We conducted a cross-sectional study with surveying nurses in small- and medium-sized hospitals.
Our participants were nurses who worked at small- and medium-sized hospitals with fewer than 300 beds located in D and G cities, who understood the purpose of the study, and who agreed to participate in the study. After obtaining permission from the institutes to conduct the survey, questionnaires were distributed by the respective nursing managers. Nurses working at Chinese medicine clinics and long-term care hospitals were excluded from the study.
The sample size necessary for correlation analysis with an effect size of .35, a significance level of p < .05, and power of .80 was 142, calculated based on a previous study  using G*power 3.1.9 . Therefore, expecting a 20% attrition rate, we chose to include 190 nurses.
Knowledge regarding falls
We assessed nurses’ knowledge regarding falls using the Hospital Falls Knowledge Scale, which measures nurses’ knowledge regarding falls  and was created in consultation with two nursing professors and two patient safety experts. The questionnaire consisted of 15 items pertaining to fall rates; types and severity of injuries caused by falls; intrinsic factors including high risk of falls, age group, sex, disease, state of consciousness, activity status, use of assistive devices, risk factors, and use of drugs that increased the risk of falls; and extrinsic factors including fall timing, location, and type. The questionnaire included 14 multiple-choice items and one subjective item (Item 15), and the highest possible score was 14. One point and zero points were awarded for correct and incorrect responses, respectively. The Kuder-Richardson Formula 20 reliability coefficient was .76. The content validity index for the modified instrument exceeded .80 for all items.
Attitudes regarding falls
Attitudes regarding falls refers to nurses’ emotional, cognitive, and behavioral reactions to inpatient falls that occurred in hospitals. We assessed these attitudes using the 13-item Hospital Falls Attitude Scale , which was used in a previous study . Responses were provided using a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Higher scores indicated higher levels of positivity in nurses’ attitudes. Items 2, 8, 9, 11, and 12 were reverse scored. Cronbach’s αs for the scale were .75 in a previous study and .72 in the present study.
Nurses’ engagement in fall-prevention activities was measured using a 20-item scale , which was based on the Hospital Nurses Association’s nursing practice guidelines for falls. Responses were provided using a four-point Likert scale ranging from 1 (never use) to 4 (always use), and higher scores indicated greater engagement in fall-prevention activities. Cronbach’s a for the scale was .92 in a previous study as well as in the present study.
Data were collected from nurses working at small- and medium-sized hospitals with fewer than 300 beds located in D and G cities from August 1 to September 1, 2016. The 190 nurses eligible were given explanations regarding the purpose and methods of the research and questionnaires were distributed among those who wanted to participate with an enclosed envelope for return. The envelopes were sealed and submitted after completion.
Ethical approval for the study was granted by the institutional review board of Eulji University (approval number: IRB No. EU16-28), and the study protocol conforms to the provisions of the Declaration of Helsinki. Written informed consent was obtained from all participants.
Participants’ characteristics and fall-related education were analyzed using frequencies, percentages, means, and standard deviations. Means and standard deviations were calculated for knowledge, attitudes, and engagement in fall-prevention activities. Differences in participants’ characteristics, knowledge, and attitudes regarding falls, and engagement in fall-prevention activities according to their experience of fall-related education were analyzed using Mann-Whitney U tests and Kruskal-Wallis tests. Pearson’s correlation coefficients were calculated for the relationships between knowledge regarding falls, attitudes regarding falls, and engagement in fall-prevention activities. Missing data were handled using listwise deletion. All data analyses were performed using SPSS/WIN 24.0.