Nurses' immediate response to the fall of a hospitalized patient: a comparison of actions and cognitions of experienced and novice nurses.

Background: Falls represent a significant threat to patient safety for hospitalized patients throughout the world. Little is known, however, regarding nurses' immediate responses to the discovery of a fallen patient.

Objectives: The objective of this study was to perform an experimental examination of experienced and novice nurses' reaction to the discovery of a fallen patient who has sustained a closed head injury.

Design: The study was based upon the expert performance approach, which utilizes a mixed methods approach to determining performance characteristics of individuals performing in a variety of domains.

Setting: The study was accomplished using a simulated task environment developed specifically for research concerning the performance of health professionals.

Participants: The study included 12 experienced and 10 novice nurses, all of whom were currently employed in critical care settings.

Methods: The study used directly observed performance, which was quantified through the use of direct coding of clinical behaviors and the analysis of verbal reports of thought.

Results: The data indicate that experienced participants were not only more likely to call for help but that they were more likely to precede this action by checking for responsiveness, and then, after calling for help, establish the effectiveness of the patient's airway, breathing and circulation. These data confirmed that experienced participants were more likely to engage in the appropriate sequence of actions when faced with this unexpected and highly stressful situation.

Conclusions: Novice nurses' superficial assessment of the situation and subsequent failure to react properly implied an overall pattern of superior performance by the experienced nurses. The results indicated that, compared with novice nurses, experienced nurses are more likely to initiate standard treatment protocols in situations such as the one reported in this study.