You are rounding on your patients on your inpatient unit, and as you enter an elderly woman's room, you find her sitting up and alert. Tell me what steps you take to prevent her from falling between now and the next time you round.
Falls are a common risk for patients who are receiving inpatient care, particularly among the elderly or patients with decreased mobility. Because of this, falls prevention is a common initiative at most hospitals and care facilities. Most nurses are expected to round on their patients hourly, at a minimum, and during these rounds, they are expected to ask their patients about the four P's - Pain, Potty, Positioning, and Possessions. By ensuring the four P's are covered, the nurse is ensuring the patient is comfortable and has everything they need, which will likely prevent them from attempting to get up on their own, hence preventing falls. The interviewer is asking this question to determine if the candidate has an understanding of falls prevention and the four P's of nursing. To effectively answer this question, the candidate should describe how they would check on the patient using the four P's. A more successful answer to this question can include a situation of how the candidate has used the four P's to prevent a patient from falling in their nursing career, how they trained a colleague on the four P's, or even how they implemented a falls prevention program at their facility using the four P's.
"In this situation, I would go through the four P's with the patient to prevent her from attempting to get up and falling between then and the next time I rounded on her. I would first assist her to the restroom then help her relieve any pain she was having. Then, before I left the room, I would ensure she was in a comfortable position and had everything she needed near her. This is something I do with all my patients, even if they seem well enough and able bodied, because failing to do so could mean they may attempt to get up on their own and fall. This is a part of my job as a nurse that I take very seriously because I know how serious patient falls are."
"Early in my nursing career, I had an alert and oriented patient fall when trying to get up himself to use the bathroom. Although the patient didn't sustain any injury, that incident really drove home to me how important it is to work to prevent falls for my patients. Before I leave this patient's room, I will assess to make sure all of her needs are met. Does she need to go to the bathroom? Is she sitting comfortably? Does she have her water, any other needed possessions, and her call light all within easy reach? Does she need any pain medication? Once I have addressed all of these concerns, I will reiterate to the patient to please call if she needs anything, rather than trying to get up herself."
Community answers are written by other candidates practicing this set. Reading how others frame the same question is one of the fastest ways to sharpen your own.
Anonymous Answer
I would proceed by making sure to inquire about the 4 P's. I would do a thorough pain assessment. I would assist the patient to the bathroom because a full bladder can encourage the need to get out of bed. I would turn and reposition the patient in bed and make sure they are comfortable by offering a warm blanket. Lastly, I would ask if they needed anything before the next comfort round.
Cindy's Feedback
Good answer. This is a very specific answer that reflects your knowledge of protocols.
Anonymous Answer
I believe that this depends on the condition of the patient and their specific fall risk assessment. If the patient is a fall risk it is important to go over a few things with them. I would go over the use of the call light, ensure that they are wearing their nonslip socks, ensure that the bed is lowered and that there are no items on the floor that they could potentially slip-on. Based on the institution's policies, the use of a bed alarm could be considered and discussed with the patient. While the nurse is in the room they can discuss the need for the patient to get out of bed whether they are in pain, need to go to the restroom, need any belongings that aren't near them and whether they are comfortable in their current position or need help repositioning for maximum comfort.
Chad's Feedback
Great answer! It sounds like you take great care to ensure the risk of falls is minimized for your patients. Consider referencing the four P's (pain, potty, positioning, possessions) explicitly, to ensure it is evident to the interviewer you understand falls prevention and the four P's of nursing. Also, in the last sentence of your response, you move away from "I" language. Try to stick to first-person pronouns (I, me, my) so your answer remains personalized to you. I have offered a slight rewording of this sentence below:
"While in the room, I always ask the patient if there is any need for them to get out of bed - whether they are in pain, need to go to the restroom, need any belongings that aren't near them, and whether they are comfortable in their current position or need help repositioning for maximum comfort.
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