Factors that influence the quality of pain management in patients with skin traction.

BACKGROUND: Pain management is a systematic multidimensional process with differing approaches. Investigating the factors that affect the quality of pain management may provide nurses with ideas, suggestions, and trends that target improvements in the pain management experience among orthopaedic patients. AIMS: To assess the elements of the quality of pain management and identify factors that significantly predict higher quality pain management in patients with skin traction. METHODS: A descriptive correlational design was used to recruit a convenience sample of 116 patients. The revised American Pain Society Patient Outcome Questionnaire was used to explore the quality of pain management. RESULTS: Patients suffered from severe pain for more than 64% of the time during the first 24 h after the skin traction was applied. The uncontrolled pain negatively affected patients' abilities to carry out activities in bed, fall asleep, and stay asleep. The quality of pain management indicators using a scale of one to 10 were: "pain severity" = 5.93, "pain interference" = 5.01, "side effects of medications" = 1.5", and "satisfaction about care" = 6.2". CONCLUSIONS: The quality of pain management for fracture patients on skin traction was not optimum in this study. The uncontrolled pain negatively affected patients' physical status and general wellbeing.

Osteoporosis knowledge and related factors among orthopedic nurses in Hunan province of China.

A low level of knowledge and awareness of specifics regarding osteoporosis among orthopedic nurses can compromise the quality of patient education and nursing care. There are significant variations in education levels among Chinese nurses, however, little is known about the awareness of osteoporosis among orthopedic nurses in China. The objective of this study was to assess the level of osteoporosis knowledge and identify factors that correlated with knowledge levels. A cross-sectional survey was conducted among orthopedic nurses at 13 tertiary hospitals in Hunan Province, China. Knowledge was assessed by the Osteoporosis Knowledge Assessment Test (OKAT). A total of 558 nurses completed the survey and 530 valid questionnaires were returned with a response rate of 95%. Each question had three response options of "True", "False" and "Don't know." The mean of scores from all OKAT questions was 11.4 (range 2-17; SD = 2.5). Factors associated with a better knowledge included age (36-45 years) marital status (married) and education (bachelor degree or above). Only 93 nurses (18%) had previously attended formal training regarding osteoporosis. Orthopedic nurses had moderate-to-low levels of knowledge regrading osteoporosis. The survey highlighted the potential areas for improvement, especially among younger single nurses with lower educational levels. In-depth education may contribute to improving service quality and offering better tutoring for fragility fracture patients through increased awareness and knowledge.

Pain Management by Nurses in Level 2 and Level 3 Hospitals in China.

BACKGROUND: Pain management practice differs among hospitals in China; however, no studies have examined the association between hospital level and nursing practice of pain management. AIMS: To evaluate the nursing practice of pain management in orthopedics wards of level 3 and 2 hospitals and compare the differences in pain management regulations, policies, and perceived barriers. DESIGN: This was a cross-sectional descriptive study. SETTING: This study was conducted during the 10th International Congress of the Chinese Orthopedic Association, November 19-22, 2015. PARTICIPANTS: Subjects: The sample included 121 nurses from China. METHODS: Quantitative research methods were used to assess pain management practice by 121 Chinese nurses as well as barriers to nursing practice. RESULTS: Nurses in level 3 hospitals were more likely to evaluate patients' pain intensity (85.23% vs. 65.38%, p < .05) and quality (77.27% vs. 53.85%, p < .05) than those in level 2 hospitals. Compared with level 2 hospitals, level 3 hospitals were more likely to participate in the Painless Orthopedics Ward program (53.41% vs. 23.08%, p < .01), conduct pain management knowledge training (88.64% vs. 69.23%, p < .05), and establish pain management regulations (68.18% vs. 34.62%, p < .01). Level 2 hospital nurses reported a higher score for barriers than level 3 hospital nurses (3.27 vs. 2.45, p < .05). CONCLUSIONS: Nurses from level 2 hospitals received less education on pain management and also paid less attention to and faced more restrictions for pain management than nurses from level 3 hospitals.

First in the Nation: One Unit's Journey to Achieving Fragility Fracture Certification.

