Educational actions for the prevention of falls in hospitalized patients: Integrative review




Health education; Patients; Nursing; Accidental falls; Hospitalization.


This article aims to analyze evidence on educational actions aimed at preventing falls from patients in the hospital environment. It is an integrative review that included studies that carried out educational actions directed at patients, family members and the hospital assistance team with a viem to preventing falls. Search performed in the databases: virtual health library, PubMed and Scopus, published between 2005 and 2020. The corpus of analysis comprised 19 articles. Most of the evidence in the articles refers to educational actions directed at the patient, Family members and/or the assistance team with various strategies in order to prevent falls, however studies that used mixed approaches obtained more striking results. The analysis indicated that the insertion of the patient is fundamental when thinking about educational actions with a view to reducing falls in the hospital environment. For educational actions to be successful, patients also need a greater contribution of knowledge, able to identify risk factors in that environment and, from that, be able to suggest, together with Family members and teams, priority actions to reduce them.

Author Biographies

Vivian Lemes Lobo Bittencourt, Universidade Regional Integrada do Alto Uruguai e das Missões

Enfermeira. Doutoranda em Educação nas Ciências. Docente no curso de Graduação em Enfermagem na Universidade Regional Integrada do Alto Uruguai e das Missões.

Sandra da Silva Kinalski, Universidade Regional do Noroeste do Estado do Rio Grande do Sul

Enfermeira. Doutoranda em Enfermagem. Docente no curso de Graduação em Enfermagem na Universidade Regional do Noroeste do Estado do Rio Grande do Sul. 

Eniva Miladi Fernandes Stumm, Universidade Regional do Noroeste do Estado do Rio Grande do Sul

Enfermeira. Doutora em Ciências - Enfermagem. Docente dos programas de Pós-graduação Stricto Sensu em Sistemas Ambientais e Sustentabilidade e Atenção Integral à Saúde Ampla associação entre a Universidade de Cruz Alta e Universidade Regional do Noroeste do Estado do Rio Grande do Sul. 

Maria Simone Vione Schwengber, Universidade Regional do Noroeste do Estado do Rio Grande do Sul

Educadora física. Doutora em Educação. Docente no Progama de Pós-graduação Stricto Sensu em Educação nas Ciências da Universidade Regional do Noroeste do Estado do Rio Grande do Sul.


Abbasi, M., Eslami, S., Mohammadi, M. & Khajouei, R. (2017). The pedagogical effect of a health education application for deaf and hard of hearing students in elementary schools. Electron Physician, 9(9), 5199-5205.

Aguiar, J.R., Barbosa, A.O., Galindo Neto, N.M., Ribeiro, M.A., Caetano, J.Á. & Barros, L.M (2019). Fatores de risco associados à queda em pacientes internados na clínica médica-cirúrgica. Acta Paul. Enferm. (Online), 32(6), 617-623.

Barbosa, A.S., Chaves, E.H.B., Ribeiro, R.G., Quadros, D.V., Suzuki, L.M. & Magalhães, A.M.M (2019). Characterization of the adult patients’ falling incidents in a university hospital. Rev. gaúcha enferm, 40(n.spe), pe20180303.

Bittencourt, V.L.L., Graube, S.L., Stumm, E.M.F., Battisti, I.D.E., Loro, M.M. & Winkelmann, E.R. (2017). Factors associated with the risk of falls in hospitalized adult patients. Rev. Esc. Enferm. USP, 51(e03237), 1-7.

Bonita, R., Beaglehole, R. & Kjellstrom, .T. (2006). Basic epidemiology 2ª ed. Geneva: WHO Press, Word Health Organization.

Brasil (2013a). Ministério da Saúde. Portaria nº 529, de 1º de abril de 2013. Institui o Programa Nacional de Segurança do Paciente (PNSP): Diário Oficial da República Federativa do Brasil.

Brasil (2013b). Ministério da Saúde. Anexo I: protocolo prevenção de quedas. Brasília: Ministério da Saúde, Anvisa, Fio Cruz; 2013.

Cangany, M., Back, D., Hamilton-Kelly, T., Altman, M. & Lacey, S. (2015). Bedside Nurses Leading the Way for Falls Prevention: An Evidence-Based Approach. Crit. care nurse, 35(2): 82-84.

Carroll, D.L., Dykes, P.C. & Hurley, A.C. (2010). Patients' perspectives of falling while in an acute care hospital and suggestions for prevention. Appl. nurs. res., 23(4), 238-241.

Clarke, H.D., Timm, V.L., Goldberg, B.R. & Harttrup, S.J. (2012). Preoperative Patient Education Reduces In-hospital Falls After Total Knee Arthroplasty. Clin. Orthop. relat. res., 470(1), 244–249.

Dean, E. (2012). Reducing falls among older people in hospital. Nurs. older people., 24(5), 6-19.

Deandrea, S., Lucenteforte, E., Bravi, F., Foschi, R., Vecchia, C.L. & Negri, E. (2010). Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiol. (Baltimore), (21)5, 658-668.

