Research Articles (Nursing and Midwifery)

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Adolescent human immunodeficiency virus self-management : needs of adolescents in the Eastern Cape
(AOSIS, 2021) Adams, Leone; Crowley, Talitha
Background: Human immunodeficiency virus (HIV) is a chronic illness and adolescents living with HIV (ALHIV) need the support of the whole family to self-manage (handle, direct and control) their chronic illness. Little is known about self-management amongst ALHIV in the context of the Eastern Cape, South Africa. Aim: This study explored the self-management needs of ALHIV in the Nelson Mandela Bay area of the Eastern Cape to make recommendations that can be used in further research to develop a programme to support adolescents with self-management. Setting: The study was conducted at two primary healthcare clinics in the Nelson Mandela Bay area of the Eastern Cape. Methods: A qualitative descriptive design was applied. Thirteen adolescents between the age of 14 and 19 years were interviewed. The data were collected through individual interviews. Data analysis was done using the six steps described by Creswell. Results: Adolescents living with HIV have limited knowledge and understanding about HIV and sexual reproductive health. Some ALHIV lack self-regulation skills related to decisions about disclosure, managing stigma and emotions, taking treatment, effective communication and setting goals. Human immunodeficiency virus services were not adolescent-friendly, with long queues and no dedicated services for adolescents. Family and friends were a key self-management resource for ALHIV. Conclusion: Adolescents living with HIV have several self-management needs in the domains of knowledge and beliefs, self-regulation skills and abilities, and self-management resources. Healthcare workers should support adolescents and their caregivers to acquire self-management skills as this may lead to better treatment and health outcomes.
Adolescent mothers lived experiences whilst providing continuous kangaroo mother care : a qualitative study
(AOSIS publishing, 2020-12-08) Robertson, Anneline; Crowley, Talitha
Background: Kangaroo mother care (KMC) is the practice of skin-to-skin contact between an infant and parent and has been found to improve the growth and decrease the morbidity and mortality of low-birth-weight and premature infants. Adolescent pregnancy is associated with a preterm birth or low-birth-weight infant; therefore, it is possible that an adolescent mother may have to provide KMC. The adolescent mother, who is likely to have her first experience of motherhood, may have to be supported to ensure that she is able to provide KMC and the routine care for her preterm infant. The literature review did not reveal any research conducted in the Western Cape province on the experiences of adolescent mothers whilst providing KMC. It is, therefore, important to conduct research on this phenomenon so that the lived experiences of adolescent mothers whilst providing KMC can be described. Aim: The aim of this study was to explore the lived experiences of adolescent mothers whilst providing continuous KMC. Setting: The study was conducted in a district and central hospital KMC wards in Cape Town in the Western Cape province of South Africa. Methods: A qualitative, descriptive, phenomenological research design was used. Ten adolescent mothers were selected through purposive sampling. Semi-structured in-depth interviews were conducted, transcribed and analysed using Colaizzi’s framework. Results: Three themes emerged from the data: providing KMC, the interactions and the support received. Conclusion: Supportive educative environments should be established in the KMC wards to ensure that the adolescent mothers receive holistic support.
Adolescent mothers’ lived experiences whilst providing continuous kangaroo mother care : a qualitative study
(AOSIS, 2020-12) Robertson, Anneline E.; Crowley, Talitha
Background: Kangaroo mother care (KMC) is the practice of skin-to-skin contact between an infant and parent and has been found to improve the growth and decrease the morbidity and mortality of low-birth-weight and premature infants. Adolescent pregnancy is associated with a preterm birth or low-birth-weight infant; therefore, it is possible that an adolescent mother may have to provide KMC. The adolescent mother, who is likely to have her first experience of motherhood, may have to be supported to ensure that she is able to provide KMC and the routine care for her preterm infant. The literature review did not reveal any research conducted in the Western Cape province on the experiences of adolescent mothers whilst providing KMC. It is, therefore, important to conduct research on this phenomenon so that the lived experiences of adolescent mothers whilst providing KMC can be described. Aim: The aim of this study was to explore the lived experiences of adolescent mothers whilst providing continuous KMC. Setting: The study was conducted in a district and central hospital KMC wards in Cape Town in the Western Cape province of South Africa. Methods: A qualitative, descriptive, phenomenological research design was used. Ten adolescent mothers were selected through purposive sampling. Semi-structured in-depth interviews were conducted, transcribed and analysed using Colaizzi’s framework. Results: Three themes emerged from the data: providing KMC, the interactions and the support received. Conclusion: Supportive educative environments should be established in the KMC wards to ensure that the adolescent mothers receive holistic support. Keywords: Adolescent; Kangaroo mother care; Preterm infant; Experiences; Holistic support.
