Unit 5
Talking About Falls
Workplace English for Nursing Assistants
Meet Rosa
Watch the video about Rosa. Watch what happens.
Rosa — A Night on the Floor
Talk about it
- What factors likely contributed to Rosa’s fall?
- What could have been done to prevent the fall?
- What may happen to Rosa’s husband while she recovers?
- What emotions might Rosa feel in the hospital and nursing home?
The Big Idea: The Danger Comes After the Fall
Most people think the fall itself is the danger. Usually it is not. The real danger is what comes next: immobility — not being able to move. When an older client cannot move, they can develop blood clots, weakness, dehydration, pressure injuries, and pneumonia. This is why a fall can lead to death.
There is also a second danger: fear. After one fall, a client becomes afraid. They look down when they walk and grab at furniture. This changes their gait (their pattern of walking) — and makes the next fall more likely.
| Term | Plain meaning |
|---|---|
| Ambulatory | Able to walk. |
| Gait | A person’s pattern of walking. |
| Orthostatic hypotension | A fast drop in blood pressure when a person stands up — it causes dizziness and falls. |
| Immobility | Not being able to move; the dangerous result of a fall. |
Practice 1
1.1 Match the term to its meaning
- 1. Ambulatory
- 2. Gait
- 3. Orthostatic hypotension
- 4. Immobility
- A. A person’s pattern of walking
- B. Able to walk
- C. Not being able to move; the dangerous result of a fall
- D. A fast drop in blood pressure when standing up, causing dizziness
Moving Clients
New workers often do a transfer alone because they feel shy, they do not want to bother a busy coworker, or they are not sure how to ask in English. The result is a fall, a back injury, or both.
Nobody is ever disciplined for asking for help. Workers are disciplined for moving a two-person client alone. Practice the sentences until they are automatic.
- • Could you please help me transfer Mr. Diaz?
- • Excuse me. Do you think that you could give me a hand?
- • I’m sorry to bother you. I wonder if you could help me for two minutes.
- • Hi, would you mind helping me with a two-person assist?
- • Sure. / Of course. / I’d be glad to.
- • No problem — give me one minute.
- • I’m afraid I can’t right now. I’m with Mrs. Park.
- • I’d like to, but I can’t. Ask Kwame — he’s free.
Before a Fall — Risk & Prevention
The first step in prevention is to identify who is at risk. The whole team helps. The nurse assesses. The pharmacist reviews the medicines. Therapists work on strength, balance, and footwear. Housekeeping keeps the floors dry. And you see the client most — you notice the unsteady walk first.
Common risk factors
Common risk factors include: certain medicines (especially anti-anxiety and antidepressant drugs), orthostatic hypotension — a drop in blood pressure when the person stands up, poor vision or hearing, earwax buildup, weakness, dementia or confusion, pain, dehydration, throw rugs and clutter, no shoes or wrong footwear, and fear of falling. An older client at home on several medicines is at high risk.
Prevention strategies
- Keep the floor clear — no throw rugs or clutter; wipe up spills right away.
- Nonskid footwear during walking and transfers.
- Call light within reach; answer basic needs quickly.
- Bed in the lowest position and locked; good lighting; grab bars.
- Keep the walker or wheelchair close by; make sure glasses and hearing aids work.
- Encourage daily exercise and balance training (gentle options like tai chi help).
Prevention is also spoken. All shift long you will offer help before a client needs it — because a client who is waiting for help is a client who gets up alone.
- • May I help you?
- • Would you like me to help you?
- • Do you need some help?
- • Let me give you a hand.
Many clients refuse help — “No, thanks, I can manage.” That is their right, and often they are correct.
But if the care plan says they need help, you cannot simply walk away. Stay nearby, offer again in a different way (“I’ll just walk with you”), and tell the nurse. Respect the person and keep them safe.
Practice 2
2.1 Risk factor for falling? Write “Yes” or “No.”
- Throw rugs and clutter on the floor.
- Taking antidepressant medication.
- Walking with no shoes.
- Taking a short daily nap.
- Earwax buildup that affects hearing.
2.2 Good fall-prevention strategy? Write “Yes” or “No.”
- Keep the call light within the client’s reach.
- Keep the bed in the lowest position and locked.
- Have the client stay in bed as much as possible.
- Make sure the client wears nonskid footwear.
2.3 Short answer
What is the FIRST step in preventing falls?
______________________________________________________________
During a Fall — What to Do
If a client becomes dizzy or confused during a transfer, there is little time. Sit them back down on the bed or into the wheelchair — whichever is closer. When you walk a client, keep the wheelchair right behind them, so you can “scoop” them into it.
Never try to hold the client upright — you will injure you both.
Ease them slowly to the floor. Hold the gait belt with both hands (underhand), or place your hands under their arms.
Protect their head from hitting the floor or objects.
