One goal of nursing care is to identify and treat potential health problems such as falls that may jeopardize the health, life and safety of hospitalized adults, which makes it a critical issue for both the patient and nurse. In one preliminary study, adults transferred from ICU to general medical and surgical units had 2 1/2 times the incidence of falls than patients never treated in ICU. This proposal focuses on this high risk group after their transfer from ICU. Using data within 24 hours after transfer from ICU, the specific aims of this study are to assess the relationship between functional competence and perceptions of these and to develop a model of environment, functional competence and cognitive appraisal factors that predicts the probability of a fall during subsequent hospitalization on general medical and surgical units. A modified version of Hogue's ecological model of functional health, falls being one indicator, provides direction in identifying factors that contribute to the risk of falls. These factors include the environment, functional competence and cognitive appraisal of both factors. As noted by Hogue, the environmental factors of interest will be medications and immobility that contribute to a changing physiologic milieu adversely affecting functional competences required to ambulate and transfer safely. Patients also need an opportunity to fall, and this will be assessed. The size of environmental effects increase with longer exposure, and thus, the length of time in ICU and duration of immobility will be measured. The competencies of interest are functional ones and include severity of illness (an indicator of functional aberrations), disease (noted by Hogue) and musculoskeletal (muscle strength, flexibility and postural stability), sensory (visual acuity, proprioception and vibratory sensation) and cognitive factors (cognitive impairment) needed to respond effectively to disruptions in body position. Mobility and activities of daily living are indicators of functional health in Hogue's model but were demonstrated to be risks for falls. Hence, they are included as indicators of overall functional competence. The third factor is cognitive appraisal of functional competences (perceived postural stability and perceived mobility and transfer) and environmental factors that contribute to the decision of the patient to ambulate or transfer from bed and chair and are included for study. Unique features of this prospective study include direct bedside measurement of functional competence and cognitive appraisal and measurement of all factors prior to a fall. Within 24 hours of transfer from ICU, 1500 persons 40 years of age and older will be assessed and followed during their continued hospitalization on medical and surgical units. Using data from preliminary work, 7.4% (n = 111) persons are expected to fall during the study period. Multiple logistic regression will be used to determine a linear model of functional competences, environmental factors and cognitive appraisal that predict the probability of a fall.
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