1 Explain the use of fall prevention techniques“Fall definition 1 to suddenly go

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1. Explain the use of fall prevention techniques.“Fall definition: 1. to suddenly go down onto the ground or towards the ground without intending to or by accident:” https://dictionary.cambridge.org/dictionary/english/fall“The key questions in identification of risk (Roberts 2002) are:• What can go wrong?• How frequently can it go wrong?• What would be the effect?• What can be done to stop it happening?”Nursing Knowledge and Practice, second edition, Maggie Mallik et al, Bailliere Tindall, 2004The risk of falls cannot be totally unavoidable but by using a risk assessment tool at the right time, they can be identified using observation and questioning beforehand and be removed from their environment or modified. Those who still remain in danger following this assessment will require specialised equipment and/or alarm systems to alert others to future falls. This assessment should be regularly reviewed and updated.There may be various reasons why a person may fall. It could be environmental, e.g. poor lighting, clutter, loose footwear, unfamiliar surroundings, safety rails not in place or used properly, stairs, rugs, faulty equipment (walkers etc), uneven, wet or slippery floors. Physical reasons, e.g. side-effects of previous falls or stroke (weak muscles, unsteadiness, unsteady mobility), aging (less physical exercise, slower mobility, not appreciating their own limits), vision and hearing problems, dizziness or loss of consciousness, delirium following an infection, dehydration, palpitations, fall in blood pressure and osteoporosis (thinning of the bones due to the loss of bone density caused by the menopause, smoking, lack of impact activity, medical conditions e.g. diabetes, medicines e.g. prostate cancer drugs). Psychological reasons are dementia (memory loss, confusion, cognitive impairment, agitation), stroke (slowed reactions), fear and anxiety of falling and depression.The introduction to the Care Inspectorate and NHS Scotland’s good practice resource “Managing falls and fractures in care homes for older people” states: “You should prevent falls while (a) preserving as much of the residents’ independence as possible, (b) continuing to encourage safe physical activity, and (c) maximising quality of life.  Falls can be a serious problem, resulting in suffering, disability, loss of independence and decline in quality of life.  Do not accept falls as an inevitable part of getting older; many falls are preventable.  A fall is nearly always due to one or more risk factors. Recognising then removing or altering an individual’s risk factors can often prevent a fall.  If a person has osteoporosis, they are more likely to break a bone if they fall. Medication for osteoporosis can help strengthen the bones and reduce the risk of having a fracture”. The effects of a person falling with lengthy time on the floor before rescue may result in:Physical EffectsFractures Immobility Cuts, bruises, soft tissue injuriesIncontinence Pressure ulcers/ leg ulceration Dislocation Head injuriesPneumonia/chest infection Dehydration Hypothermia DeathPsychological EffectsFeelings of uselessness Embarrassment Increased dependency Fear of further falls Loss of confidence Anxiety/DepressionLow self-esteem Loss of control Emotional distressSocial isolation/withdrawal Carer stress 2. Explain two organisational policies essential to the delivery of safe care.Delivery of a safe care environment does not only include being physically safe but also emotionally, cognitively, socially and culturally safe (just as in SPECC needs). Staff should also be aware of their duty of confidentiality and follow Data Protection legislation to protect those they care for, whilst keeping safeguarding in mind.• NHS Tayside, Health and Safety, General Risk Assessment Policy, March 2018 outlines the responsibilities and significance of risk assessment and control measures of the workplace to maintain the health, safety and welfare of its staff and therefore, the patients they care for. Robust record keeping must be followed to ensure all the risks are monitored and reviewed. This is in accordance with “the Management of Health and Safety at Work Regulations 1999, reg. 3.”• NHS Tayside, Risk Health and Safety, Promoting Safe Manual Handling Policy, June 2017 outlines the standards required to ensure staff are not at risk when using manual handling techniques or equipment.  Staff should be competent at manual handling and employers should make sure staff have the knowledge and training to do so.  Patients in need of manual handling should be supported to remain as independent as possible without risk to themselves whilst following the person centred approach to care. Patients and staff should be safe from avoidable Injury or harm whilst performing manual handling. Employers must have manual handling documentation available to staff. Quality should be continuously monitored, reviewed and audited to ensure standards are improving and patient satisfaction levels are high.  Employers must make effective use of the manual handling policy and strategy to control risks from manual handling. 3. Explain two requirements for continuous professional development.Care staff should self-manage to recognise any limitations they may have and utilise professional support/supervision as a way of gaining knowledge. According to the SSSC Code of Practice, 2016 (Employees), care staff should “6.9 Undertake relevant learning to maintain and improve my knowledge and skills and contribute to the learning and development of others” and 6.10 “Listen to feedback from people who use services, carers and other relevant people and consider that feedback to improve my practice.”To keep up to date with new clinical guidelines and policies staff should follow the Scottish Intercollegiate Guidelines Network (SIGN) and the National Institute for Health and Care Excellence (NICE) to continue their professional development.SIGNFormed in 1993 to improve the quality of healthcare of nursing, pharmacy, dentistry, professions allied to medicine, patients, health service managers, social services and researchers in Scotland. There