Physiatry for Treating Hip, Knee, and Back Pain.

Physical Medicine and Rehabilitation (PM&R) is a rapidly expanding field. Physicians who practice PM&R are known as physiatrists and provide care primarily for patients who have disabilities or physical impairments affecting the musculoskeletal system, brain, and spinal cord. Physiatrists may work in an inpatient or outpatient setting, with outpatient physiatrists being an invaluable resource in treating patients experiencing pain. It is worthwhile to refer patients experiencing hip, knee, or back pain to a PM&R specialist because of their skill in making specific and accurate diagnoses, as well as providing a wide range of modalities to treat pain and augment function such as management of pain medications, osteopathic manipulative therapy, trigger point injections, intra-articular steroid injections, orthobiologic therapy, and interventional spinal procedures. Emphasis is on the use of the least invasive modality before employing more invasive treatments. The need for physiatrists to help individuals maximize function and enhance quality of life is increasing with the aging population, expanding workforce of older adults, and a growing population of people with a disability, especially since the COVID-19 pandemic.

Blood Management for the Orthopaedic Surgical Patient.

Prevention and management of anemia and blood loss in the orthopaedic patient undergoing surgery is a major concern for healthcare providers and patients. Although transfusion technology can be lifesaving, there are risks to blood products that have led to increased awareness of blood management and development of hospital patient blood management programs. Use of patient blood management can be effective in addressing preoperative anemia, a major modifiable risk factor in patients undergoing surgery. In this informational article, evidence-based practice guidelines for perioperative blood management are addressed. A case scenario is introduced focusing on a patient whose religious preference is Jehovah's Witness having "no blood wishes" undergoing elective orthopaedic surgery. Orthopaedic nurses can facilitate optimal patient blood management through multidisciplinary collaboration.

The Future of Nursing: Application of Health Equity in Orthopaedics.

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report was released in May 2021 by the National Academies of Sciences, Engineering, and Medicine. The goal is attainment of health equity in the United States using nursing capacity and expertise by designing a pathway for the nursing profession to generate a culture of health, reduce health disparities, and improve the nation's health and well-being. The focus of this article is to develop an awareness and understanding of the nine Future of Nursing recommendations for attaining health equity over the next decade with an application to orthopaedic nursing.

Transgender Individuals and Osteoporosis Prevention.

BACKGROUND: Risk behaviors and hormone use place transgender individuals (TIs) in jeopardy for osteoporosis. PURPOSE: The purpose of this study was to expand the science about the knowledge, health beliefs, and osteoporosis (OP) preventing behaviors of TIs. METHODS: This was a mixed-methods pilot study of a convenience sample of 31 TIs 30 years and older. Participants completed an online Osteoporosis Bone Health Survey. Fifteen participants were randomly selected for an interview to describe their perceptions of bone health. RESULTS: Transgender individuals performed poorly on the knowledge measure. There were no significant findings for osteoporosis health beliefs. Participants' daily dietary dairy calcium intake was 800 mg and daily walking activity was 17 minutes. Perceptions of bone health revealed two essential elements, knowing and doing. CONCLUSION: Determining TIs' bone health perception is important because of their unique healthcare issues. Healthcare providers need to be aware of TIs' bone health needs to help enhance TIs' OP knowledge, health beliefs, and preventing behaviors.

Caring for the Transgender Individual.

Issues about transgender individuals (TIs) as a disparate population are now being more openly discussed in the general public. However, healthcare providers often express feeling uncomfortable in interacting with TIs because they have not been educated about care of TIs and often base their care on insensitive stereotyping. The purpose of this informational article is to provide a foundation of knowledge for nurses and healthcare professionals for providing competent patient-centered care for TIs. Topics discussed include a description of the transgender population, commonly used terms to describe TIs, health risks and healthcare needs of TIs, and how to provide quality healthcare for TIs.

Bone density, health beliefs, and osteoporosis preventing behaviors in men.

