Screening complications in the postoperative period of orthopedic surgeries by video arthroscopy

To analyze the prevalence and characteristics of late postoperative complications of orthopedic surgeries by video arthroscopy.This was a descriptive cross-sectional study that evaluated, through its own instrument, local and systemic postoperative complications of patients undergoing orthopedic surgeries by video arthroscopy. The study included 270 patients, who were evaluated on days 30(without prosthesis) and 90(with prosthesis placement) of the postoperative period, by telephone service. The selection of participants occurred sequentially and population-based, within the data collection period, from February to July 2020, in a large hospital for medium and high complexity surgeries. Of the 270 procedures performed in the period, 4.4% (n = 12) presented late postoperative infection. The most frequent complications were erythema (83%), edema (75%) and secretion (67%) in the surgical wound. Most used antibiotic therapy (92%) and anti-inflammatory drugs (67%). Hospital readmission was not necessary concerning the complications. Only 50% required medical evaluation before the scheduled time.The need for practices that ensure the quality of perioperative care and improve the active search to assess surgical outcomes is reinforced.

Planning and analysing 'Green' post-COVID-19 orthopaedic perioperative recovery pathway.

The effect of the severe acute respiratory syndrome coronavirus 2 pandemic on the National Health Service in the United Kingdom has been profound and unprecedented with suspension of most elective surgeries. As we are emerging from lockdown now, restarting elective surgical procedures in a safe and effective manner is an expected challenge. Many perioperative factors including patient prioritisation, risk assessment, health infrastructure and infection prevention strategies need to be considered for patient safety. The British Orthopaedic Association, along with the National Health Service, have provided recent guidelines for restarting non-urgent and orthopaedic care in the United Kingdom. In this article we review the current guidelines and literature to provide some clarity for clinical practice.

The efficacy of a phone assistance nursing program for functional outcomes in patients after shoulder instability surgery: A protocol for randomized controlled trial.

OBJECTIVE: We conduct this research protocol for the assessment of the effect of phone-assisted care programs on functional outcomes in patients receiving shoulder instability surgery. METHODS: This is a randomized controlled, single center trial which will be implemented from October 2020 to December 2021. This trial is conducted according to the SPIRIT Checklist of randomized researches. It was authorized via the Ethics Committee of the First People's Hospital of Xiangyang city affiliated to Hubei Medical College (XY234-026). Ninety participants who undergo shoulder instability surgery are analyzed. Patients are randomly divided into control group (standard management group, with 45 patients) and study group (the phone program group, with 45 patients). In control group, the exercises at home are not monitored. Whereas in study group, patients are asked about their at-home activities, and the extra coaching sessions are provided to patients on self-care, exercise guidance, and the importance of exercise at home, and then answers to their questions. The primary outcome is the range of motion of the shoulder joint, and the pain arcs are determined through the range of motion. The extra assessments include the shoulder functional outcome, pain, and the quality of life. All the analysis needed in this study is implemented with SPSS (IBM, Chicago, USA) for Windows Version 19.0. RESULTS: The clinical outcome variables between groups are shown in Table. CONCLUSION: This investigation can offer a reliable basis for the effectiveness of phone assistance nursing program in patients after shoulder instability surgery. TRIAL REGISTRATION NUMBER: researchregistry6010.

Nurse-managed basal-bolus versus sliding-scale insulin regimen in subjects with hyperglycemia at admission for orthopedic surgery: a propensity score approach.

