Quality of counselling for knee and shoulder arthroscopy patients during day surgery.

BACKGROUND: Counselling for day surgery patients is one of the core components for a knee or shoulder arthroscopy patient to succeed in self-care. AIM: This cross-sectional study examined the quality of counselling given to patients (n = 86) during their day surgery, using the Counselling Quality Instrument (CQI). METHODS: The data were analysed using basic and multivariate statistical methods. RESULTS: Most respondents were male and aged over 50 years. Almost all knee and shoulder arthroscopy patients were satisfied with the counselling given on follow-up and rehabilitation as well as the counselling given relating to wound and pain treatment. There was a lack of patient-centred and goal-oriented counselling, although interaction during counselling was good. Counselling was perceived as providing benefit in regard to a patient's self-care, emotions and knowledge. Respondents aged below 40 years were more dissatisfied with counselling for day surgery than those aged 40 years and over. CONCLUSION: This study identified a need to train healthcare staff in patient-centred and goal-oriented counselling. Counselling with people who are aged below 40 years should take account of patients' specific concerns.

Evidence of prophylaxis treatment in adult haemophiliacs. Need of this treatment strategy?

In contrast to children with haemophilia the scientific evidence of prophylaxis treatment in adults is not yet proven. Existing studies are of observational character and mostly retrospectively designed. Therefore, opinion leaders in this field postulate prospectively designed, randomized, controlled and multicentric studies to set up urgently needed guidelines. Evidence according to the Canadian task force ranking is assessed as level III with a recommendation grade C by the authors. The recognition of benefits of health care providers in accordance with the German Federal Joint Committee generally demands a Grade-Ia to Ib evidence. As long as the actual evidence of prophylaxis in adult haemophiliacs does not meet the postulated criteria of the German Federal Joint Committee, prophylactic replacement therapy of the individual case has to be well documented and reasonably explained.

European orthopaedic and trauma patients' perceptions of nursing care: a comparative study.

AIM: To compare English, Finnish, Greek and Swedish orthopaedic and trauma patients' perceptions of nursing care received during hospitalisation. BACKGROUND: Patient perceptions are important when evaluating nursing care delivery. Evaluations usually take place sub-nationally though European citizens may be treated throughout the European Union. International comparative studies are possible because of the universal nature and philosophical roots of quality in nursing care. They are needed to assist in improving care outcomes. DESIGN: A cross-sectional, comparative study design was used. METHOD: The Schmidt Perception of Nursing Care Survey was used to obtain data from orthopaedic and trauma patients in acute hospitals in four countries: Finland (n = 425, response rate 85%), Greece (n = 315, 86%), Sweden (n = 218, 73%) and UK (n = 135, 85%). Data were first analysed using descriptive statistics, then between-country comparisons were computed inferentially using a one-way analysis of variance and a univariate analysis of covariance. RESULTS: Between-country differences were found in patients' perceptions of the nursing care received. Over the whole Schmidt Perception of Nursing Care Survey the Swedish and Finnish patients gave their care the highest assessments and the Greek patients the lowest. The same trend was seen in each of the four sub-scales: Seeing The Individual Patient, Explaining, Responding and Watching. Responding was given the highest assessments in each participating country and Seeing the Individual Patient the lowest except in Greece. CONCLUSIONS: Further research is needed to consider whether the between-country differences found are caused by differences between cultures, nursing practices, roles of healthcare personnel or patients in the different countries. The Schmidt Perception of Nursing Care Survey is suitable for the assessment of European orthopaedic and trauma patients' perceptions of nursing care received during hospitalisation. RELEVANCE TO CLINICAL PRACTICE: The results are useful in evaluating and developing nursing care in hospitals from different European countries.

Building a bone & joint program: nursing leads the way in developing a cost-effective, quality-driven program in a community hospital setting.

The face of joint replacement surgery is changing quickly. An aging, more active population, combined with technological advances in orthopaedic devices and care, has resulted in a growing number of physicians recommending joint replacement surgery as a proactive intervention and not one of last resort for those with debilitating joint disease. Given the current trend and the anticipated increase in surgical volume associated with it, the need for an evidence-based, comprehensive, and well-coordinated Bone & Joint Program to provide patients and their families with the highest quality of care was clear. This is an article about how Hallmark Health System, 370-bed, community-based hospital system, north of Boston, MA, utilized the expertise of a skilled nurse to lead the way. Now, just over a year old and using an interdisciplinary team approach, the Bone & Joint Program at Hallmark Health is already returning dividends in patient satisfaction and in the hospital's bottom line.

Educación sanitaria al paciente sometido a pruebas diagnósticas osteoarticulares / Healthcare education for the patient undergoing osteoarticular testing

En los últimos años las exploraciones de diagnóstico por la imagen han experimentado una importante transformación que las ha consolidado como una herramienta básica para el diagnóstico de la patología osteoarticular. En este contexto el papel de los enfermeros/as, como referente más próximo del paciente es básico para resolver las necesidades de información, consentimiento informado, preparación y posibles cuidados posteriores al procedimiento diagnóstico. El objetivo del presente artículo es proporcionar las herramientas para que los enfermeros/as conozcan las pruebas diagnósticas en la enfermedad osteoarticular y puedan responder a las demandas de los pacientes. Esto facilitará una correcta preparación del paciente y permitirá conocer y prevenir las complicaciones posteriores derivadas de la técnica. Por una parte se recorren las pruebas diagnósticas: radiografía convencional, tomografía computarizada, resonancia magnética y ecografía; y además se abordan las técnicas en función de la zona corporal explorada: hueso, articulación y partes blandas (AU)