PURPOSE: To examine the effect of bone mineral density (BMD) screening via dual-energy x-ray absorptiometry (DXA) results on osteoporosis preventing behaviors (OPB), knowledge of osteoporosis, and health beliefs of men aged 50 years or older (N = 196) was evaluated. DESIGN: An experimental, 2-group longitudinal design was used. The independent variable was DXA, dependent variables were osteoporosis preventing behaviors, and mediating variables were general knowledge of osteoporosis and Health Belief variables. Half of the men had low bone density. Men diagnosed to be osteoporotic increased their calcium intake. FINDINGS: Health belief variables predicted calcium intake and/or exercise. In addition, 9 men in the experimental group were taking medications to prevent/restore bone loss at Time 3. Healthcare providers play a significant role in assessing bone loss and preventing and treating osteoporosis in men. IMPLICATIONS: The cost of a DXA screen is far less than financial and social costs due to osteoporotic fractures.

Structural model for osteoporosis preventing behavior in men.

This longitudinal study evaluates the effect of bone mineral density screening on calcium intake and daily exercise of 196 healthy men older than 50 years over a period of 1 year. In this randomized clinical trial, the experimental group received personal bone density information via dual-energy X-ray absorptiometry (DXA). The men completed measures addressing knowledge, health beliefs, calcium intake, and exercise behaviors. Outcome measures were collected by a questionnaire at three time points: initial (Time 1 [T1]; pre-DXA), 6 months (Time 2 [T2]), and 12 months (Time 3 [T3]). Using structural equation modeling for data analysis, results indicated that men in the experimental group had a significantly higher T2 calcium intake than the control group, with no additional direct effect at T3. T1 daily calcium intake was significantly predicted by T1 health beliefs. Men with higher levels of health motivation tended to have higher initial levels of daily calcium intake. Personal knowledge of DXA results relate significantly to increased calcium intake.

Validation of the Osteoporosis Smoking Health Belief instrument.

Smoking has a deleterious effect on bone mineral density. Psychometric properties were conducted for 3 smoking cessation subscales of the Osteoporosis Smoking Health Belief (OSHB) instrument: barriers, benefits, and self-efficacy. The instrument was evaluated by 6 nurse researchers, administered to a pilot sample of 23 adult smokers aged 19-39, and to a convenience sample of 59 adult smokers aged 19-84 years attending bingo at churches and community centers. Principal components factor analyses were conducted on the 18 items at both time points and accounted for 65.05% of the variances in the matrix at Time 1 and 71.19% at Time 2. The 3 statistical factors corresponded to the theoretically derived concepts. Cronbach's alphas for benefits of not smoking were .86 at Time 1 and .88 at Time 2; for barriers, .78 at Time 1 and .89 at Time 2; and for self-efficacy, .94 at Time 1 and .96 at Time 2. The test-retest correlations were .68 for benefits, .74 for barriers, and .79 for self-efficacy. Paired t tests showed no significant change over time. The OSHB meets relevant measurement criteria.

Judgments of critical care nurses about risk for secondary brain injury.

BACKGROUND: Interdisciplinary care for patients with traumatic brain injury focuses on treating the primary brain injury and limiting further brain damage from secondary injury. Intensive care unit nurses have an integral role in preventing secondary brain injury; however, little is known about factors that influence nurses' judgments about risk for secondary brain injury. OBJECTIVE: To investigate which physiological and situational variables influence judgments of intensive care unit nurses about patients' risk for secondary brain injury, management solely with nursing interventions, and management by consulting another member of the health care team. METHODS: A multiple segment factorial survey design was used. Vignettes reflecting the complexity of real-life scenarios were randomly generated by using different values of each independent variable. Surveys containing the vignettes were sent to nurses at 2 level I trauma centers. Multiple regression was used to determine which variables influenced judgments about secondary brain injury. RESULTS: Judgments about risk for secondary brain injury were influenced by a patient's oxygen saturation, intracranial pressure, cerebral perfusion pressure, mechanism of injury, and primary diagnosis, as well as by nursing shift. Judgments about interventions were influenced by a patient's oxygen saturation, intracranial pressure, and cerebral perfusion pressure and by nursing shift. The initial judgments made by nurses were the most significant variable predictive of follow-up judgments. CONCLUSIONS: Nurses need standardized, evidence-based content for management of secondary brain injury in critically ill patients with traumatic brain injury.

The clinical nurse specialist as change agent: reducing employee injury and related costs.

