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  2. Preventing Falls in Hospitals
  3. Dr. Dweck’s research into growth mindset changed education forever

Chandrasekaran and Kraus further demonstrated in their study that:. Musicians showed enhanced induced gamma-band activity GBA , which is oscillatory activity in the 25 Hz Hz range. Induced GBA is argued to reflect integration of top-down and bottom-up sensory processing [ Trainor et al. Although musical engagement implicates a vast range of brain areas, a detailed discussion of which would require an article in its own right for instance, see the nice review by Zatorre et al.

It is plausible that the different forms of improved functioning resulting from musical experience that we have discussed above could either directly or indirectly influence our positive emotional states; directly, if positive affect is directly associated with improved functioning in the forms mentioned above, or indirectly if these forms of improved functioning lead one to greater practical success e.

Further, these findings are of practical import since studies have shown that individuals spend a significant amount of time and energy structuring their lives in ways that will facilitate positive feelings and emotions Gollwitzer, ; Mischel et al. Furthermore, music can influence our emotional states, which in turn influence our orientation toward the world, our comportment, and our action readiness, all of which are usually manifested in our observable behavior.

Since our emotional states typically influence our observable behavior, and since others often take our observable behavior into consideration when interacting with us, our emotional states can also typically influence our interactions and relationships with other people. For example, the presence of positive emotions such as happiness tends to increase liking and social interaction with others, whereas the presence of negative emotions such as sadness tends to decrease liking and social interaction with others Clark et al.

So one way music can influence our relationships with other people is by influencing our emotions that in turn influence our relationships with other people. Emotional regulation is one of the important reasons for establishing relationships with others in the first place Zillmann et al. Through their influence on the emotions, music can facilitate the strengthening of bonds with others by demonstrating commitment in relationships and by providing evidence of those commitments to others Frank, For instance, many group selectionists argue that musical behavior is evolutionarily adaptive because it promotes group coordination and cohesion among members, synchronizing group actions, emotions, and identity Merriam, ; Turnbull, ; Lomax, ; Hood, ; Seeger, ; Richman, ; Feld, ; Freeman, ; McNeill, ; Richman, , p.

For instance, synchronized chorusing has been found in certain species of insects Otte, ; Greenfield and Shaw, and frogs Wells, ; Klump and Gerhardt, , and fireflies have been shown to synchronize their bioluminescent flashing at night Buck, Researchers have also found that there are at least several hundred species of birds that perform precisely synchronized duets in order to stay in sync reproductively, strengthen partnership bonds, or defend territories Brown, b , p. So it is plausible, many group selectionists argue, that musical behavior likewise evolved in humans to unite individuals into groups and strengthen partnership bonds Brown, b , p.

This, in turn, is hypothesized to facilitate interpersonal coordination, social bonding, and possibly even reproductive benefits. For instance, one hypothesis that has been suggested is that a group of male chimpanzees, upon discovering a resource such as large fruit trees, synchronize their chorusing in order to produce a stronger vocalization than other groups of males for the purpose of attracting the attention of — and thus increasing the probability of mating with — migrating females Merker, , pp.

In this sort of way, synchronized group chorusing among chimpanzees and even humans might have conferred reproductive advantages, in addition to more obvious advantages in hunting and combat. In any case, regardless of the specific details of our evolutionary past, a great deal of our behavior today is in fact oriented toward strengthening our social bonds with others, and we typically experience better physical, mental, and emotional health when we have others to bond with Argyle, ; Myers, Our positive emotions are largely influenced by and directed at others Seligman, and it has been shown by several scholars that participating in enjoyable activities with friends is predictive of subjective well-being Heady et al.

