Duty to catch 'em?

[Music in My Heart]

I was just reading another post about a nurse who had a patient fall on her with a resultant serious back injury. It got me to thinking about something which I often debate with myself. Do we, as nurses, have a responsibility to attempt to break the fall of a toppling patient?

My general feeling is, "no." Honestly, even for a very, very small patient, the risk that I would cause myself permanent, disabling injury is very significant, especially since I couldn't possibly maintain good mechanics as someone's going over. It seems like the best I could manage is to perhaps try to shield their head from whacking something but if they're going to fall, I'm not likely to prevent it and I am likely to get hurt in the process. Neither of us wins by me getting injured. It's analogous to my lifeguard training in which it was drilled into my head that we should only attempt a rescue if we can do so safely.

What do you think? Do nurses have a responsibility to try to catch the falling patient or just pick up the pieces afterward (and of course, to minimize the probability of a fall to begin with)?

[canoehead, BSN, RN]

I can break the fall a little without injuring my back, if I'm right beside them. Just ease them to the floor if they become dead weight.

[caliotter3]

I got hurt one time just by helping a resident rise from his elevating recliner and helping him pivot to the bed. It was a couple of days later and I had to have assistance to get out of bed, dress, and be driven to the hospital. After that, I would be very, very hesitant to help although I had it drummed into me in my CNA days that I was supposed to keep people from hitting the floor. Don't know about that now. The employer refused to cover my work related injury.

[onetiredmomma]

Many years ago we were taught in LPN school how to lower a pt to the floor, how to to stand pivot transfers and how to recognize when we needed to call for help. It amazes me how often I work with students or new grads who have no idea how to safely transfer a pt or how to best support them while walking with them.

[6mostogo]

I understand the trepidation, but if you don't feel like you are able to prevent an injury if the person were to be unstable, then please, please don't ambulate this person by yourself.

I am just a nursing student now, but I have been a CNA for 9 years, and I've held Restorative aide positions during this time as well. I have had to execute "unplanned relocations to the ground," but never had a pt fall during a transfer or while ambulating. Neither I nor a pt has ever been injured due to a need to lower them to the floor.

You don't "catch" a falling person. Catching implies a sudden wrenching movement to stop a fall, which of course opens you to injury. Neither should you act as a human bean bag to break a fall.

When I am walking with somebody, I stay one step back and slightly to one side of them. I have a hand on them at all times, preferably on a gait belt. This alerts me quickly if the pt is having balance issues - I feel that they are off balance before they appear to be visually. It also has me properly positioned in case they do become unsteady. If they pull forward, I can pull back, if they fall back, I can guide them forward. If they are majorly unsteady, I don't attempt to hold them upright - a controlled lowering to the ground is much better than a quick stuggle resulting in the both of us on the ground. If the pt is small, i can slide them down my leg to the floor on my own. For a larger pt, I have someone else walking with me pushing a wheelchair or also behind the pt on the opposite side to assist me in lowering to the ground.

Im still upset over work this weekend, so if I seem lecturing, please forgive me. I go to school full time during the week and work every weekend. A resident who has been at my facility for several months had been steadily making improvement the past month or so. This weekend I went in and she had been given the ok by therapy to walk with nursing staff. She was excited by her progress, and as I walked her to and from meals, activities, the bathroom, etc, all she could talk about was how she hadn't been able to walk this well in over two years, that her therapist were talking about home visits to plan for discharge, etc, she greeted all the residents she passed with huge smiles and in general was over the moon about her progress.

I walked her to the afternoon activity shortly before the end of my shift. Passed on to the next shift where she was and when the activity would be over so they could walk her back to her unit. Left. Came back the next morning to learn that shortly after I clocked out, this resident wanted to return to her room, ask the help of the activity volunteer. Who, instead of alerting an aide, took it upon herself to walk this person back to the unit. She didn't even make it to through the doorway of the activity room... broken hip. I'm just sick about it. Since Sunday I can't keep the picture out of my mind of this poor woman lying on the ground, crying "I was doing so well. I was so close. I was going to go home!"

[Music in My Heart]

I understand the trepidation, but if you don't feel like you are able to prevent an injury if the person were to be unstable, then please, please don't ambulate this person by yourself.

I'm not thinking about ambulating them.

I'm actually thinking about several events that have happened when the patient decided to stand/climb/walk by themselves.

One was a EtOH abuser who decided to go AMA and stood up without warning, only to stumble backwards - fortunately right into a chair.

One was a very old guy who, after days and days of lying peacefully in bed decided to get up. I just happened to see him as he was 50% of the way out of bed.

Another was a psychotic patient (on my med-surg floor) who was combative when approached and who decided to walk down the hall (with me trailing a wheelchair). Fortunately, when she finally stumbled, she went back into the chair instead of forward or sideways.

Another was an old lady with UTI psychosis (again, combative, very, very) who I found climbing over the bedrails.

I've never had trouble with the patients that I ambulate.

Sure, if I am in a position to gently lower them down, I will.

[totally_nuts]

We are told to let them fall. I try not to, but sometimes if it's a case of them or me getting hurt I let them fall and try to control it. Not the perfect solution but it's what management wants.

[canoehead, BSN, RN]

Oh, well, that's different. If you aren't right beside them, what can you do? Making a run and dive usually doesn't help. We used to tie really confused people in, and if they were in line of sight it slowed them down enough that someone could get to the bed before they actually hit the floor. It brought up a whole set of other issues though.

[cnmbfa]

In skills lab we teach our students how to safely lower a patient down your extended leg without hurting your back. we then go out in the hall and practice it on each other several times. We are big into the Safe Patient Handling movement and are changing our focus from body mechanics, how to do pivot transfersm etc. to using lift equipment and other assists, along with plenty of humans to move patients.

[HiHoCherry-O]

In skills lab we teach our students how to safely lower a patient down your extended leg without hurting your back.

This sounds great and all, but I highly doubt it would be very effective when attempting to lower a 300+ lb patient, especially when in the process of falling.

My facility has lifts in all the rooms except two for which we can use a portable one.

[Music in My Heart]

In skills lab we teach our students how to safely lower a patient down your extended leg without hurting your back.

Of course, a wrenched knee ain't no fun either.

[cnmbfa]

I should have clarified that this is when they are walking a normal sized person with a safety belt, like when getting a newly deliverd PP Mom up to the bathroom the first time who may faint. I also emphasize not doing anything to risk hurting themselves, and to only use it when things are under control. Otherwise, yell for someone to get a wheelchair, and don't risk it when the fall cannot be controlled or prevented, or if the client is huge or combative.