Scielo RSS <![CDATA[Health SA Gesondheid (Online)]]> vol. 25 num. lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>Pain assessment and management: An audit of practice at a tertiary hospital</b>]]> BACKGROUND: In spite of advances in techniques and analgesics for pain management, pain remains a major health problem. Regular assessment and reassessment of pain using guidelines with measurable goals is essential for effective pain management in surgical wards. Unfortunately, no such guidelines exist in South Africa. To implement appropriate precepts for the South African context, the current practice must be understood. AIM: The aim of this article was to evaluate pain assessment and management of patients in two surgical wards at a tertiary hospital in South Africa. SETTING: The study was conducted within the Western Cape Province of South Africa in a government-funded tertiary academic institution. The patients at this hospital are generally from the low-income strata and live in resource-poor communities METHODS: A cross-sectional, retrospective medical record audit was conducted. The folders of all 215 patients admitted to a specific orthopaedic trauma and urogynaecological ward of a tertiary hospital in South Africa over a span of 1 month were targeted for review. Medical folders that were not available or had missing notes were excluded. Variables evaluated included the number of pain assessments recorded, pain assessor, assessment tool and management plan. RESULTS: A total of 168 folders were available for review. Nearly half of the patients had no documented pain assessment. The Verbal Rating Scale was the predominant tool used, and assessments were mostly conducted by the ward doctor. Pain interventions appeared to be primarily based on the professional knowledge of the practitioner and were not evidence-based. CONCLUSION: Pain assessment and management was a problem in the two wards reviewed, which is similar to the findings from studies referenced in this text. Health professionals must be empowered to manage pain adequately. An assessment tool that integrates the biopsychosocial factors that influence the pain experience should be routinely employed by a multidisciplinary team to facilitate goal-directed therapy. <![CDATA[<b>Changing youth behaviour in South Africa</b>]]> BACKGROUND: Youth behaviour in South Africa continues to be a public health concern. Primary prevention interventions remain a pre-requisite for promotion of improved social and health outcomes. AIM: The aim of the study was to assess the impact of a behavioural youth risk reduction intervention among grade 10 learners. SETTING: The Study was conducted in KwaZulu-Natal high schools, at UMgungundlovu District Municipality. METHODS: We conducted a cluster randomised controlled trial at 16 KwaZulu-Natal high schools where learners completed a self- administered questionnaire assessing youth risk behaviours. Schools were divided into two arms, intervention and a control arms. RESULTS: The intervention reduced learners' reports of carrying of a weapon to school in the past 30 days, but did not significantly reduce other assessed risk behaviours. Although the intervention appeared more likely to reduce learners' risk behaviours when compared to the control group, such as carrying weapons, risky sexual behaviour and alcohol and drug abuse. CONCLUSION: This study was unable to show statistical significance for these outcomes. <![CDATA[<b>Student nurses' experiences regarding their clinical learning opportunities in a public academic hospital in Gauteng province, South Africa</b>]]> BACKGROUND: During the training of student nurses, clinical placement is a compulsory requirement, as it exposes them to learning opportunities for the acquisition of clinical skills. This prepares them to become safe and competent professional nurses. However, the increased intake of student nurses in the Gauteng nursing colleges led to overcrowding in a public academic hospital, thus negatively influencing their learning experiences and availability of clinical learning opportunities. AIM: The purpose was to explore and describe the student nurses' experiences regarding their clinical learning opportunities to make recommendations to enhance their clinical learning opportunities in order to address the optimisation of their learning experiences METHODOLOGY: A qualitative, exploratory, descriptive and contextual research design was used. A purposive sampling method was used to select second-year student nurses registered in the Regulation (R425) programme for qualifying as a nurse (general, psychiatry and community) and midwife, as they would have acquired at least 1 year of clinical experience. Four focus groups, which comprised six to eight participants, were constituted, and research was conducted until data were saturated. Field notes were simultaneously taken to enrich the data collected. Thematic coding of qualitative data was used. Principles of trustworthiness and ethical principles were adhered to. RESULTS: The study revealed four themes. Three were negative experiences that included overcrowding, negative emotional experiences of student nurses and challenges of professional nurses. A theme concerning positive experience entailed knowledge-sharing amongst various health care disciplines. CONCLUSION: