Safety Team to Prevent Falls Article Summary

Assignment 2
Nursing 130 EBP Article and PICO Question Assignment
Grading Rubric
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Article Presented
Summarize article so that your classmates don’t
have to read it. Hit the major points:
* Who did the study? Why?
* What are they studying or testing?
* What change are they investigating?
* What are the statistics of interest?
PICO components identified
Population
Intervention
Comparison
Outcome
PICO Question formulated
How can you phrase what they are doing in a
way that makes sense and includes the PICO
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Uses humor appropriately, but takes assignment
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4
5
5
0
20
This assignment tests your abilities with SLO #7: Demonstrates and support of life-long learning and quality improvement. You have to
know how to find, read, and interpret research, and then incorporate it into your practice.
0
Original Article
Implementing Evidence-?Based Guidelines
for Falls Prevention: Observations of Nursing
Activities During the Care of Older People
With Cognitive Impairment
Laurie Grealish, PhD, RN
? Belinda Real, BN, RN ? Jo-Anne Todd, PhD ?
Jacob Darch, BN, RN ? Dawn Soltau, MNP, RN ? Maggie Phelan, MClinRehab, RN ?
Matthew Lunn, MBA, RN ? Susan Brandis, PhD, B.Occ.Thy ? Marie Cooke, PhD, RN ?
Wendy Chaboyer, PhD, RN
Key words
adult health, adult
care, care delivery
system, clinical
guidelines, dementia,
Alzheimer?s, memory
loss, descriptive
analysis, gerontology,
geriatrics,
quantitative
methodology
ABSTRACT
Background: Evidence-?based guidelines assist clinicians in practice, but how the guidelines
are implemented is less established.
Aim: To describe the nurses? implementation of activities recommended in evidence-?based
guidelines for falls prevention and care of older people with cognitive impairment.
Methods: Structured observation with a categorical checklist was used. Nursing personnel
were recruited from one subacute and two acute wards in two hospitals in one tertiary-?level
health service in south-?eastern Queensland, Australia. The data collection instrument identified 31 activities drawn directly from the evidence-?based guidelines, which were categorized
into six domains of nursing practice: clinical care, comfort, elimination, mobility, nutrition and
hydration, and social engagement. Four-?hour observation periods, timed to occur across the
morning and evening shifts, were conducted over 2 months.
Results: Nineteen registered nurses, six enrolled nurses, and 16 assistants in nursing (N = 41)
were observed for 155 hr of observation. There was variability in adherence with specific activities, ranging from 21% to 100% adherence. Three categories with the highest adherence were
nutrition and hydration, mobilization safety, and social engagement. The clinical care, comfort,
and elimination categories had lower adherence, with lowest adherence in activities of education provision about falls risk, pain assessment, using a clock or calendar to reorient to time and
place, and bowel care.
Linking Evidence to Action: Nursing care is delivered within an interdisciplinary team.
Therefore, responsibility for the everyday fundamental care activities known to prevent falls in
older people with cognitive impairment requires localized negotiation. A practical guide for
preventing in-?hospital falls in older people with cognitive impairment addressing the interdisciplinary context of practice is required. Interdisciplinary teams should develop strategies to
enhance the implementation of pain assessment and prevention of constipation in the context
of regularly implemented hydration, nutrition, and mobilization care strategies.
INTRODUCTION
In-?hospital falls pose a significant economic and operational burden for health services. The increasing number
of safety incidents and harms in hospital is attributed to the
ageing population and the overall number of people living
with (often multiple) conditions, which carry some functional, sensory, and cognitive impairment (Oliver, 2012).
Nurses constitute 41% of the hospital workforce (Australian
Institute of Health and Welfare, 2017) and therefore carry
significant responsibility for patient safety. Falls are generally recognized as a nurse-?sensitive outcome (D?Amour,
Worldviews on Evidence-Based Nursing, 2019; 16:5, 335?343.
? 2019 Sigma Theta Tau International
Dubois, Tchouaket, Clarke, & Blais, 2014; Montalvo, 2007).