Adolescent mothers’ lived experiences whilst providing continuous kangaroo mother care : a qualitative study
(AOSIS, 2020) Robertson, Anneline E.; Crowley, Talitha
Background: Kangaroo mother care (KMC) is the practice of skin-to-skin contact between an infant and parent and has been found to improve the growth and decrease the morbidity and mortality of low-birth-weight and premature infants. Adolescent pregnancy is associated with a preterm birth or low-birth-weight infant; therefore, it is possible that an adolescent mother may have to provide KMC. The adolescent mother, who is likely to have her first experience of motherhood, may have to be supported to ensure that she is able to provide KMC and the routine care for her preterm infant. The literature review did not reveal any research conducted in the Western Cape province on the experiences of adolescent mothers whilst providing KMC. It is, therefore, important to conduct research on this phenomenon so that the lived experiences of adolescent mothers whilst providing KMC can be described. Aim: The aim of this study was to explore the lived experiences of adolescent mothers whilst providing continuous KMC. Setting: The study was conducted in a district and central hospital KMC wards in Cape Town in the Western Cape province of South Africa. Methods: A qualitative, descriptive, phenomenological research design was used. Ten adolescent mothers were selected through purposive sampling. Semi-structured in-depth interviews were conducted, transcribed and analysed using Colaizzi’s framework. Results: Three themes emerged from the data: providing KMC, the interactions and the support received. Conclusion: Supportive educative environments should be established in the KMC wards to ensure that the adolescent mothers receive holistic support.
Antimicrobial resistance phenotype of staphylococcus aureus and escherichia coli isolates obtained from meat in the formal and informal sectors in South Africa
(ps202304, 2020-09) Jaja, Ishmael Festus; Jaja, Chinwe-Juliana Iwu; Chigor, Nnamdi Vincent; Anyanwu, Madubuike Umunna; Maduabuchi, Ezealisiji Kenneth; Oguttu, James Wabwire; Green, Ezekiel
Background: Foodborne diseases (FBD) caused by resistant pathogens are a global public health problem. One main driver of the increasing FBD incidence is the transfer of pathogenic organisms from animal guts to carcasses during processing and subsequent transfer from meat products to consumers. Methods: In this study, meat samples from abattoirs in the formal meat sector (FMS) (n = 140) and slaughter points in the informal meat sector (IMS) (n = 104) were collected for microbial detection and phenotypic AMR determination using polymerase chain reaction. Results. The antibiogram of Staphylococcus aureus isolates revealed that resistance to clindamycin (74.3%) and ampicillin (59.5%) was highest in the FMS, while resistance to penicillin (83.8%) and tetracycline (82.1%) was highest in the IMS. Escherichia coli isolates show significant resistance to chloramphenicol (90.7%) and tetracycline (82.3%) in the FMS. Likewise, resistance to tetracycline (92.3%) and sulfamethoxazole/trimethoprim (87.5%) was highest in the IMS. The multiple antibiotic resistance index (MARI) for S. aureus and E. coli ranged from 0.3 to 0.8 and 0.2 to 0.5, respectively. Conclusion: This study suggests high-level contamination of meat with resistant pathogens and highlights the public health consequences associated with consuming such unhygienic products
Attitudes to organ donation among some urban South African populations remain unchanged : a cross-sectional study (1993 - 2013)
(Health & Medical Publishing Group, 2014-02) Etheredge, Harriet R.; Turner, Roseanne E.; Kahn, Delawir
Background. A 1993 paper in the SAMJ suggested that public attitudes to organ donation in South Africa were positive. However, statistics reveal a decline in the annual number of transplants in this country. Objective. To repeat the 1993 survey as far as possible and determine whether public attitudes to organ donation in some South African populations have changed over the past 20 years. Methods. The 1993 study was replicated in 2012 to generate a current data set. This was compared with the raw data from the 1993 study, and an analysis of percentages was used to determine variations. Results. Generally attitudes to organ donation have not changed since 1993, remaining positive among the study population. However, individuals are significantly more hesitant to consider donating the organs of a relative without being aware of that person’s donation preference. Individuals in the black African study population are currently more willing to donate kidneys than in 1993 (66% v. 81%; p<0.0001), but less willing to donate a heart (64% v. 38%; p<0.0001, a liver (40% v. 34%; p<0.036) and corneas (22% v. 15%, p<0.0059).Conclusions. Publicity campaigns aimed at raising awareness of organ donation should emphasise the importance of sharing donation preferences with one’s family in order to mitigate discomfort about making a decision on behalf of another. These campaigns should be culturally and linguistically sensitive. The study should be repeated in all populations over time to continually gauge attitudes.
