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  1. Fehlberg, Elizabeth A. PhD, RN
  2. Cook, Christa L. PhD, RN, PHNA-BC
  3. Bjarnadottir, Ragnhildur I. PhD
  4. McDaniel, Anna M. PhD, RN, FAAN
  5. Shorr, Ronald I. MD, FACP
  6. Lucero, Robert J. PhD, RN, FAAN


OBJECTIVE: The aim of this study was to examine acute care registered nurses' (RNs') fall prevention decision-making.


BACKGROUND: The RN decision-making process related to fall prevention needs to be investigated to ensure that hospital policies align with nursing workflow and support nursing judgment.


METHODS: Qualitative semistructured interviews based on the Critical Decision Method were conducted with RNs about their planning and decision making during their last 12-hour shift worked.


RESULTS: Data saturation was achieved with 12 RNs. Nine themes emerged related to the RN decision-making process and included hospital-level (eg, fear of discipline), unit-level (eg, value of bed alarm technology), and nurse-level (eg, professional judgment) factors that could influence fall prevention.


CONCLUSIONS: Nursing administrators should consider a multilevel approach to fall prevention policies that includes promoting a practice environment that embraces self-reporting adverse events without fear of shame or being reprimanded, evaluating unit-level practice and technology acceptance and usability, and supporting autonomous nursing practice.