Implementing Evidence‐Based Guidelines for Falls Prevention: Observations of Nursing Activities During the Care of Older People with Cognitive Impairment

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

Research output: Contribution to journalArticleResearchpeer-review

Abstract

BACKGROUND: Evidence-based guidelines assist clinicians in practice, but how the guidelines are implemented is less established.

AIM: To describe the nurses' implementation of activities recommended in evidence-based guidelines for falls prevention and care of older people with cognitive impairment.

METHODS: Structured observation with a categorical checklist was used. Nursing personnel were recruited from one subacute and two acute wards in two hospitals in one tertiary-level health service in south-eastern Queensland, Australia. The data collection instrument identified 31 activities drawn directly from the evidence-based guidelines, which were categorized into six domains of nursing practice: clinical care, comfort, elimination, mobility, nutrition and hydration, and social engagement. Four-hour observation periods, timed to occur across the morning and evening shifts, were conducted over 2 months.

RESULTS: Nineteen registered nurses, six enrolled nurses, and 16 assistants in nursing (N = 41) were observed for 155 hr of observation. There was variability in adherence with specific activities, ranging from 21% to 100% adherence. Three categories with the highest adherence were nutrition and hydration, mobilization safety, and social engagement. The clinical care, comfort, and elimination categories had lower adherence, with lowest adherence in activities of education provision about falls risk, pain assessment, using a clock or calendar to reorient to time and place, and bowel care.

LINKING EVIDENCE TO ACTION: Nursing care is delivered within an interdisciplinary team. Therefore, responsibility for the everyday fundamental care activities known to prevent falls in older people with cognitive impairment requires localized negotiation. A practical guide for preventing in-hospital falls in older people with cognitive impairment addressing the interdisciplinary context of practice is required. Interdisciplinary teams should develop strategies to enhance the implementation of pain assessment and prevention of constipation in the context of regularly implemented hydration, nutrition, and mobilization care strategies.

Original languageEnglish
Pages (from-to)335-343
Number of pages9
JournalWorldviews on Evidence-Based Nursing
Volume16
Issue number5
Early online date3 Jun 2019
DOIs
Publication statusPublished - 1 Oct 2019

Fingerprint

Nursing
Nurses
Guidelines
Observation
Pain Measurement
Queensland
Negotiating
Constipation
Nursing Care
Checklist
Practice Guidelines
Health Status
Health Services
Safety
Education
Cognitive Dysfunction
Patient Comfort

Cite this

Grealish, Laurie ; Real, Belinda ; Todd, Jo-Anne ; Darch, Jacob ; Soltau, Dawn ; Phelan, Maggie ; Lunn, Matthew ; Brandis, Susan ; Cooke, Marie ; Chaboyer, Wendy. / Implementing Evidence‐Based Guidelines for Falls Prevention: Observations of Nursing Activities During the Care of Older People with Cognitive Impairment. In: Worldviews on Evidence-Based Nursing. 2019 ; Vol. 16, No. 5. pp. 335-343.
@article{95390b2109bf44bb8341a2ee19e25395,
title = "Implementing Evidence‐Based Guidelines for Falls Prevention: Observations of Nursing Activities During the Care of Older People with Cognitive Impairment",
abstract = "BACKGROUND: Evidence-based guidelines assist clinicians in practice, but how the guidelines are implemented is less established.AIM: To describe the nurses' implementation of activities recommended in evidence-based guidelines for falls prevention and care of older people with cognitive impairment.METHODS: Structured observation with a categorical checklist was used. Nursing personnel were recruited from one subacute and two acute wards in two hospitals in one tertiary-level health service in south-eastern Queensland, Australia. The data collection instrument identified 31 activities drawn directly from the evidence-based guidelines, which were categorized into six domains of nursing practice: clinical care, comfort, elimination, mobility, nutrition and hydration, and social engagement. Four-hour observation periods, timed to occur across the morning and evening shifts, were conducted over 2 months.RESULTS: Nineteen registered nurses, six enrolled nurses, and 16 assistants in nursing (N = 41) were observed for 155 hr of observation. There was variability in adherence with specific activities, ranging from 21{\%} to 100{\%} adherence. Three categories with the highest adherence were nutrition and hydration, mobilization safety, and social engagement. The clinical care, comfort, and elimination categories had lower adherence, with lowest adherence in activities of education provision about falls risk, pain assessment, using a clock or calendar to reorient to time and place, and bowel care.LINKING EVIDENCE TO ACTION: Nursing care is delivered within an interdisciplinary team. Therefore, responsibility for the everyday fundamental care activities known to prevent falls in older people with cognitive impairment requires localized negotiation. A practical guide for preventing in-hospital falls in older people with cognitive impairment addressing the interdisciplinary context of practice is required. Interdisciplinary teams should develop strategies to enhance the implementation of pain assessment and prevention of constipation in the context of regularly implemented hydration, nutrition, and mobilization care strategies.",
author = "Laurie Grealish and Belinda Real and Jo-Anne Todd and Jacob Darch and Dawn Soltau and Maggie Phelan and Matthew Lunn and Susan Brandis and Marie Cooke and Wendy Chaboyer",
note = "{\circledC} 2019 Sigma Theta Tau International.",
year = "2019",
month = "10",
day = "1",
doi = "10.1111/wvn.12376",
language = "English",
volume = "16",
pages = "335--343",
journal = "Worldviews on Evidence-Based Nursing",
issn = "1545-102X",
publisher = "Wiley-Blackwell",
number = "5",

}

Implementing Evidence‐Based Guidelines for Falls Prevention: Observations of Nursing Activities During the Care of Older People with Cognitive Impairment. / Grealish, Laurie; Real, Belinda; Todd, Jo-Anne; Darch, Jacob; Soltau, Dawn; Phelan, Maggie; Lunn, Matthew; Brandis, Susan; Cooke, Marie; Chaboyer, Wendy.

