Preoperative Education for Total Knee Replacement: A National Survey of Orthopaedic Nurses.

BACKGROUND: Preoperative education aids in reducing the incidence of poor outcomes after total knee replacement (TKR) and increasing patient readiness for discharge home but is not well described in the literature. PURPOSE: The purpose of the study is to describe the current design of preoperative education for TKR across the United States. METHODS: A large, national sample of orthopaedic nurses completed an online survey to describe preoperative education at their facilities. RESULTS: Most participants provided preoperative education as part of interprofessional teams in either a group format or combined group and individual education. Verbal instruction was the most common educational delivery method, followed by written instruction. Education typically lasted between 1 and 1.5 hours, was delivered in a single session, and included a variety of topics. CONCLUSION: Results of this study describe preoperative educational practices and can support future research to improve patient outcomes following TKR surgery.

International Nursing: Use of a Commercially Available Smartphone Application to Solve Information Needs of Orthopedic Scrub Nurses.

The purpose of this article is to describe the use of a commercially available smartphone application to solve information needs of scrub nurses in orthopedic surgery. A semistructured, focus group interview was conducted with orthopedic scrub nurses. These nurses had solved their information needs about orthopedic surgery by using a commercially available smartphone application. Because of smartphone technology's convenience, accessibility, mobility, ease of use, and use at no charge, it is worth considering in nursing practice, education, and research.

Opioid induced constipation management in orthopaedic and trauma patients: treatment and the potential of nurse-initiated management.

BACKGROUND: Opioid analgesics treat moderate to severe pain with proven analgesic efficacy, although their use is associated with dose-limiting side effects, such as constipation. Orthopaedic and trauma patients are at high risk of developing opioid-induced constipation (OIC) due to reduced mobility and increased opioid requirements to manage prolonged pain after injury. OBJECTIVES: To examine the evidence base to guide clinicians on the most effective or tolerated laxative regimen for the management of OIC and nurse-initiated management of OIC. METHOD: A review of the literature was undertaken. Databases were searched to identify studies on OIC, laxatives and nurse-initiated management. RESULTS: Laxatives do not address the underlying cause of OIC and there is currently insufficient evidence to guide clinicians on the most effective or tolerated laxative regimen for the management of OIC. The use of peripheral acting mu-opioid receptor antagonists (PAMORAs) could be considered in those for whom regular use of a combination of laxatives has not been sucessful, and nurses should take a broader role in the assessment of symptoms and response to treatment. CONCLUSION: The important balance between adequate analgesia and minimising OIC symptoms is an ongoing challenge for clinicians, and an area of patient care where nurses could be leading management.

Understanding the integration of family caregivers in delirium prevention care for hospitalized older adults: A case study protocol.

AIM: To understand family caregiver involvement in delirium prevention care for older adults hospitalized for orthopaedic surgery hospitals and family caregiver integration by nurses. DESIGN: Multiple-case study. METHODS: The model of Care Partner Engagement was selected as theoretical framework. Eight cases will comprise an older adult hospitalized a family caregiver and a ward nurse. They will be recruited with a non-probability sampling on two orthopaedic surgery wards in two hospitals. Semi-structured interviews with participants will be audiotaped. Sociodemographic data will be collected. These data, researcher field notes and interview transcripts will be subjected to within- and across-case thematic analysis. Regional ethics committee approved the study protocol in August 2018. DISCUSSION: The study will allow surgical nursing teams to gain a better understanding of the issues and possibilities regarding family caregiver integration in delirium prevention care for older adults.

Nurse Practitioners in Orthopaedic Surgical Settings: A Review of the Literature.

PURPOSE: The purpose of this article was to conduct an extensive literature review of nurse practitioners (NPs) in orthopaedic surgical settings to delineate whether a need exists for NPs in these settings. BACKGROUND: Due to physician shortages and changes in healthcare, patients are experiencing difficulty accessing orthopaedic surgeons. To meet this need, NPs are becoming an essential part of the multidisciplinary orthopaedic team in Level 1 trauma hospitals. RESULTS: Nurse practitioners are qualified and competent to work in a variety of orthopaedic settings including preoperative clinics, primary care orthopaedic clinics, and pre-/postoperative care within the hospital. The benefits of NPs in orthopaedic surgical settings includes increased access to care, improved team communication, decreased length of stay, improved quality of care, and improved patient satisfaction. Moreover, NPs meet patient needs while surgeons are operating, and have a positive impact on resident surgeon education. CONCLUSION: A need exists for NPs in orthopaedic surgical settings to both improve access to healthcare for patients and reduce the burden on orthopaedic surgeons.

