Menzies Health Institute Queensland, Griffith University, QLD, Australia.
Gold Coast Hospital and Health Service, QLD, Australia.
J Clin Nurs. 2019 Apr;28(7-8):1346-1353. doi: 10.1111/jocn.14724. Epub 2019 Jan 8.
To explore nurse and nursing assistant reflections on the care of older patients with cognitive impairment who have experienced a fall.
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.
Critical incident technique.
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.
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.
Falls prevention for older people with cognitive impairment is complex and belies the simple application of policy.
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.
探索护士和护理助理对经历跌倒的认知障碍老年患者护理的反思。
虽然有预防和管理跌倒以及护理认知障碍老年人的循证临床指南，但认知障碍老年人的跌倒率是没有认知障碍的老年人的三倍。
关键事件技术。
在昆士兰州东南部的一家三级保健服务的一家亚急性和两家急性病房工作的 11 名注册护士和 2 名注册护士助理和 4 名护理助理。个体半结构化访谈集中在两名认知障碍患者在医院跌倒的过去两次事件上：一次是伤害最小，另一次是伤害严重。进行了主题分析。遵循了 COREQ 清单。
从 23 个关于跌倒事件的反思报告中出现了三个主题：“直接观察受到多个观察者的干扰”和“了解患者有认知障碍是不够的”，以及“想依赖指南，但不确定如何实施它”。虽然参与者了解预防跌倒的政策和可用技术，但由于认知障碍老年人所需护理的复杂性，实施这些技术具有挑战性。
预防认知障碍老年人跌倒很复杂，不能简单地应用政策。
为了减少跌倒，护士可以让家属参与进来，支持“了解患者”，以便预测冲动行为；将在职培训的重点从讲座转移到具体案例介绍，与合作分析以患者为中心的策略，预防认知障碍老年人跌倒；重新考虑从简单观察者到助理的座位角色，专注于助行和支持日常生活活动的独立性。
