Despite the existence of guidelines for the management of falls, it is always difficult to implement them in the field. It is always a question of reconciling the published literature with the realities in practice.
The geriatric patient evolves in a complex system: the care environment.
Medicine is a field where knowledge is constantly evolving. Healthcare institutions are professional environments that are still compartmentalized, where tasks and skills are highly segmented.
They say that nursing is a profession of the heart. Indeed, the patients will also have to deal with the caregivers as people, with their limits and their abilities.
This article offers avenues for reflection to better understand our place in the hospital system as caregivers. To improve the quality of care, it is important to provide more fluidity in the management of geriatric patients.
What’s a theoretical framework for the transfer of skills?
The PARHIS (Promoting Action on Research Implementation in Health Services) is a conceptual framework that allows us to approach knowledge sharing in the context of falls prevention. PARHIS offers 3 lines of action for knowledge sharing.
First, the nature of knowledge. Then, the context in which the knowledge sharing must take place. Finally, the agent vector of this knowledge.
1. The nature of knowledge
The knowledge to be transmitted must necessarily come from various sources, taking into account the experience of caregivers. We care for people, so we have to draw on a large body of knowledge to meet the needs of each patient.
We must be aware of the medical knowledge, the evolution of techniques and technologies of care, the knowledge of psychology. They all have a different weight.
The experience of the caregivers will filter this knowledge and they will end up retaining only the portion that they deem relevant within their framework of thought and in their practice (Gabbay et al., 2003). Knowledge will therefore inevitably be transformed before it is used for the needs of the organization.
Each piece of knowledge is only a fraction of what we need to work. They all have their own development, and over the course of a career that can change dramatically. Thus, the caregivers spend their lives collecting, integrating and adapting to the evolution of the knowledge they gain.
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 caregivers practice. It is therefore the institution that is responsible for transforming this knowledge into care skills.
First, analysis of the general context is essential for any change. Who is responsible for the transfer of skills? What are the resources?
Then, you have to understand the culture of the institution. What are the values? Does the institution promote research and support the desire for change of its caregivers?
Finally, how do we measure our progress? How do we see our efforts to change?
3. The agent facilitating the sharing of knowledge
Knowledge sharing requires the assistance of people who can make the connection between the knowledge of each member or each specialist of the healthcare team.
Thanks to his or her communication and leadership skills, he or she will be able to assess the strengths, the favorable and constraining elements of the institution, in order to establish a skills transfer strategy.
What type of knowledge sharing strategy to adopt?
The published literature identifies two main types of strategies: passive strategies and active knowledge sharing strategies.
The first consists of the production of documents supporting established methods, such as informational posters, providing syllabi, etc. … They are insufficient, but allow the transmission of information and do not require extensive organizational changes.
Active knowledge sharing requires more involvement, but is also much more effective. Examples of these type of efforts are early consultation with caregivers and workshops with small groups.
How can ISA support knowledge sharing?
Beyond the added value of detecting falls, ISA helps support the institution’s quality approach. For example, in CHwapi (Centre Hospitalier de Wallonie Picarde), the ISA system is fully integrated into a knowledge sharing strategy.
How the CHwapi manages knowledge sharing with ISA
Patrick Dewaele, nursing manager 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 organized for this purpose.
Concretely, it is about reviewing the recordings captured by the fall detector with the nurses and other caregivers to learn and understand their point of view regarding these events.
This will be an opportunity to check what the CHWAPI can do best in relation to patient care, but also to allow caregivers to explain the reason for the fall.
Does it have to do with patients who do not listen to staff recommendations? Are the falls related to nightstands with defective brakes? In such a case, it is no longer the nurse who should be called upon, but the organization, the department that buys the nightstands, or the chairs that do not have an armrest, etc. In this process, the fall register automatically kept by ISA will be of great help.