Research Article| Volume 67, P102-106, November 2022

Children's falls inside the inpatient setting: A qualitative study of parent perceptions and the implications for falls prevention messaging

Published:September 06, 2022DOI:


      • Falls tend to occur in the presence of a parent-caregiver, yet their perspectives on fall risk are often not considered or incorporated into routine messaging about falls prevention in pediatric care settings.
      • Evidence indicates that health behaviors and responses to health advice are strongly influenced by parent mental representations of illness which also include their children’s unique identities.
      • Falls prevention education in pediatrics should be individualized, sensitive to what parent-caregivers already know and understand about their children's health and risk and differentiated based on the age of the child.



      To explore how parents understand their children's falls during hospitalization and how they perceive hospital interventions and messaging related to fall risk and prevention.

      Design and methods

      Semi-structured interviews were conducted to explore parent-caregiver descriptions of their children's falls during hospitalization. Prospective purposive sampling was used to identify eligible participants. Interviews were conducted with the parent-caregiver who was present at the time of the fall event. Themes were coded both inductively and deductively using a constant comparative method.


      Twelve parent-child groupings participated. Three themes emerged: parental knowledge of risk, parent sense of threat to the identity of the child, and age differences in perception of level of controllability of risk.


      Falls prevention education is usually delivered as a straightforward presentation of generic factual information about risk factors, with the assumption that families need more information. Findings from this study challenge this approach. This study indicates that parent-caregivers have fairly high levels of knowledge about children's fall risks; parent-caregiver beliefs about the controllability of falls may differ based on age of the child; finally, as has been found in previous studies of adult falls, parent-caregivers may perceive hospital falls prevention measures as a source of potential threat to their child’'s already vulnerable social identity.

      Practice implications

      Involving the parent-caregiver in the fall risk assessment and collaborative development of falls prevention interventions may increase family alliance with health advice and reduce the incidence of falls in hospitalized children.