Orthopaedic Snafus: When Adverse Events Happen in Orthopaedics.

The potential for adverse events exists when treating and managing orthopaedic patients in the intraoperative or postoperative environments, especially when it comes to falls, surgical site infections, venous thromboembolism, and injuries to nerves and blood vessels. Orthopaedic nurses play a vital role in the promotion and use of evidence-based interventions to decrease the incidence of these adverse events, improve quality of care, and minimize the financial burden related to these adverse events.

Low- vs. high-pressure suction drainage after total knee arthroplasty: a double-blind randomized controlled trial.

AIM: The aim of this study was to assess the efficacy of continuous low-pressure suction drainage compared with closed high-pressure suction following total knee arthroplasty. BACKGROUND: Closed wound drainage systems are used in surgical interventions to reduce the incidence of haematomas, promote wound healing and reduce infections. However, evidence shows that using a closed wound drainage system can increase transfusion requirements. DATA SOURCES: A randomized, double-blind and parallel controlled trial was performed. Adult knee replacement patients recruited between May 2006 and March 2007 were assigned to receive low-pressure suction of 50 mmHg (experimental drainage) or high-pressure suction of 700 mmHg (comparator drainage). METHODS: The primary outcome was total blood loss after surgery. Secondary outcomes were incidence of transfusion, complications and mortality. Statistical analysis was based on an intention-to-treat approach. Linear regression was performed to account for factors that could influence blood loss. RESULTS: A total of 169 patients were included. Mean age was 73 (±6) years, 128 women and 41 men. A total of 84 patients were randomized to the experimental drainage and 85 to the comparator drainage. Analysis showed a total postoperative blood loss of 541·8 mL in the experimental group and 524·4 mL in the comparator group (P = 0·734). The only factor that showed an association with blood loss was the length of surgery. Linear regression did not show differences between the groups. CONCLUSION: Continuous low-pressure suction of 50 mmHg is not more effective than the higher aspiration pressure system to diminish the blood loss in total knee arthroplasty. The results do not support any change in current nursing practice relating to the use of this drain system.

Visão como instrumento da percepção na assistência em enfermagem traumato-ortopédica / Vision as an instrument of perception in trauma and orthopedic nursing care / La visión como instrumento de percepción en la atención de enfermería tráumato-ortopédica

A visão, mais do que um sentido, é um poderoso instrumento que identifica e seleciona, de forma que tudo depende do que já se viu antes para determinar a maneira como interpretamos o que está sendo visto. O objetivo deste artigo é discutir o papel da visão como instrumento para uma assistência de enfermagem holística e de qualidade. É um estudo exploratório, de abordagem qualitativa, utilizando o método da Sociopoética. Os dados foram agrupados nas seguintes categorias: (1) Visão como instrumento e (2) Alterações corporais externas. Como em traumato-ortopedia, os enfermeiros devem ser capazes de conduzir à assistência a pacientes em condições complexas em um ambiente de cuidado que muda rapidamente. Os resultados demonstraram a visão como poderoso instrumento de cuidado em Enfermagem Traumato-Ortopédica, permitindo uma atuação profissional verdadeiramente adequada às necessidades do paciente.

More than being a sense, vision is a powerful instrument that identifies and selects, hence everything depends on what one has seen before to determine how to interpret what is currently being seen. The objective of this article is to discuss the role that vision plays as an instrument for holistic and quality nursing care. This is a qualitative, exploratory study, using the Sociopoetic method. The data was categorized as follows: (1)Vision as an instrument and (2)Outer body changes. In trauma and orthopedics, nurses should be able to provide patients with care in complex conditions and in an environment which changes fast. Results show that vision is a powerful health care instrument in trauma and orthopedic nursing, promoting professional practice that is truly appropriate to the patients' needs.

