Nursing older people最新文献

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.

Background: Pain management in older people presents unique challenges due to age-related physiological changes, altered responses to medicines, comorbidities and polypharmacy. These challenges, which are exacerbated in those aged ≥75 years, can compromise the efficacy and safety of pharmacological treatment, including after discharge following orthopaedic surgery.

Aim: To evaluate pain management and follow-up care provided in primary care settings in Jordan to older people who had undergone orthopaedic surgery.

Method: For this descriptive study, data were collected from the discharge summaries and electronic health records of older people who were receiving support from community nurses in rural primary care units in the Aqaba Governorate in Jordan after undergoing orthopaedic procedures in hospital.

Results: Of the 100 participants, 63 lived in a nursing home and 30 had been diagnosed with dementia. Hip fractures, diagnosed in 56 participants, were the most common reason for surgery. Thirty-two participants had a documented post-discharge follow-up plan regarding pain management in primary care. Of the 90 participants who were still being followed up 12 weeks after discharge, 51 (57%) were still being prescribed opioids for regular use or as required.

Conclusion: Nurses have a crucial role in ensuring effective and safe pain management in older people, particularly when using opioids, due to the heightened risk of adverse effects and medicine interactions. Tailored pain management involves careful initiation of medicines; regular monitoring and assessment of pain levels, adherence to medicines and monitoring of potential side effects; and individualised follow-up plans.

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.

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.

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.

Knowledge about research participation in care homes is sparse. To explore research participation in Scottish care homes, including the potential barriers and facilitators, a short survey was distributed to all care homes in Scotland in 2014. The survey was repeated in 2022 as care homes emerged from the effects of the coronavirus disease 2019 (COVID-19) pandemic. This article provides a comparison of the results of the 2022 survey (45 responses) with those of the 2014 survey (130 responses); the surveys were completed by care home staff. The results indicate that there has been a slight increase in the proportion of care homes involved in research in the intervening period but overall, research participation has remained low in this sector. In the 2022 survey, the main factors identified as influencing a resident's decision to participate in research were 'to help others', 'to benefit the resident' and the 'resident's desire to participate'. The main obstacles to research participation by staff and/or residents were workload pressure and lack of time, which had increased significantly since the 2014 survey. The results reinforce the importance of ensuring care home staff feel equipped to participate in research.

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 ).