized as follows in descending order of importance: “support for safe behavior by setting up activities, rest, excretion, and clothing”; “support for early detection and alleviation of symptoms that lead to fall risk due to side effects of drugs and diseases”; “use of environmental control and resources to minimize the degree of injury when falling”; “securing communication means by selecting items according to patients’ condition”; “motivate each patient in practicing fall prevention behaviors”; and “strengthening the patient's ability to adapt to the environment by working on their psychosocial characteristics.”