Lay them on the floor and leave them there. Call for help.
During those few seconds you are speaking to three people at once: warning your partner, directing the client, and calling for help.
- • Watch out — she’s going down.
- • Careful — his knees are buckling.
- • Nice and easy.
- • Lower her down.
- • I’ve got you. Bend your knees.
- • Let’s sit down right here. Slowly.
- • Put your hands on my arms.
- • Stay down. Don’t get up yet.
Short sentences, calm voice, one instruction at a time.
Practice 3
3.1 Put the steps in order (1–4) for a client who starts to fall
- Lay the client on the floor and call for help.
- Ease the client slowly toward the floor.
- Protect the client’s head from hitting the floor.
- Hold the gait belt with both hands (or place hands under the arms).
3.2 Choose the best action
1. Your client becomes dizzy during a transfer. You should:
- keep walking to the bathroom quickly
- sit them back down on the bed or into the wheelchair
- hold them upright until the dizziness passes
2. Why should you never try to hold a falling client upright?
______________________________________________________________
After a Fall — What to Do
Keep the client on the floor until the nurse assesses them. Do not rush to get them up.
Give emotional support — the client will be frightened.
If seriously injured: keep them still, take vital signs, and wait for EMS. Help move them to the stretcher as directed.
If not seriously injured: the nurse directs you to help them up.
How to help a client up safely: if the client can help, have them get on hands and knees and pull up on a sturdy chair while you steady it — the client does the work, so you protect your back. If the client cannot help, use a mechanical lift.
Then you report. Keep it short, in order, and factual.
- • In summary, she went down in the bathroom at about nine o’clock.
- • So what happened is, her knees gave way and I eased her to the floor.
- • To sum up, no head injury that I saw, and she is awake and talking.
- • It sounds like she felt dizzy before she stood — is that right?
Helpful Tools (and Their Limits)
- Anti-roll-back brakes lock the wheelchair automatically when the client stands up — good for a client who forgets to lock the brakes.
- Floor pads beside a low bed protect a client who might roll out — but never for an ambulatory client, because the pad becomes a trip hazard.
- Alarms only alert staff — they are not prevention.
Practice 4
4.1 Fill in the blank
- Keep the client on the until the nurse assesses them.
- If the client is too weak to help, use a to move them.
4.2 True or False
- You should help the client up quickly, before the nurse arrives.
- A frightened client after a fall needs emotional support.
- If a client can help, they get on hands and knees and pull up on a chair while you steady it.
- Why can a fall lead to death, even when the fall itself is not serious?
- Why does fear of falling make the next fall more likely?
- A two-person client seems weak today. May you use a lift? May you go alone?
- Ask a busy coworker for two minutes of help.
- Name three fall-prevention strategies you can do yourself.
- A client on bed rest wants to walk to the toilet. What do you do?
- Why must you never hold a falling client upright?
- Where should the wheelchair be when you walk a client?
- What do you protect as the client goes down?
- Why do you keep the client on the floor?
Dialogue Practice
Read these dialogues out loud with a partner.
Mrs. Whitaker, 86, is on the fall-risk list. She is reaching for her walker to go to the bathroom alone.
You: Good morning, Mrs. Whitaker. Would you like me to help you?
Mrs. Whitaker: No, thank you. I can manage myself.
You: Of course. How about letting me just walk with you? I’m going that way anyway.
Mrs. Whitaker: I’m not helpless, you know. I raised four children in this town.
You: I know you’re not. I’d be walking down the hall anyway — keep me company.
Mrs. Whitaker: (laughs) All right. But I’m holding my own walker.
You: It’s all yours. First, let’s put your shoes on — the nonskid ones.
The nurse arrives in the hallway. Mr. Diaz is on the floor, awake and talking.
Supervisor: What happened?
You: In summary, we were walking him back from the bathroom at about ten fifteen. He said he felt funny, and his knees gave way.
Supervisor: Did he hit his head?
You: No. We had the gait belt and we eased him down together. I guarded his head — it did not touch the floor. This was a witnessed fall; both of us saw it.
Supervisor: Good. Any complaint of pain?
You: He says his left hip aches a little. To sum up, witnessed fall, no head contact, awake and talking, left hip aching.
Supervisor: Thank you. Stay with him. I’ll assess and then we’ll use the lift to get him up.
You: Stay with him, and the lift after your assessment — is that right?
Supervisor: Correct. And vitals once a shift for 24 hours.
Roleplays
Work with a partner.
Situation
Mrs. Ivanova is a two-person assist and needs the toilet now. It is the end of the shift and everyone is busy. Get the help you need — without going alone and without leaving her waiting too long.
Your Goals:
- Use a full polite request (greeting + what + how long).
- When refused, ask who IS free.
- Ask a second person with a new full request.
- When that also fails, go to the nurse and say plainly that you cannot do it alone.