As Argyle writes:. Argyle, , p. Other work has shown that individuals in close relationships with others cope better with stress and illness Cohen, ; House et al. Individuals that have a network of social support are likely to live longer than individuals that do not Vaillant, , and when participants were asked which element in life would bring them the most happiness, most cited love, or close interpersonal relationships Freedman, ; Berscheid, ; Pettijohn and Pettijohn, It should be clear that participating in a band or musical group can serve as a means for building close relationships with others, since the mastery of a musical work provides the band members with a common purpose, common ground, and a potentially extensive amount of time together for the sake of rehearsal and performance.

That is to say, participation and commitment to activities, such as musical events, often involves participation with and commitment to others, as many activities involve a social component and are of sociocultural significance Erikson, ; Havighurst, Musicians, like other performers, have the opportunity to care for others every time they perform. Insofar as music listeners enjoy listening to music, musicians have the opportunity to provide listeners with something that they enjoy, and thereby have the opportunity to perform a kind deed for others every time they perform.

And insofar as performing kind deeds for others can reliably produce momentary increases in well-being, as Seligman has argued, this suggests that performing music for others can produce momentary increases in well-being also. Furthermore, insofar as a musician is cognizant of the fact that their performance is providing pleasure and momentary increases of well-being to their listeners, that musician is afforded evidential support for believing that they have actually accomplished something see Music and Accomplishment and that their actions are meaningful or purposeful see Music and Meaning; see also Seligman, Thus, participation and commitment to shared activities can facilitate social bonding or connection with others Baumeister and Leary, , often times through the development of shared sensitivities and norms for evaluative ascriptions Croom, a , b , a , b , , which influence both the individual and the larger community within which that individual participant is engaged Putnam, Musical activity is not only of practical application for the cultivation of positive emotions and strong interpersonal relationships, although musical activity often does serve these functions.

Music can also positively influence other features that we have identified as characteristic of a flourishing life. Another important feature that we identified as characteristic of a flourishing life was the presence of flow experiences, i. Features of flow experiences include perceptions of control, task focus, and a resultant absence of public self-consciousness Vallerand et al. Previous research has shown that, in contrast with people that do not experience flow, people with flow experiences typically report higher levels of well-being Haworth and Hill, ; Haworth and Evans, ; Haworth, ; Csikszentmihalyi, ; Eisenberger et al.

One psychologist that has done extensive research in this area is Csikszentmihalyi, and in his book Flow: The Psychology of Optimal Experience , he reports finding that people are happiest when they are most absorbed in their actions and experiencing flow. Findings like this are relevant for our understanding of flow because, insofar as background factors that distract someone from engaging attentively with their current activity interrupts their experience of flow Nakamura and Csikszentmihalyi, ; Carpentier et al.

We can even experience the pleasures of virtuosity relative to our prior lack of ability, as, for instance, Sudnow , describes his experience of accomplishment over the 6 year period in which he learned to improvise jazz on the piano. In flow experience we are optimally attentive and tuned in to what we are doing, deploying our most developed skills which in turn afford us feedback in the form of positive emotions, a sense of accomplishment and purpose, and even better relationships Seligman, , p.

So musical practice and performance, as a conduit for flow experiences, likewise offers us an avenue for attunement, perceptual and cognitive exercise, the accomplishment of successful motor execution, the experience of positive emotional states and pleasurable auditory stimulation, the meaning derived from participating in a larger social entity and offering a distinctive contribution, and connecting with others. Many practicing musicians are likely to feel the same way, and accordingly, musical involvement can help people attain a sense of personal accomplishment.

Numerous findings have demonstrated that those individuals that made the most significant accomplishments in their field of practice were those that spent the most time devoted to carefully practicing what it is that they do Chase and Simon, a , b ; Hayes, ; Bloom, ; Ericsson et al. For instance, Bloom conducted a study based on interviews of accomplished professionals from a broad range of fields — including, for instance, highly accomplished scientists e. A study conducted by Ericsson et al. But the main finding for our purposes here is that what distinguishes a truly outstanding musician, or any other specialist or professional, from those of less or no skill is the amount of structured motor behavior they have unreflectively available for action, which is itself typically the result of undergoing hard-earned practice and repetitive motor drill Seligman, For instance, studies have found that world-class musicians averaged 10, h of solo practice by the time they were 20 years old, in contrast to 5, h for the next lower level musician, and in contrast with 2, h for merely serious amateur musicians Ericsson et al.