It was evident that student nurses had more negative emotional experiences than positive experiences. Therefore, the need to enhance their clinical learning opportunities in order to address the optimisation of learning experiences is eminent. <![CDATA[<b>Conceptual framework for strengthening nurse-initiated management of antiretroviral therapy training and implementation in North West province</b>]]> BACKGROUND: The implementation of nurse-initiated management of antiretroviral therapy (NIMART) management training is a challenge in the primary health care (PHC). It is evident from the literature reviewed and the data obtained from the North West province that gaps still exist. There is no conceptual framework providing guidance to NIMART training and implementation. AIM: Therefore, the aim of this study was to develop a conceptual framework to strengthen NIMART training and implementation in the North West province to improve patients and human immunodeficiency virus (HIV) programme outcomes. SETTING: The study was conducted in the North West Province, South Africa. METHODS: A pragmatic, explanatory, sequential, mixed-methods research design was followed. A descriptive and explorative programme evaluation design was used. Data were collected from two sources: antiretroviral therapy (ART) statistics from District Health Information System (DHIS) & of 10 PHC facilities to evaluate and determine the impact of NIMART on the HIV programme and five focus group discussions conducted amongst 28 NIMART nurses and three HIV programme managers to describe challenges influencing NIMART training and implementation. RESULTS: The study revealed that there was low ART initiation compared to the number of clients who tested HIV-positive. There was poor monitoring of patients on ART, which was evident in the low viral load collection and suppression, high loss to follow-up and deaths related to HIV. Challenges exist and this was confirmed by the qualitative findings, including human resource ratios, training and mentoring and the entire absence of a conceptual framework or model that guides training and implementation. CONCLUSION: The study findings were conceptualised to describe and develop a framework needed to facilitate and influence NIMART training and implementation to improve the HIV programme and patient outcomes. Dickoff, James and Wiedenbach's practice-oriented theory and Donabedian's structure process outcomes model provided a starting point in the ultimate development of the framework. Although the study was limited to the North West province's PHC clinics and community health centres and did not include hospitals, it is of high significance as there is no such conceptual framework in the province or in even South Africa. <![CDATA[<b>Predictors of aggression of university students</b>]]> BACKGROUND: Post-secondary education forms the backbone of delivering high-powered persons in a country. Students are subjected to high levels of pressure to achieve success. This often promotes aggression towards self, others and even the environment. Predicting aggression is important as this can assist in managing aggression and the facilitation of the mental health of students. Little research has been published on the prediction of aggression in a university AIM: To describe the prediction of aggression of students in one faculty in a university SETTING: Students in one faculty in a university METHODS: A deductive quantitative methodology was applied. Multivariate statistical techniques were used to answer the research questions. An online survey was conducted by using a questionnaire that comprised items related to biographic, personality and aggression aspects. Data were analysed by calculating Cronbach's alpha values, various factor analyses (principal component analysis) and several multiple regression analyses to identify and describe the predictors of aggression RESULTS: Findings reflect that aggression can be predicted by intra- and interpersonal variables, such as 'positive inclination towards others', 'positive inclination towards self' and 'acting responsibly towards self.' Aggression is lower when a student's positive inclination towards others is higher and towards self is lower and when a student acts with greater responsibility towards self CONCLUSION: Students should understand and manage their own aggression. Overall, the findings showed that students are seemingly 'adjusted' conformists using an external locus of control. The facilitation of an internal locus of control and autonomous behaviour is imperative <![CDATA[<b>Occupational exposure to blood and body fluids and use of human immunodeficiency virus post-exposure prophylaxis amongst nurses in a Gauteng province hospital</b>]]> BACKGROUND: Healthcare facilities in South Africa are confronted by several challenges arising from Human immunodeficiency virus (HIV) and acquired immune diseases syndrome infection pandemic. All categories of nurses continue to experience accidental occupational exposure to blood and body fluids (BBFs) of patients who are HIV-positive. Studies conducted revealed that nurses fail to report the occurrence of the exposures. This represents a serious challenge because they contract HIV infections whilst in the process of helping others. OBJECTIVES: The purpose of this study was