Fall prevention

Knowledge transfer in the management of falls

14 Jun 2022

Despite the existence of guidelines in the management of falls, it is still complicated to implement them in the field. It is always a question of comparing the literature with practice.

The geriatric patient is part of a complex system: the care environment.

Medicine is a field where knowledge is constantly evolving. Health care institutions are still compartmentalised professional environments, where tasks and skills are highly segmented.

It is said that nursing is a profession of the heart. Indeed, the patient will also have to deal with the carer as a person, with his or her limits and representations.

This article offers some food for thought in order to better perceive our place in the hospital system as a carer. In order to improve the quality of care, it is important to provide more fluidity in the care of geriatric patients.

What theoretical framework for skills transfer?

PARHIS (Promoting Action on Research Implementation in Health Services) is a conceptual framework that allows us to address knowledge transfer in the context of falls prevention.

PARHIS proposes 3 lines of action on knowledge transfer.
First, the nature of the knowledge. Second, the context in which the transfer of knowledge should take place. Finally, the agent who is the vector of this knowledge.

1. The nature of knowledge

The knowledge to be imparted must necessarily be from a variety of sources, taking into account the experience of the carers. We care for people, so we need to draw on a wide range of knowledge to meet the needs of each patient.

There is medical knowledge, the evolution of care techniques and technologies, and psychological knowledge. They all have a different speed.

The experience of the carer will filter this knowledge and they will end up retaining only the portion that they deem relevant to their thinking and practice (Gabbay et al., 2003). The knowledge will therefore inevitably be transformed before it is used for the needs of the organisation.

Each piece of knowledge is only a part of what we need to work with. They all have their own evolution and over the course of a career this can change dramatically. Thus, the carer spends his or her life collecting, integrating and adapting to the evolution of knowledge.

2. The general context

We will not know what to do with the extent of our knowledge if we do not take into account the context of the institution in which the carers work.

It is therefore the institution that is responsible for transforming this knowledge into care skills.

Firstly, the analysis of the general context is essential for any change. Who is responsible for the transfer of skills? What are the resources?

Secondly, the culture of the institution must be identified. What are the values? Does the institution promote research and support the desire of its staff to change?

Finally, how do we evaluate our progress? How do we look back on our efforts to change?

3. L’agent facilitant le transfert des connaissances

Knowledge transfer requires the intervention of people who can link the knowledge of each member or specialist of the health care team.

With his or her communication and leadership skills, he or she will be able to assess the strengths, enabling and constraining elements of the institution, in order to establish a strategy for the transfer of skills.

What kind of knowledge transfer strategy should be adopted?

The literature identifies two main types of strategy: passive and active knowledge transfer strategies.

The former consist of the production of documents supporting the knowledge, such as posters, the provision of sillabi, etc. They are insufficient, but allow information to be transmitted and do not require major organisational changes.

The latter require more involvement, but are also much more effective. These include early consultation with carers and small group workshops, for example.

How can ISA support knowledge transfer?

In addition to the added value of falls detection, ISA supports the institution's quality approach. For example, at the Chwapi, the ISA system is fully integrated into a knowledge transfer strategy.

How CHWAPI manages knowledge transfer with ISA

Patrick Dewaele, a nurse at CHWAPI, has taken the necessary steps to get closer to his teams. In 2021, once the Covid period is a little less restrictive, working groups will be organised in this sense.

In concrete terms, the aim is to review the recordings captured for the falls detector with the nursing staff and other carers to find out their views on these events.

This will be an opportunity to check what the CHWAPI can do better in relation to patient care, but also to allow the carers to explain why the fall occurred.

Is it related to patients not listening to staff recommendations? Are the falls related to bedside tables with faulty brakes? In this case, it is no longer the nurse who should be questioned, but the structure or department that buys the bedside tables, or the chairs that do not have armrests, etc.

In this process, the falls register automatically kept by ISA will be a precious help.