But not only are individual members brought together to collectively constitute the larger whole that is their band, but this collective constitution also typically assigns each member a unique role to perform within that larger whole. Finally, musical engagement can afford one a sense of meaning or purpose in life. The emotion that music is capable of soliciting from us may influence our well-being, not only through positively influencing our social interactions and relationships with others, but also by positively influencing our sense of coherence in the world and our sense of identity Frijda, Research has shown that pursuing and making progress toward goals that one finds valuable, such as becoming a more proficient musician, are associated with positive affect, as well as physical and psychological well-being Diener, ; Emmons, ; Cantor and Sanderson, It has been suggested that this is because commitment to particular goals can provide one with a consistent sense of personal agency Cantor, , structure, and purpose in their daily life Klinger, ; Little, ; Cantor and Sanderson, In this way, musical goals can provide one with a consistent sense of personal agency e.

Each band member, as a dependable musical comrade, has a role and a responsibility to the larger band to which they submit themselves as constituent members. And insofar as one consistently performs their social role and responsibility as a contributing musical member, this can provide the musician with a venue through which to continually re-experience a moment of purpose in their life.

Various musical performances that the musician has previously accomplished with success could also provide the musician with salient memories of those prized moments when he had served his musical purpose successfully in the past. It should be mentioned before concluding this article that musical activity does not always or necessarily lead to well-being. In fact, there are various risks associated with musical activity, like any other physically demanding activity that can be done excessively or incorrectly Sataloff et al.

Some of these risks are more instrument-specific than others. For instance, pianists are particularly susceptible to musculoskeletal pain and problems in the hands and wrists Yoshimura et al. Another study by Kreutz et al. Accordingly, research suggests that musicians wanting to prevent or downplay potential music-related injuries while maximizing music-related benefits should spend an appropriate amount of time warming up, cooling down, and resting at intervals during practice sessions, pay particular attention to the posture of their spine and upper limbs, and maintain a healthy diet and exercising regimen Wynn Parry, ; Kreutz et al.

Fortunately, music departments and conservatories have become increasingly aware of the potential risks associated with musical practice and performance, and have been actively creating special programs concerned with both the prevention and treatment of music-related injuries Chesky et al.

For further discussion I refer the reader to the literature Fishbein et al. My claim was that musical activity can do this, and throughout the course of this article I have offered new evidence in support of this claim. The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. I would first and foremost like to thank Marty Seligman and the Positive Psychology Center at the University of Pennsylvania for generously offering me financial support to carry out this research.

Finally, I would like to express my gratitude to Dan Lloyd and the two reviewers of this article for their very helpful comments and suggestions. Abbey, A. Modeling the psychological determinants of quality of life. CrossRef Full Text. Apter, M. San Diego: Academic Press. Argyle, M. The Social Psychology of Leisure. London: Penguin. Kahneman, E. Diener, and N. Nicomachean Ethics , trans.

Chase New York: E. Avant, S. Stress management techniques: anxiety reduction, appeal, and individual differences. Bangert, M. BMC Neurosci. Classical conditioned responses to absent tones. Bargh, J. Wyer Mahwah: Erlbaum , 1—6. Batson, C. The Religious Experience. New York: Oxford University Press. Baumeister, R. The need to belong: desire for interpersonal attachments as a fundamental human motivation. Bayens, F.

Contingency awareness in evaluative conditioning: a case for unaware affective-evaluative learning. Beauvios, M. Time decay of auditory stream biasing. Bengtsson, S. Extensive piano practicing has regionally specific effects on white matter development. Berscheid, E. Kelley San Francisco: Freeman , — Bidelman, G. Cross-domain effects of music and language experience on the representation of pitch in human auditory brainstem.