to determine the occupational exposures and use of HIV post-exposure prophylaxis (PEP) amongst nurses at the selected tertiary academic hospital, Tshwane district, Gauteng province, South Africa. METHODS: A quantitative descriptive study was conducted with 94 male and female clinical nurses, using a self-administered questionnaire that facilitated collection of biographical data, occupational exposures to BBFs and use of HIV PEP. The data analysis included univariate and bivariate descriptive analyses. RESULTS: Of the 94 nurses, n = 40 (43%) had been exposed to BBFs, either through sharp or needle prick injuries or splashes but only 16 (46%) of them reported the incident. Nurses were not keen to report accidental occupational exposures to BBFs in their own facility and rather sought HIV PEP outside their workplace. They gave different reasons for their behaviour. For example, 'I did not know where to report'. CONCLUSION: Our study highlights the gaps that exist in reporting occupational exposure to BBFs and obtaining HIV PEP. Therefore, we recommend evaluation of these occupational exposures to BBFs and the management thereof, as well as to address the identified problems. <![CDATA[<b>Analysis of Patient Safety Incident reporting system as an indicator of quality nursing in critical care units in KwaZulu-Natal, South Africa</b>]]> BACKGROUND: Patient Safety Incidents occur frequently in critical care units, contribute to patient harm, compromise quality of patient care and increase healthcare costs. It is essential that Patient Safety Incidents in critical care units are continually measured to plan for quality improvement interventions. AIM: To analyse Patient Safety Incident reporting system, including the evidence of types, frequencies, and patient outcomes of reported incidents in critical care units. SETTING: The study was conducted in the critical care units of ten hospitals of eThekwini district, in KwaZulu-Natal, South Africa. METHODS: A quantitative approach using a descriptive cross sectional survey was adopted to collect data from the registered nurses working in critical care units of randomly selected hospitals. Self-administered questionnaires were distributed to 270 registered nurses of which 224 (83%) returned completed questionnaires. A descriptive statistical analysis was initially conducted, then the Pearson Chi-square test was performed between the participating hospitals. FINDINGS: One thousand and seventeen (n = 1017) incidents in ten hospitals were self-reported. Of these incidents, 18% (n = 70) were insignificant, 35% (n = 90) minor, 25% (n = 75) moderate, 12% (n = 32) major and 10% (n = 26) catastrophic. Patient Safety Incidents were classified into six categories: (a) Hospital-related incidents (42% [n = 416]); (b) Patient care-related incidents (30% [n = 310]); (c) (Death 12% [n = 124]); (d) Medication-related incidents, (7% [n = 75]); (e) Blood product-related incidents (5% [n = 51]) and (f) Procedure-related incidents (4% [n = 41]). CONCLUSION: This study's findings indicating 1017 Patient Safety Incidents of predominantly serious nature, (47% considering moderate, major and catastrophic) are a cause for concern. <![CDATA[<b>Challenges influencing nurse-initiated management of antiretroviral therapy training and implementation in Ngaka Modiri Molema district, North West province</b>]]> BACKGROUND: The increasing number of people testing human immunodeficiency virus positive and who demand antiretroviral therapy (ART) prompted the Department of Health to adopt World Health Organization's task shifting where professional nurses (PNs) initiate ART rather than doctors. This resulted in decentralisation of services to primary healthcare (PHC), generating a need to capacitate PNs on nurse-initiated-management of ART (NIMART). The impact of NIMART was assessed and even though there was an increased number of patients on ART, the quality of care is of serious concern. AIM: The aim of this study was to explore and describe the challenges influencing NIMART training and implementation amongst PNs and programme managers. SETTING: The study was conducted from the PHC facilities, in the rural districts of the North West province. METHODS: An exploratory programme evaluation and contextual research design was used in the study. Purposive sampling was used. Focus group discussion (n = 28) and individual interviews were used to collect data. Data was analysed using ATLAS.ti software RESULTS: The results revealed two themes: inadequacy in NIMART training and the healthcare system challenges that influence NIMART training and implementation. Theme 1 included among others the lack of standardised curriculum and model or conceptual framework to strengthen NIMART training. And theme 2 included patient and district healthcare structural system. CONCLUSION: There a need to improve NIMART training and implementation through the standardisation of NIMART curriculum, introduction of pre-service NIMART training in institutions of higher learning, addressing staff shortages and negative attitude of PNs providing ART. <![CDATA[<b>Consciring subjects: Q methodology described</b>]]> BACKGROUND: Despite the availability of Q methodology as a qualitative research alternative that seemingly circumvents the limits of standard qualitative methods across various