PURPOSE: The purpose of this study was, first, to examine the role of the clinical nurse specialist (CNS) as it relates to the implementation of a CNS-initiated Safe Movement Program and, second, to report findings from a CNS-initiated safe movement program (SMP) in reducing healthcare workers' injuries and related costs. DESIGN: A longitudinal preimplementation and postimplementation study design was used. SETTING: Healthcare workers in a 156-bed, extended-care facility (nursing home) participated in the study. SAMPLE: Participants at the onset of the study included 52 healthcare workers who participated in the study preimplementation and postimplementation of the SMP. Attrition resulted in a final sample of 46. METHODS: Data were collected on healthcare workers' perceptions of injuries as well as existing incident reports and workers' compensation records preimplementation and postimplementation of the study. FINDINGS: Outcomes included major reduction in healthcare worker injuries and related workers' compensation cost savings. The number of healthcare workers who thought an injury occurred as a result of lifting or transferring a resident was reduced by 75%, and perceptions of lifting and transfer injuries resulting in a back strain were reduced by 80%. The number of times in a month healthcare workers felt lifting or transferring a resident was "too much" for them was reduced by 73%. Workers' compensation insurance was reduced by 93%. CONCLUSIONS: A CNS-initiated SMP reduces injuries and costs and may recoup the cost of the program in 5 years. IMPLICATIONS: Job-related musculoskeletal injuries are a critical problem. As the healthcare workforce continues to age, a comprehensive SMP needs to be implemented to ensure safety of employees in the clinical practice setting. The program may pay for itself in 5 years.

Development of the National Association of Orthopaedic Nurses guidance statement on safe patient handling and movement in the orthopaedic setting.

High-risk patient-handling tasks lead to work-related musculoskeletal disorders for orthopaedic nurses and other members of the healthcare team who are involved in moving patients with orthopaedic issues. Serious consequences can arise from manually moving/lifting these patients. A task force was organized that included representatives from the National Association of Orthopaedic Nurses, the Patient Safety Center of Inquiry at the James A. Haley Veterans Administration Medical Center in Tampa, the National Institute for Occupational Safety and Health, and the American Nurses Association to identify high-risk tasks performed in the orthopaedic setting and to develop evidence-based solutions to minimize the risk of musculoskeletal disorders. High-risk tasks for moving and lifting orthopaedic patients were identified. Four orthopaedic algorithms and a clinical tool were developed by the task force to direct nurses and healthcare team members caring for orthopaedic patients through the use of scientific evidence and available safe patient-handling equipment and devices.

Recommended weight limits for lifting and holding limbs in the orthopaedic practice setting.

Nurses and other caregivers face high risk for developing work-related musculoskeletal disorders while lifting and holding limbs in the orthopaedic practice setting. A task force including representatives from the National Association of Orthopaedic Nurses, American Nurses Association, National Institute for Occupational Safety and Health, Patient Safety Center of Inquiry at the James A. Haley Veterans Administration Medical Center in Tampa, Diligent Services, and Guldmann, Inc., developed an orthopaedic clinical tool for determining maximum recommended weight limits for lifting and holding arms and legs for treatment of the orthopaedic patient. Scientific evidence, concepts of ergonomic safety, and safe patient-handling equipment were incorporated into this clinical tool.

Osteoporosis knowledge, health beliefs, and DXA T-scores in men and women 50 years of age and older.

PURPOSE: To compare the knowledge of osteoporosis, revised health belief model variables (RHBM), and DXA (dual energy x-ray absorptiometry) T-scores among men and women 50 years of age and older. DESIGN: This was a secondary analysis that used 218 healthy community-based women 50 to 65 years of age and 226 healthy community-based men >or=50 years of age. Data for women were collected for 18 months during 2001-2003, and data for men were collected for 18 months during 2004-2006. The variables were knowledge of osteoporosis, RHBM variables (susceptibility, seriousness, benefits and barriers of calcium intake and of exercise, health motivation, self-efficacy of calcium intake and exercise), and DXA T-scores. METHOD: The women and men completed an osteoporosis questionnaire prior to having a DXA screening test. A total of 190 women and 187 men had DXA scans. FINDINGS: More than half of the sample had abnormal bone density scans. Knowledge of osteoporosis was low for women and even lower for men. Seven of the nine health belief variables were associated with gender. Women perceived osteoporosis to be serious and that they were susceptible. Men did not perceive osteoporosis to be serious or that they were susceptible. Men were more health motivated and more confident of their ability to engage in exercise.