Blacking, J. Music, Culture, and Experience. London: University of Chicago Press. Bloch, C. Moods and quality of life. Happiness Stud. Bloom, B.

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Developing Talent in Young People. New York: Ballantine Books. Brandt, P. Music and the abstract mind. Music Meaning 7, 1— Brickman, P. Brickman Englewood Cliffs: Prentice-Hall , — Brown, S. Wallin, B. Merker, and S. Tonneau and N. Thompson New York: Plenum Publishers , — Buck, J. Synchronous rhythmic flashing in fireflies II. Cantor, N. Caporael, L. Reviving evolutionary psychology: biology meets society. Issues 47, — Carlsen, J. Some factors which influence melodic expectancy. Psychomusicology 1, 12— Carpentier, J. Ruminations and flow: why do people with a more harmonious passion experience higher well-being?

Carter, C. Neuroendocrine perspectives on social attachment and love. Psychoneuroendocrinology 23, — Chandrasekaran, B. Music, noise exclusion, and learning. Music Percept. Relative influence of musical and linguistic experience on early cortical processing of pitch contours. Brain Lang.

Chase, W. Perception in chess. Chase New York: Academic Press , — Chesky, K. Health promotion in schools of music: initial recommendations for schools of music. Christensen-Dalsgaard, J. Music and the origin of speeches. Music Meaning 2, 1— Clark, M. Fletcher and J.

Fitness Mahwah: Erlbaum , — Clarke, S. Cohen, S. Psychosocial models of the role of social support in the etiology of physical disease. Health Psychol. Collins, S. Music therapy in the neonatal intensive care unit. Neonatal Netw. Pubmed Abstract Pubmed Full Text. Conard, N. New flutes document the earliest musical tradition in southwestern Germany.

Nature , — Cosmides, L. Hirschfeld and S. Lewis and J. Haviland-Jones New York: Guilford , 91— Croom, A. South Afr. Aesthetic concepts, perceptual learning, and linguistic enculturation: considerations from Wittgenstein, language, and music. Adaptations, aesthetics, and the evolutionary origins of music. Cross, I. Music, cognition, culture, and evolution. Csikszentmihalyi, M. Beyond Boredom and Anxiety. San Francisco: Jossey Bass. Flow: The Psychology of Optimal Experience. New York: Harper Perennial.

Darwin, C. London: John Murray. Delle Fave, A. Linley and S. Joseph Hoboken: Wiley , — DeNora, T. Music in Everyday Life. New York: Cambridge University Press. Diener, E. Subjective well-being. Eisenberger, R. Flow experiences at work: for high need achievers alone?

Elbert, T. Increased cortical representation of the fingers of the left hand in string players. Science , — Emmons, R. Personal strivings: an approach to personality and subjective well-being. Ericsson, K. The role of deliberate practice in the acquisition of expert performance. Erikson, E.

Childhood and Society. New York: Norton. Esteves, F. Automatically elicited fear: conditioned skin conductance responses to masked facial expressions. Feld, S. Klein and S. After the patient's needs are attended to, you need to document your findings in the medical record and complete an incident report. In this section we highlight some elements of a careful clinical review for injuries and also discuss conducting a root cause analysis to understand the causes of the fall.

An understanding of the events surrounding a fall can inform the care plan for the patient who fell, as well as guide ongoing quality improvement efforts at the unit level. Using data on falls to monitor your improvement efforts is discussed in more detail in section 5. A postfall clinical review is a structured way to collect information after a fall.

The clinical review aims to determine whether there are injuries or other complications Tool 3N, "Postfall Assessment, Clinical Review ".

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The clinical review focuses on immediate risk of injury or complications. Depending on the type of fall and patient comorbidities, including clotting disorders and use of anticoagulants, the clinical review may include assessment for injury, serial neurologic exams, and a fresh fall risk factor assessment. The new assessment will include medication review and ordering of laboratory tests. Root cause analysis is used in organizations to evaluate and understand what problems contributed to error or undesired outcomes. After a fall, you will collect data to reconstruct the event and determine the causes of and contributing factors to the fall Tool 3O, "Postfall Assessment for Root Cause Analysis".

