Suzanne Mitten-Lewis

A volunteer companion‐observer intervention reduces falls on an acute aged care ward

PURPOSE Falls are the most frequently reported adverse event in hospitalised patients and carry a risk of great harm for the frail elderly. This intervention aimed to prevent high-risk in-patients on an acute aged care ward from falling. DESIGN/METHODOLOGY/APPROACH Patients assessed at high falls risk were accommodated in a room staffed by volunteer companion-observers. The volunteers engaged them in conversation, played cards, opened meals and used the call bell to summon nurses if patients attempted to move from the bed or chair without assistance. Because of occupational health and safety considerations, the volunteers did not assist patients to ambulate. FINDINGS The falls rate in the acute aged care ward decreased by 44 percent (p < 0.000). No patients fell in the observation room when volunteers were present. Relatives of participating in-patients expressed appreciation of the volunteer role, in terms of increased safety and also companionship. Volunteers exercised initiative in determining their pattern of work and developing resources to support their role. RESEARCH LIMITATIONS/IMPLICATIONS Because volunteers are not present around the clock, other strategies are needed to prevent wandering, frequently confused older in-patients from falling during the night. PRACTICAL IMPLICATIONS In a context where frail elderly patients need constant supervision, using volunteers is a reasonable strategy. ORIGINALITY/VALUE This intervention used an inexpensive, human resources-based approach to significantly reduce the incidence of falls in the population at highest risk of falling. The additional benefits to patients in terms of cognitive improvement bear further investigation.

Determining and Discerning Expert Practice: A Review of the Literature

Although the nature and characteristics of expert practice have been described in the literature, the description is incomplete. How expertise is gained is not fully understood, and definitions of expert competencies have yet to be developed. Essential issues for education arise from the demand for knowledge for expert practice. Because expertise is gained in the context of practice, expertise cannot be achieved out of context or taught as an academic exercise. A clear picture of the practice of expert nurses is necessary so that those in the profession can know and articulate expert practice and direct it to the community.

Evaluating key dimensions of the breast care nurse role in Australia.

A survey of women who had surgery for breast cancer during 1997–1998 at The St George Public and St George Private Hospitals identified substantial deficits in information provision, perceived support, and use of available services. Consequently, a breast care nurse (BCN) was appointed for a 12-month trial to assess womens needs and provide emotional support, education, and referral to appropriate services from diagnosis through to completion of treatment, according to evidence-based guidelines set out by the Australian National Breast Cancer Centre. A questionnaire regarding the role of the BCN was sent to 63 women who had surgery at either hospital from September 1999 to January 2000. Fifty women responded, for a 79% response rate. Ninety percent of respondents reported that it was helpful to talk to the BCN and rated verbal information given as helpful. Women accessed significantly more services than reported in 1998, and disparities in service use by age and public/private sector were eliminated. These results show strong consumer endorsement of service provision by the BCN. During this 12-month trial, consumer demand resulted in service expansion from 24 hours per week to 80. Ongoing evaluation of this developing role is required to ensure that womens needs are managed optimally.

Validating components of a falls risk assessment instrument

Falls are a significant burden on the Australian health care budget and can result in loss of personal independence, injury or death. A sustained high rate of inpatient falls in a 550‐bed acute care hospital has made it imperative for nurses to identify patients at highest risk, in order to implement preventive interventions. This study examined the prevalence of “intrinsic high risk” characteristics identified by the literature in people who fell during hospitalisation, to confirm the validity of these predictors in detecting risk. Over ten weeks 91 inpatients fell (total 118 falls) and were assessed for intrinsic risk factors. Most prevalent was impaired ambulatory status resulting in balance instability. Other high prevalence factors included cognitive impairment and age > 75. Commonly cited factors, such as urinary or faecal incontinence, medications and history of prior falls, were found less frequently. No significant differences in risk factors by gender were identified.