Barriers to quality patient care in rural district hospitals
(AOSIS Publishing, 2012-05) Eygelaar, Johanna E.; Stellenberg, Ethelwynn L.
Currently barriers exist in delivering quality health care. This study aimed to investigate such barriers in the eight rural district hospitals of the West Coast Winelands Region, three type A and five type B hospitals. A quantitative descriptive design was applied which included the total population of nursing staff (n = 340) working at the time of data collection. A self-administered questionnaire was distributed with a response rate of 82%. Reliability of the instrument was verified using the Cronbach alpha coefficient and a pilot study. The validity, specifically construct and content validity, were assured by means of an extensive literature review, pilot study and use of experts. Ethics approval was obtained from the relevant stakeholders. Results showed that 272 participants (97%) disagreed that provision of staff was adequate, with staff above 40 years of age more likely to disagree (p = 0.01). A statistically significant association was shown between availability of doctors and staff not being able to cope with emergencies (p = <0.01). Most participants (n =212; 76%) indicated that they were not receiving continuing education, with the registered nurses more likely to disagree (÷² test, p = 0.02). Participants in both hospital types A (n = 131; 82%) and B (n = 108; 91%) also disagreed that provision of equipment and consumables was adequate. The research showed that inadequacies relating to human resources, professional development, consumables and equipment influenced the quality of patient care. Urgent attention should be given to the problems identified to ensure quality of patient care in rural hospitals.
A comprehensive model for intimate partner violence in South African primary care : action research
(BioMed Central, 2012-11) Joyner, Kate; Mash, Bob
Background: Despite extensive evidence on the magnitude of intimate partner violence (IPV) as a public health problem worldwide, insubstantial progress has been made in the development and implementation of sufficiently comprehensive health services. This study aimed to implement, evaluate and adapt a published protocol for the screening and management of IPV and to recommend a model of care that could be taken to scale in our underdeveloped South African primary health care system. Methods: Professional action research utilised a co-operative inquiry group that consisted of four nurses, one doctor and a qualitative researcher. The inquiry group implemented the protocol in two urban and three rural primary care facilities. Over a period of 14 months the group reflected on their experience, modified the protocol and developed recommendations on a practical but comprehensive model of care. Results: The original protocol had to be adapted in terms of its expectations of the primary care providers, overly forensic orientation, lack of depth in terms of mental health, validity of the danger assessment and safety planning process, and need for ongoing empowerment and support. A three-tier model resulted: case finding and clinical care provision by primary care providers; psychological, social and legal assistance by ‘IPV champions’ followed by a group empowerment process; and then ongoing community-based support groups. Conclusion: The inquiry process led to a model of comprehensive and intersectoral care that is integrated at the facility level and which is now being piloted in the Western Cape, South Africa.
Convalescent plasma or hyperimmune immunoglobulin for people with COVID‐19
(Health & Medical Publishing Group, 2020-07-16) Nnaji, C. A.; Iwu, C. J.; Ndwandwe, D. E.; Jordan, P.; Wiysonge, Charles S.
Convalescent plasma is being considered as a potential therapy for COVID‐19. We highlight and contextualise the findings of a recent Cochrane rapid review that evaluated the effectiveness and safety of convalescent plasma or hyperimmune immunoglobulin transfusion in the treatment of people with COVID‐19. The review found low‐certainty evidence of the therapeutic effectiveness and safety of convalescent plasma. As the novel coronavirus continues to spread in South Africa (SA), convalescent plasma may offer a therapeutic ray of hope for mitigating the morbidity and mortality burdens of the disease. Further investigation of the clinical benefits of the therapy in well-designed studies is needed to provide more evidence that will guide COVID-19 treatment decision-making in the SA context.