La visión, más allá de ser un sentido, es un poderoso instrumento que identifica y selecciona, de modo tal de que todo depende de lo que ya se vio antes para determinar la manera en la que interpretamos lo que está siendo visto. El objetivo de este artículo es discutir el papel de la visión como instrumento para una atención de enfermería holística y de calidad. Es un estudio exploratorio, de abordaje cualitativo, utilizando el método de la Sociopoética. Los datos fueron agrupados en las siguientes categorías: (1) Visión como instrumento, y (2) Alteraciones corporales externas. Como en tráumato-ortopedia los enfermeros deben ser capaces de brindar atención a pacientes en condiciones de complejidad en un ambiente de cuidado que muda rápidamente, los resultados demostraron que la visión es un poderoso instrumento de cuidado en Enfermería Tráumato-Ortopédica, permitiendo una actuación profesional verdaderamente adecuada a las necesidades del paciente.

Developing a standard of care for halo vest and pin site care including patient and family education: a collaborative approach among three greater Toronto area teaching hospitals.

Caring for an individual with a halo vest can be a frustrating and anxiety-provoking experience for healthcare professionals, the patient, and their families. Physicians or trained nurses apply halo vests in various situations in which cervical spine stabilization is required for an extended period. This device can be used as a first-line treatment in the management of nonoperative cervical trauma, that is, fractures, or placed following cervical surgery. Standardizing the application techniques and care associated with the halo vest, pin site care, and day-to-day activities of daily living will increase the comfort and self-confidence of healthcare professionals and the patient and family members in the provision of care. A collaborative approach among three greater Toronto area teaching hospitals aided in the development of standardizing care and patient educational materials for patients with halo vests.

Effect of telephone follow-up on surgical orthopedic recovery.

We examined the effect of telephone follow-up on surgical orthopedic patients' postdischarge recovery. The sample consisted of 438 patients randomly assigned to receive routine care with or without telephone follow-up 24 to 72 hours after discharge (intervention). During the intervention, the nurse caller assessed each patient's status, identified problems, and provided needed follow-up care. Structured telephone interviews were conducted with all participants during the third week after their discharge. Key outcomes were self-reports of problems, progress, and unanticipated contact with the health care system. The primary self-reported problems were mood changes, constipation, pain, and swelling. Women and younger participants tended to report more problems. Availability of help was positively associated with progress. Although telephone follow-up did not affect the first two outcomes, it was associated with increased occurrence of health care contacts, as was living farther from the hospital. The study findings highlight the need to clearly explicate the requirements and outcomes for nurse-initiated telephone follow-up programs.

Using 'cling film' to protect lower limb plaster casts in babies with club foot.

Clubfoot or congenital talipes equinovarus is a common condition affecting babies and non-surgical treatment involves serial manipulation and plaster casting for many weeks. The casts are susceptible to soiling during this time, which makes management and child care even more challenging. The authors report initial experience in a typical district general hospital clubfoot clinic where the parents of a baby used conventional cling film to cover the casts and provide a low-cost, effective and well-tolerated method of protection. Informal reports received from these parents were very positive and encouraging throughout the duration of treatment. The authors believe parents with babies undergoing such treatment for clubfoot could be advised of the benefits of using cling film to protect plaster casts. More formal analysis of feedback from parents and collaborative experience with other hospitals is required before widespread use is recommended. There may also be scope for using cling film to protect lower limb casts used in managing developmental dysplasia of the hip or fractures in children and potentially adults.

Prevention of DVT after orthopaedic surgery: the A-V Impulse System.

Deep vein thrombosis (DVT) is a major health problem, which affects 1 in 1000 people in the general population each year. It may be asymptomatic or cause swelling and pain, and can lead to potentially fatal complications. Immobilisation following bone surgery significantly increases the risk of DVT, and prevention is a salient goal for nursing. This article reviews the pathogenesis of DVT, and therapeutic venous thromboembolic prophylaxis in the prevention of DVT following orthopaedic surgery. Best nursing practice is outlined from management of the Arteriovenous (A-V) Impulse System(R), the advent of which has had a positive impact on the incidence of DVT following orthopaedic surgery but requires further research to substantiate its effectiveness and determine patient acceptability.

Assisting older adults with orthopaedic outpatient acute-pain management.

Management of acute pain by older adults with orthopaedic conditions in their community setting after surgical procedures or injury can be challenging. As older adult orthopaedic outpatients have unique requirements in their pain management, nurses and advanced practice nurses must be cognizant of these needs and intervene when needed to promote a satisfactory recovery. This article will focus on the older adults experiences of orthopaedic pain, barriers to their pain reporting and relief, and acute pain management considerations for the older adult in the home setting.