However, evidence for falls as a specific outcome sensitive to nursing care has not been consistently demonstrated (Burston, Chaboyer, & Gillespie, 2014; Stalpers, de
Brouwer, Kaljouw, & Schuurmans, 2015).
Several studies have indicated a strong association between
in-?hospital falls and older people with cognitive impairment
(Harlein, Dassen, Halfens, & Heinze, 2009; Hignett, Sands, &
Griffiths, 2013). One form of cognitive impairment in older
people, delirium, is emerging as another in-?hospital complication that may be sensitive to nursing care. Evidence-?based
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Confusion and Falls in Older Patients
delirium care guidelines recommend fundamental clinical
and psychosocial interventions to prevent and manage delirium (Australian Commission for Safety and Quality in Health
Care [ACSQHC], 2016; National Institute for Health and Care
Excellence [NICE], 2010). These fundamental interventions
include adequate nutrition and hydration, mobilization,
and social engagement (Inouye, Westendorp, & Sacynski,
2014) and are mostly conducted by nurses. Evidence-?based
guidelines for the care of older people with another form
of cognitive impairment, dementia recommend person-?
centred approaches (ACSQHC, 2014; Guideline Adaptation
Committee, 2016; NICE, 2016), which are also arguably
in the domain of nursing care. People with dementia are at
much higher risk of developing delirium (Bail et al., 2013),
and the psychosocial care recommendations are similar for
both, so these conditions are often bundled into the term
?cognitive impairment? (Australian Commission for Safety
and Quality in Health Care, 2014).
Cognitive impairment is associated with several hospital-?
acquired complications (Bail et al., 2013), sometimes called
?cascade iatrogenesis? (Thornlow, Anderson, & Oddone,
2009). Fundamental nursing care, attending to nutrition and
hydration, mobilization, elimination, comfort, hygiene, and
social engagement may prevent the development of multiple complications (Bail & Grealish, 2016). However, one
study found that acute care nurses were spending less than
half of their time on direct care activities, and only 13.5%
on personal activities (Chaboyer et al., 2008). More recent studies of acute care nurses (Ausserhofer et al., 2014;
Kalisch, Tschannen, & Lee, 2012) and patients (Kalisch,
Xie, & Dabney, 2014) confirm that fundamental care is
often missed, with missed nursing care associated with falls
(Kalisch et al., 2012). In particular, a mixed methods study
of nursing workload, staffing, work environment, and patient outcomes identified more nursing hours per patient day
was associated with reduced fall rates (Duffield et al., 2011).
In-?hospital falls, and particularly falls in older people
with cognitive impairment, constitute a significant economic and operational burden for health services and poor
outcomes for patients. Nursing practices are recognized as
important for falls prevention in caring for older people
with cognitive impairment, both delirium and dementia.
Given the importance of fundamental nursing care for
people with cognitive impairment, the strong association
between cognitive impairment and falls, and the rising
prevalence of dementia internationally (Prince, Comas-?
Herrara, Knapp, Guerche, & Karagiannidou, 2016), greater
understanding of the actual nursing care provided to older
hospitalized patients with cognitive impairment is urgent.
BACKGROUND
The risk of falls in older people has led to national evidence-?
based guidelines that target older people (ACSQHC, 2009;
336
NICE, 2013; Panel on Prevention of Falls in Older Persons,
American Geriatrics Society and British Geriatrics Society,
2011). However, most of these guidelines offer limited
advice about the prevention of falls in older people with
cognitive impairment. Further, evidence-?
based guidelines for the care of older people with cognitive impairment (Australian Commission for Safety and Quality in
Health Care, 2014; Guideline Adaptation Committee, 2016;
National Institute for Health and Care Excellence, 2016) do
not specifically address in-?hospital falls prevention. There
is emerging evidence that clinical guidelines implementation is complex for both falls prevention (Dempsey, 2009;
Ireland, Kirkpatrick, Boblin, & Robertson, 2013; Milisen
et al., 2013) and care of the older person with cognitive
impairment (Adams et al., 2015; Yevchak et al., 2014).