Developing lay health worker policy in South Africa : a qualitative study
(BioMed Central, 2012-03) Daniels, Karen; Clarke, Marina; Ringsberg, Karin C.
Background Over the past half decade South Africa has been developing, implementing and redeveloping its Lay Health Worker (LHW) policies. Research during this period has highlighted challenges with LHW programme implementation. These challenges have included an increased burden of care for female LHWs. The aim of this study was to explore contemporary LHW policy development processes and the extent to which issues of gender are taken up within this process. Methods The study adopted a qualitative approach to exploring policy development from the perspective of policy actors. Eleven policy actors (policy makers and policy commentators) were interviewed individually. Data from the interviews were analysed thematically. Results Considerations of LHW working conditions drove policy redevelopment. From the interviews it seems that gender as an issue never reached the policy making agenda. Although there was strong recognition that the working conditions of LHWs needed to be improved, poor working conditions were not necessarily seen as a gender concern. Our data suggests that in the process of defining the problem which the redeveloped policy had to address, gender was not included. There was no group or body who brought the issue of gender to the attention of policy developers. As such the issue of gender never entered the policy debates. These debates focused on whether it was appropriate to have LHWs, what LHW programme model should be adopted and whether or not LHWs should be incorporated into the formal health system. Conclusion LHW policy redevelopment focused on resolving issues of LHW working conditions through an active process involving many actors and strong debates. Within this process the issue of gender had no champion and never reached the LHW policy agenda. Future research may consider how to incorporate the voices of ordinary women into the policy making process.
Development of a cultural and contextual appropriate HIV self-management instrument using interpretive phenomenology and focus group cognitive interviews
(Elsevier, 2020) Crowley, Talitha; Van Der Merwe, Anita; Skinner, Donald
Qualitative methods are valuable to ensure the important cultural and contextual appropriateness of research instruments but not often used. Interpretive phenomenology (IP) and focus group cognitive interviews are well placed to inductively develop and refine items used to measure adolescent HIV self-management in a South African context. IP was used to situate the experiences of adolescents, caregivers and healthcare workers, as narrated in individual interviews and focus groups, in their social and cultural context. Components of adolescent HIV self-management were developed based on the participants’ experiences, behavioural theory and literature. The components and items were further validated in focus groups using cognitive interviews to refine, revise and add items as suggested by the participants. This study contributes to qualitative research methods and the rigor of instrument development by unpacking how to use IP and focus group cognitive interviews meaningfully in instrument development.
Development spots in communication during the management of the intrapartum period : an interpretive multiple case study in a developing context
(AOSIS publishing, 2017-07) M'Rithaa, Doreen K.M.; Fawcus, Susan R.; De La Harpe, Margaretha; Korpela, Mikko
Background: Health care activities are influenced by information communication between women during pregnancy, birth and motherhood and skilled birth attendants (SBAs) and further, between the health care workers during the continuum of care. Therefore, effective information communication processes (ICP) within and between health care facilities are a requirement for appropriate management of patients or clients. The management of the intrapartum period requires swift responses while managing critical information required for further referral and management processes. The involvement of multiple actors at different times with the same client carries the risk of communication breakdown at different points and at different levels of care. The information communicated during the intrapartum period is critical and should be accurate, timely and more importantly appropriate to enable better maternal and neonatal outcomes. Purpose: The purpose of this article is to discuss the complexities around ICP identified within a developing context that influence the management of the intrapartum period. Methods: Multi-method, multiple case study approach was used to analyse two case studies. Only the challenges from one case study (A) are discussed in this article. In-depth interviews were conducted with the SBAs. The role of observer-as-participant was utilised during the observation; field notes and document review methods were used to gather the data. Thematic analysis and activity analysis were applied to analyse the data. Results: The findings identified challenges with information and communication that influenced the management of the intrapartum period. Conclusion: This study exhibited the challenges identified as development points that can influence the management of the intrapartum period. These challenges were also identified as desirable changes from the present state depending on the perspective of the actor.
Die kind in die hospitaal
(Health & Medical Publishing Group, 1974) Hofmeyr, I. M.