is patient involvement through networks, publications, groups and there is a SIGN App. SIGN guidelines intend to: Help health and social care professionals and patients understand medical evidence and how to utilise it to make decisions about healthcare. Reduce unwarranted variations in practice and make sure patients get the best care available, no matter where they live. Improve healthcare across Scotland by focusing on patient-important outcomes.NICEWeb site sets out evidence-based recommendations developed by independent committees (including professionals and lay members). Topics can be found by subject, e.g. diabetes, or group, e.g. health and wellbeing. There are interactive flowcharts on all NICE guidance and an area for advice. It also sets out quality standards and advice.4. Describe two signs and symptoms of pain and the appropriate response.Sudden acute pain arises suddenly to an injury and may manifest itself with the physiological responses of increased blood pressure, increased pulse and/or respiration rate, dilated pupils or perspiration, feelings of tightness, soreness, stiffness or aching. Some of these may be psychological triggers (e.g. stress) to the release of adrenaline and noradrenaline linked to the fight or flight mechanism of being in pain. A few of these symptoms will adapt and normalise over time, therefore, careful monitoring should be done. The person may also show behavioural responses to the pain e.g. observable signs of discomfort, cries and reporting of pain which can be observed (Nursing Knowledge and Practice).Chronic pain usually persists over a period of time and may be related to different medical conditions (e.g. arthritis), present or previous injury. Chronic pain can be treated with medication, a change of lifestyle or pain management.5. Recognise three changes in skin integrity and identify the appropriate responses, care and its benefits for the individual.Skin integrity should be assessed by observing its colour, temperature, texture, moisture, turgor, distinctive odours and presence of blemishes and lesions. Skin hygiene is essential for skin health, but for older people over washing may injure their thinner skin and damage its use as a barrier to infection. It is important, therefore, to choose the correct washing products and use emollients to counter attack dry skin. Bacteria e.g. MRSA which normally lives on the skin but can cause infection if the skin has been compromised due to wounds, burns, feeding tubes, drips or urinary catheters. MRSA is a bacteria that is resistant to several widely used anti-biotics so preventative measures should be taken to ensure the skin remains healthy.People who are immobile or reduced mobility due to conditions such as Parkinson’s disease, brain injury, being an amputee, acutely ill, sensory impairment, malnourished etc. are at an increased risk of developing pressure ulcers. The common areas for these are the head, shoulder, rib cage, elbow, spine, hip, buttocks and sacrum, thighs, knees, back of calves, heels and toes. Ulcers are due to shearing causing decreased blood supply to the skin, friction, poor handling, poor hygiene and knocks to the skin. This allows bacterial growth and infection if not treated in time and could lead to gangrene.One of the Preliminary Pressure Ulcer Risk Assessment (PPURAS) scales is the “Braden Scale”. This is made up of six subscales – sensory perception, moisture, activity, mobility, nutrition and friction and shear for predicting pressure sore risk. Each subscale has four descriptors and scores of 1 (severe risk) to 4 (mild risk). Totals are added up and a score of < 12 represents a high risk (≤ 9 is severe). There is space for four dated assessments to compare progress in treatment. The Braden Scale use can determine who is at risk from pressure ulcers to plan prevention strategies. Using this easy, clear and visual classification tool is useful for those cognitively impaired patients who cannot communicate their needs. A weakness however, is that it is dependant on the carer’s observations, clinical judgement and training to correctly predict and treat pressure ulcers correctly.Nursing Times, 29 November 2012 and Nursing Knowledge and Practice, 2004.6. Describe two requirements for assisting in the administration of medicine.According to the Medicines Act 1968, medicines are classified into 3 categories: POM - Prescription only medicine, to be administered to the named person. P- Pharmacy medicines, sold by a Pharmacist, and GSL - General Sales List, medicines not requiring a Pharmacist, e.g. supermarket.When collecting of dispensed medicines from the Chemist/Pharmacy you must take care that the correct medicines have been given to you, check that the name and address on the medication is correct. If the dosage has changed or new medication prescribed, check with the person before administering them (if the person is uncertain, contact their GP to get confirmation). Medication should be stored in a safe accessible place.Through illness or disability, the person may require help with opening medicine bottles or packaging. There should be organisational policies in place when those being cared for require prompting to take their medicines. This decision to prompt should be part of their care needs assessment and recorded in their care plan. The carer must be fully aware of when the medicines should be administered with strict record keeping taken to ensure that no errors in wrong, missed or overdose are made, and be aware of the procedures to take if this occurs. Keeping up to date records of the administering of medications also helps when other professionals, family or carers must take over this task. ReferencesCare Inspectorate and NHS Scotland. “Managing falls and fractures in care homes for older people. Good practice self assessment resource”, published 2012. http://hub.careinspectorate.com/media/107603/ci-falls-and-fractures-guidance-2012.pdfhttp://socialworkscotland.org/wp-content/uploads/2018/01/SSSCCodesofPractice2016.pdfNursing Knowledge and Practice, second edition, Maggie Mallik et al, Bailliere Tindall, 2004https://www.nursingtimes.net/roles/older-people-nurses/maintaining-skin-health-in-older-people/5052416.articleD & A, mylearning