Developmental dysplasia of the hip: nursing implications and anticipatory guidance for parents.

Developmental dysplasia of the hip (DDH) is a comprehensive term used to describe an abnormal relationship between the femoral head and the acetabulum. Developmental dysplasia of the hip includes a very wide spectrum of abnormality from a frank dislocation (very unstable) to a stable hip with a slightly shallow acetabulum. As many of these findings may not be present at birth, the term developmental more accurately reflects the biologic features than does the term congenital. Despite the recent increased awareness of DDH and the importance of thorough screening programs, hip dysplasia continues to be a frequently missed diagnosis in pediatrics. Earlier detection and diagnosis of DDH is associated with a much more successful and less invasive outcome.

Revision total hip and total knee arthroplasty.

For thousands of patients with advanced degenerative joint disease, total joint arthroplasty provides improved function, decreased pain, and the opportunity to resume a more active lifestyle (Drake, Ace, & Maale, 2002). Although hip and knee replacements are both successful interventions for degenerative joint conditions, complications may arise that require revision of the original surgery. In 1999, approximately 25,000 revisions of knee replacements (ICD Code 81.22) and 30,000 revisions of hip replacements (ICD Code 81.53) were performed in the United States (American Academy of Orthopaedic Surgeons [AAOS], 2002). Approximately 10,000 revision total hip arthroplasty procedures were performed on Medicare patients in 2000. The total cost of revision surgery, including the 10,000 total knee revision procedures performed on this same patient population during that year, exceeds USD 3 billion (Bourne, Maloney, & Wright, 2004). Descriptions of the risk factors and indications for revision total hip and total knee arthroplasty are included in this article. Nursing interventions and patient education specific to these patient populations are outlined, and a discussion of complications following revision total joint arthroplasty is included.

Palliative care: a challenge for orthopaedic nursing care.

Patients who face chronic, incurable, or life-ending musculoskeletal conditions often receive inadequate care either due to a lack of caregiver awareness or inattention to maintaining the highest quality at the end of life. Palliative care focuses on the comprehensive physical, psychological, social, spiritual, and existential needs of patients with life-threatening or debilitating illness. Orthopaedic nurses and all nurses in general are challenged to incorporate palliative care principles into care planned with patients and families facing end-of-life issues. This article addresses the leadership role the National Association of Orthopaedic Nurses (NAON) has taken to develop a consensus document which endorses the Last Acts Precepts of Palliative Care and affirms the need for palliative care with patients who experience life-threatening illness. A case study is used to illustrate the opportunity a multidisciplinary team has to center care on the individual, while remaining sensitive to the holistic needs of the patient for self-determination at the end of life.

Caring for the orthopaedic patient who is obese.

Obesity is a major health problem in the United States, and it is occurring at an increasing rate. When an orthopaedic patient is obese, the care plan and interventions must be adjusted for the specific patient needs. This article explores the multidimensional challenges and suggests strategies to provide safe care for the patient who is obese.

Prehabilitation in preparation for orthopaedic surgery.

By improving an individual's functional capacity through increased physical activity before an anticipated orthopaedic procedure, it seems reasonable to assume that the individual will maintain a higher level of functional ability and rebound more rapidly in the rehabilitation process. Prehabilitation is the process of enhancing functional capacity of the individual to enable him or her to withstand the stressor of inactivity associated with an orthopaedic procedure. A generic prehabilitation program incorporates the components of warm-up, a cardiovascular component, resistance training, flexibility training, and practicing functional tasks.

'Linking the orthopaedic patient with community family violence resources'.

An early article on health system response to domestic abuse by Randall in JAMA stated that health providers may be the first and only professionals in a position to recognize violence in their patient's lives. Health providers see many more victims of domestic violence than they realize. In fact, victims of domestic violence will interact with their health providers for both routine and abuse-related care. Early, effective intervention can interrupt the cycle of violence, prevent more serious injuries and symptoms, prevent long-term mental health and psychiatric symptoms, and prevent abuse to children. The most important contribution health providers can make to end abuse and protect the health of its victims is to identify and acknowledge that abuse, because that alone can empower the victim to begin a progression toward safety.