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 language | English |
|---|---|
| Pages (from-to) | 1346-1353 |
| Number of pages | 8 |
| Journal | Journal of Clinical Nursing |
| Volume | 28 |
| Issue number | 7-8 |
| Early online date | 5 Dec 2018 |
| DOIs | |
| Publication status | Published - 1 Apr 2019 |
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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 journal › Article › Research › peer-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 -