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

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    Author(s)
    Grealish, Laurie
    Chaboyer, Wendy
    Darch, Jacob
    Real, Belinda
    Phelan, Maggie
    Soltau, Dawn
    Lunn, Matthew
    Brandis, Susan
    Todd, Jo-anne
    Cooke, Marie
    Griffith University Author(s)
    Chaboyer, Wendy
    Cooke, Marie L.
    Year published
    2019
    Metadata
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    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 ...
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    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.
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    Journal Title
    JOURNAL OF CLINICAL NURSING
    Volume
    28
    Issue
    7-8
    DOI
    https://doi.org/10.1111/jocn.14724
    Copyright Statement
    © 2019 John Wiley & Sons Ltd. This is the peer reviewed version of the following article: Caring for the older person with cognitive impairment in hospital: Qualitative analysis of nursing personnel reflections on fall events, Journal of Clinical Nursing, Vol. 28:1346–1353, 2019, which has been published in final form at 10.1111/jocn.14724. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving (http://olabout.wiley.com/WileyCDA/Section/id-828039.html)
    Subject
    Nursing
    Health services and systems
    Public health
    Psychology
    Publication URI
    http://hdl.handle.net/10072/382858
    Collection
    • Journal articles

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