[No abstract available]
Discourses and practices in institutionalised nursing in South Africa : challenges for care
(Taylor & Francis, 2014-10) Joyner, Kate; Shefer, Tamara; Smit, Estian
ENGLISH SUMMARY : South African nursing remains a largely feminised and devalued profession, further undermined by the popular construction of nurses as indifferent and the healthcare systems as hindered by multiple challenges. Over the last 20 years of democracy, multiple efforts have been made at the level of policy, practice and knowledge production to address the challenges of the primary healthcare sector where nurses are such central role players. There are clearly resource challenges in South Africa which may undermine caring practices; however, this article also foregrounds the dominant discourses that shape international and local nursing, and which arguably mitigate against care that is democratic, socially responsive and sensitive to the diverse care needs of communities and individuals. Drawing on Tronto's political ethics of care and on Foucauldian frameworks, the paper analyses the processes currently shaping the experience of nurses and practices of care. Key themes are the hierarchical, regulatory framework of surveillance in nursing, the dominance of biomedical discourse and the mechanistic framework that fragments nursing practice. These aspects not only disempower nurses and deny them recognition but, together with institutional disregard for the need for self-care, also reproduce a system that is inherently unable to provide humane healthcare.
Effort and reward imbalance factors motivating Namibian professional nurses to participate in continuous professional development : a confirmatory factor analysis
(Publishers version, 2021-11) Mbidi, Tekla S. N.; Damons, Anneleen
Background: To improve professional development, it is important to understand the motivational factors behind nurses’ participation in specific types of continuous professional development activities. Effort–rewards imbalance (ERI) posits an imbalance between high efforts spent at work and low rewards sometimes received in turn. However, professional nurses have various ERIs that can influence their reasons to participate in continuous professional development activities. Aim: The purpose of this article was to propose a model for selected ERI factors, which motivate professional nurses to participate in continuous professional development activities. Setting: Two hundred and forty-one professional nurses working in a public national referral hospital in Namibia participated in the study. Methods: Survey data on professional nurses’ reasons and motivations to participate in the professional development activities were analysed using a literature-based framework on ERI and reasons for participation in continuous professional development. The survey data were analysed for reflective relationships of ERI and reasons for participation in continuous professional development activities. A confirmatory factor analysis method using IBM SPSS AMOS version 23 was used to develop and validate the effort–reward motives for a continuous professional development model. Results: Four effort-reward imbalance factors were derived from sixteen CPD motives. The reflective factors were (1) extrinsic efforts, (2) intrinsic efforts, (3) reward motives, and (4) over-commitment motives. The four conceptual factors made up a second-order effort-reward motives factor for the nurses’ reasons to take part in continuous professional development activities. Conclusions: The results of this study show that professional nurses consider taking part in continuous professional development activities in order to carry out their work better but not as a way to increase chances of promotion. The study also concluded that the older professional nurses tend to have higher intrinsic effrot motivation than their younger counterparts. Thus, nurses could use these findings to understand the reasons which motivate them to develop professionally.
Effort and reward imbalance factors motivating Namibian professional nurses to participate in continuous professional development : a confirmatory factor analysis
(AOSIS, 2020) Mbidi, Tekla S. N.; Damons, Anneleen
Background : To improve professional development, it is important to understand the motivational factors behind nurses’ participation in specific types of continuous professional development activities. Effort–rewards imbalance (ERI) posits an imbalance between high efforts spent at work and low rewards sometimes received in turn. However, professional nurses have various ERIs that can influence their reasons to participate in continuous professional development activities. Aim: The purpose of this article was to propose a model for selected ERI factors, which motivate professional nurses to participate in continuous professional development activities. Setting: Two hundred and forty-one professional nurses working in a public national referral hospital in Namibia participated in the study. Methods: Survey data on professional nurses’ reasons and motivations to participate in the professional development activities were analysed using a literature-based framework on ERI and reasons for participation in continuous professional development. The survey data were analysed for reflective relationships of ERI and reasons for participation in continuous professional development activities. A confirmatory factor analysis method using IBM SPSS AMOS version 23 was used to develop and validate the effort–reward motives for a continuous professional development model. Results: Four effort-reward imbalance factors were derived from sixteen CPD motives. The reflective factors were (1) extrinsic efforts, (2) intrinsic efforts, (3) reward motives, and (4) over-commitment motives. The four conceptual factors made up a second-order effort-reward motives factor for the nurses’ reasons to take part in continuous professional development activities. Conclusions: The results of this study show that professional nurses consider taking part in continuous professional development activities in order to carry out their work better but not as a way to increase chances of promotion. The study also concluded that the older professional nurses tend to have higher intrinsic effrot motivation than their younger counterparts. Thus, nurses could use these findings to understand the reasons which motivate them to develop professionally.