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        • Ablewhite J.
        • Peel I.
        • McDaid L.
        • Hawkins A.
        • Goodenough T.
        • Deave T.
        • Kendrick D.
        Parental perceptions of barriers and facilitators to preventing child unintentional injuries within the home: A qualitative study.
        BMC Public Health. 2015; 15: 280
        • Ajzen I.
        The theory of planned behavior.
        Organizational Behavior and Human Decision Processes. 1991; 50: 179-211
        • Almis H.
        • Bucak I.H.
        • Konca C.
        • Turgut M.
        Risk factors related to caregivers in hospitalized children’s falls.
        Journal of Pediatric Nursing. 2017; 32: 3-7
        • Barley E.
        • Lawson V.
        Using health psychology to help patients: Theories of behaviour change.
        British Journal of Nursing. 2016; 25: 924-927
        • Charmaz K.
        • Thornberg R.
        The pursuit of quality in grounded theory.
        Qualitative Research in Psychology. 2021; 18: 305-327
        • CHCA
        Pediatric falls: State of the science.
        Pediatric Nursing. 2009; 35: 227-231
        • Child S.
        • Goodwin V.
        • Garside R.
        • Jones-Hughes T.
        • Boddy K.
        • Stein K.
        Factors influencing the implementation of fall-prevention programmes: A systematic review and synthesis of qualitative studies.
        Implementation Science. 2012; 7: 91
        • Clancy A.
        • Balteskard B.
        • Perander B.
        • Mahler M.
        Older persons’ narrations on falls and falling—Stories of courage and endurance.
        International Journal of Qualitative Studies on Health and Well-Being. 2015; 10: 26123
        • Donovan H.S.
        • Ward S.
        A representational approach to patient education.
        Journal of Nursing Scholarship. 2001; 33: 211-216
        • Dryhurst S.
        • Schneider C.R.
        • Kerr J.
        • Freeman A.L.J.
        • Recchia G.
        • van der Bles A.M.
        • van der Linden S.
        Risk perceptions of COVID-19 around the world.
        Journal of Risk Research. 2020; 23: 994-1006
        • Fujita Y.
        • Fujita M.
        • Fujiwara C.
        Pediatric falls: Effect of prevention measures and characteristics of pediatric wards.
        Japan Journal of Nursing Science. 2013; 10: 223-231
        • Gettens S.
        • Fulbrook P.
        • Jessup M.
        • Low Choy N.
        The patients’ perspective of sustaining a fall in hospital: A qualitative study.
        Journal of Clinical Nursing. 2018; 27: 743-752
        • Goffman E.
        The presentation of self in everyday life.
        Doubleday, 1959
        • Goffman E.
        Stigma : Notes on the management of spoiled identity.
        J. Aronson, 1974
        • Gustavsson J.
        • Jernbro C.
        • Nilson F.
        There is more to life than risk avoidance - elderly people's experiences of falls, fall-injuries and compliant flooring.
        International Journal of Qualitative Studies on Health and Well-Being. 2018; 13: 1479586
        • Hagger M.S.
        • Orbell S.
        The common sense model of illness self-regulation: A conceptual review and proposed extended model.
        Health Psychology Review. 2021; 1-31
        • Hayes B.
        • Moller S.
        • Wilding H.
        • Burgell R.
        • Apputhurai P.
        • Knowles S.R.
        Application of the common sense model in inflammatory bowel disease: A systematic review.
        Journal of Psychosomatic Research. 2020; 139110283
        • Hoffman J.M.
        • Keeling N.J.
        • Forrest C.B.
        • Tubbs-Cooley H.L.
        • Moore E.
        • Oehler E.
        • Walsh K.E.
        Priorities for pediatric patient safety research.
        Pediatrics. 2019; 143e20180496
        • Hogan C.M.
        • Weaver N.L.
        • Cioni C.
        • Fry J.
        • Hamilton A.
        • Thompson S.
        Parental perceptions, risks, and incidence of pediatric unintentional injuries.
        Journal of Emergency Nursing. 2018; 44: 267-273
        • Jamerson P.A.
        • Graf E.
        • Messmer P.R.
        • Fields H.W.
        • Barton S.
        • Berger A.
        • Lunbeck M.
        Inpatient falls in freestanding children’s hospitals.
        Pediatric Nursing. 2014; 40: 127-135
        • Kiyoshi-Teo H.
        • Northrup-Snyder K.
        • Robert Davis M.
        • Garcia E.
        • Leatherwood A.
        • Seiko Izumi S.
        Qualitative descriptions of patient perceptions about fall risks, prevention strategies and self-identity: Analysis of fall prevention motivational interviewing conversations.
        Journal of Clinical Nursing. 2020; 29: 4281-4288
        • Lee Y.L.G.
        • Yip W.K.
        • Goh B.W.
        • Chiam E.P.J.
        • Ng H.P.C.
        Fall prevention among children in the presence of caregivers in a paediatric ward: A best practice implementation.
        International Journal of Evidence-Based Healthcare. 2013; 11: 33-38
        • Leventhal H.
        • Phillips L.A.
        • Burns E.
        The common-sense model of self-regulation (CSM): A dynamic framework for understanding illness self-management.
        Journal of Behavioral Medicine. 2016; 39: 935-946
        • National Database of Nursing Quality Indicators (NDNQI)
        Guidelines for data collection and submission on patient falls indicator.
        • Neiman J.
        • Rannie M.
        • Thrasher J.
        • Terry K.
        • Kahn M.G.
        Development, implementation, and evaluation of a comprehensive fall risk program.
        Journal for Specialists in Pediatric Nursing. 2011; 16: 130-139
        • Nyman S.R.
        • Hogarth H.A.
        • Ballinger C.
        • Victor C.R.
        Representations of old age in falls prevention websites: Implications for likely uptake of advice by older people.
        British Journal of Occupational Therapy. 2011; 74: 366-374
        • Rogers R.W.
        A protection motivation theory of fear appeals and attitude Change1.
        The Journal of Psychology. 1975; 91: 93-114
        • Schaffer P.L.
        • Daraiseh N.M.
        • Daum L.
        • Mendez E.
        • Lin L.
        • Huth M.M.
        Pediatric inpatient falls and injuries: A descriptive analysis of risk factors.
        Journal for Specialists in Pediatric Nursing. 2012; 17: 10-18
        • Shala D.R.
        • Brogan F.
        • Cruickshank M.
        • Kornman K.
        • Sheppard-Law S.
        Exploring Australian parents’ knowledge and awareness of pediatric inpatient falls: A qualitative study.
        Journal for Specialists in Pediatric Nursing. 2019; 24e12268
        • Siu G.
        • Batte A.
        • Tibingana B.
        • Otwombe K.
        • Sekiwunga R.
        • Paichadze N.
        Mothers' perception of childhood injuries, child supervision and care practices for children 0–5 years in a peri-urban area in Central Uganda; implications for prevention of childhood injuries.
        Injury Epidemiology. 2019; 6 (N.PAG-N.PAG)
        • Whitehead E.
        • Owens D.
        Parental perceptions of unintentional injury risks to children.
        International Journal of Health Promotion and Education. 2012; 50: 20-27