Preventing in-?hospital falls in older people with cognitive
impairment requires attention to practice, specifically to
how practice adheres to the guidelines.
While the dominant narrative in nursing emphasizes
the importance of following evidence-?based guidelines in
practice, workplace studies suggest that procedures (guidelines) are only one resource used for practitioner action
(Suchman, 2007). Taken-?
for-?
granted activities are often
an active alignment of human and nonhuman elements to
become a stable ?practice,? noting that the ordering processes required to keep the practice going are fragile (Law,
1994). A study of airplane pilots found that in emergencies
and other non-?normal situations, pilots drew upon a range
of resources, using only fragments of the procedures and
checklists as resources in their actions (Carim et al., 2017).
From this perspective, nursing practice is inseparable from
the networks that produce it, including the number of staff
rostered on a shift, availability of equipment, accessibility
of information, and presence of other staff such as doctors, allied health, cleaner, administrator, wards men, and
kitchen staff. Enacting specific activities for each patient
is contingent upon alignment of elements from multiple
sources. In situations that are more complicated, with
greater variability than anticipated by the guidelines, such
as preventing falls in people who are cognitively impaired,
the ordering processes required to keep the practices going
may not align, resulting in more patient falls. Identification
of those activities that may be more fragile and therefore
evade consistent enactment is required to focus our attention on the ordering processes used to enact guideline recommendations (activities).
METHODS
Aim
The aim of the study was to describe the nurses? implementation of activities recommended in evidence-?based guidelines for falls prevention and for care of older people with
cognitive impairment.
Worldviews on Evidence-Based Nursing, 2019; 16:5, 335?343.
? 2019 Sigma Theta Tau International
Original Article
Design
This observational study used a category system with a
specific checklist to conduct structured observations of
nursing care for hospitalized older people with cognitive
impairment. A category system designates qualitative behaviors transpiring in the observational setting (Polit &
Beck, 2017). The research question guiding this study is
as follows: How frequently do nurses undertake evidence-?
based activities for falls prevention and cognitive impairment management in older patients who are cognitively
impaired?
Setting and Sample
One subacute and two acute wards from two hospitals in
a south-?eastern Queensland region health service provided
the setting for the study. This health service had a strong
quality improvement framework for falls prevention, inclusive of an executive lead, interdisciplinary committee, appointed program lead, and comprehensive prevention and
investigation activities. The program related to cognitive
impairment was in an early, more embryonic stage.
Consenting registered and enrolled nurses and consenting assistants in nursing?health service employees who
were trained to provide close observation of individual
patients working in the three wards were invited to participate. Outside staff, such as private agency staff, were not
included in the study. Staff who worked permanent night
duty were excluded. A convenience sampling strategy (Polit
& Beck, 2017) was used, in which nurses who were available on days when there were patients with cognitive impairment were recruited into the study.
Observation Instrument
The structure observation instrument in this study consisted
of 31 activities, drawn from the evidence-?based guidelines
A Better Way to Care (Australian Commission for Safety
and Quality in Health Care, 2014) and Preventing Falls and
Harm From Falls in Older People: Best Practice Guidelines
for Australian Hospitals (Australian Commission for Safety
and Quality in Health Care, 2009). These were grouped
into six domains: clinical care, comfort, social engagement, mobility, nutrition and hydration, and elimination.
Content validity for the instrument was established through
a panel of experts familiar with the guidelines, including
three clinical experts and three researchers in the field.
A member of the research team, whose expertise was in
the care of older people and who was knowledgeable about
the various guidelines and involved in the development
and revisions of the data collection instrument, trained and
assessed the inter-?rater reliability of the research assistants
(RAs). Simultaneous recording of observations by this expert
and each RA was undertaken. The inter-?rater reliability was
70% agreement with RA1 and 90% agreement with RA2.
Nursing activities were recorded on the observation instrument as (a) applicable and completed; (b) applicable
Worldviews on Evidence-Based Nursing, 2019; 16:5, 335?343.