Osteoporosis is related to more than 2 million fractures and $19 billion in healthcare costs each year (). A fragility fracture (FF) is a low-energy fracture of the distal radius, proximal humerus, ankle, or proximal femur (hip) from minimal trauma such as a fall from a standing height. In addition to cost, FFs often result in the loss of independence and productivity (). In 2015, our orthopaedic unit received the first certification ever awarded for FFs. Fragility fracture certification is a new certification demonstrating that a healthcare facility complies with national patient care standards and uses evidence-based practice guidelines to deliver quality outcomes. Orthopaedic nurses have a critical role in optimizing future bone health and fracture prevention. Our story describes the process and challenges faced becoming the first organization in the nation to be successfully surveyed for The Joint Commission's Fragility Fracture Certification.

A comparison of treatment setting for elderly patients with hip fracture, is the geriatric ward superior to conventional orthopedic hospitalization?

INTRODUCTION: Hip fractures in the elderly are a major cause of morbidity and mortality. The treatment settings of these patients may change their outcomes. The aim of this study is to compare the outcomes of patients with displaced femoral neck fractures who were admitted to the orthopedic vs. geriatric wards. PATIENTS AND METHODS: A retrospective study was conducted on 217 consecutive older patients with 219 displaced femoral neck fractures admitted either to the orthopedic or the geriatric ward between Jan. 2013 and Jun. 2015. Information regarding demographic, medical history, surgical management, hospitalization, and one year readmissions and mortality data was retrieved from electronic charts. RESULTS: 102 hemiarthroplasty patients were admitted to the orthopedic ward and 117 to the geriatric ward. Patients' characteristics, including age, living arrangements, mobility status and the Charlson Comorbidity Index were similar between groups. Patients from the orthopedic ward had shorter hospitalization time (9±5.1 vs. 10.8±6.7days, p=0.022) and presented a lower in-hospital complication rates (0.6±0.96 vs. 1±1.9, p=0.022), namely fewer events of urinary retentions, urinary tract infections and pneumonias (8.8% vs. 23.9%, p=0.004, 3.9% vs. 14.5%, p=0.010 and 2.9% vs. 12.2%, p=0.034, respectfully). Readmission rates were similar. Neither in hospital nor one year mortality rates differed between groups. CONCLUSIONS: Our study found that geriatric care was not superior to orthopedic directed management in the treatment of elderly patients with hip fractures in terms of in-hospital complications, and hospitalization times.

Changing caring behaviours in rehabilitation after a hip fracture - A tool for empowerment?

Different rehabilitation programs after surgery have been presented to improve the outcome for patients with a hip fracture. Empowerment has been suggested as useful, but requires a change in the caring behaviours of health professionals. The aim with this study was to evaluate if training and supervision of the nursing staff could alter caring behaviours. A case-control study of nursing staff treating hip fracture patients was performed at a hospital with two sites. Training and supervision was given to the nursing staff at the intervention site. The intervention focused on creating positive care interaction by using eight guidelines. The evaluation was performed with recordings of a constructed caring situation before training, and observations of care situations at the ward before and after intervention. The results showed no differences at baseline between the two sites in the caring behaviours. After intervention, significant effects of caring behaviours were seen in seven out of eight guidelines, the effect sizes ranged from medium to large. The findings indicate that the nursing staff can change caring behaviours and facilitate the empowerment of patients with a hip fracture.

Identification of factors influencing patient satisfaction with orthopaedic outpatient clinic consultation: A qualitative study.

BACKGROUND: In recent years, new models of health service delivery in orthopaedic outpatient clinics, including physiotherapists working in orthopaedic triage roles, have become increasingly common. Evaluation of patient satisfaction with orthopaedic clinic services is dependent on an understanding of factors influencing patient satisfaction in this clinical context. OBJECTIVES: The objective of this study was to identify the factors influencing patient satisfaction with orthopaedic outpatient clinic services. STUDY DESIGN: A cross-sectional, qualitative design including focus groups and interviews. METHODS: Interviews and focus group sessions were undertaken with 36 participants representing patients, health professionals and clinical support staff in an orthopaedic outpatient clinic. Interviews and focus groups provided a rich narrative which was subjected to a process of thematic analysis. RESULTS: The analysis identified seven themes influencing patient satisfaction with orthopaedic clinic assessment. These themes were clinic waiting time, clinical contact time, trust, empathy, communication, expectation and relatedness. CONCLUSIONS: Understanding factors influencing patient satisfaction is important to inform organisational and clinical processes that aim to foster high levels of patient satisfaction. Clinician awareness of the interpersonal issues which dominate stakeholders' perspectives of patient satisfaction may improve the patient experience and potentially foster patient behaviours toward a therapeutic advantage. An understanding of these factors in the context of orthopaedic clinics is also important in the development of questionnaires designed to evaluate patient satisfaction with health service delivery.

