Implementing Evidence‐Based Guidelines for Falls Prevention: Observations of Nursing Activities During the Care of Older People With Cognitive Impairment

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.

Barriers and enablers to embedding fundamental nursing care for older patients—Implications of a mixed methods study for nursing leadership

“…acute care, leadership, mixed method design, older people adherence to fundamental nursing care practices for nutrition and hydration was high, mobility and elimination were variable, and pain assessment was low, thereby illuminating this variability (Grealish et al, 2019). Further research into the causes of missed fundamental care for older patients is now required.…”

“…The concept of ‘failure to maintain’ describes how hospital‐acquired complications may be related to missed fundamental nursing care for older patients (Bail & Grealish, 2016). In a study of the care of older patients with cognitive impairment and falls prevention, adherence to fundamental nursing care practices for nutrition and hydration was high, mobility and elimination were variable, and pain assessment was low, thereby illuminating this variability (Grealish et al, 2019). Further research into the causes of missed fundamental care for older patients is now required.…”

Barriers and enablers to nurses' use of harm prevention strategies for older patients in hospital: A cross‐sectional survey

“…By their nature, preventable harms can be minimized or avoided by consistent delivery of comprehensive high‐quality care (Duckett, Jorm, Moran, & Parsonage, 2018 ; Nabhan et al, 2012 ). Evidence‐based strategies to prevent common patient harms during hospitalization are often poorly understood (Steel et al, 2021 ; Walsh et al, 2020 ) and poorly implemented (Dahlke et al, 2019 ; Grealish et al, 2019 ; Swoboda et al, 2020 ; van Hell‐Cromwijk et al, 2021 ) by nurses.…”