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and not completed; or (c) not applicable. An example of
an intervention rated as ?not applicable? would be ?insert
a hearing aid for someone who can hear and has no hearing aid.? While engagement in the specific activity was recorded, the time spent on the activity was not (Polit & Beck,
2017).
Data Collection
Data were collected over 2 months, from December 2015 to
January 2016. Participants were observed performing care
for older people who were identified as cognitively impaired. The RA observed care delivery from the hallway or
doorway. Each nurse was observed caring for a person with
cognitive impairment once. To get a good range of events
in each ward, we aimed to observe nursing staff over a 4-?hr
period, during the time when falls prevention was considered most important: 0700?1800. Two RAs were provided
with 7 hr of training to ensure data collected were both
reliable and valid.
Data Analysis
The data were entered into a Microsoft Excel spreadsheet
and then transferred to IBM SPSS AMOS version 22 (IBM
Corp.,Armonk, NY, USA) for analysis. Demographic information about the nurses was reported as frequency and
percentage. For the purpose of analysis, activities were
grouped into six categories of nursing care (Berman et al.,
2017): clinical care, comfort, social engagement, mobility,
nutrition and hydration, and elimination. Initially, activities
were analysed descriptively, counting the number of times
an activity was undertaken, not undertaken but deemed by
the observer to be required, and not required (not applicable). Then, all ?not applicable? data were removed, and
adherence was calculated as a percentage, using the number of times nurses enacted the care behavior divided by
the total number of times the behavior was deemed to be
required.
Ethics
Nursing staff members who agreed to participate provided
written informed consent. The Gold Coast Hospital and
Health Service and the Griffith University Human Research
Ethics Committees approved the study.
RESULTS
Forty-?one participants, consisting of 19 registered nurses,
six enrolled nurses, and 16 assistants in nursing, were observed for a total of 155 hr of observation. Approximately
half the observations involved registered nurses (Table 1).
Table 2 shows the type of staff observed by ward.
Adherence to the targeted activities, grouped into six categories, is described in Table 3. Two categories of activities had
higher adherence: nutrition and hydration (i.e., ensures meals
are eaten, and fluids are taken) and mobilization safety (e.g.,
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Confusion and Falls in Older Patients
Table 1. Nurse Demographics
Characteristic
Number (%)
Total
41 (100)
Age, mean (SD)
41.5 (14.9)
Qualification
Registered nurse (RN)
19 (46.3)
Enrolled nurse (EN)
6 (14.6)
Assistant in nursing (AIN)
16 (39.1)
Gender
Female
35 (85.4)
Training in cognitive impairment
No
29 (70.7)
Table 2. Nurse Type and Ward
Ward A
Ward B
Registered
nurse
7
7
5
Enrolled
nurse
1
4
1
Assistant in
nursing
5
6
5
13
17
11
Total
Ward C
checking floor, low beds, mobility aids, bed brakes locked,
and adequate lighting). Adherence was lower for activities
in the clinical, comfort, and elimination categories. Specific
activities with relatively low adherence included providing
education about falls risk, evening settling routine, pain assessment, using a clock or calendar to reorient to time and
place, and bowel care. While evening settling was low, the
number of observations was also low.
DISCUSSION
Missing fundamental nursing activities has been attributed to the taken-?
for-?
granted nature of those activities
(Kalisch et al., 2012). However, this study found that key
fundamental activities in nutrition and hydration, use of
hearing aid, including family member, and assistance with
elimination, were seldom missed. Hourly rounding, a key
activity for both falls prevention and care of older people
with cognitive impairment was frequently enacted, with
86% adherence. There were some key differences in this
study, compared to those in the landmark international
study of nursing care left undone (Ausserhofer et al., 2014).
The international study of 33,659 nurses in 488 hospitals
across 12 European countries used nurses? self-?report of
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care left undone (Ausserhofer et al., 2014) rather than direct observation.
