• Jennifer Dempsey.
• School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW, Australia. jenniferdempsey@bigpond.com
• J Clin Nurs. 2009 Mar 1;18(6):838-48.

AimTo test changes in adherence to nurses' falls prevention work resulting from improving attitudes and ownership of practice.BackgroundWorkforce surveys indicate that nurses leave nursing because they cannot deliver the care they value. When challenged why, nurses claim no power of decision-making or authority to change their work with dissatisfaction and disengagement with work ensuing. Nurses espouse 'caring' but are observed taking risks with patients' safety reflecting poor congruence between values and behaviours. Attitudes and decision-making involvement are factors that influence work behaviours. Hence, increased adherence should be achieved by improving nurses' attitudes through active decision-making surrounding practice.DesignMixed methods study.MethodsMixed methods were employed during 2004 by surveying attitudes (self-esteem, professional values and work satisfaction) before and after re-engineering nurses' work using practice development (PD) to gain time to spend in prevention work. Practice behaviour was observed and measured at intervals during the study.ResultsInitially, nurses had good self-esteem and professional values but were not satisfied with their work. Following the PD, self-esteem and professional values were unaffected; however, nurses expressed increased sense of ownership and greater satisfaction. Nurses were observed to engage in more prevention work. More effective ways of assessing and communicating risk and monitoring nurses' performance of prevention work were created and evaluated. Patients' environments were made safer and more patient-centred.ConclusionManipulation of attitudes and values is not warranted if attitudes and values are good. However, participation in work-related decision-making engages practitioners and leads to greater congruence between values and behaviour. Recommendations include promoting reflection and action to achieve cultural change and person-centred care.Relevance To Clinical PracticeThis study is relevant to international readership as adds to what is known about nurses' practice behaviours related to falls prevention and will assist others when designing and implementing programs that address patient safety and optimise nurses' adherence.

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