Table 5.

NP Reported Barriers to Managing Fractures in LTC.

Unpredictable Nature of Falls

“It’s the unpredictable ones, like this one lady who had low fall risk, she normally walks with a walker and had no issues, and then she just turns herself one way and trips herself and falls on the ground. I mean we couldn’t predict that.” (NP 4)

Lack of Individualized Care

“I think within the LTC outreach team that I belong to we try to put out this blanket approach and it really has to be individualized and you need somebody with that thinking ability to tweak it in the homes.” (NP2)

Lack of Staff

“I think the problem with that is we have that information but we have trouble implementing it and even the most basic recommendations for falls prevention, it doesn’t matter if they know what they are we can’t implement them if we don’t have the staff.” (NP5)

“In terms of prevention, the families have to pay for things like hip protectors and sometimes there are cash concerns there too. So sometimes preventative measurements aren’t done, even if it has been recommended in a therapy assessment and nurse practitioner assessment.” (NP 1)

Lack of Resources and Diagnostic Delays

“I’ve worked emerg[ency] 25 years and I could put on a cast on wrists but in LTC I can’t because I can’t get the X-ray. Um, you know, like I’m certainly not going to do anything about a fractured hip in LTC but there are things that we probable could do but we can’t just get timely interventions done for the people. And you know, it’s all heartbreaking to have to send them to hang around in an emergency department for hours on end.” (NP 3)

“More than likely it’s going to be next day or even two or three days later which can make the difference. Um, and then the other problem we have is, even if we do get access to the imaging um, contact with the surgeons to discuss plan of care. Because a lot of time the residents would be able to be convalesced in the home and then you know, be transferred over for surgery the same day. But what keeps happening is if we try to contact the surgeon they will just default automatically to say send them to the ER and then we’ll work from there. So even if they’ve had an x-ray done that seems to be their default. So if we had great connections to our surgical staff I think that would be beneficial.” (NP 8)

Lack of Education for Families

“Sometimes families just don’t get it, they [staff] are trying not to go to restraints, at least minimal restraint, and families want them restrained and it’s just an ongoing battle. They think being restrained is going to create no fractures but in essence it agitates the patient more and they take their belt off and they get up and go. And they can’t get up and go because they have been sitting for too long and they don’t have the muscles that they used to and they tend to fall more when we have made them sit too long. Yeah, so they kind of don’t get that, so there’s a lot of teaching and reassuring on the nursing staff part to the families to figure out preventing falls.” (NP 8)

Note. NPs = nurse practitioners. LTC = long-term care.