Nurses in this study talked to the patients, with 76%
adherence, compared with 52% of talking with patients
left undone (Ausserhofer et al., 2014). While orientation to
time and date had low adherence of 21%, this is attributed
to nonroutine use of wall clocks and calendars in this hospital. Social engagement and orientation to time and date
are recognized as key psychosocial prevention strategies for
delirium (ACSQHC, 2016) and therefore are important to
achieve higher levels of engagement throughout the day.
We were surprised to find that adherence with comfort
strategies was low, with pain assessment at 34% adherence.
This is quite different from the low 10% of nurses claiming
that pain management was left undone in the Ausserhofer
and colleagues? study (2014). While there are validated instruments to assess pain in people with cognitive impairment (Abbey et al., 2004; Warden, Hurley, & Volicer, 2003),
the lack of pain assessment in this population is a critical
area requiring further investigation.
In the category of clinical care, adherence with education was 58%. This is consistent with the findings in the international study, where 40% of nurses claimed educating
patients and families was left undone (Ausserhofer et al.,
2014). Like most Australian health services, a plethora of
resources is available to support falls prevention education
in this service. However, the processes required to enact
education provision for patients and families appear to
be more difficult for nurses to align. Few studies have
investigated how high-?quality falls prevention education
resources are implemented in practice generally, and none
that we could find for older people with cognitive impairment specifically. This is an important area for further
investigation.
While mobility safety was high, mobility adherence, particularly walking, scored lower adherence, at 68%. Mobilization was not explored in the Ausserhofer and colleagues?
(2014) study. Reduced mobility is associated with more
falls in older inpatients (Harlein et al., 2009), and more falls
have been associated with nurses not ambulating patients
(Kalisch et al., 2012). While not ambulating patients may
constitute missed care, it is also possible that nonambulation is emerging as a falls circumvention strategy. It is possible that the taken-?for-?granted practice of labelling older
patients as a falls risk on the grounds of carrying several risk
factors for falling may shift from a person-?centred focus, encouraging activity to maintain strength, to a risk-?avoidance
focus, simply circumventing all falls by keeping the person
safely in bed or in a chair. Another possibility is that mobilization has become the domain of other health professionals,
such as the physiotherapist, and therefore, some nurses may
not consider ambulation a nursing responsibility. The lack
of mobilization of older people with cognitive impairment
requires further investigation.
Worldviews on Evidence-Based Nursing, 2019; 16:5, 335?343.
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Original Article
Table 3.
Observed Behaviors
Behavior
Yes
N
Applicable
N
Adherence (%)
Clinical care
Hourly rounding
32
37
86
Provide patient/family education about falls risk
(e.g., DVD or brochure)
11
19
58
Share falls risk at handover
28
35
80
Assess for cognitive impairment
32
40
80
2
3
67
Check belongings within reach
30
40
75
Check buzzer in reach
25
41
61
Pain is assessed
13
38
34
6
6
100
Comfort
Psychosocial setting (evening; e.g., warm milk or
massage)
Social engagement
Correctly apply hearing aid
Talk with family/caregiver
7
7
100
Correctly apply glasses
14
18
78
Social conversation
31
41
76
8
38
21
Reorient using clock or calendar
Mobility
Check floor area is free of clutter
41
41
100
Provide low or floor bed
41
41
100
Check mobility aid within reach
13
15
87
Check bed brakes are locked
39
41
95
Check adequate lighting
38
41
93
Correctly uses walking aid
19
23
83
Turn on bed alarm
8
14
57
Nonslippery shoes provided before walking
26
35
74
Mobilize (walk)
26
38
68
Nutrition and hydration
Correctly fit dentures
19
19
100
Dentures provided before meals
29
20
100
Offer/provide preferred food
40
41
100
Provide (ensure eats) meals
38
40
95
Provide (ensure takes) fluids
37
40
93
Elimination
Assist with elimination
32
37
86
Assess urinary continence
29
39
74
Assess for constipation
29
41
71
Acts to reduce constipation
22
32
69
While assisting with elimination overall had good adherence, constipation assessment and management had relatively low adherence, 71% and 69%, respectively. Assess
urinary continence was slightly higher, at 74% adherence.
