Risk assessment for people living with dementia: a systematic review.

OBJECTIVE: This systematic review identified key components of risk assessment for people with dementia, examined attitudes toward risk identification and risk assessment, and appraised existing risk assessment tools. METHODS: Systematic searches of five databases on two platforms (EBSCO, OVID) and gray literature databases (Open Grey, Base) were conducted. Studies were screened for inclusion based on predetermined eligibility criteria and quality assessed using the Mixed Methods Appraisal Tool. Findings were tabulated and synthesized using thematic synthesis. RESULTS: Our review found people with dementia, their family carers, and healthcare professionals differed in how risk is conceptualized, with views being shaped by media perceptions, personal experiences, socio-cultural influences, dementia knowledge, and dementia severity. We found that mobilization (causing falls inside and getting lost outside) is the most frequently identified risk factor. Our findings show people with dementia are generally risk-tolerant, while healthcare professionals may adopt risk-averse approaches because of organizational requirements. We found factors that disrupt daily routines, living and caring arrangements, medication management, and unclear care pathways contribute toward adverse risk events. We discovered that most studies about risk and risk assessment scales did not consider insight of the person with dementia into risks although this is important for the impact of a risk. No risk instrument identified had sufficient evidence that it was useful. CONCLUSION: Accurate risk assessment and effective communication strategies that include the perspectives of people with dementia are needed to enable risk-tolerant practice. No risk instrument to date was shown to be widely acceptable and useful in practice.

Virtual reality as a tool to promote wellbeing in the workplace.

Background: NHS staff are disproportionately impacted by workplace stress, threatening not only quality of service delivery, but the sustainability, of this vital healthcare system. There is an urgent need for accessible and cost-effective interventions that promote the wellbeing of this integral workforce. Aim: The aim of this study was to explore the potential propensity of a short virtual reality (VR) nature experience, delivered during the workday, to induce positive mood states NHS clinicians. Method: NHS clinicians working in a fast-paced trauma service were offered the opportunity to take part in a short virtual reality (VR) relaxation session, during their working day, in which they were able to explore the "Green Meadows" experience available within the Nature Treks application. An indication of physiological arousal (heart rate) was obtained, and subjective measures of emotional state were employed to assess the effect of the intervention on participants' mood. Further, feedback was gathered to provide an initial indication of the acceptability of the experience. Results: Analysis of data from 39 clinicians revealed that, following the VR experience, participants reported significantly increased feelings of happiness (p < 0.001) and relaxation (p < 0.001), and significantly decreased feelings of sadness (p = 0.003), anger (p < 0.001) and anxiety (p < 0.001). No significant differences in reported levels of surprise (p = 0.603) or vigour (p = 0.566) were found. Further, the experience was associated with a significant reduction in heart-rate (p = 0.025), and had high acceptability ratings, despite participants' varied experience with computers and VR technology. Conclusions: The findings of this study indicate that the administration of VR for the promotion of NHS staff wellbeing in the workplace is a potentially fruitful avenue of exploration that warrants further investigation.

Flexible rostering in nursing student clinical placements: A qualitative study of student and staff perceptions of the impact on learning and student experience.

AIM: To explore whether a flexible rostering system for nursing students during their clinical placements enhanced their experience and contributed to a positive learning environment. BACKGROUND: In England, attrition from nursing programmes is an enduring issue, often related to student experience of clinical placements. Students juggle caring responsibilities, academic assessment and additional part-time jobs to mitigate financial hardship, while they are undertaking the clinical placement aspect of their courses. Flexible or self-rostering is a system that has been implemented with qualified practitioners in several NHS organisations and may present a solution to the need for flexibility in clinical placements for students. DESIGN: This was a qualitative pre-and post-intervention study. METHOD: A flexible rostering system was co-produced with nursing and midwifery students and subsequently implemented in four in-patient areas in an inner-city NHS healthcare organisation between November 2019 and February 2020. Qualitative interview data were collected from participating students and NHS staff from participating clinical areas, before and after implementation between October 2019 and February 2020. RESULTS: Three focus groups and one interview were undertaken pre-intervention, involving 13 students. Seven students and seven staff participated in a focus group or interviews post implementation. Findings indicated that the flexible rostering system gave students control over their work-life balance and enabled them to feel empowered in their clinical areas, less anxious and more focused on their development. Clinical staff reported unexpected benefits in terms of student attitude and attendance, allowing them to focus on teaching rather than dealing with concerns or changing the rota. Some staff felt there were challenges with implementation, which both students and staff agreed could be addressed by developing rostering guidelines. CONCLUSION: The findings indicate that wider implementation of the flexible rostering system should be recommended to capitalise on the personal and contextual benefits.

A custom made interface to integrate recording of pulse rate and blood pressure during urodynamics investigations.

Patients with a spinal cord injury above the 6th thoracic vertebrae may be prone to autonomic dysreflexia (AD) in response to bladder stimulus associated with a urodynamics investigation. It is essential that these patients are managed carefully in the urodynamics clinic in order to prevent life-threatening hypertension and bradycardia. Part of this management is the measurement and manual recording of pulse rate (PR) and non-invasive blood pressure (NIBP), alongside the standard urodynamics data set. The purpose of recording these additional data is to identify the characteristic drop in PR and rise in NIBP that indicates the onset of AD. This technical note describes the development of a novel, in-house constructed interface that allows PR and NIBP to be recorded alongside the standard urodynamics data set, using a commonly available vital signs monitor and urodynamics workstation.

Real-time symptom reporting during elective intracranial pressure monitoring using an interactive handset.

BACKGROUND: Determining whether symptoms are related to abnormal intracranial pressure (ICP) may prove challenging in some cases. We evaluated the utility of an in-house designed interactive handset which allows the real-time recording of symptoms during ICP monitoring. METHODS: Adult patients undergoing elective continuous ICP monitoring using the device to investigate symptoms between November 2013 and June 2015 were included in this retrospective observational cohort study. The device allowed the following symptoms to be recorded: mild, moderate and severe headache, visual disturbance and nausea. The corresponding ICP and ICP trend were also recorded. RESULTS: Twenty seven patients underwent 29 episodes of ICP monitoring, reporting 383 symptoms (mild 18%, moderate 39%, severe 20% headaches, visual disturbance 15% and nausea 8%) over a median period of 48 hours (IQR 12). The median number of symptoms reported during each episode was 11 (IQR 11). The mean ICP associated with a symptom episode was 7mmHg (Range -10 to 45). Mild, moderate and severe headache complaints were associated with mean ICPs of 5 (-9 to 26), 6 (-10 to 35) and 14 (-10 to 45) mmHg respectively. The majority of complaints (68%) were reported during instances of normal ICP. Following monitoring, non-operative management was employed on 21 occasions (72%) including valve pressure adjustment on two occasions whilst surgical intervention was required on eight occasions (28%; two surgeries for under-drainage and six for over-drainage). CONCLUSIONS: The device allows the clinician to accurately match a patient's symptoms with ICP to facilitate management decisions. In most instances, symptoms did not closely correlate with an abnormal ICP. By automating and standardising the collection of symptom data, this device may serve as an efficient adjunct when investigating patients with complex hydrocephalus.