In: Worldviews on Evidence-Based Nursing, Vol. 16, No. 5, 01.10.2019, p. 335-343.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Implementing Evidence‐Based Guidelines for Falls Prevention: Observations of Nursing Activities During the Care of Older People with Cognitive Impairment

AU - Grealish, Laurie

AU - Real, Belinda

AU - Todd, Jo-Anne

AU - Darch, Jacob

AU - Soltau, Dawn

AU - Phelan, Maggie

AU - Lunn, Matthew

AU - Brandis, Susan

AU - Cooke, Marie

AU - Chaboyer, Wendy

N1 - © 2019 Sigma Theta Tau International.

PY - 2019/10/1

Y1 - 2019/10/1

N2 - BACKGROUND: Evidence-based guidelines assist clinicians in practice, but how the guidelines are implemented is less established.AIM: To describe the nurses' implementation of activities recommended in evidence-based guidelines for falls prevention and care of older people with cognitive impairment.METHODS: Structured observation with a categorical checklist was used. Nursing personnel were recruited from one subacute and two acute wards in two hospitals in one tertiary-level health service in south-eastern Queensland, Australia. The data collection instrument identified 31 activities drawn directly from the evidence-based guidelines, which were categorized into six domains of nursing practice: clinical care, comfort, elimination, mobility, nutrition and hydration, and social engagement. Four-hour observation periods, timed to occur across the morning and evening shifts, were conducted over 2 months.RESULTS: Nineteen registered nurses, six enrolled nurses, and 16 assistants in nursing (N = 41) were observed for 155 hr of observation. There was variability in adherence with specific activities, ranging from 21% to 100% adherence. Three categories with the highest adherence were nutrition and hydration, mobilization safety, and social engagement. The clinical care, comfort, and elimination categories had lower adherence, with lowest adherence in activities of education provision about falls risk, pain assessment, using a clock or calendar to reorient to time and place, and bowel care.LINKING EVIDENCE TO ACTION: Nursing care is delivered within an interdisciplinary team. Therefore, responsibility for the everyday fundamental care activities known to prevent falls in older people with cognitive impairment requires localized negotiation. A practical guide for preventing in-hospital falls in older people with cognitive impairment addressing the interdisciplinary context of practice is required. Interdisciplinary teams should develop strategies to enhance the implementation of pain assessment and prevention of constipation in the context of regularly implemented hydration, nutrition, and mobilization care strategies.

AB - BACKGROUND: Evidence-based guidelines assist clinicians in practice, but how the guidelines are implemented is less established.AIM: To describe the nurses' implementation of activities recommended in evidence-based guidelines for falls prevention and care of older people with cognitive impairment.METHODS: Structured observation with a categorical checklist was used. Nursing personnel were recruited from one subacute and two acute wards in two hospitals in one tertiary-level health service in south-eastern Queensland, Australia. The data collection instrument identified 31 activities drawn directly from the evidence-based guidelines, which were categorized into six domains of nursing practice: clinical care, comfort, elimination, mobility, nutrition and hydration, and social engagement. Four-hour observation periods, timed to occur across the morning and evening shifts, were conducted over 2 months.RESULTS: Nineteen registered nurses, six enrolled nurses, and 16 assistants in nursing (N = 41) were observed for 155 hr of observation. There was variability in adherence with specific activities, ranging from 21% to 100% adherence. Three categories with the highest adherence were nutrition and hydration, mobilization safety, and social engagement. The clinical care, comfort, and elimination categories had lower adherence, with lowest adherence in activities of education provision about falls risk, pain assessment, using a clock or calendar to reorient to time and place, and bowel care.LINKING EVIDENCE TO ACTION: Nursing care is delivered within an interdisciplinary team. Therefore, responsibility for the everyday fundamental care activities known to prevent falls in older people with cognitive impairment requires localized negotiation. A practical guide for preventing in-hospital falls in older people with cognitive impairment addressing the interdisciplinary context of practice is required. Interdisciplinary teams should develop strategies to enhance the implementation of pain assessment and prevention of constipation in the context of regularly implemented hydration, nutrition, and mobilization care strategies.

UR - http://www.scopus.com/inward/record.url?scp=85067043956&partnerID=8YFLogxK

U2 - 10.1111/wvn.12376

DO - 10.1111/wvn.12376

M3 - Article

VL - 16

SP - 335

EP - 343

JO - Worldviews on Evidence-Based Nursing

JF - Worldviews on Evidence-Based Nursing

SN - 1545-102X

IS - 5

ER -