The data collection will obtain information that may help prevent the next fall in this patient or future patients. The postfall assessment for root cause analysis captures information from the patient, staff, and other witnesses about how the fall occurred. For more on root cause analysis, go to section 5. Many components of the clinical review and root cause analysis overlap. For example, understanding the circumstances of the patient's fall can assist in assessing the patient for injuries, while also being important for understanding potential causes.

You may need to adapt Tools 3N and 3O to your hospital's specific needs. Documenting and communicating the clinical review are critical to the patient's safety, because a medical provider may need to take action based on the assessment, such as ordering lab tests or imaging studies or changing medications. In cases of falls with significant trauma, the patient may need to be taken to surgery. An oral handoff to the treating medical provider is therefore essential. Careful documentation and communication of your root cause analysis are critical to preventing future falls in the same patient. For example, if a patient was given a sedative overnight for insomnia and then fell due to being drowsy, the entire treating team including nursing, pharmacy, and medical provider needs to know what happened.

That way, they will not prescribe the sedative again to that patient or future patients in similar circumstances. After a fall occurs and the patient's root cause analysis is complete, a safety huddle go to section 3. With frequent handoffs between hospital personnel, whether it be nursing staff who change shift every 8 hours, or hospitalists who rotate every week and have separate night or weekend coverage, communication is critical. The care plan discussed in section 3.

If applicable, the patient's risk factor profile can also be updated electronically by a designated member of the unit team to reflect the recent fall and any new risk factors that were discovered. For more information about what information should go into the hospital's incident reporting system, go to section 5. Performance of postfall assessments, whether for clinical review or root cause analysis, may be improved by having a standard protocol and ensuring that this protocol is easily accessible to staff on the unit.

Also, the information gathered on the assessment tool should contain all the information needed to file an incident report go to section 5 so that information does not need to be gathered twice. In settings where a medical provider makes scheduled rounds, having a nurse or pharmacist join rounds to discuss potential culprit medications related to the fall may improve the assessment process. A modified version of the tool used in this study is presented as Tool 3O. In section 3, we have outlined best practices in fall prevention that you can use to improve your fall prevention program.

Research evidence suggests that your program is most likely to succeed when it addresses multiple components, including universal precautions section 3. However, it may not be possible to tackle all these elements at once. In addition, you may want to include additional items beyond what is discussed here. Some of these items can be identified through the use of additional guidelines go to section 3. In addition to creating a program that is tailored to your hospital, you will need to customize the fall prevention program to each unit due to patient acuity and specific individual circumstances.

Thus, it is important to identify fall risk factors that are more prevalent on each specific unit. For example, a neurology unit may have a high proportion of cognitively impaired patients requiring closer monitoring. A rehabilitation unit may have a high number of patients with mobility problems. Other units may have patients whose needs fluctuate rapidly or involve frequent patient transport.

These include the emergency department, observation units for patients staying less than 24 hours in the hospital, and radiology. In addition, pediatric patients have special assessment tools, as discussed in section 3. Examples from some hospital units addressing fall prevention. Note that some of these examples include activities that may be applicable to other units as well. A number of guidelines have been published describing best practices for fall prevention in hospitals.

These guidelines can be important resources for improving fall prevention programs. Once you have read through this section, use the checklist for best practices to monitor your progress on completing the activities that have been described here. The user assumes all risk for use of the materials.

Effects of an intervention to increase bed alarm use to prevent falls in hospitalized patients. Ann Intern Med ; 10 National Patient Safety Agency, "Essential care after an inpatient fall. Search ahrq. Latest available findings on quality of and access to health care. Funding Opportunity Announcements.