Duckworth, M. et al. (2019). Assessing the Effectiveness of Engaging Patients and Their Families in the Three-Step Fall Prevention Process Across Modalities of an Evidence-Based Fall Prevention Toolkit: An Implementation. Science Study. J. med. internet res., 21(1), e10008.

Dupree, E., Fritz-Campiz, A. & Musheno, D. (2014). A new approach to preventing falls with injuries. J. nurs. care qual., 29(2), 99-102.

Dykes, P.C., I-Ching, E.H., Soukup, J.R., Chang, F. & Lipsitzet, S. (2012). A Case Control Study to Improve Accuracy of na Electronic Fall Prevention Toolkit. Proc. AMIA Annu. Symp., 170–179.

Fineout-Overholt, E. & Stillwell, S.B. (2011). Asking compelling, clinical questions. In: B. M. Melnyk, E. Fineout-Overholt. Evidence-based practice in nursing & healthcare: a guide to best practice. Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins, 25-39.

France, D., Slayton, J., Moore, S., Domenico, H., Matthews, J. & Steban, R.L. et al. (2017). A multicomponent fall prevention strategy reduces falls at an academic medical center. The Joint Commission Journal on Quality and Patient Safety, 43(9), 460–470.

Goljar, N., Globokar, D., Puzic, N. & Kopitar, N. (2016). Effectiveness of a fall-risk reduction programme for inpatient rehabilitation after stroke. Disabil. rehabil., 38(18),1-9.

Gottlieb, S. & Makower, J. (2013). A role for entrepreneurs: an observation on lowering healthcare costs via technology innovation. Am. j. prev. med., 44(1).

Heck, J., Gebhart, A. & Gaehle, K. (2015). Accountability and teamwork: tools for a fall-free zone. Nurs. manage., 46(1), 40-45.

Hernández-Herrera, D., Aguilera-Elizarraraz, N., Veja-Argote, M., Gonzálesz-Quirarte, N., Castañeda-Hidalgo, H. & Isase-Hernández, L. (2017). Aplicación de las actividades de la intervención de enfermería Prevención de caídas en adultos hospitalizados. Enferm. univ., 14(2),118-123.

Hill, A., McPhail, A., Francis-Coad, N., Waldron, N., Erherton-Beer, C. & Flicker, L., et al. (2015). Educators’ perspectives about how older hospital patients can engage in a falls prevention education programme: a qualitative process evaluation. BMJ Open, 5(e009780).

Hill, A., McPhail, A., Waldron, N., Erherton-Beer, A., Ingram, K. & Flicker, L. et al. (2015). Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: A pragmatic, steppedwedge, cluster-randomised controlled trial. Lancet, 385(9987), 2592–2599.

Hitcho, E.B. et al. (2004). Characteristics and circumstances of falls in a hospital setting: A prospective analysis. J. gen. intern. med. Medicine, 19(7), 732–739.

Hurley, A.C., Dyckes, P., Carroll, D.L., Dykes, J. & Middleton, B. (2009). Fall TIP: Validation of Icons to Communicate Fall Risk Status and Tailored Interventions to Prevent Patient Falls. Studies in Health Technology and Informatics, 146, 455–459.

Ireland, S., Lazar, T., Mayrak, C., Morgan, B., Pizzacalla, A. & Reis, C., et al. (2010). Designing a Falls Prevention Strategy That Works. J. nurs. care qual., 25(3), 198–207.

Jeske, L., Kolmer, V., Muth, M., Cerns, S., Moldenhaur, S. & Hook, M.L. (2006). Partnering With Patients and Families in Designing Visual Cues to Prevent Falls in Hospitalized Elders. J. nurs. care qual., 21(3), 236–241.

Kuhlenschmidt, M.L., Reeber, C., Wallace, C., Chen, Y., Barnholtz-Sloan, J. & Mazanec, S. (2016). Tailoring Education to Perceived Fall Risk in Hospitalized Patients With Cancer: A Randomized, Controlled Trial. Clin. j. oncol. Nurs., 20(1), 84-89.

Luzia, M.F., Cassola, T.P., Suzuki, L.M., Dias, V.L.M., Pinho, L.B. & Lucena, A.F. (2018). Incidência de caídas y acciones preventivas en un Hospital Universitario. Rev. Esc. Enferm. USP., 52(e03308).

Luzia, M.F., Prates, C.G., Bombardelli, C.F., Adorna, J.B. & Moura, G.M.S.S. (2019). Characteristics of falls with damage to hospitalized patients. Rev. gaúcha enferm., 40(n.spe), e20180307.

Melin C. (2018). Reducing falls in the inpatient hospital setting. Int. j. evid.-based healthc., 16(1), 25–31.

Mendes, K.D.S., Silveira, R.C.C.P. & Galvão, C.M. (2008). Integrative literature review: a research method to incorporate evidence in health care and nursing. Texto Contexto Enferm., 17(4), 758-764.