DXA, health beliefs, and osteoporosis prevention behaviors.

OBJECTIVE: This experimental longitudinal study was designed to examine the relationship between having a bone density through dual energy X ray absorptiometry (DXA) and osteoporosis preventing behaviors (OPB) among healthy postmenopausal women. METHODS: Subjects were 203 healthy community-based women 50-65 years of age. Mediating variables were general knowledge of osteoporosis and revised health belief model variables. Treatment group women (n = 101) had a DXA screen and control group women (n = 102) did not. Study questionnaires were completed at three time points; initially and at 6 months and 12 months. RESULTS: Repeated measures ANOVA revealed treatment group women scored significantly higher on perceived susceptibility and calcium intake. Wilks's Lambda F revealed a significant difference in use of osteoporosis preventing medications. DISCUSSION: Personal knowledge gained from DXAs increased perceived susceptibility to osteoporosis, calcium intake, and use of osteoporosis preventing medications and appears to be an effective intervention in promoting OPB in younger postmenopausal women.

Structural model for osteoporosis preventing behavior in postmenopausal women.

BACKGROUND: Osteoporosis prevention behaviors (OPBs) can prevent and delay bone deterioration; dual-energy X-ray absorptiometry (DXA) scan can identify osteoporosis and provide personal osteoporosis risk information that may promote prevention behaviors. OBJECTIVES: This study was designed to estimate relationships between receiving personal knowledge of bone mineral density (gained through DXA scan), general knowledge of osteoporosis, health beliefs, and the two OPBs of calcium intake and weight-bearing exercise in healthy postmenopausal women 50 to 65 years. METHODS: In this longitudinal, randomized clinical trial (including covariates), receipt of personal DXA information was manipulated by random assignment to the experimental or control group. The remaining antecedent and outcome variable measures were collected by questionnaire at three time points (initial [T1; pre-DXA], 6 months [T2], 12 months [T3]) and by bone density assessment from 203 women over an 18-month period in 2001-2003. RESULTS: The experimental manipulation (DXA results) had a direct positive effect (beta = .23, p < .05) on calcium intake at T2, and indirectly at T3 through T2. Women in the experimental group who were informed they had osteopenia or osteoporosis had a greater T1-T2 change in daily calcium intake than those with normal bone density (beta = .23, p < .05). However, providing DXA results did not relate to change in exercise. Health beliefs and general osteoporosis knowledge predicted initial calcium and exercise levels; there was tentative evidence that susceptibility beliefs partially mediate between DXA results and change in calcium intake. DISCUSSION: Personal knowledge of DXA results was related significantly to increases in calcium intake in postmenopausal women, but not to exercise. Directions for further study are discussed.

Tailored interventions to enhance osteoporosis prevention in women.

PURPOSE: The purpose of this pilot study was to determine if tailored nursing interventions based on personal knowledge of bone mineral density from a dual-energy x-ray absorptiometry cause increases in knowledge of osteoporosis, health beliefs, or osteoporosis-prevention behaviors in postmenopausal women 50-65 years of age, 6 months after the intervention. METHOD: The design for this pilot study was a two group quasi-experimental design. The treatment group received a tailored intervention; the control group did not. Outcome data were gathered at 6 months after dual-energy x-ray absorptiometry. The tailored intervention was designed and given to each woman via telephone using her dual-energy x-ray absorptiometry results and osteoporosis questionnaire data that addressed her knowledge of osteoporosis and osteoporosis-prevention behaviors of calcium intake, exercise, smoking, and alcohol use. A written mailed copy of the intervention followed the telephone interview. Six months after the intervention, the women were mailed another osteoporosis questionnaire to determine if the tailored intervention made a difference in the outcome variables. SAMPLE: A total 124 women between the ages of 50 and 65 (101 control, 23 treatment) comprised the sample. RESULTS: There was no difference in knowledge between groups. On the average, there were significantly more perceived barriers to calcium in the tailored group (mean = 13.48) than in the nontailored group (mean = 11.55) (t = 2.147; df = 122; p = .034). There were significantly more perceived barriers to exercise in the tailored group (mean = 14.39) than in the nontailored group (mean = 12.21) (t = .144; df = 122; p = .034). Daily calcium intake increased in both the tailored and the nontailored groups. The tailored intervention increased women's daily calcium intake from 614.28 to 1039.10 mg (t = -2.896; df = 22; p = .008). The nontailored group daily calcium intake increased from 587.91 to 916.30 mg (t = -3.541; df = 100; p = .001); there was no significant difference between the groups. Weight-bearing exercise behaviors decreased from 96.04 minutes to 59.2 minutes in the tailored group but increased slightly in the nontailored group from 81.47 to 87.26 minutes of exercise. CONCLUSION: Tailored interventions increased women's perceived barriers to calcium and exercise. Both groups increased calcium intake. The mixed findings of increased perception of barriers to calcium and exercise and decreased exercise behaviors indicate the need for further study. This important intervention has implications for orthopaedic nurses and healthcare professionals involved in health promotion and prevention of osteoporosis.

