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

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.

Suggested Citation

  • Laurie Grealish & Wendy Chaboyer & Jacob Darch & Belinda Real & Maggie Phelan & Dawn Soltau & Matthew Lunn & Susan Brandis & Jo‐anne Todd & Marie Cooke, 2019. "Caring for the older person with cognitive impairment in hospital: Qualitative analysis of nursing personnel reflections on fall events," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(7-8), pages 1346-1353, April.
  • Handle: RePEc:wly:jocnur:v:28:y:2019:i:7-8:p:1346-1353
    DOI: 10.1111/jocn.14724
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    References listed on IDEAS

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    1. Victoria Traynor & Kumiyo Inoue & Patrick Crookes, 2011. "Literature review: understanding nursing competence in dementia care," Journal of Clinical Nursing, John Wiley & Sons, vol. 20(13‐14), pages 1948-1960, July.
    2. Sarah Burston & Wendy Chaboyer & Brigid Gillespie, 2014. "Nurse‐sensitive indicators suitable to reflect nursing care quality: a review and discussion of issues," Journal of Clinical Nursing, John Wiley & Sons, vol. 23(13-14), pages 1785-1795, July.
    3. Jürgen Härlein & Ruud JG Halfens & Theo Dassen & Nils A Lahmann, 2011. "Falls in older hospital inpatients and the effect of cognitive impairment: a secondary analysis of prevalence studies," Journal of Clinical Nursing, John Wiley & Sons, vol. 20(1‐2), pages 175-183, January.
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    1. Gillian Stockwell‐Smith & Adeniyi Adeleye & Wendy Chaboyer & Marie Cooke & Maggie Phelan & Jo‐anne Todd & Laurie Grealish, 2020. "Interventions to prevent in‐hospital falls in older people with cognitive impairment for further research: A mixed studies review," Journal of Clinical Nursing, John Wiley & Sons, vol. 29(17-18), pages 3445-3460, September.

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