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.

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.

Rationale and key points: Nutrition is a fundamental aspect of nursing care, however older people cared for in hospital, in a care home or in their own home do not always receive adequate support with their nutritional needs, which can leave them at risk of malnutrition. Using a holistic, biopsychosocial framework to support a comprehensive nutritional assessment that includes malnutrition screening can support the nurse to identify the older person's nutritional status and nutrition needs. Nurses undertaking this procedure must ensure they have the knowledge and skills to do so and work within the limits of their competence. • Malnutrition in older people can lead to a decline in functional ability, reduced muscle strength, fatigue, impaired immunity, suboptimal wound healing, increased risk of infection and increased risk of falls. • Screening for, and assessing the risk of, malnutrition is an important part of nursing assessments in any healthcare setting. • A holistic nutritional assessment should incorporate physiological, psychological, emotional, spiritual, social and cultural elements. 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 a holistic nutritional assessment with an older person. • How you could use this information to educate nursing students or your colleagues on the appropriate techniques and evidence base for undertaking a holistic nutritional assessment with an older person.

Recent policy focus in dementia care has been on living well with the condition; however, being able to die well with dementia is of equal importance. Advance care planning (ACP) enables people to consider, express and record their wishes and preferences for palliative and end of life care, however there is a low uptake of ACP in people with dementia. Although ACP discussions should be initiated as soon as possible after a diagnosis of dementia, there are other opportunities and transition points in the person's care during which health and social care professionals could promote, engage in and support ACP discussions. This article considers the importance of ACP in dementia care and uses a case study to explore opportunities for initiating and engaging in ACP with people with dementia.

Older adulthood is a unique time of transition often referred to as the 'golden years'. It is characterised by positive life experiences such as retirement but also by a loss of routine, identity and meaning. The literature identifies alcohol misuse as a growing issue in this population. However, the stigma, perceptions and patterns of drinking associated with alcohol misuse among older people can be a barrier to individuals seeking health advice. This article identifies that older adulthood is a period when nurses can offer health education and support using their unique relationships with patients to encourage healthy drinking behaviours.

Healthy ageing is defined as 'the process of developing and maintaining the functional ability that enables well-being in older age' ( World Health Organization 2015 ). Key factors for healthy ageing are subdivided into intrinsic capacity such as motor, cognitive and sensory function, and extrinsic factors such as health and social care systems, and support from charities, volunteers and the private sector ( Ellis et al 2018 ).

Pain is a relatively common experience among older people, but unrelieved pain has significant functional, cognitive and emotional consequences for this population. A comprehensive and accurate pain assessment is essential for effective pain management. Self-report tools are suitable to assess pain in older people with normal or mildly impaired cognition, while observational tools are suitable for use with those with significant cognitive impairment or communication difficulties. However, pain assessment in older people can be challenging. The use of one tool on its own is rarely sufficient and it is crucial to involve family carers in assessment of pain in older people with severe cognitive impairment. This article discusses different tools and strategies, including the benefits and limitations, for assessing pain in older people.

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.

Skin tears are common injuries that result from mechanical forces. Older people with fragile skin are at greater risk of this type of wound. They are usually categorised as acute wounds that typically heal in 7-21 days but the healing process can be disrupted, leading to chronic, non-healing wounds. They have the potential to compromise quality of life and disrupt daily activities, so it is important to identify risk factors and implement prevention strategies for those at risk. An interdisciplinary approach has a pivotal role in promptly and precisely identifying skin tears, and the use of evidence-based interventions for efficient skin damage management can enhance the recovery process. This article adopts a case study approach to explore the prevention, evaluation and treatment of skin tears, using the case of an individual living with a skin tear in a community setting.

Reflection is an essential aspect of nursing practice that facilitates continuing professional development and practice improvement. Critical reflection is a more in-depth form of reflection and can be described as a creative, dynamic and transformative learning process that enhances practice by promoting self-awareness and critical thinking. Older adults often present with complex and multiple healthcare needs. Engaging in critical reflection can assist nurses to provide the high-quality, person-centred care required to meet those needs, support older people to retain their independence and enhance their well-being. This article discusses critical reflection within the context of nursing older people and describes various models that can be used to support the reflective process. The authors use a practice example to illustrate how using critical reflection in practice can enable nurses to develop a deeper understanding of themselves and use what they have learned to enhance their delivery of person-centred care.