The epidemic of sexual violence in South Africa
(Health and Medical Publishing Group, 2016-11) Joyner, Kate
ENGLISH SUMMARY : No abstract available.
Ethical issues that confront nurses in private hospitals in the Western Cape Metropolitan area
(AOSIS Publishing, 2014-06) Stellenberg, Ethelwynn L.; Dorse, Alta J.
Background: Nurses are faced daily with a variety of ethical issues which could be as a result of budget cuts, target setting, the shortage of nurses and expertise. Objectives: The objectives of the study were to identify ethical issues related to patient care, to describe ethical issues related to patient diversity, rights and human dignity. To describe ethical issues related to caring in nursing and to the workplace environment. Method: A quantitative explorative descriptive research design was applied. A stratified sample of (n = 142/5%) was drawn from all nurses and caregivers (N = 2990) working in a selected group of eight private hospitals. Self-administered questionnaires were used to collect the data. Statistical tests were applied to determine statistical relationships between variables. Results: Results included (95%) of respondents provided safe and committed care to their patients, (99%) loved to care for their patients and (93%) believed in the Nurses’ Pledge of Service. Fifty percent (50%) of the respondents indicated verbal abuse from patients and only (59%) experienced openness and transparency in the work environment. Analysis further identified that the caregivers did not respect the noble tradition of the profession and experienced the most verbal abuse. Conclusion: This study has identified ethical issues which may give rise to conflict within the workplace environment if not adequately addressed by management. The study further showed that the use of caregivers not regulated in nursing practice may pose as a threat to the safety of the patient
Experiences of women in survivorship following mastectomy in the Cape Metropole
(Health and Medical Publishing Group, 2018) Stecher, N. E.; Cohen, M. A.; Myburgh, E. J.
BACKGROUND: In spite of significant improvements in the treatment of breast cancer, many women still undergo mastectomy. The effects of breast cancer surgery on the diverse population of South African women have not been well studied. Insight may be gained in how to aid recovery in survivorship by identifying the support needs of women following mastectomy. This study aimed to explore and describe the lived experiences of women in the Cape Metropole following mastectomy in survivorship METHODS: A qualitative study guided by descriptive phenomenology and grounded in the post positivist philosophy of Husserl. Seven women from the Cape Metropole were interviewed in English following ethical approval. The semi-structured interviews were thematically analysed RESULTS: Three general themes emerged: Psychological impact of breast cancer diagnosis and treatment, the impact of an altered body image and concern for family and reliance on them for support, with a theme specific to stigmatisation within the Xhosa culture CONCLUSION: The need to shield family members from breast cancer diagnosis was contrasted by the need for family support. Cultural stigmata still prevail within the South African population.
Factors influencing patient falls in a private hospital group in the Cape Metropole of the Western Cape
(AOSIS, 2020) Janse van Rensburg, Renee; Van der Merwe, Anita; Crowley, Talitha
Background: The fall rate of patients in hospitals is a worldwide concern due to the impact falls have on patients, the family or relatives, as well as the healthcare setting. Factors influencing patient falls are categorised as intrinsic and extrinsic. Intrinsic factors refers to physical conditions and the extrinsic factors include the environment of the patient, nursing staffing levels and skill mix. Aim: The study aimed to determine the factors that influence patient falls. Setting: A private hospital group in the Cape Metropole of the Western Cape. Methods: A quantitative retrospective descriptive research approach was used by analysing 134 records of patients that have fallen from October 2016 to February 2018. Data was collected using a data extraction sheet and analysed using the Statistical Package for the Social Sciences (SPSS). Results: Intrinsic factors contributing to patient falls includedthe patient’s age, hypertension, co-morbidities and the use of benzodiazepines as a sedative. Extrinsic factors were the incorrect use of bed rails and the skill mix of the staff. In over half of the cases (n = 68; 50.7%), risk assessments were not performed according to the protocol. Only 5 (3.7%) patients sustained major injuries due to the falls. However, the risk of more severe falls increased 2.4 times with the lack of risk assessment. Conclusion: The lack of accurate and consistent patient fall risk assessments, use of benzodiazepines as a sedative and the staff skill mix were contributors to the fall rate in these hospitals.

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