Caring for the older person with cognitive impairment in hospital: Qualitative analysis of nursing personnel reflections on fall events.
dementia
falls
hospitalised patients
older patients
patient safety
Journal
Journal of clinical nursing
ISSN: 1365-2702
Titre abrégé: J Clin Nurs
Pays: England
ID NLM: 9207302
Informations de publication
Date de publication:
Apr 2019
Apr 2019
Historique:
received:
29
03
2018
revised:
02
11
2018
accepted:
26
11
2018
pubmed:
7
12
2018
medline:
2
5
2019
entrez:
7
12
2018
Statut:
ppublish
Résumé
To explore nurse and nursing assistant reflections on the care of older patients with cognitive impairment who have experienced a fall. While there are evidence-based clinical guidelines for the prevention and management of falls and for the care of older people with cognitive impairment, the falls rates for older people with cognitive impairment are three times as high as those without. Critical incident technique. Eleven registered and two enrolled nurses and four assistants in nursing working in one subacute and two acute wards within two hospitals of a tertiary level health service in south-east Queensland. Individual semistructured interviews focused on two past events when a patient with cognitive impairment had fallen in hospital: one when there was minimal harm and the second when there was significant harm. Thematic analysis was undertaken. The COREQ checklist was followed. Three themes emerged from 23 reflective accounts of fall events: "direct observation is confounded by multiple observers" and "knowing the person has cognitive impairment is not enough," and "want to rely on the guideline but unsure how to enact it." While participants were aware of the falls prevention policy and techniques available to prevent falls, the implementation of these was challenging due to the complexity of care required by the older person with cognitive impairment. Falls prevention for older people with cognitive impairment is complex and belies the simple application of policy. To reduce falls, nurses can involve the family to support "knowing the patient" to enable prediction of impulsive actions; shift the focus of in-service from lectures to specific case presentations, with collaborative analysis on person-focused strategies to prevent falls in older people with cognitive impairment; and reconsider the sitter role from simple observer to assistant, focused on ambulation and supporting independence in activities of daily living.
Sections du résumé
AIMS AND OBJECTIVES
OBJECTIVE
To explore nurse and nursing assistant reflections on the care of older patients with cognitive impairment who have experienced a fall.
BACKGROUND
BACKGROUND
While there are evidence-based clinical guidelines for the prevention and management of falls and for the care of older people with cognitive impairment, the falls rates for older people with cognitive impairment are three times as high as those without.
DESIGN
METHODS
Critical incident technique.
METHODS
METHODS
Eleven registered and two enrolled nurses and four assistants in nursing working in one subacute and two acute wards within two hospitals of a tertiary level health service in south-east Queensland. Individual semistructured interviews focused on two past events when a patient with cognitive impairment had fallen in hospital: one when there was minimal harm and the second when there was significant harm. Thematic analysis was undertaken. The COREQ checklist was followed.
RESULTS
RESULTS
Three themes emerged from 23 reflective accounts of fall events: "direct observation is confounded by multiple observers" and "knowing the person has cognitive impairment is not enough," and "want to rely on the guideline but unsure how to enact it." While participants were aware of the falls prevention policy and techniques available to prevent falls, the implementation of these was challenging due to the complexity of care required by the older person with cognitive impairment.
CONCLUSIONS
CONCLUSIONS
Falls prevention for older people with cognitive impairment is complex and belies the simple application of policy.
RELEVANCE TO CLINICAL PRACTICE
CONCLUSIONS
To reduce falls, nurses can involve the family to support "knowing the patient" to enable prediction of impulsive actions; shift the focus of in-service from lectures to specific case presentations, with collaborative analysis on person-focused strategies to prevent falls in older people with cognitive impairment; and reconsider the sitter role from simple observer to assistant, focused on ambulation and supporting independence in activities of daily living.
Types de publication
Journal Article
Langues
eng
Pagination
1346-1353Subventions
Organisme : Gold Coast Hospital and Health Service Private Practice Trust Fund
ID : PPTF120-18.6.15
Informations de copyright
© 2018 John Wiley & Sons Ltd.