Caring for the older person with cognitive impairment in hospital: Qualitative analysis of nursing personnel reflections on fall events

Aims and objectives To explore nurse and nursing assistant reflections on the care of older patients with cognitive impairment who have experienced a fall. Background While there are evidence‐based clinical guidelines for the prevention and management of falls and for the care of older people with cognitive impairment, the falls rates for older people with cognitive impairment are three times as high as those without. Design Critical incident technique. Methods Eleven registered and two enrolled nurses and four assistants in nursing working in one subacute and two acute wards within two hospitals of a tertiary level health service in south‐east Queensland. Individual semistructured interviews focused on two past events when a patient with cognitive impairment had fallen in hospital: one when there was minimal harm and the second when there was significant harm. Thematic analysis was undertaken. The COREQ checklist was followed. Results Three themes emerged from 23 reflective accounts of fall events: “direct observation is confounded by multiple observers” and “knowing the person has cognitive impairment is not enough,” and “want to rely on the guideline but unsure how to enact it.” While participants were aware of the falls prevention policy and techniques available to prevent falls, the implementation of these was challenging due to the complexity of care required by the older person with cognitive impairment. Conclusions Falls prevention for older people with cognitive impairment is complex and belies the simple application of policy. Relevance to clinical practice To reduce falls, nurses can involve the family to support “knowing the patient” to enable prediction of impulsive actions; shift the focus of in‐service from lectures to specific case presentations, with collaborative analysis on person‐focused strategies to prevent falls in older people with cognitive impairment; and reconsider the sitter role from simple observer to assistant, focused on ambulation and supporting independence in activities of daily living.Full Tex

Digital fabrikation for unge i specialtilbud

Fælles for børn og unge med kognitive handicap er, at de typisk kommunikerer bedst ved brug af visuel kommunikation, simple sætninger, langsomt tempo, kendt struktur, gentagelser og individuelt målrettet kommunikation. Det kan derfor som udgangspunkt være vanskeligt for denne målgruppe at deltage i digital fabrikation, som er kendetegnet ved teambaserede aktiviteter, samfundsrelevante problemstillinger og en høj grad af ansvar for egen læring. I denne artikel præsenterer vi to eksempler på, hvordan digital fabrikation kan praktiseres på en specialskole for børn og unge med autismespektrum forstyrrelser. Vores analyser viser, at arbejdet med digital fabrikation inden for specialområdet især kræver læringsforløb, der tager udgangspunkt i den enkelte elev (dvs. individbaseret frem for teambaseret), interesser (dvs. særinteresser frem for samfundsmæssige problemstillinger) og lærerstøtte (dvs. styrede forløb frem for egen initieret aktivitet). En anden vigtig pointe fra studiet er, at digital fabrikation kan påvirke de unges sociale liv, hvilket er en positiv udvikling for målgruppen. &nbsp

The effect of transcutaneous vagus nerve stimulation in patients with polymyalgia rheumatica

(1) Polymyalgia rheumatica (PMR) is an inflammatory disease characterised by pain, morning stiffness, and reduced quality of life. Recently, vagus nerve stimulation (VNS) was shown to have anti-inflammatory effects. We aimed to examine the effect of transcutaneous VNS (t-VNS) on PMR. (2) Fifteen treatment-naïve PMR patients completed the study. Patients underwent a 5-day protocol, receiving 2 min of t-VNS stimulation bilaterally on the neck, three times daily. Cardiac vagal tone (CVT) measured on a linear vagal scale (LVS), blood pressure, heart rate, patient-reported outcome, and biochemical changes were assessed. (3) t-VNS induced a 22% increase in CVT at 20 min after initial stimulations compared with baseline (3.4 ± 2.2 LVS vs. 4.1 ± 2.9 LVS, p = 0.02) and was accompanied by a 4 BPM reduction in heart rate (73 ± 11 BPM vs. 69 ± 9, p p = 0.04). No changes in CRP or proinflammatory analytes were observed. (4) t-VNS modulates the autonomic nervous system in patients with PMR, but further investigation of t-VNS in PMR patients is warranted

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