Nobre, M.R., Bernardo, W.M. & Jatene, F.B. (2004). Evidence based clinical practice: part I - well structured clinical questions. Rev. bras. reumatol., 44(6), 397-402.

Opsahl, A.G., Ebright, P., Cangany, M., Lowdwe, M., Scott, D. & Shaner, T. (2017). Outcomes of Adding Patient and Family Engagement Education to Fall Prevention Bundled Interventions. J. nurs. care qual., 32(3), 252-258.

Paiva, M.C.M.S., Gallasch, C.H., Lima, S.A.M., Sitton-Kent, L., Devo, R. & Xyrichis, A. (2017). Patients’ perceptions of health care-related infections and safety measures. Rev. enferm UERJ, 25(e27468).

Paula, C.C., Padoin, S.M.M. & Galvão, C.M. (2016). Metodologias da pesquisa para a enfermagem e saúde: da teoria à prática. In: Lacerda LMR, Costenaro RGS, editores. Revisão integrativa como ferramenta para tomada de decisão na prática em saúde. 226 – 230.

Pereira, A.S et al. (2018). Metodologia da pesquisa científica [recurso eletrônico] / Adriana Soares Pereira ... [et al.]. – 1. ed. – Santa Maria, RS : UFSM, NTE, 2018. 1 e-book.

Quigley, P.A. (2016). Evidence levels: applied to select fall and fall injury prevention practices. Rehabil. nurs., 41(1), 5-15.

Radecki, B., Reynolds, S. & Kara, A. (2018). Inpatient fall prevention from the patient's perspective: A qualitative study. Appl. nurs. res., 43:114–119.

Renteln-Kruse, W. & Krause, T. (2007). Incidence of In-Hospital Falls in Geriatric Patients Before and After the Introduction of an Interdisciplinary Team–Based Fall-Prevention Intervention. J. am. geriatr. soc., 55(12), 2068-2074.

Ribeiro, H.C.T.C, Santos, D.S., Paula, A.O., Freire, E.M.R. & Alves, M. (2016). Non-conformities in hospitals related to the infection and adverse events prevention and control. Rev. enferm. UFPE on line, 10(9), 3344-51.

Ryu, M., Roche, J.P. & Brunton, M. (2009). Patient and Family Education for Fall Prevention. J. nurs. care qual., 24(3), 243–249.

Saiz-Vinuessa, M.D., Muñoz-Mansilha, E., Muñoz-Serrano, T., Córcoles-Jiménez, M.P., Ruiz-García, M.V. & Fernández-Pallarés, P., et al. (2016). Implantación de una guía de buenas prácticas para la prevención de caídas: percepción de los pacientes hospitalizados y sus cuidadores. Rev. calid. asist., 31(6), 329-337.

Schwendimann, R., Bühler, H., Geest, S. & Milisen, K. (2006). Falls and Consequent Injuries in Hospitalized Patients: Effects of an Interdisciplinary Falls Prevention Program. BMC health serv. res. (Online)., 6(69), 1-7.

Tzeng, H., Yin, C., Fitzgerald, K. & Graham, K. (2015). i Engaging User Testing Lessons Learned From Inpatients and Health Care Providers. J. nurs. care qual., 30(3), 275–282.

Vaccari, E., Lenardt, M.H., Wilig, M.H., Betiolli, S.E. & Andrade, L.A.S. (2016). Patient safety and falls in the hospital environment. Rev. cogitare enferm., 21(n. esp), 01-09.

Vasconcelos, E.M. (2001). A saúde nas palavras e nos gestos: reflexões da rede de educação popular e saúde. 1 ª ed. São Paulo: Hucitec.

Vasconcelos, E.M. (2019). Educação popular em saúde: constituição e transformação de um campo de estudos e práticas na saúde coletiva. In: Pelicioni MCF, Mialh FL, editores. Educação e promoção da saúde: teoria e prática. Rio de Janeiro: Santos.

WHO, World Health Organization. (2018). Fall. Geneva(CH): WHO.

WHO, World Health Organization. (2004). Patient safety: a global priority. Bull World Health Organ.

Yasan, C., Burton, T. & Tracey, M. (2020). Nurses’ documentation of falls prevention in a patient centred care plan in a medical Ward. Aust. j. adv. nurs., 37(2), 19-24.

Zuyev, L., Benoit, A.N., Chang, F.Y. & Dykes, P.C. (2011). Tailored Prevention of Inpatient Falls. Comput. inform. nurs., 29(2), 93–100.



How to Cite

BITTENCOURT, V. L. L.; KINALSKI, S. da S.; STUMM, E. M. F.; SCHWENGBER, M. S. V. Educational actions for the prevention of falls in hospitalized patients: Integrative review. Research, Society and Development, [S. l.], v. 10, n. 4, p. e21110413954, 2021. DOI: 10.33448/rsd-v10i4.13954. Disponível em: Acesso em: 7 may. 2021.



Health Sciences