Nursing older people最新文献

Rationale and key points: Hospital admissions can be challenging for people with Parkinson's disease, in part because of the lack of understanding, among some healthcare professionals, of the importance of administering antiparkinsonian medicines on time. This article outlines the steps that nurses can take to optimise medicines management for people with Parkinson's disease who are admitted to hospital. • Pharmacotherapy is the primary treatment for Parkinson's disease and aims to increase dopamine levels in the brain to relieve symptoms. • People with Parkinson's disease require careful administration, titration, adjustment and monitoring of their antiparkinsonian medicines regimen, which is highly individualised. • It is crucial that people with Parkinson's disease take their antiparkinsonian medicines at exactly the right time, since the inaccurate timing of these medicines can have significant adverse health implications. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when undertaking medicines management for people with Parkinson's disease in hospital. • How you could use this information to educate nursing students or your colleagues on optimising medicines management for people with Parkinson's disease in hospital.

Background: Older people living in the community are at risk of preventable nighttime falls. Technology can support falls interventions but there is a lack of research into this area. A new bedside device called Bide senses movement and changes in light levels and plays a prerecorded message encouraging the user to follow falls prevention advice when trying to mobilise at night.

Aim: To test the feasibility of using the Bide device in a community health service.

Method: Healthcare workers were trained in the use of the Bide device and asked to identify potential participants. The research team subsequently recruited participants, provided them with a device and explained how to use it. After four weeks, participants took part in face-to-face semi-structured interviews regarding the acceptability of the device. Participants' fear of falling was calculated before and after the intervention using the Falls Efficacy Scale-International.

Findings: The Bide device appeared to increase patients' confidence to mobilise at night and no adverse events were reported from its use. The device was generally found to be acceptable and easy to use, although one participant found it irritating. Healthcare workers flagged up very few potential participants to the research team, which may have been due to workload pressures and a disconnect between healthcare workers and technology.

Conclusion: It appears feasible to study the use of the Bide device for nighttime falls prevention in the community. To enhance recruitment, a member of the research team may be embedded in the clinical team with the aim of proactively identifying potential participants.

Dementia is characterised by memory loss, behavioural changes and decline of cognitive, social and physical functions and is a life-limiting condition. At the point of diagnosis it is classed as a palliative condition, yet there is limited public and healthcare professional awareness that, once diagnosed, a person will either die of dementia or die with dementia. This article discusses how the recognition and timing of the need for palliative dementia care is pivotal in providing person-centred care. The authors explore factors such as optimal prognostication, advance care planning, staff education and accessing support from palliative and end of life care teams and Admiral Nurses. The authors also use a fictional case study to demonstrate best practice in palliative dementia care.

Background: A Walk Through Dementia (AWTD) is a learning resource that shows dementia from the perspective of people with the condition. Its three 360-degree simulation films depict a person with dementia in different everyday situations and can be viewed online or on a smartphone using an app.

Aim: To evaluate how first-year undergraduate healthcare students react to the AWTD app, what they learn from it and the influence it has on their clinical practice during placements.

Method: The app was used as a learning tool during two dementia training days attended by 414 students at Bournemouth University. Data were collected on the day via a post-training survey and four months later via two focus groups with a small purposive sample of students.

Findings: The survey was completed by 271 of the 414 students (65% response rate) and 11 students participated in the focus groups. Survey respondents found the app easy to use and engaging. They reported a deeper understanding of dementia and felt that the app had changed their attitude towards people with dementia. Focus group participants discussed how they approached people with dementia with more awareness, more confidence and in a more person-centred manner.

Conclusion: There are potential benefits of using the AWTD app in dementia education for undergraduate healthcare students, but further research is needed to confirm its effectiveness as a learning tool.

A virtual ward can provide hospital-level care for older people in their usual place of residence during an episode of acute illness. Care on a virtual ward may be delivered through a mix of in-person home visits, telephone or video calls and remote monitoring. This model of care can prevent unnecessary inpatient admissions, which in turn can prevent the development of associated complications in this patient population, such as deconditioning, delirium and hospital-acquired infections. However, there are barriers to the use of virtual wards in the care of older people. This article provides an overview of technology-enabled virtual wards and discusses some of the barriers to their use in older people's care as well as ways in which these can be addressed. The author also considers how nurses can help ensure that the care provided to an older person admitted to a virtual ward is person-centred and safe.

During the coronavirus disease 2019 (COVID-19) pandemic, restrictions were placed on social contacts and group activities in long-term care settings. Evidence has suggested that social isolation can lead to the onset of health issues including depression and cognitive decline in older people. This article details a quality improvement project undertaken by the managers of nine long-term care settings in Northern Ireland that aimed to enhance meaningful activity and meaningful engagement for residents following the easing of COVID-19 restrictions. The findings suggest that improving meaningful activity and meaningful engagement can benefit residents in terms of nutrition and hydration, sleep patterns, use of medicines and number of falls.

Person-centred care is based on the notion that patients' independence and dignity is sustained during the care planning process. Negotiating person-centred care with the older person involves exploring their self-care beliefs, values and attitudes. This article discusses patient beliefs, values and attitudes in the context of self-care and suggests ways in which nurses might explore these as a collaborative enquiry. The author also describes the use of a simple reflective framework as a starting point for engaging in this exploration.

Musculoskeletal conditions are highly prevalent among older adults and can have a significant impact on their quality of life. Musculoskeletal health is an important component of maintaining well-being and independence. A proactive approach is required, with nurses implementing strategies such as healthy diets and physical exercise that will support optimal health. This article considers the importance of musculoskeletal health, examines the risk factors for a decline in musculoskeletal health, and explores approaches that can improve outcomes and promote healthy ageing.

The first intervention in pressure ulcer prevention is often the completion of a pressure ulcer risk assessment, which aims to identify a patient's level of risk of developing a pressure ulcer. Appropriate care planning should then follow. There are several pressure ulcer risk assessment tools that nurses can use in their clinical practice, but it has not always been clear which is the most effective. One of these tools - the PURPOSE T (Pressure Ulcer Risk Primary or Secondary Evaluation Tool) - has recently been recommended in national guidelines and is now considered to be the only tool with an up-to-date evidence base. This article examines some of the risk assessment tools used to assess pressure ulcer risk, as well as providing an overview of the PURPOSE T and explaining its significance in pressure ulcer prevention.

Despite prevention efforts, falls in hospital are a common and ongoing safety concern, with older people more likely to fall and experience harm as a result of falls. Clinical guidelines recommend multifactorial falls risk assessment and multidomain, personalised interventions to reduce falls risks in hospitals. This article reflects on findings from a multi-site study on the implementation of multifactorial falls prevention practices that informed the development of actionable guidance. The discussion focuses on strategies used by nurse leaders, at different levels of seniority, that shaped practice on orthopaedic and older person wards. While falls risk assessment documentation was monitored routinely by senior leaders, in practice falls prevention often relied on risk screening and enhanced patient supervision. Findings suggest that nurses need to be empowered to lead practices that modify and mitigate individual falls risks where possible, with greater multidisciplinary and patient and carer involvement.