Abstract
This literature review explores the adaptation of the Morse Fall Scale (MFS) for assessing fall risk in stroke and neuro-oncology inpatients with cognitive and motor deficits. Utilising APA research proposal guidelines, the review identifies gaps in current fall risk assessment tools and proposes a tailored approach to enhance patient safety. The problem is framed in PICO format, and the methodology adheres to PRISMA guidelines. Key findings suggest that while the MFS is widely used, its applicability to populations with neurological impairments is limited due to insufficient consideration of cognitive and motor-specific factors. Recommendations include modifying the tool to incorporate relevant parameters and further empirical validation. This study underscores the need for specialised fall risk assessments to improve clinical outcomes in vulnerable inpatient groups.
Introduction
Falls remain a significant concern in hospital settings, particularly among inpatients with neurological conditions such as stroke and neuro-oncology disorders. These patients often present with unique challenges, including motor impairments and cognitive deficits, which heighten their fall risk. The Morse Fall Scale (MFS), a widely used tool for assessing fall risk, offers a structured approach by evaluating factors such as history of falling, gait, and mental status (Morse, 2008). However, its generic design may not fully address the specific needs of stroke and neuro-oncology patients. This essay aims to explore the limitations of the MFS in these populations, propose potential adaptations, and outline a research framework for tailoring the tool. The discussion is structured around a literature review following APA guidelines, a problem statement in PICO format, and a methodology guided by PRISMA principles. Ultimately, this review seeks to contribute to improved fall prevention strategies in clinical nursing practice.
Definitions of Terms
To ensure clarity, key terms are defined as follows:
– Morse Fall Scale (MFS): A clinical tool developed to assess fall risk in hospitalised patients based on six criteria, including history of falling, secondary diagnosis, ambulation aid, gait, and mental status (Morse, 2008).
– Stroke Inpatients: Patients hospitalised due to acute or chronic cerebrovascular events resulting in motor or cognitive impairments.
– Neuro-Oncology Inpatients: Patients receiving inpatient care for brain or central nervous system tumours, often experiencing neurological deficits.
– Cognitive Deficits: Impairments in memory, attention, or executive functioning that may affect a patient’s ability to follow safety instructions.
– Motor Deficits: Physical limitations, such as weakness or paralysis, that impair mobility and balance.
Statement of the Problem (PICO Format)
The problem under investigation is articulated using the PICO framework:
– Population (P): Stroke and neuro-oncology inpatients with cognitive and motor deficits.
– Intervention (I): Tailoring the Morse Fall Scale to include specific assessments for cognitive and motor impairments.
– Comparison (C): Standard application of the Morse Fall Scale without modifications.
– Outcome (O): Improved accuracy in identifying fall risk and reducing fall incidence in the target population.
This framework highlights the need to adapt existing tools to address the unique challenges faced by these patients, as the standard MFS may underestimate risks associated with neurological impairments.
Literature Review
Falls are a leading cause of injury in hospital settings, with significant implications for patient safety and healthcare costs. The MFS, introduced by Janice Morse in 1989, is a validated tool widely adopted in acute care settings to predict fall risk (Morse, 2008). It assigns scores based on six parameters, with higher scores indicating greater risk. However, research suggests that the MFS may lack sensitivity for patients with neurological conditions. For instance, a study by Breisinger et al. (2014) found that stroke patients often exhibit fluctuating motor and cognitive statuses, which are not adequately captured by the MFS’s static assessment criteria. Similarly, patients with brain tumours may experience sudden changes in mental status due to tumour progression or treatment effects, further complicating risk prediction (Taphoorn & Klein, 2004).
Moreover, the MFS’s reliance on broad categories for gait and mental status may fail to account for the severity of deficits in these populations. Indeed, a systematic review by Oliver et al. (2008) indicated that fall risk tools designed for general inpatient populations often perform poorly in specialised neurological wards. This raises concerns about the tool’s applicability, as overlooking specific impairments could lead to inadequate fall prevention measures. Therefore, tailoring the MFS to include detailed assessments of motor function (e.g., hemiparesis severity) and cognitive capacity (e.g., ability to comprehend safety instructions) appears necessary. Such modifications, however, must be grounded in empirical evidence to ensure validity and reliability across clinical settings.
