Caring for the older person with cognitive impairment in hospital: Qualitative analysis of nursing personnel reflections on fall events

Laurie Grealish, Wendy Chaboyer, Jacob Darch, Belinda Real, Maggie Phelan, Dawn Soltau, Matthew Lunn, Susan Brandis, Jo-anne Todd, Marie Cooke

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Aims and objectives: To explore nurse and nursing assistant reflections on the care of older patients with cognitive impairment who have experienced a fall. 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: Critical incident technique. 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: 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: Falls prevention for older people with cognitive impairment is complex and belies the simple application of policy. Relevance to clinical practice: 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.

Original languageEnglish
Pages (from-to)1346-1353
Number of pages8
JournalJournal of Clinical Nursing
Volume28
Issue number7-8
Early online date5 Dec 2018
DOIs
Publication statusPublished - 1 Apr 2019

Fingerprint

Nurses
Nursing
Guidelines
Queensland
Cognitive Dysfunction
Task Performance and Analysis
Activities of Daily Living
Checklist
Tertiary Care Centers
Health Status
Walking
Health Services
Patient Care
Observation
Interviews

Cite this

Grealish, Laurie ; Chaboyer, Wendy ; Darch, Jacob ; Real, Belinda ; Phelan, Maggie ; Soltau, Dawn ; Lunn, Matthew ; Brandis, Susan ; Todd, Jo-anne ; Cooke, Marie. / Caring for the older person with cognitive impairment in hospital : Qualitative analysis of nursing personnel reflections on fall events. In: Journal of Clinical Nursing. 2019 ; Vol. 28, No. 7-8. pp. 1346-1353.
@article{c10f6effb65949c295225aab931b10ce,
title = "Caring for the older person with cognitive impairment in hospital: Qualitative analysis of nursing personnel reflections on fall events",
abstract = "Aims and objectives: To explore nurse and nursing assistant reflections on the care of older patients with cognitive impairment who have experienced a fall. 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: Critical incident technique. 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: 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: Falls prevention for older people with cognitive impairment is complex and belies the simple application of policy. Relevance to clinical practice: 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.",
author = "Laurie Grealish and Wendy Chaboyer and Jacob Darch and Belinda Real and Maggie Phelan and Dawn Soltau and Matthew Lunn and Susan Brandis and Jo-anne Todd and Marie Cooke",
year = "2019",
month = "4",
day = "1",
doi = "10.1111/jocn.14724",
language = "English",
volume = "28",
pages = "1346--1353",
journal = "Journal of Clinical Nursing",
issn = "0962-1067",
publisher = "Wiley-Academy",
number = "7-8",

}

Grealish, L, Chaboyer, W, Darch, J, Real, B, Phelan, M, Soltau, D, Lunn, M, Brandis, S, Todd, J & Cooke, M 2019, 'Caring for the older person with cognitive impairment in hospital: Qualitative analysis of nursing personnel reflections on fall events' Journal of Clinical Nursing, vol. 28, no. 7-8, pp. 1346-1353. https://doi.org/10.1111/jocn.14724

Caring for the older person with cognitive impairment in hospital : Qualitative analysis of nursing personnel reflections on fall events. / Grealish, Laurie; Chaboyer, Wendy; Darch, Jacob; Real, Belinda; Phelan, Maggie; Soltau, Dawn ; Lunn, Matthew; Brandis, Susan; Todd, Jo-anne; Cooke, Marie.

In: Journal of Clinical Nursing, Vol. 28, No. 7-8, 01.04.2019, p. 1346-1353.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Caring for the older person with cognitive impairment in hospital

T2 - Qualitative analysis of nursing personnel reflections on fall events

AU - Grealish, Laurie

AU - Chaboyer, Wendy

AU - Darch, Jacob

AU - Real, Belinda

AU - Phelan, Maggie

AU - Soltau, Dawn

AU - Lunn, Matthew

AU - Brandis, Susan

AU - Todd, Jo-anne

AU - Cooke, Marie

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Aims and objectives: To explore nurse and nursing assistant reflections on the care of older patients with cognitive impairment who have experienced a fall. 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: Critical incident technique. 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: 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: Falls prevention for older people with cognitive impairment is complex and belies the simple application of policy. Relevance to clinical practice: 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.

AB - Aims and objectives: To explore nurse and nursing assistant reflections on the care of older patients with cognitive impairment who have experienced a fall. 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: Critical incident technique. 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: 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: Falls prevention for older people with cognitive impairment is complex and belies the simple application of policy. Relevance to clinical practice: 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.

UR - http://www.scopus.com/inward/record.url?scp=85059634200&partnerID=8YFLogxK

U2 - 10.1111/jocn.14724

DO - 10.1111/jocn.14724

M3 - Article

VL - 28

SP - 1346

EP - 1353

JO - Journal of Clinical Nursing

JF - Journal of Clinical Nursing

SN - 0962-1067

IS - 7-8

ER -