Preventing Falls in Hospitals 3. Which fall prevention practices do you want to use? Previous Page Next Page. Preventing Falls in Hospitals. Are you ready for this change? How will you manage change?

Islamic Spirituality and Mental Well-Being | Yaqeen Institute for Islamic Research

How do you implement the fall prevention program in your organization? How do you measure fall rates and fall prevention practices? How do you sustain an effective fall prevention program? Tools and Resources. Team members should reach consensus on the following questions: Which fall prevention practices should you use? Which universal fall precautions should be applied throughout the hospital? How should a standardized assessment of fall risk factors be conducted?

How should identified risk factors be used for fall prevention care planning? How should you assess and manage patients after a fall? How can your hospital incorporate these practices into a fall prevention program? Some factors that make fall prevention challenging include: Fall prevention must be balanced with other priorities for the patient. The patient is usually not in the hospital because of falls, so attention is naturally directed elsewhere.

Yet a fall in a sick patient can be disastrous and prolong the recovery process. Fall prevention must be balanced with the need to mobilize patients. It may be tempting to leave patients in bed to prevent falls, but patients need to transfer and ambulate to maintain their strength and to avoid complications of bed rest. Fall prevention is one of many activities needed to protect patients from harm during their hospital stay.

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How should fall prevention be reinforced while maintaining enthusiasm for other priorities, such as infection control? Fall prevention is interdisciplinary. Nurses, physicians, pharmacists, physical therapists, occupational therapists, patients, and families need to cooperate to prevent falls. How should the right information about a patient's fall risks get to the right member of the team at the right time? Fall prevention needs to becustomized.

Each patient has a different set of fall risk factors, so care must thoughtfully address each patient's unique needs. Return to Contents 3. Which fall prevention practices should you use?

Healthcare Delivery

To simplify things, we have broken down fall prevention activities into separate steps: Universal fall precautions, including scheduled rounding protocols section 3. Standardized assessment of fall risk factors section 3. Care planning and interventions that address the identified risk factors within the overall care plan for the patient section 3.

Postfall procedures, including a clinical review and root cause analysis section 3. Falls can be classified into three types: Physiological anticipated. How are the different components of the fall prevention program related? Implementing Fall Prevention Practices: Locally Relevant Considerations Hospitals have experienced local challenges in trying to implement best practices. Examples of challenges with risk assessment tools include: Hospitals indicate that their current risk assessments do not sufficiently cover some factors e.

The fall risk score is associated with a standard set of interventions that is not customized to individual patients' needs. The current fall risk assessment results in almost all patients being categorized as high risk for falls, which dilutes the value of this designation with staff and their compliance with fall prevention strategies. Examples of challenges with specific interventions include: Some medication order sets include medications that are known to have a high risk for falls.

There is overreliance on bed alarms as a fall prevention strategy. The use of various flags to indicate fall risk is so prevalent that their use becomes ineffective. Early mobilization may be compromised by extended bed rest orders that are not discontinued. What are universal fall precautions and how should they be implemented? What are universal fall precautions? Have the patient demonstrate call light use. Maintain call light within reach. Keep the patient's personal possessions within patient safe reach. Have sturdy handrails in patient bathrooms, room, and hallway.

Place the hospital bed in low position when a patient is resting in bed; raise bed to a comfortable height when the patient is transferring out of bed. Keep hospital bed brakes locked. Keep wheelchair wheel locks in "locked" position when stationary. Keep nonslip, comfortable, well-fitting footwear on the patient. Use night lights or supplemental lighting. Keep floor surfaces clean and dry. Clean up all spills promptly. Keep patient care areas uncluttered. Follow safe patient handling practices.

Why are universal fall precautions important? How are universal fall precautions performed? For example, the 5 P's could be: Pain: Assess the patient's pain level. Provide pain medicine if needed. Position: Help the patient get into a comfortable position or turn immobile patients to maintain skin integrity. Placement: Make sure patient's essential needs call light, phone, reading material, toileting equipment, etc. To read more about the evidence that supports hourly rounding, see: Halm MA. Hourly rounds: what does the evidence indicate?

