Care of an individual who is falling

When undertaking any movement and handling activity, including mobilizing of a client, the importance of undertaking a thorough assessment of the task before commencing is crucial. By undertaking a comprehensive assessment and utilizing all the information gained, it is possible to identify constraints of an activity that may result in a client falling if the manoeuvre is performed, and thus influence the decision as to whether or not to utilize such a manoeuvre.

Figure 2.3 Common positions used in nursing

It is much safer to prevent a client falling in the first instance than to have them fall whilst moving or mobilizing them. With good assessment, it is possible to significantly reduce the incidence of trips, slips or falls.

To aid in the assessment of clients and their ability to weight-bear a simple assessment can be performed. This involves getting the client into a seated position. The client should then be asked to raise the lower part of their legs from the knee downwards, so that the legs are straight. The ability to successfully accomplish this will indicate whether or not the client is likely to be able to weight-bear.

If a client does fall, this can have a detrimental effect not only on them, but also on their family and indeed those caring for the client. The client may be physically injured during the fall, which may result in their ability to mobilize being reduced, with the concomitant risks. There may be subsequent loss of confidence in their own abilities to mobilize, and they may suffer from heightened anxieties and fear when people are trying to help them mobilize or move them in future. Relatives of the client who has fallen may display feelings of anxiety, anger or concern that this has happened, this being particularly, but not necessarily, more likely if physical harm has actually occurred to the client as a result of falling. For those caring for the client, there may also be feelings of anxiety. It is not
uncommon for nurses to feel a sense of anger with themselves, and a great deal of responsibility, when one of their clients has fallen, and, when physical harm has occurred, these feelings are often heightened.

However, despite the best assessment and planning in the world, unfortunately, clients do occasionally fall. Remember that when thingsdo go wrong and a client starts to fall or appears to be falling, it is by far safer for all concerned to let them fall than to attempt to catch them. The key is, whilst allowing the client to fall, to attempt to enter an element of control to the fall. This can be achieved by taking care of and cushioning the client’s head and ensuring that inanimate objects such as drip stands or other pieces of equipment attached to the client do not also fall, as they have the potential to cause further injury should they hit the client.

If at all possible allow the client to fall in a more controlled way where the least possible harm will be incurred as a result of the incident.

Proceed then to treat the client who has fallen (see below), document the occurrence and undertake a post-incident risk assessment with the aim of reducing the potential for reoccurrence following local policy. It may also be prudent to inform the client’s next of kin.