Year of Publication


Degree Name

Doctor of Education (EdD)

Document Type

Doctoral Dissertation




Curriculum and Instruction

First Advisor

Dr. Joan Mazur


Existing research demonstrates the usefulness of multi-factorial approaches to the challenge of patient fall prevention (Spoelstra, Given, & Given, 2012; Wexler, D’Amico, & Rolston, 2011; Hart-Hughes, Quigley, Tatjana, & Scott, 2004). Some of the current strategies include assessment of a patient’s risk for falling based on a valid assessment instrument, management of a patient’s environment to provide a safe space, medication monitoring and management to avoid use of medications that could lead to falls, patient teaching, post-incident evaluation, and more. Implementation of these strategies is dependent upon patient care employees including nurses, nursing assistants, and physical therapists.

Instructional systems design models provide an approach to addressing the problem of awareness of patient fall prevention opportunities with instruction through assessment of the specific circumstances of the hospital environment and learner needs, design of interventions to address the identified needs, development and implementation of an educational plan, and evaluation of the effectiveness of the implemented interventions (Dick & Carey 1990; Morrison, Ross, & Kemp, 2004). The model is easily likened to that of the nursing process involving assessing, planning, implementing, and evaluating to achieve holistic caring for individuals or groups of patients. In the case of this study, the models are applied to addressing the identified instructional needs of hospital staff in order to influence change in their knowledge and behaviors related to fall prevention and to decrease the incidence of falls in the hospital environment.

In this case study research, from 2015-17, 1,126 employees at a large urban hospital were trained using a fall prevention program entitled “Reducing Inpatient Falls Using an Evidence-Based Practice Approach” as part of the hospital site’s fall prevention program. The training combined an innovative user-tested narrative simulation with fall-prevention informative instruction. There were three cohorts of repeat users (as the fall prevention program is required each year). Cohorts were defined by their performance levels on a criterion referenced fall prevention knowledge test, based on the content of the simulation and informative content. Using a mastery scoring approach, trainees needed to achieve a score of 85% or higher on the knowledge test. To achieve mastery a trainee could 1) retake the simulation or 2) upon a second failure to master, was provided didactic training and another (different) commensurate simulation on fall prevention. The study analysis focuses on the performance of the three cohorts (high, medium, and low performing groups) over time. The findings suggest among high initial performers who achieve mastery, there was evidence of high retention of fall prevention content and increased mastery scores over subsequent annual trainings. The hospital site documented an actual 30.6% reduction of patient falls over the study years, from a mean of 3.46 to 2.40 patient falls per 1,000 patient days.

Digital Object Identifier (DOI)