Am J Crit Care ; Hourly rounding: challenges with implementation of an evidence-based process. J Nurs Care Qual ; Local Approaches to Implementing Scheduled Rounding An opening and closing script for interaction with the patient is provided. The closing script states, "If you need a nurse before I come back, use the call bell or contact the charge nurse at the phone number on the white board.

Document completion of rounding on an hourly rounding tracking tool kept in the patient rooms. Conduct rounds every 2 hours between the hours of 10 p. The following tools can be found in Tools and Resources: Hourly rounding protocol to ensure that universal precautions are in place Tool 3B, "Scheduled Rounding Protocol".

Inspection checklist for regular environmental rounds with nursing staff and facilities engineers to identify and resolve environmental safety issues Tool 3C, "Tool Covering Environmental Safety at the Bedside". Hazard report form to alert the unit manager that items require fixing Tool 3D, "Hazard Report Form".

Fable hospital 2. Hastings Cent Re p ; How should universal fall precautions be documented? What are some barriers to implementing universal fall precautions? What is a standardized assessment of risk factors for falls, and how should this assessment be conducted? What is a standardized assessment of risk factors for falls? Why is a standardized assessment of risk factors necessary? Assessment of risk factors for falls is essential for a number of reasons: It aids in clinical decisionmaking. Use of a standardized assessment helps ensure that key risk factors are identified and therefore can be acted on.

It allows the targeting of preventive interventions to the correct patients. Fall prevention is resource intensive. Resources should be targeted toward those who would most benefit. It facilitates care planning. Care plans can better focus on the specific dimensions that place the patient at greatest risk.

It facilitates communication between health care workers and between care settings. Workers have a common language by which they describe risk. How is the assessment of risk factors performed? Key risk factors common to assessments include: History of falls: All patients with a recent history of falls, such as a fall in the past 3 months, should be considered at higher risk for future falls. Mobility problems and use of assistive devices: Patients who have problems with their gait or require an assistive device such as a cane or a walker for mobility are more likely to fall.

Medications: Patients on a large number of prescription medications, or patients taking medicines that could cause sedation, confusion, impaired balance, or orthostatic blood pressure changes are at higher risk for falls. Mental status: Patients with delirium, dementia, or psychosis may be agitated and confused, putting them at risk for falls.

Continence: Patients who have urinary frequency or who have frequent toileting needs are at higher fall risk. Other patient risks include being tethered to equipment, such as an IV pole, that could cause the patient to trip; impairment in vision that could cause a patient not to see an environmental hazard; and orthostatic hypotension, which could cause the patient to become lightheaded or pass out when standing. Instructions on measuring and evaluating orthostatic vital signs can found in the Tools and Resources section Tool 3F, "Orthostatic Vital Sign Measurement".

What is the role of fall risk scores? Research has shown that scores from fall risk prediction tools do not actually predict falls any better than a clinician's judgment. For details, go to: Oliver D. Falls risk-prediction tools for hospital inpatients. Time to put them to bed? Age Ageing ;37 3 Which assessment tools are used most often? Ask yourself and your team: Do unit staff understand why they are assessing fall risk factors?

Do they systematically assess the most important risk factors for falls among patients in your units?

Preventing Falls in Hospitals

For instructions on how to locally validate your preferred fall risk factor tool, you can use this spreadsheet "How effective is your Falls Prediction Tool? The Morse tool also has links to a training module. Exploring and evaluating five paediatric falls assessment instruments and injury risk indicators: an ambispective study in a tertiary care setting. J Nurs Manage ; How often is the assessment of fall risk factors done?