Cultural competence among nursing students and faculty.

Healthcare consumers are entitled to culturally competent care. Therefore, nursing curricula need to include cultural content and student nurses and faculty members need to be culturally competent. The purpose of the study was to describe cultural competence of students and faculty at a college of nursing and to discuss the implications for nursing curricula related to cultural competence. Campinha-Bacote's model (Campinha-Bacote, J., 1994. Cultural competence in psychiatric mental health nursing. Nursing Clinics of North America 29 (1), 1-8.) of culturally competent care provided the theoretical framework. The Inventory for Assessing the Process of Cultural Competence (IAPCC) (Campinha-Bacote, J., 1998. The Process of Cultural Competence in the Delivery of Healthcare Services: A Culturally Competent Model of Care. Transcultural C.A.R.E. Associates, Cincinnati, OH. Available from: .) was used to measure levels of self-reported cultural competence. A convenience sample of 88 first year, 121 fourth year baccalaureate students and 51 faculty members at a college of nursing was studied. Analysis of variance revealed a statistically significant difference (F=43.915, df=259, p<.0001) between the three groups. A positive correlation was found between IAPCC scores and several demographic variables. Findings suggest that cultural competence can be increased by including structured cultural content in nursing curricula.

Height change and bone mineral density: revisited.

PURPOSE: To evaluate the relationship between height change, osteoporosis risk factors, and bone mineral density. SAMPLE: Secondary data collected on 168 healthy women, ages 50 to 65 years, who had a dual energy x-ray absorptiometry screening of the hip and spine to determine bone mineral density. METHOD: A quantitative secondary analysis of data that replicated in part a study by Hunt (1996). FINDINGS: The relationships between height change, osteoporosis risk factors, and bone mineral density were not significant for this group of healthy postmenopausal women. However, these women did not meet daily minimum requirements for dietary calcium intake and daily exercise. IMPLICATIONS: The good news is that healthy women ages 50 to 65 years still have time to engage in osteoporosis preventing behaviors to prevent bone loss and eventual height loss. The use of measured height change, as an indicator for osteoporosis risk, is a cost-saving tool and should be considered as one component of a comprehensive osteoporosis health appraisal incorporating daily calcium intake and exercise. Further research, with more precise measurement of height, needs to be done to evaluate the relationship between height change, osteoporosis risk factors, and bone mineral density.

Knowledge and health beliefs of osteoporosis in college nursing students.

PURPOSE: This purpose of this study was to describe college students' knowledge of osteoporosis, health beliefs regarding osteoporosis, self-efficacy to perform osteoporosis-preventing activities, and actual performance of osteoporosis-preventing activities. METHOD: This descriptive study used a survey method. Participants completed a questionnaire consisting of the Osteoporosis preventing Behaviors Survey, the Osteoporosis Knowledge Test, the Osteoporosis Health Belief Scale, and the Osteoporosis Self-Efficacy Scale. SAMPLE: One-hundred ninety-four nursing student subjects (86 sophomore students and 108 senior students). RESULTS: Senior students were more knowledgeable about osteoporosis than sophomore students and were more confident about performing osteoporosis-preventing behaviors. There were no significant differences between the groups regarding their health beliefs about osteoporosis, their performance of weight-bearing exercise, dietary calcium intake, or intake of caffeinated products. CONCLUSION: These results may be useful in examining the nursing curricula at colleges of nursing, as well as investigating methods of helping beginning nurses, as health promoters, to make lifestyle changes. This, in turn, may lead to behaviors to prevent osteoporosis in themselves and those for whom they provide care.