Situation
Mr. Achebe, 79, is a proud retired teacher on the fall-risk list. He is standing up to go to the day room alone, without his walker. Offer help without insulting him.
Your Goals:
- Use at least TWO different Offering Help phrases.
- When refused, do NOT argue and do NOT walk away.
- Offer something smaller instead (walk with him, carry something, hold the door).
- Get the nonskid footwear and the walker into the picture.
- Say that you will tell the nurse he prefers to walk alone.
Cumulative Review
Multiple Choice
1. A fall in an older client may lead to
- a higher level of care
- immobility
- all of the above
2. A client who recently fell now looks down and grabs furniture while walking. This is most likely because they are
- afraid of falling again
- unable to follow directions
- too weak to stand
3. All of these raise fall risk EXCEPT
- earwax buildup
- a short daily nap
- antidepressant medicine
4. You are walking a client with a gait belt when they suddenly begin to fall. You should
- try to catch them and hold them up
- ease them to the floor using the gait belt and both hands
- lower them with one hand on the belt
5. After a WITNESSED fall, the nurse usually asks for vital signs
- once each shift for 24 hours
- only at the time of the fall
- once each shift for 72 hours
6. A client who fell is too weak to help with the transfer to bed. You should
- use a gait belt and an assist of two
- use a mechanical lift
- let them rest, then move them alone
7. The FIRST step in preventing falls is to
- assist clients with basic needs
- place alarms on beds
- identify who is at risk of a fall
8. Which is a good fall-prevention strategy?
- encourage the client to attend activities
- keep the client in bed as much as possible
- put an alarm on the wheelchair
9. The person MOST at risk of falling is a
- 77-year-old at home on pain medicine
- 21-year-old on depression medicine
- 67-year-old with asthma
10. A client falls because they forget to lock their wheelchair brakes before standing. The BEST solution is
- tell them never to stand alone
- add leg rests so they cannot stand
- install anti-roll-back brakes
11. Your client is a two-person assist. You ask two coworkers and both say they are busy. You should
- do the transfer alone, carefully
- tell the nurse you need help
- let the client walk without help
Case Study: Reducing Falls
Read the case. Answer in complete sentences.
Rosa is 84 and lives at home. She is the main caregiver for her husband, who has dementia. One night, on her way to the bathroom, Rosa tripped on a throw rug and fell. She could not get up, and her husband could not help her. Rosa stayed on the floor until her son visited the next day. She broke her hip and her wrist. After three nights in the hospital, she was moved to a nursing home for rehabilitation.
1. What factors likely contributed to Rosa’s fall?
______________________________________________________________
2. What could have been done to prevent the fall?
______________________________________________________________
3. What may happen to Rosa’s husband while she recovers?
______________________________________________________________
4. What emotions might Rosa feel in the hospital and nursing home?
______________________________________________________________
5. How can a healthcare worker help Rosa during her recovery?
______________________________________________________________
Instructor Answer Key
Unit 5 — Talking About Falls
This unit examines why older adults fall and what nursing assistants should do before, during, and after a fall. Learners study risk factors, environmental hazards, immobility, fall-prevention strategies, gait belts, mechanical lifts, and other safety equipment. A case study about Rosa connects a nighttime fall to injury, rehabilitation, fear, and loss of independence. Through illustrated readings, flashcards, knowledge checks, dialogues, and role-plays, learners practice offering help before it is needed, requesting assistance from coworkers, responding when a client refuses help, and giving a short, factual report after a fall.
Practice 1–4 and Review
Practice 1.1: 1-B, 2-A, 3-D, 4-C.
Practice 2.1 (risk?): 1. Yes 2. Yes 3. Yes 4. No 5. Yes. Practice 2.2 (good strategy?): 1. Yes 2. Yes 3. No 4. Yes. Practice 2.3: Identify who is at risk of a fall.
Practice 3.1 order: 1. Hold the gait belt with both hands 2. Ease the client toward the floor 3. Protect the head 4. Lay them down and call for help. Practice 3.2: 1-b. 2: Holding them up can injure your back and the client; ease them down instead.
Practice 4.1: 1. floor 2. mechanical lift. Practice 4.2: 1. False 2. True 3. True.
Multiple Choice: 1-c, 2-a, 3-b, 4-b, 5-a, 6-b, 7-c, 8-a, 9-a, 10-c, 11-b.
Back to Rosa Best Response: 1-c (follow the bed-rest order; offer the bedpan). 2-b (educate and report; do not remove belongings yourself). 3-b (a floor pad is a trip hazard for an ambulatory client, so use a reminder sign instead). 4-b (refusal + reason + alternative — and never leave your own client unattended on the toilet).
Stand students in a line. The learner must ask each person in turn for help; every person refuses. The learner may not stop, may not do it alone, and must reach the nurse. Run it until asking a third time feels normal rather than embarrassing.