Interpreting and using meta-analysis in clinical practice.

Systematic reviews, which can include a meta-analysis, are considered the gold standard for determination of best practice. Meta-analysis combines the results from many primary studies to identify patterns among the individual study results and then assesses the overall effectiveness of a specific healthcare intervention. The purpose of this article was to describe the process of performing a meta-analysis, discuss advantages and disadvantages of meta-analyses, and interpret the results of a meta-analysis from current research relevant to orthopaedic nursing practice.

Older orthopaedic patients' perceptions of individualised care: a comparative survey.

AIM AND OBJECTIVES: To describe and compare the individualised care perceptions of older orthopaedic patients' and patients of working age. BACKGROUND: Age has been found to influence perceptions of care and although individualised care is highlighted in the literature, it is seldom studied from an older person's perspective. DESIGN: Descriptive and comparative. METHODS: Data were collected using the Individualised Care Scale from orthopaedic patients (n = 420, response rate 84%). The participants were divided into two groups: those 65 and over (n = 149) and those under 65 and working (n = 271). Data analysis used descriptive and inferential statistics. RESULTS: Patients expressed a desire for individualised care, and gave relatively good evaluations about the perceived support for their individuality and the realisation of individualised care. Differences in the perceptions of individualised care were found between, but not within, the two groups. The older patients were more positive in their evaluations. CONCLUSIONS: There is a need for programmes of individualised care that are age-adjusted. RELEVANCE TO CLINICAL PRACTICE: As the older population rises worldwide individualised care becomes more important in the care of older people. These findings provide baseline data for the development of individualised nursing care from the patients' perspective.

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.

Proactive patient rounding to increase customer service and satisfaction on an orthopaedic unit.

Customer service and patient satisfaction have become increasingly important in the healthcare industry. Given limited resources and a myriad of choices, on which facets of patient satisfaction should healthcare providers focus? An analysis of 40,000 observations across 4 hospitals found 1 important intervention: timely staff responsiveness. Using the Plan-Do-Check-Act (PDCA) quality methodology, the goal was set to improve staff responsiveness to orthopaedic patient needs and requests, thus improving patient satisfaction. A model to improve staff responsiveness was systematically developed and implemented. The I Care Rounding model places the emphasis on proactively meeting patient needs through hourly rounding, rather than caregivers providing care in a reactionary mode. After full implementation, positive improvement was demonstrated.

FMECA methodology applied to two pathways in an orthopaedic hospital in Milan.

INTRODUCTION: Adverse events pose a challenge to medical management: they can produce mild or transient disabilities or lead to permanent disabilities or even death; preventable adverse events result from error or equipment failure. METHODS: IRCCS Istituto Ortopedico Galeazzi implemented a clinical risk management program in order to study the epidemiology of adverse events and to improve new pathways for preventing clinical errors: a risk management FMECA-FMEA pro-active analysis was applied either to an existing clinical support pathway or to a new process before its implementation. RESULTS: The application of FMEA-FMECA allowed the clinical risk unit of our hospital to undertake corrective actions in order to reduce the adverse events and errors on high-risk procedure used inside the hospitals.

Changing paediatric orthopaedic education and certification for the RN in Northern Ireland?

This article highlights the development of orthopaedic nurse education in Northern Ireland and how it equates with the United Kingdom and United States when focused on children's nursing. It also examines the historical development of initial preregistration nurse education and equates it to children's nursing where children are generally acknowledged as a vulnerable group. This article concludes by offering recommendations that may further enhance the development of Northern Ireland's orthopaedic nurse education that demonstrate standardization and equality for all practicing nurses within the specialty of orthopaedics.