Considering the specific patient situation, ask yourself and your team: How often should the assessment of fall risk factors be done on your unit? How often is it actually being done? How can we improve the accuracy of the fall risk factor assessment? Check how risk factor assessment is performed on each unit: Unit managers can look at the patient record and see if the risk factors identified have been consistent go to Tool 5B, "Assessing Fall Prevention Care Processes". Wide fluctuations in risk factors are unusual in stable patients. Similarly, when there is a major change in clinical condition, check whether the patient's risk factors have changed.

Select a patient and see if the assessment is accurate. Staff may give the patient "the benefit of the doubt" and underreport the number of risk factors. Learn more about risk assessment: Oliver D, Healey F. Falls risk prediction tools for hospital inpatients: do they work? Nursing Times ; Available at: www.

Employees in high-trust organizations are more productive, have more energy at work, collaborate better with their colleagues, and stay with their employers longer than people working at low-trust companies. They also suffer less chronic stress and are happier with their lives, and these factors fuel stronger performance.

Leaders understand the stakes—at least in principle. In this article I provide a science-based framework that will help them. About a decade ago, in an effort to understand how company culture affects performance, I began measuring the brain activity of people while they worked.

Dr. Dweck’s research into growth mindset changed education forever

The neuroscience experiments I have run reveal eight ways that leaders can effectively create and manage a culture of trust. Back in I derived a mathematical relationship between trust and economic performance. I hypothesized that there must be a neurologic signal that indicates when we should trust someone. So I started a long-term research program to see if that was true. Experiments show that having a sense of higher purpose stimulates oxytocin production, as does trust. Trust and purpose then mutually reinforce each other, providing a mechanism for extended oxytocin release, which produces happiness.

So, joy on the job comes from doing purpose-driven work with a trusted team. In the nationally representative data set described in the main article, the correlation between 1 trust reinforced by purpose and 2 joy is very high: 0. I knew that in rodents a brain chemical called oxytocin had been shown to signal that another animal was safe to approach. I wondered if that was the case in humans, too.

No one had looked into it, so I decided to investigate. To measure trust and its reciprocation trustworthiness objectively, my team used a strategic decision task developed by researchers in the lab of Vernon Smith, a Nobel laureate in economics. In our experiment, a participant chooses an amount of money to send to a stranger via computer, knowing that the money will triple in amount and understanding that the recipient may or may not share the spoils. Therein lies the conflict: The recipient can either keep all the cash or be trustworthy and share it with the sender.

We found that the more money people received denoting greater trust on the part of senders , the more oxytocin their brains produced. And the amount of oxytocin recipients produced predicted how trustworthy—that is, how likely to share the money—they would be. Since the brain generates messaging chemicals all the time, it was possible we had simply observed random changes in oxytocin.

To prove that it causes trust, we safely administered doses of synthetic oxytocin into living human brains through a nasal spray. Comparing participants who received a real dose with those who received a placebo, we found that giving people 24 IU of synthetic oxytocin more than doubled the amount of money they sent to a stranger. Using a variety of psychological tests, we showed that those receiving oxytocin remained cognitively intact. We also found that they did not take excessive risks in a gambling task, so the increase in trust was not due to neural disinhibition. Oxytocin appeared to do just one thing—reduce the fear of trusting a stranger.

My group then spent the next 10 years running additional experiments to identify the promoters and inhibitors of oxytocin. This research told us why trust varies across individuals and situations. For example, high stress is a potent oxytocin inhibitor. Most people intuitively know this: When they are stressed out, they do not interact with others effectively.

We were starting to develop insights that could be used to design high-trust cultures, but to confirm them, we had to get out of the lab. This research even took me to the rain forest of Papua New Guinea, where I measured oxytocin in indigenous people to see if the relationship between oxytocin and trust is universal. It is. Drawing on all these findings, I created a survey instrument that quantifies trust within organizations by measuring its constituent factors described in the next section.

That survey has allowed me to study several thousand companies and develop a framework for managers. Through the experiments and the surveys, I identified eight management behaviors that foster trust. These behaviors are measurable and can be managed to improve performance.