Methodology (PRISMA Headings)
Eligibility Criteria
This review includes studies focusing on fall risk assessments in stroke and neuro-oncology inpatients published between 2000 and 2023. Only peer-reviewed articles, systematic reviews, and meta-analyses in English are considered. Studies unrelated to hospitalised patients or lacking a focus on fall risk tools are excluded.
Information Sources
Searches are conducted across databases such as PubMed, CINAHL, and Cochrane Library, supplemented by manual searches of reference lists from key articles. NHS and WHO guidelines on fall prevention are also consulted for contextual relevance.
Search Strategy
Keywords include “Morse Fall Scale,” “fall risk assessment,” “stroke inpatients,” “neuro-oncology,” “cognitive deficits,” and “motor deficits.” Boolean operators (AND, OR) are used to refine searches, ensuring comprehensive coverage of relevant literature.
Study Selection
Studies are screened based on titles and abstracts, with full-text reviews conducted for potentially relevant articles. Two independent reviewers assess eligibility to minimise bias, resolving discrepancies through discussion.
Data Collection Process
Data extraction focuses on study design, population characteristics, fall risk tools assessed, and outcomes related to tool effectiveness. Findings are synthesised narratively to identify gaps in the application of the MFS.
Risk of Bias
The quality of included studies is evaluated using the Critical Appraisal Skills Programme (CASP) checklist, ensuring a robust analysis of potential biases in methodology or reporting.
Discussion and Implications
The literature reveals a clear gap in the application of the MFS for stroke and neuro-oncology inpatients, particularly concerning its limited consideration of cognitive and motor deficits. While the tool is effective in general populations, its generic framework arguably overlooks the nuanced needs of neurologically impaired patients. Tailoring the MFS could involve integrating specific subscales, such as detailed cognitive assessments or motor function tests, to enhance its predictive accuracy. Furthermore, clinical validation of such modifications would be essential to ensure their feasibility in busy inpatient settings.
From a nursing perspective, implementing a tailored MFS aligns with the principles of patient-centred care, enabling more accurate risk stratification and resource allocation. However, challenges remain, including the need for staff training and potential resistance to adopting modified protocols. Future research should focus on pilot testing adapted versions of the MFS in specialised wards, with an emphasis on longitudinal outcomes such as fall incidence and patient satisfaction.
Conclusion
This review has highlighted the limitations of the standard Morse Fall Scale in assessing fall risk among stroke and neuro-oncology inpatients with cognitive and motor deficits. By framing the problem in PICO format and employing PRISMA-guided methodology, the essay underscores the need for a tailored assessment tool that accounts for the unique challenges faced by these populations. The proposed adaptations, while promising, require rigorous validation to ensure clinical utility. Ultimately, enhancing fall risk assessment tools like the MFS could significantly improve patient safety and outcomes in specialised inpatient settings. As nursing professionals, adopting evidence-based modifications to existing protocols remains a critical step towards addressing this pressing healthcare challenge.
References
- Breisinger, T. P., Skidmore, E. R., Niyonkuru, C., Terhorst, L., & Campbell, G. B. (2014). The Stroke Assessment of Fall Risk (SAFR): Predictive validity in inpatient stroke rehabilitation. Clinical Rehabilitation, 28(12), 1218-1224.
- Morse, J. M. (2008). Preventing Patient Falls: Establishing a Fall Intervention Program (2nd ed.). Springer Publishing Company.
- Oliver, D., Connelly, J. B., Victor, C. R., Shaw, F. E., Whitehead, A., Genc, Y., … & Gosney, M. A. (2008). Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: Systematic review and meta-analyses. BMJ, 334(7584), 82.
- Taphoorn, M. J., & Klein, M. (2004). Cognitive deficits in adult patients with brain tumours. The Lancet Neurology, 3(3), 159-168.
