Nursing staff attitudes of hip protector use in long-term care, and differences in characteristics between adherent and non-adherent residents: A survey and observational study

Background

Hip fractures represent an increasing public health burden with a simple fall to the floor as the most common cause. Because nursing home residents are particularly at risk, nursing homes should implement a broad range of fall prevention strategies. However, not all fall incidents can be avoided and external hip protectors may contribute to prevent hip fractures. A major problem in studying the effectiveness of hip protectors is residents’ poor adherence. In nursing homes, adherence is dependent not only on the resident, but also on staff knowledge of and attitudes about hip protectors.

Objectives

To describe (1) attitudes of day versus night shift caregivers towards the use of a soft hip protector, (2) residents’ adherence about the use of such protectors, and (3) differences in characteristics between adherent and non-adherent residents.

Design

Survey and observational study.

Setting

Nursing home.

Participants/methods

: Survey of care staff (n = 37) in a nursing home after 8 months of continued application of a soft hip protector policy in residents (n = 68). Adherence to wearing the hip protector, measured by weekly unannounced, randomly determined checks during day and night in the 8 months after the start of the study.

Results

Overall, 85% agreed to wear a hip protector. At 8 months, only 29% was still wearing their hip protector; with significant differences between day and night shifts. Although virtually all caregivers (97%) considered a hip protector policy in residential care as feasible, the attitude towards hip protectors was found to be significantly different between day and night caregivers. Pain and discomfort, patient insight in the usefulness of these devices, interference with incontinence materials, and the overall resident mix and care acuity were reported as major barriers.

Conclusion

Implementing a hip protector policy for injury prevention in long-term care is not an issue of whether or not to use the devices. Rather, it is a continued clinical nursing decision process about when and when not, by whom and by whom not, why and why not, for how long, and to what clinical benefit - considering both the needs of the individual resident and the feasibility of such a policy in the context of resident mix and nursing staff.