Worldviews on Evidence-Based Nursing, 2019; 16:5, 335?343.
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Constipation and urinary retention are known triggers for
delirium in people with dementia (Inouye et al., 2014) and
should be proactively managed. However, the management
of constipation is challenging when older people are in
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Confusion and Falls in Older Patients
hospital, with limited ambulation and dietary, and sometimes medication, changes.
Reaction to internal stimuli of cramping abdominal
pain, bloating, feeling as if a movement has not completely
passed, or urgency related to a full bladder can lead to
impulsivity-?related falls in older people with cognitive impairment (Ferrari, Harrison, & Lewis, 2012). Impulsivity-?
related falls are due to unplanned reaction to internal or
external stimuli without regard to the negative consequences of these reactions and characterized by greater
motor activation, less attention, and less planning (Moeller,
Barratt, Dougherty, Schmitz, & Swann, 2001). Therefore,
a sense of urgency associated with elimination can lead
to impulsivity-?related falls in older people with cognitive
impairment.
This study focused on nurses? enactment of the activities
recommended in evidence-?based guidelines for the prevention of falls and care of older people with cognitive impairment. While there were high levels of adherence with some
activities, others had much lower levels. The structured observation technique has provided a method for gathering
important information about what activities are more stable and routinely enacted. It also highlights those activities
that require further investigation, specifically pain assessment, patient and family education, mobility, and elimination. Each of these activities requires alignment of multiple
human and nonhuman elements such as other members of
the interdisciplinary team, assessment tools, medications,
equipment to enable rapid and safe access to a toilet, and
more.
The traditional response to study findings such as these
is to recommend more education (Enns, Rhemtulla, Ewa,
Fruetel, & Holroyd-?Leduc, 2014; Hill et al., 2015) or more
qualified staff (Ausserhofer et al., 2014). However, we suggest that further investigation into the arrangements necessary for the alignment of multiple elements required to
enact practice consistently, and in a variety of highly localized situations, is required. Like the study of airline pilots
(Carim et al., 2017), the use of evidence-?based guidelines is
likely only one element that is aligned into a stable practice
in each of the observed 41 unique care situations. Further
research into the contingencies that disrupt the arrangements for falls prevention activities in older patients with
cognitive impairment is required. While missing one of
these activities once per shift may seem minor and would
not negatively affect most patients, when activities are
missed over several shifts, or several practices are missed in
one shift, the risk of falling rises. While multicomponent
interventions are recommended (Fonda, Cook, Sandler,
& Bailey, 2006; Healey et al., 2014), understanding the
processes that nurses use to align the available resources
to enact those activities is critical. When alignment of resources cannot be achieved, guideline implementation can
fail (Milisen et al., 2013).
340
LIMITATIONS
In this study, the nursing activities were not associated with
or linked to fall rates, nor were the practices of other health
professionals observed. We were interested in the nursing
activities known to maintain safety for older people with
cognitive impairment. However, other health professionals
such as allied health therapists also carry responsibility for
some of these activities. Because the focus of observations
was on the nurses? practice, it may be that the missed care
for mobilization or cognitive assessment was carried out by
other allied health therapists or their assistants.
While the convenience sampling method used in this
study enabled gathering data in a short time period, it does
introduce the possibility of bias, with an over-?or under-?
representation of specific groups of participants (Polit &
Beck, 2017). Rather than suggest that these findings are
generalizable, it raises important considerations in the care
of older patients with cognitive impairment and the need
for further research in this area of practice.
While the short 4-?hr time blocks were distributed across
most of the day, it is possible that care activities undertaken
during more intimate activities, such as during toileting
and bathing, may have occurred but were not observed.
Further studies in this population may require observation
of more intimate activities and inclusion of activities undertaken with staff other than nurses. Further, with the
possibility that patients? conditions may change, we may
not have captured all practices.
