In the critical care population, heart rate and rhythm, blood pressure, respiratory rate, and oxygen saturation are monitored continuously, providing immediate feedback regarding any changes in patient status. Hemodynamic instability is a term commonly used by clinicians to describe labile changes in cardiopulmonary status, although this term is poorly defined in the literature. The clinician's perception of hemodynamic instability may cause a delay or omission in turning, repositioning, and other interventions to advance patient mobility and may contribute to pressure ulcer formation. The intensive care unit's practice culture and individual clinician perceptions regarding hemodynamic instability may lead to staff not turning patients out of fear that they are "too unstable to turn." This article provides a discussion of the link between pressure ulcers and immobility, provides a review of current literature on progressive mobility and hemodynamic instability, and presents the results of a critical care consensus panel on safe and effective turning of critical care patients.

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In the final stages of dementia, individuals may lose the ability to use verbal language. Linda Currie explains how staff in general practice can use a method called adaptive interaction to help communicate with people living with dementia Significant numbers of people in the UK are living with dementia. In the final stages of dementia, individuals may experience a loss of verbal language ability. All staff in general practice are in a key position to engage with individuals using non-verbal communication methods. Adaptive interaction is one such method, which is simple to initiate, and in doing so offers a lifeline to help prevent social isolation.

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