Scenario 1 (FALLS PREVENTION)
Mrs Ida OffnFalls
Background information:
Mrs. Ida Offnfalls is a left-handed, 75-year-old, English-speaking widow who lived alone on her dairy
farm outside of Clitheroe for most of her adult life.
She moved recently into a care home located in the town because of her desire to retire from the
dairy farm and her declining ability to manage living without resources close by. Her accommodation
is a single storey modern home. The Living area is large well lit and has linoleum flooring, her room is
situated at the end of a long corridor which is carpeted. There are no ‘spare’ mobility assist devices.
Her bedroom area is typical and relatively cluttered with mementos that she has brought with her,
though the staff regularly clear the floor around her bed and wash basin. The room is en-suite with
disabled type facilities.
She is a member of the Women's Institute and the Clitheroe Farmer's Association and enjoys
gardening, cheese making, and jam making.
Mrs. Offnfalls has two adult children. Her son took over management of the dairy farm eight years
ago. She is in contact with him on a regular basis but rarely gets to see him because he is busy with
the farm. He is married and has three children. Her daughter lives in Clitheroe and provides most of
the support for her mother. She encouraged Mrs. Offnfalls to move so that her mother could be
closer to her daughter and various support services. The daughter is married and has two young
children.
Medical information:
Mrs. Offnfalls is in good general health. She suffers from osteoarthritis in both hips and knees,
cataracts, kyphosis, and she reported having "ringing in her ears" (i.e. tinnitus). She is taking, 1
aspirin per day, and uses Clear Vision eye drops as needed. She is physically strong and was quite
active until a fall which occurred October 18th.
On October 21st, Mrs. Offnfalls moved into her new accommodation. Her daughter noticed that her
mother was limping as a result of bruising from her recent fall.
On November 30th, Mrs. Offnfalls had a second fall, this time in the living area, slipping on a patch of
wet flooring, severely bruising her left side. On December 1st, the daughter took Mrs.Offnfalls to her
own family doctor because Mrs. Offnfalls' physician had recently retired. The young male family
physician assessed the bruising. During the session, he communicated primarily with the daughter
who periodically translated what the doctor said to Mrs. Offnfalls. The doctor referred Mrs. Offnfalls
to Physiotherapy.
She saw a physical therapist on December 8th.
Her history of bruising from falls has resulted in the development of a fear of falling.
Discussion of following points to consider to prevent falls:
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Risk Factors (fear, clutter, wet floor, long corridor, eye meds, tinnitus)
Involvement of MDT (role of Physio, GP involvement)
Prevention /assessment methods (Falls team)
Home hazard management ( Use STEADY tool)
Education (Relatives/Carers)
Scenario 2 (RISK ASSESSMENT)
Mr Peter Trick
Background information:
Mr. Trick is 67 years old and has lived in St. Martha's Nursing Home in Blackpool, for the past 12
years. He has a high school education and English is his only language. He worked as a supervisor in a
shipping company for nineteen years but took early retirement to go on a disability pension for
medical reasons. He was divorced over 25 years ago. He has no children or close family. He has a
good relationship with some of the cleaning and kitchen staff, and with the recreation worker and
several of the volunteers. He likes to participate in all recreation activities (e.g., bingo, movies,
outings, etc.). He also likes to write poetry using his typewriter.
Medical information:
Mr. Trick was diagnosed with chronic progressive multiple sclerosis (MS) in his early 40s. Currently,
he demonstrates significant trunk and limb ataxia. He is right-handed and cannot write due to the
ataxia, but is still able to type using one hand to stabilise the other. His voice also is affected (low
volume and articulation problems), so he uses a typewriter to communicate, preparing notes for
people who have difficulty understanding him. He is beginning to show limitations in his insight.
Mr. Trick propels his wheelchair independently but requires the assistance of one staff member to
transfer. He can feed himself finger foods but requires the assistance of one staff member for all
other self-care activities. He is on anti-spasticity medication to deal with elevated tone in skeletal
muscle. He has neurogenic bladder problems and has stress and spasm incontinence, for which he
wears an incontinence garment.
At this particular nursing home, routine care includes the medical, nursing, pastoral, recreation, and
dietetic support. Other therapies are available by referral to private agencies.
Discussion:
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Mobility assessments
FRAT tool
Mental capacity (declining abilities, cognitive impairment, declining ability to cocooperate/assist in his own movement)
Poly-pharmacy
Provision of suitable Aids (hoists, transfer boards etc)
Likely future needs.
Scenario 3 (MANAGING FALLS)
Mrs Falsafarun (Urma) Karrapetski
Background information:
Mrs Falsafarun (Urma) Karrapetski is an 81-year-old Polish female who lives in a converted end
terrace Nursing Home in Padiham. Her Nursing home is a crowded five bedroom building. She does
not speak or understand English very well and requires a translator when meeting with health care
professionals. She is a very independent lady with a large family most of who visit regularly. There
have been occasions where the care of the mother (or rather the perception of this) have caused
them to challenge the Nursing Home staff.
Despite excellent risk assessment and care planning Mrs Falsafarun (Urma) Karrapetski has had a fall
today and is found on the floor.
Discussion:
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How will Urma’s condition and possible injuries be assessed. What information is required?
How will staff communicate with Urma to identify her injuries?
How will staff communicate their decisions to family and attending healthcare practitioners
or subsequently other agencies?
Scenario 4 (MANAGING FALLS- Injury assessment)
Mr Don Tripp
Background information:
Mr Don Tripp is a retired accountant who has lived in a large purpose built residential and nursing
home in the Wigan area. Lately he has developed symptoms and subsequently been diagnosed with
Alzheimer’s disease.
Most of the time Don can mobilise freely by himself, responds in a way which to staff has become
his ‘norm’, that is he gets a little confused, he can ‘over react’ etc but most of the time he is oriented
and can communicate his feelings.
It had been a busy day in the home and it was only by accident that someone heard Don shouting
from his room. On entering Don is on the floor as you can see. He is shouting that no-one is listening
and that he is hurt but wants to get off the floor.
Discussion:
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What are the obvious signs of injury?
What might you ask?
What physical assessment might be performed?
What might be gained from physical findings?
How will Don be managed from this point?
What communication issues might arise?
What will you do next?
Scenario 5 (SAFETY NET/CARE PLANNING)
Mrs Alice Well
Background information:
Alice is an independent 75 year old lady who has a lovely singing voice. She is fully mobile and
generally the life and soul of the party. Alice does have mild dementia and occasionally forgets what
day it is.
Always one to share a story she was on her way to the communal area in the Ribble Valley Nursing
home where she has lived for the last 10 years since the death of her husband.
Unfortunately Alice tripped over a frayed edge of carpet and stumbled then fell onto the floor
landing on the carpeted area. She doesn’t want to make a fuss but needed assistance to her feet.
Discussion:
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The assessment process
Moving and handling considerations
Further investigation
The use of safety netting
NWAS community care pathways
Record keeping.