fields, a recent review of qualitative research literature in leading health-related South African journals indicated that Q methodology is hardly a method of choice in South Africa. AIM: This article demonstrates the application of Q methodology, a qualitative research option, in psychological research. The methodology is suitably designed to investigate and clarify diverse subjective experiences, attitudes, opinions and/or beliefs held by a group of people on a given topic. METHODOLOGY: A study on the subjective understandings and perceptions of epilepsy is used to illustrate how Q methodology works. In this particular study, a diverse group of participants, comprising students, traditional healers, doctors, nurses, pastors, high school teachers, laypeople domiciled in rural and urban areas, and speakers of two of the dominant African dialects in the area, was used. RESULTS: Analysis produced three distinctive factors that are appositely named the scientific, the moderated traditionalist and the community-oriented stances. Each factor, constituted on the basis of close resemblance and statistical association between the rank orderings, represents an identifiable understanding of epilepsy by an exclusive grouping of participants. CONCLUSION: Concluding remarks about Q methodology are provided. <![CDATA[<b>Ethical conflicts experienced by intensive care unit health professionals in a regional hospital, Limpopo province, South Africa</b>]]> BACKGROUND: Conflicts arise when healthcare providers disagree about providing optimal care to critically ill patients where resources and services are constrained AIM: This study investigated ethical conflicts experienced by intensive care unit (ICU) healthcare professionals working in a regional hospital, Limpopo province of South Africa SETTING: The study was conducted at a rural public regional hospital in Vhembe district, Limpopo Province. Communities served by the hospital are poor and medically uninsured METHODS: This study adopted a qualitative, exploratory and descriptive design. The target population comprised Health care professionals working in an ICU of the regional hospital. Purposive sample was selected and 17 unstructured interviews were conducted. Tesch's method of data analysis was used. Ethical considerations were adhered to RESULTS: Patients' care needs were compromised because of the unavailability of beds and high-technology equipment, such as well-functioning ventilators. Doctors were not having the necessary skills required in the ICU as the majority were on community service/internship and nurses acted beyond their scope of practice because of a lack of adequately trained intensive care specialists. Infection control practices were overlooked and 'use once' pieces of equipment were reused. Conflicting values between nurses, patients and family of patients exist CONCLUSION: Lack of resources compromises provision of optimal and intensive care. Patients were prone to infections and their safety might have been compromised <![CDATA[<b>Experiences of the homeless accessing an inner-city pharmacy and medical student-run clinic in Johannesburg</b>]]> BACKGROUND: Mental and physical health problems are both contributory factors and drivers of homelessness. Adding to this, the homeless encounter numerous barriers when accessing healthcare services. AIM: The aim was to determine the experiences of the homeless when accessing healthcare services and the reason why they visit Trinity Health Services (THS). SETTING: Trinity Health Services, a student-run clinic (SRC) based at an inner-city church in Johannesburg, South Africa, provides free acute healthcare services to the homeless. METHODS: This qualitative study comprised three focus group discussions (FGDs) with the homeless who access services provided by the church. Those who had previously visited THS on at least one occasion were invited to participate in FGDs. The FGDs were audio-taped and transcribed verbatim. The data were analysed thematically using Tesch's eight steps. RESULTS: Three themes were identified. The first theme, homelessness affecting health, explains how limited access to food, ablution facilities and shelter negatively impact their well-being. This led to the second theme, health needs, where tuberculosis, influenza, sexually transmitted diseases and dental infections were identified as ailments occurring frequently. The need for healthcare services was explicit, yet participants were reluctant when accessing healthcare services as they faced stigma and discrimination. The third theme, THS in addressing health needs, denotes the value of THS in the community it serves where they were treated with compassion and empathy. CONCLUSION: The needs of this homeless community as well as the role played by THS were clearly identified. However, THS provides limited services, and integration with existing healthcare services is essential. <![CDATA[<b>Experiences of mental healthcare providers regarding integration of mental healthcare into primary healthcare at the iLembe health district in KwaZulu-Natal province</b>]]> BACKGROUND: Institutionalisation of mental healthcare users was a prevalent treatment approach in the apartheid era in South Africa. The introduction of community-based mental healthcare is aimed at improving mental healthcare services. The