Sunday, 20 September 2015

Patient repositioning

Seamus Cowman, Associate Editor
Professor Seamus Cowman

Patient repositioning is a commonly implemented pressure injury prevention strategy in health care. The surprising thing is that there is little evidence on how frequently patients should be repositioned, there is also a lack of understanding of the frequency of movement among hospitalized patients with reduced mobility. A new study by Latimer et al 2015: ‘The repositioning of hospitalized patients with reduced mobility: a prospective study’ published in Nursing Open, provides new insights for health professionals in planning care for pressure ulcer, at risk patients. The problem of pressure ulcers represents a serious failing in the delivery of health services and it remains as an enigma to health service professionals and administrators alike, as this is largely a preventable problem.

This observational study incorporated two data collection methods: chart audits and semi-structured observations. Using a consecutive sampling plan, 241 participants were recruited from two large Australian hospitals with one of the inclusion criteria being reduced mobility. The results showed that patients were repositioned more frequently than might have been previously believed and were observed to be repositioned on average 15 times over a 24 hour period. A lack of patient understanding about proper positioning for prevention of pressure ulcers is an important finding. Interestingly older patients and males were repositioned less frequently, placing them at greater risk for pressure ulcer development. Patients were repositioned less at night than they were during the day.

The findings of this study should be of interest to health professionals in their efforts to tackle a mostly preventable health problem. The authors in their conclusion echo a recommendation that is a recurring theme from the literature on pressure ulcers: ‘Targeted and individualized pressure injury prevention management should be incorporated into clinical practice, however, this can only be achieved with nurse’s support and concurrent organizational support’.    

Reference
Latimer, S., Chaboyer, W. and Gillespie, B. M. (2015), The repositioning of hospitalized patients with reduced mobility: a prospective study. Nursing Open, 2: 85–93. doi: 10.1002/nop2.20


 July 2015

Friday, 18 September 2015

Calmness and agitation in people with dementia

Roger Watson, Editor

Anyone caring for people with dementia will know how hard mealtimes can be: the noise; movement; and resistance to feeding can all lead to agitation with the result that older people with dementia receive a low food intake with the consequent negative effects of undernutrition.  In a study by Begland et al. (2105) titled: 'A qualitative study of professional caregivers' perceptions of processes contributing to mealtime agitation in persons with dementia in nursing home wards and strategies to attain calmness' professional caregivers were interviewed about this phenomenon.

As the authors explain, the aim of the study was to: 'Describe professional caregivers’ perceptions of factors and processes contributing to mealtime agitation and strategies for attaining and maintaining calm mealtimes.'  Through the interviews the following factors leading to agitation were identified: lack of social interaction; negative social interaction around the table; too many stimuli.

The authors concluded that: 'When PCs perceived agitation as developing from negative emotional reactions to episodes that were happening during the meal, they are able to take actions to prevent these episodes. This approach is different from an attitude that perceives agitation as solely caused by the dementia disease and thus as something that the staff cannot influence or prevent.'  and that 'Head nurses in nursing home wards for persons with dementia should be aware of the need for knowledge about how to conduct positive mealtimes and should ensure that PCs receive adequate support and supervision while participating in mealtimes. Head nurses should communicate to their staff that participating during mealtimes is an essential part of high quality dementia care.'

Reference

Bergland, Å., Johansen, H. and Sellevold, G. S. (2015), A qualitative study of professional caregivers' perceptions of processes contributing to mealtime agitation in persons with dementia in nursing home wards and strategies to attain calmness. Nursing Open. doi: 10.1002/nop2.24