IMPLICATIONS FOR FUTURE RESEARCH
We suggest that the narrative for falls prevention in older
people with cognitive impairment should shift from emphasizing the importance of implementing activities that
are sourced from evidence-?based guidelines to focusing on
how guidelines are used in combination with other elements in highly localized and unique situations to enact
practice. Exploring the other elements, both human and
nonhuman, that are actively arranged to make certain activities more consistently enacted can provide fresh insights
into a significant and rising problem for patients, families, and health services. This work could start with three
specific areas where there was lower adherence to recommended activities: pain assessment, promoting mobility,
and elimination management.
CONCLUSIONS
The availability of multiple guidelines indicates international agreement around how to prevent falls and how
to care for an older person with cognitive impairment in
the hospital. However, there is no single guide on how to
prevent falls in older people with cognitive impairment.
Further, there is little guidance on how to implement these
Worldviews on Evidence-Based Nursing, 2019; 16:5, 335?343.
? 2019 Sigma Theta Tau International
Original Article
guidelines. It is timely to reconsider taken-?
for-?
granted
nursing practices as activities that occur in complex arrangements of nonhuman and human elements to become
stable practices. Further, practical guidelines to prevent falls
for the specific population of older people with cognitive
impairment could be developed, recognizing that they
are one resource for nurses. Specifically, further investigation into pain assessment and management of elimination in hospitalized older patients is required. Using the
resources available and understanding how the alignment
of resources is achieved to routinely produce practice in
highly localized settings can lead to negotiations around
responsibility for fundamental care practices for older people with cognitive impairment and ensure that such care is
not missed. WVN
LINKING EVIDENCE TO ACTION
? Explore the local negotiations within the interdisciplinary team that are required to ensure that care is not
missed.
? Carefully consider multiple guidelines and how they
are used to tailor individualized care.
? Create a practical, interdisciplinary guide for preventing in-hospital falls in older people with cognitive
impairment.
? Develop strategies to implement pain assessment specific to people with cognitive impairment.
? Aggressively manage constipation, inclusive of quality
nutrition and mobilization.
Author information
Laurie Grealish, Associate Professor Subacute and Aged
Nursing, School of Nursing & Midwifery and Menzies
Health Institute Queensland, Griffith University,
Southport, QLD, Australia, and Gold Coast Hospital
and Health Service, Southport, QLD, Australia; Belinda
Real, Clinical Nurse Consultant-Falls, Gold Coast
Hospital and Health Service, Southport, QLD, Australia;
Jo-Anne Todd, Senior Research Assistant, School of
Nursing & Midwifery, Griffith University, Southport,
QLD, Australia; Jacob Darch, Clinical Nurse Consultant
& Research Manager Clinical Trials, Cancer Access and
Support Services Research Unit, Gold Coast Hospital
and Health Service, Southport, QLD, Australia; Dawn
Soltau, Nurse Practitioner-Dementia, Gold Coast
Hospital and Health Service, Southport, QLD, Australia;
Maggie Phelan, Clinical Nurse Consultant, Falls and
Balance Clinic, Gold Coast Hospital and Health Service,
Robina, QLD, Australia; Matthew Lunn, Director of
Worldviews on Evidence-Based Nursing, 2019; 16:5, 335?343.
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Nursing, Gold Coast Hospital and Health Service,
Southport, QLD, Australia; Susan Brandis, Professor of
Occupational Therapy, Bond University, Gold Coast,
Robina, QLD, Australia; Marie Cooke, Professor, School
of Nursing & Midwifery and Menzies Health Institute
Queensland, Griffith University, Nathan, QLD, Australia;
Wendy Chaboyer, Professor & Deputy Head of School
(Research) School of Nursing & Midwifery and Menzies
Health Institute Queensland, Griffith University,
Southport, QLD, Australia
A grant from the Gold Coast Hospital and Health Service
Private Practice Trust Fund (PPTF 120 18.5.16) supported
the conduct of this study.
Address correspondence to Laurie Grealish, Griffith
University and Gold Coast Hospital and Health Service,
Office 2.05c, Building G01, Parkland Drive, Southport,
QLD 4222, Australia; [email protected]
Accepted 30 September 2018
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