integration into primary healthcare improves access to mental health services. This integration is implemented by professional nurses working in the primary healthcare clinics. AIM: The aim of this study was to explore and describe experiences of professional nurses regarding integration of mental health into primary healthcare at the iLembe district of KwaZulu-Natal. SETTING: This study was conducted at a public hospital in the iLembe health district of KwaZulu-Natal province. METHODS: An explorative, descriptive and contextual qualitative research study was conducted. Semi-structured interviews were conducted with 15 professional nurses. Data were transcribed verbatim, organised into codes and finally analysed thematically using Tesch's method of data analysis. RESULTS: This study revealed that majority of participants experienced and faced challenges regarding integration of mental health into primary healthcare. Professional nurses stated that they require support from the management and training to equip themselves with knowledge and skills to render effective mental healthcare services. CONCLUSION: The integration of mental healthcare into primary healthcare is pivotal to ensure easy and accessible mental healthcare services to its users. This strategy requires planning and implementations of available policies and guidelines regarding mental healthcare. Furthermore, adequate funding is required to secure human and material resources to aid the integration of mental healthcare into primary healthcare. <![CDATA[<b>Roles of role players in the implementation of school-based human immunodeficiency virus and acquired immunodeficiency syndrome prevention programmes in local high school settings</b>]]> BACKGROUND: Worldwide, a large proportion of all new HIV infections occur in people under the age of 25. HIV and AIDS remain the leading cause of deaths among adolescents in sub-Saharan Africa and second leading cause of death globally. Preventing new HIV infections and AIDS-related deaths are at the heart of South Africa's National Strategic Plan on HIV and AIDS, STIs and TB 2017-2022. AIMS: Explore and describe the roles of the local role players in the implementation of the school-based HIV and AIDS prevention programmes in local high school settings. SETTINGS: The study was conducted in the Bushbuckridge local municipal area in Mpumalanga Province. METHODS: A qualitative, explorative, descriptive design and contextual study was used. Individual interviews and focus group interviews were conducted with the purposively selected participants from the clinic, health centre, high schools and community members. Data was analysed using Tesch's method of data analysis. RESULTS: Although all the local role players were found to have important roles to play in the implementation of the school-based HIV and AIDS prevention programme, gaps exist in the rendering of youth friendly services (YFS); accessible clinic times; HIV and AIDS education; life skills education; Life Orientation (LO) and health education; information sessions; counselling; school health programmes; campaigns as well as collaborative working strategy. CONCLUSION: Successful development and collaborative implementation of the school-based HIV and AIDS prevention programme can result in significant changes in knowledge and attitudes that affect sexual behaviour of young people, leading to significant decrease in HIV infection among young people. <![CDATA[<b>Acceptance of ambulatory blood pressure monitoring in a semi-rural population in South Africa</b>]]> BACKGROUND: Ambulatory blood pressure monitoring is a valuable tool that helps in providing an insight into the diagnosis and management of hypertension; however, no evidence exists of its acceptance in the diverse South African population. AIM: We assessed the acceptance of an ambulatory blood pressure monitor in patients attending public sector primary health care (PHC) clinics. SETTING: Five PHC clinics in the Makana subdistrict in the Eastern Cape. METHOD: A cross-sectional study was conducted with 70 hypertensive patients. Eligible patients were between 40 and 75 years old, taking either enalapril and hydrochlorothiazide or enalapril, hydrochlorothiazide and amlodipine. Socio-demographic, clinical and acceptance data were collected. The monitor cuff remained in place for 24 h. Acceptance was assessed after the monitor was removed. An overall acceptance score was generated to classify acceptance as either good or poor. RESULTS: The mean years of schooling was 5.9 years, with 22 reporting no school attendance. Generally, acceptance was good, with 70% of the population rating the technique as 'acceptable' (acceptance score of > 23/30). Most participants reported minimal discomfort with only 13.3% reporting that it hindered normal daily activities. Night readings interrupted sleep in 43%, with extreme sleep disturbance (≥ 3 awakenings) reported in just over half the patients. Increased years of schooling was the only variable associated with acceptance score (r = −0.243, p = 0.042. CONCLUSION: Ambulatory blood pressure monitoring was generally well-accepted, with few adverse effects being reported. Use of this technique at PHC facilities could reduce the incidence of misdiagnosis and uncontrolled hypertension. <![CDATA[<b>Knowledge, attitude and