In the past few years diagnostic imaging techniques have experienced an important transformation that has consolidated their role as a basic tool for the diagnosis of osteoarticular pathology. In this context the role of nurses, who are the reference point closest to the patient, is paramount to resolve information needs, informed consent, preparation and possible care following the diagnostic procedure. The objective of this article is to provide the tools for nurses to learn about diagnostic tests in osteoarticular disease and to respond patient needs. This will aid in the correct preparation of the patient and will also help them learn about and prevent subsequent technique-related complications. First, a general overview of diagnostic imaging technique is presented, followed by a description of particular techniques depending on the body area to be examined: bone, joint, or soft tissue (AU)

La artrosis / Arthrosis

La artrosis es la enfermedad reumática más frecuente. La prevalencia de artrosis sintomática en España es del 10,2% en la artrosis de rodilla y del 6,2% en la artrosis de manos, alcanzándose el porcentaje máximo en persona de entre 70-79 años (33,7%, artrosis de rodilla;y 23,9%, artrosis de manos). En general, es más frecuente y más severa en mujeres. Se caracteriza por la degeneración y pérdida del cartílago articular. Los cuidados enfermeros, en esta patología, pueden ser muy importantes para facilitar el autocuidado y elafrontamiento eficaz de la enfermedad y deberían estar centrados en programas estructurados de Educación para la Salud dirigidos específicamente a estos enfermos.En este artículo, segundo de una serie dirigida a los cuidados enfermeros en Reumatología, se presenta la artrosis, recorriendo generalidades de esta patología, sus manifestaciones clínicas, las afectacionesarticulares específicas, factores de riesgo para la aparición y progresión de la enfermedad y manejo del régimen terapéutico en estos pacientes

Arthrosis is the most frequent rheumatic disease. The prevalence of symptomatic arthrosis in Spain is 10,2% in knee arthrosis and 6,2% in hand arthrosis, with the highest percentage being in people aged70-79 years (33,7% knee arthrosis and 23,9% hand arthrosis). Generally speaking, it is more frequent and severe in women. It is characterized by degeneration and loss of joint cartilage. Nursing care for this pathology can be very important to facilitate self-care andsuccessful tackling of the disease and should focus on health education structured programs aimed specifically at these nurses.This article, the second in a series aimed at nursing care in Rheumatology, gives an introduction to arthrosis, covering its main characteristics,its clinical manifestations, specific joint ailments, risk factors for the appearance and progression of the disease and management of the therapeutic regime in these patients

Dependencia en el anciano artrósico e intervención enfermera / Dependency in the arthrosic elderly and nursing intervention

La artrosis como enfermedad degenerativa osteoarticular incide de forma directa en la capacidad de independencia del individuo, sobre todo en el anciano. En este último se complejiza enormemente la respuesta ante la necesidad de desplazarse o de moverse condicionada, no ya solamente por factores orgánicos y fisiológicos, sino que, además, se intercalan aspectos de carácter psicológico, económico, social, cultural, etc. que convierten, no ya la necesidad sino incluso el placer del movimiento, en una verdadera tortura para el anciano amén de restar, considerablemente, su capacidad de independencia. Realizamos en el presente trabajo una valoración de dichos condicionantes en pacientes ancianos tributarios de tratamiento protésico en las articulaciones de la cadera y la rodilla, al tiempo que comprobamos la necesidad de implementar actuaciones enfermeras, en este tipo de pacientes, que rentabilicen mejor los recursos terapéuticos a través de una adecuada educación para la salud. (AU)

A practical guide to improving patient outcomes.

With advancements in research and technology, total joint arthroplasty has become one of the most consistently successful procedures in use today. Relief of pain and improvement in movement and joint function are among the most important benefits of total joint arthroplasty. However, patient involvement and contribution to the recovery process frequently make the difference in achieving optimal outcomes. Therefore, efforts to improve patient outcomes need to be patient-focused and address patient participation, beginning in the outpatient setting through hospitalization and discharge. Early preparation of the patient (physically, emotionally, and psychosocially) for surgery and rehabilitation is essential to improving patient outcomes. Patients who understand and are knowledgeable about the entire total joint arthroplasty process have faster recoveries and fewer problems. With preadmission patient education, patients experience less anxiety and emotional distress and have increased coping skills because they know what to expect. Through effective interviewing and assessment, the nurse can identify and address individual patient needs. As understanding and confidence increases, the patient's feeling of control increases. This encourages the patient to become involved and to actively participate in the therapeutic process. The orthopaedic nurse serves as the primary conduit for knowledge and understanding as the patient prepares for and progresses through the perioperative period. Working with the health care team to develop, support, and implement the interdisciplinary plan of care, the orthopaedic nurse ensures quality of care and improved outcomes during preadmission, hospitalization, and discharge/follow-up.

Management approaches for improved patient outcomes.

Joint replacement surgery generally provides greater mobility and decreases discomfort for patients whose pain cannot be managed with medications or physical therapy. Optimal patient outcomes are closely related to the management approaches, pharmacologic and nonpharmacologic, used to address well-being in the patient undergoing total joint replacement. Areas that commonly impact well-being in the patient undergoing total joint replacement include nutrition, pain, deep-vein thrombosis, infection, and anemia. Adequate assessment of these areas can help to determine appropriate approaches that will result in improved patient outcomes in patients undergoing total joint replacement. Effective patient education encourages patients undergoing total joint replacement to become actively involved in their health care, which promotes improved patient outcomes. Nonpharmacologic and pharmacologic approaches are available that help optimize patient recovery and rehabilitation, as well as the use of health care resources, which will result in improved patient outcomes. Health-related QOL is an important patient outcome in all patients and particularly those undergoing total joint replacement. Assessment of postoperative vigor may optimize patient rehabilitation and use of health system resources. Assessment provides the nurse with a better understanding of the specific patient and what therapy outcomes areas are important to that patient, which allows for individualized therapy and thus improvement in patient outcomes.