The best way possible! A fieldwork study outlining expectations and needs for nursing of patients in endoscopy facilities for short-term stay.

This paper is a descriptive study of nursing in facilities for short-term stay, aiming to outline the expectations and needs for nursing of patients undergoing gastroscopy in outpatient endoscopy clinics. Existing research finds it important to meet patients' expectations and needs for help to get through a procedure in the best and safest way possible. Despite recent years' focus on patient expectations, little attention has been paid to understanding the patients' distinct expectations and needs for nursing in the context of facilities for short-term stay. A fieldwork study influenced by practical ethnographic principles was performed in high-technology endoscopy outpatient clinics during 2008 - 2010. Data were collected using triangulation of participant observation for 12 weeks including participant reports and semi-structured interviews with eight patients and four nurses. The expectations and needs for nursing of patients undergoing gastroscopy were related to two main areas, summarized by the categories: 'Nervousness and anxiety' and 'Maintaining control'. The former concerned how patients managed their nervousness and anxiety and was described differently in terms of 'Getting it over with', 'The meaning of words' and 'Taking precautions'. The latter 'Maintaining control' concerned how patients in different ways managed to maintain control over their situation and was described in terms of 'Being informed', 'Others are in the same "boat"' and 'Being proactive'. The study concludes that nervousness and anxiety are expressed differently in patients undergoing gastroscopy and that patients have individual ways of claiming their right to elements of control over the situation and the course of gastroscopy. In order for nursing in endoscopy settings to be tailored to the individual patient, it must be adapted to the individual patient's ways of managing nervousness and anxiety as well as ways of claiming control.

What to know and how to get to know? A fieldwork study outlining the understanding of knowing the patient in facilities for short-term stay.

AIM: To report a descriptive study of nursing in facilities for short-term stay aiming to outline what 'knowing the patient' means in an endoscopic outpatient clinic. BACKGROUND: 'Knowing the patient' is indispensable to the effort of tailoring nursing to the individual patient's needs. Structural changes in the practice environments, however, reduce the amount of time a nurse spends getting to know the patient. Despite recent years' focus on the subject, no uniform description of 'knowing the patient' in facilities for short-term stay exists. DESIGN: A fieldwork study influenced by practical ethnographic principles was performed in a high-technology endoscopic outpatient clinic during 2008-2010. METHODS: Data were collected using participant observation for 12 weeks and semi-structured interviews with eight patients and four nurses. FINDINGS: Findings were summarized into two categories 'What to know?' and 'How to get to know?' The former concerned practical issues in relation to gastroscopy and was described in terms of the patient's level of anxiety, wish for medication and previous experiences. The latter 'How to get to know?' concerned instruments employed in getting to know the patient and was described in terms of the use of communication and sensing. CONCLUSIONS: 'Knowing the patient' in the endoscopic outpatient clinic was understood in a very practical sense. Conversation and the use of the eyes and physical touch enabled a situational awareness. It helped tailor nursing to the patient's needs and allowed the nurse to treat every patient as a unique individual.

Calcium phosphate cement enhances primary stability of open-wedge high-tibial osteotomies.

We investigated if injectable calcium phosphate cement improves primary stability in open-wedge high-tibial osteotomy. A 10 mm open-wedge osteotomy was performed on eight pairs of preserved cadaver tibiae and seven pairs of composite (Sawbone) left tibiae. Osteosynthesis was performed with the Dynafix plate system. The gap resulting from surgery either was filled with 15 g injectable calcium phosphate cement in half the bones or was left untreated. The composite tibiae were loaded at a ramp speed of 20 mm/min up to 20 kN. The cadaver tibiae were exposed to 100 cycles with a maximum compressive force of 2,250 N. After 100 cycles of loading with 2,250 N, the final loaded displacement was 1.2 mm for the cadaver tibiae treated with injectable calcium phosphate cement as compared with 3.6 mm for the empty defects (P = 0.028). All the seven empty defect composite specimens failed prior to 20 kN (median 2.8 kN) as compared with five of the injectable calcium phosphate cement specimens (median 17 kN) (P = 0.005). The injection of injectable calcium phosphate cement following open-wedge osteotomy of the proximal tibia increases the initial stability of the bone as measured by load-to-failure and displacement after cyclic loading. Clinical studies are ongoing to investigate whether injectable calcium phosphate cement also has clinical advantage on wedge healing and stability.