practices of environmental health practitioners conducting food-borne disease outbreak investigation at a local municipality in Gauteng province, South Africa</b>]]> BACKGROUND: Food-borne disease (FBD) outbreaks are a common occurrence that is either not investigated or poorly investigated. According to anecdote evidence, this is because of non-uniformity to environmental health practices in South Africa. AIM: This study aimed to determine and describe the knowledge, attitude and practices (KAP) of environmental health practitioners (EHPs) when conducting outbreak investigations of FBD at a local municipality. SETTING: This study was conducted in three sub-districts of Ekurhuleni Metropolitan Municipality (EMM), one of five municipalities in Gauteng province, South Africa. METHODS: A descriptive cross-sectional study was conducted to collect data using a semi-structured questionnaire. Data collected were analysed using IBM Statistical Package for the Social Sciences. Continuous variables were compared using analysis of variances, and correlation was used to determine any association. RESULTS: Knowledge responses were scored out of 9. Open-ended questions were themed into five items (support, guidelines, resources, training and specialisation). Sixty-one (76.3%) participants were randomly selected to participate in the study. There were more female participants (55.7%) than male participants, and the mean age was 30.9 years. The participants' knowledge scores ranged from 1 to 9. There were 17 (27.9%) participants who have conducted FBD outbreak investigation. Twenty-six (42.6%) believed that they were properly trained to conduct FBD outbreak investigations. Age was associated with position (p = 0.000) and qualification (p = 0.033). CONCLUSION: The results indicated that there are gaps and challenges in the knowledge, while the practices were not consistent amongst environmental health practitioners. However, the attitude of EHPs was positive with regard to their role in FBD outbreak investigations. <![CDATA[<b>Trust in independent community pharmacies: Do employee-related factors matter?</b>]]> BACKGROUND: Offering quality healthcare services in South Africa's remote areas remains a challenge. Pharmacies, and independent community pharmacies (ICPs) in particular, can play a vital role in providing access to pharmaceutical products and services in these areas. AIM: Part of the success of ICPs is the role that their employees play in building trusting relationships with pharmacy clients. It is against this background that this article investigates key employee-related factors that contribute towards building affective, calculative and contractual trust when pharmacy clients are serviced. SETTING: Clients of a specific ICP group participated in the study. The selected ICP group, which manages eight pharmacies across the Western Cape Province, has between 8000 and 41 000 active client profiles per pharmacy. METHODS: All 299 respondents who participated in the study were personally interviewed. Statistical analyses were done through Statistica, and structural equation modelling (SEM) with partial least squares (PLS) was used to assess both the measurement and the structural model. RESULTS: Although a number of significant relationships were confirmed, the importance of especially familiarity is highlighted when trust is managed in a pharmacy client-employee relationship. CONCLUSION: Given their geographical location, ICPs are ideally situated to provide access to healthcare services in the more remote areas of South Africa. By focusing on managing trust, ICPs can ensure a more constructive experience to their clients. <![CDATA[<b>Factors influencing patient falls in a private hospital group in the Cape Metropole of the Western Cape</b>]]> BACKGROUND: The fall rate of patients in hospitals is a worldwide concern due to the impact falls have on patients, the family or relatives, as well as the healthcare setting. Factors influencing patient falls are categorised as intrinsic and extrinsic. Intrinsic factors refers to physical conditions and the extrinsic factors include the environment of the patient, nursing staffing levels and skill mix. AIM: The study aimed to determine the factors that influence patient falls. SETTING: A private hospital group in the Cape Metropole of the Western Cape. METHODS: A quantitative retrospective descriptive research approach was used by analysing 134 records of patients that have fallen from October 2016 to February 2018. Data was collected using a data extraction sheet and analysed using the Statistical Package for the Social Sciences (SPSS). RESULTS: Intrinsic factors contributing to patient falls includedthe patient's age, hypertension, co-morbidities and the use of benzodiazepines as a sedative. Extrinsic factors were the incorrect use of bed rails and the skill mix of the staff. In over half of the cases (n = 68; 50.7%), risk assessments were not performed according to the protocol. Only 5 (3.7%) patients sustained major injuries due to the falls. However, the risk of more severe falls increased 2.4 times with the lack of risk assessment. CONCLUSION: The lack of accurate and consistent patient fall risk assessments, use of benzodiazepines as a sedative and the staff skill mix were contributors to the fall rate in these hospitals.