The responses of patients highlighted three different types of attitudes which summarised the ways in which they regarded their falls experience of falling. The patients’ beliefs, attitudes, emotions and coping strategies were integral to each of these three attitudes (Kloseck et al., 2008).
4.8.1 Stoicism
The first attitude was a very stoical stance, whereby the individual had clearly recognised that they had fallen but were determined to move forward and progress in their rehabilitation. Their fall did not seem to concern them too much and they appeared more focused on improvement. They perceived their fall to be accidental in origin, as if it was an isolated event that was unlikely to happen again:
Joan: “…it was just a one-off accident. It didn’t matter.”
When Joan was required to consider the short- and long-term effects of her fall, including factors beyond the physical domain (i.e. psychological, emotional and social consequences), some of her deeper fears, anxieties and changes in behaviour were exposed. This did not appear to cause any signs of distress; rather, by helping her to recognise the issues that impacted on her life following a fall, it seemed to encourage Joan to talk more openly about how she viewed her hospital rehabilitation.
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4.8.2 Succumbing to the aftermath
A second type of profile held by other patients was at the opposite end of the spectrum in comparison to stoicism. These individuals, such as Ron (particularly after his second fall) and Margaret, were clearly affected by their fall, with the negative consequences being immediately evident in their responses:
Ron: “Losing my confidence was a big thing. I do want more exercise but it can be too dangerous. I walk less and less now.”
Margaret: “This fall was stupid, it was my own fault. Being in hospital is a problem, and falling is one of the hazards.”
They were unsure whether they expected to fall before coming into hospital but their expectations to fall again, as well as their attitude towards their worsening unsteadiness related to their fall, showed that falling in hospital was a problem to them. The way in which they had began to describe their experience showed how deeply they had been affected by falling. They seemed to have succumbed to a negative post-fall aftermath, which was essentially a capitulation to their problem.
In contrast to the other patients, the responses given by Ron and Margaret gave an early indication that their rehabilitation had been affected. In particular, some of their responses suggested a reluctance to perform tasks independently, therefore requiring more assistance from ward staff. There was also a clear reference to the psychological consequences of falling, such as fear of falling again and reduced confidence:
Ron: “There have been changes in how much assistance I need – an increased need for support from staff. I tend to ask of the wheelchair now.”
Margaret: “I’m concerned I might fall again. This makes life more difficult as I require more help. Falling has affected my confidence.”
4.8.3 Detached and nonchalant
The third type of attitude, mainly exhibited by David and Pat, was more nonchalant. These individuals seemed to take a calmer, more casual approach when discussing their falls
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experience. They seemed content in accepting the fall as an incidental event; the occurrence of a second fall was essentially undecided:
David: “No, I didn’t think I’d fall before coming into hospital – I just might or not”; “I don’t know whether I’ll fall again, though not if I can help it”; “I’m unsure if to expect it or not.”
Both David and Pat seemed indifferent as to whether they would be likely to prevent a second fall. Their responses gave a feeling of being slightly detached from the falls experience, as if it was a phenomenon that could have easily been separate from the true purpose of their hospital stay i.e. for rehabilitation. Their attitudes were not necessarily careless or entirely fatalistic - both of which could be seen to be detrimental to promoting their functional independence.
4.8.4 Influences on patients’ attitudes
All three attitudes suggested how a patient’s progress during their stay in hospital could be influenced by beliefs and values (Kloseck et al., 2008). For example, the more positive opinions, whereby the patient did not feel their fall was such a major issue, could have suggested the possibility for better outcomes for the patient, including reduced length of stay, the achievement of rehabilitation goals, being discharged to their own home, and optimised functional independence (ACSQHC, 2009). These patients were more likely to engage in therapy sessions, continue to improve (and not limit) their mobility, and adhere to medical and nursing procedures (Whitehead et al., 2006). Better motivation was at the core of this positive attitude:
David: “I just feel that I need to get on with life on the ward…I’m used to the occasional fall or trip.”
Joan: “There has been no effect on my rehabilitation. I want to carry on as I was before this happened.”
Negative attitudes were reflective of some patients who were less likely to be as successful in coping with the short- and longer-term consequences following their fall:
Pat: “If the nurses don’t keep a hold of me I might fall again.”
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Ron: “Falling is a problem to me, though less than when I’m at home as there are more staff around. However, they must walk behind me, not in front.”
Margaret appeared to be in a position of instability, whereby she could fluctuate between managing consequences either well enough to move forward and make progress, or poorly, which could have resulted in less successful outcomes:
Margaret: “I’m unsure whether I’ll fall again – it might have been just one of those things. I am more cautious now though, especially when I’m alone.”