AIMS: A sliding-scale (SS) regimen is discouraged to correct hyperglycemia in hospital patients, but there is resistance to adoption of basal-bolus (BB) treatment in surgical units. We tested the feasibility and the effects of a nurse-based BB regimen in orthopedic surgery. METHODS: Following an intense training to implement a protocol amenable by nurses, a group of patients admitted with hyperglycemia in an orthopedic institute were prospectively followed according to a basal-bolus insulin regimen (BB, n = 80). They were compared with a hyperglycemic group eventually treated by sliding-scale insulin on demand (SS, n = 122). Diabetes was present in 196 cases. Metabolic control was assessed during the first 3 days of surgery; outcome data were tested by logistic regression, after adjusting for propensity score. RESULT: Average blood glucose and glucose variability were lower in BB versus SS (P < 0.001), in the presence of similar 3-day insulin doses. Complications were recorded in 68 cases (16.2% vs. 45.1% in BB and SS, respectively). BB regimen was associated with propensity-adjusted reduction in all adverse events [odds ratio (OR) 0.36; 95% confidence interval (CI) 0.17-0.76] and of systemic infections (OR 0.18; 95% CI 0.07-0.50) and with shorter hospital stay (8.8 ± SD 5.2 days vs. 12.5 ± 7.4; P < 0.01). The superiority of BB regimen was confirmed in the pair-matched analysis. CONCLUSIONS: The study proves the feasibility and the superiority of nurse-based BB versus SS treatment in metabolic control and on the risk of adverse events in orthopedic surgery patients with hyperglycemia.

"Wow I had no idea"-How job rotation is experienced by nurses caring for elective orthopaedic patients: A qualitative study.

AIMS AND OBJECTIVES: To explore gains and impacts of job rotation through the experiences of involved nursing personnel responsible for different parts of care during the elective orthopaedic patient's pathway. BACKGROUND: When patients undergo elective orthopaedic surgery, they encounter nurses from different wards. So far, job rotation has only been described through the experiences of the job rotating nurses. This study includes all involved nursing personnel and bases the job rotation on the pathway of the elective orthopaedic patient. DESIGN: This study has an exploratory-descriptive and qualitative approach and follows the Consolidated Criteria for Reporting Qualitative Research guidelines. METHOD: A total of nine focus groups including 16 informants were conducted before, during and after a 5-month trial period. The data were analysed using thematic analysis. RESULTS: The findings show that existing work structures and work content combined with a lack of a common understanding of the job rotation impacted the expectations of the nursing personnel regarding (in)dependence, individual and collegial involvement and investment, as well as the collegial belongingness expressed through terminologies of "home" and "culture." The personal gains among the job rotating nurses showed increased knowledge, skills and influence. When knowledge was shared and exchanged, the job rotating nurses became "cultural translators" of the care to the elective orthopaedic patient. CONCLUSIONS: This study shows personal gains among the job rotating nurses through increased knowledge, skills and influence as well as collegial gains by sharing and exchanging knowledge. When this exchange was utilised, the job rotation was evaluated positively, and contrary, when not utilised the job rotation had a negative impact on the work environment. RELEVANCE TO CLINICAL PRACTICE: Job rotation among nurses following the care of the patient's pathway can be a way of promoting patient safety and quality through increased knowledge across wards by including every aspect and element of the patient's pathway.

Understanding and Optimizing Tourniquet Use During Extremity Surgery.

Tourniquet use during extremity surgery is commonplace and a relatively safe practice. The surgical team's knowledge of the patient history, proper assessment, and indications and contraindications for and risks of tourniquet use can prevent unwanted outcomes. Exploration of these critical areas reinforces perioperative nurses' awareness and understanding of safe tourniquet use. Additionally, a review of the physiological effect of tourniquets on the skin, the body's response to local compression, the risk of vascular compromise, and the effect of the tourniquet on postoperative pain and swelling provides insight into AORN recommended practice guidelines. This article summarizes the indications and assessments for and risks of tourniquet use for patients during extremity surgery. An understanding of these topics can improve surgical outcomes and promote safe perioperative care.

A presença do familiar/acompanhante da criança submetida à cirurgia ortopédica: implicações para a enfermagem / The presence of the family/child accompanied by orthopedic surgery: implications for nursing

Introdução: Quando a criança é submetida à cirurgia, a presença do familiar transmite segurança e tranquilidade nos momentos que perpassam o período perioperatório. Objetivos: Descrever as experiências do familiar/acompanhante da criança submetida à cirurgia ortopédica no período perioperatório; analisar a presença do familiar/acompanhante da criança submetida à cirurgia no período perioperatório; e discutir a presença do familiar/acompanhante no período perioperatório e suas implicações para a prática assistencial de enfermagem. Método: estudo qualitativo baseado nos conceitos de família saudável e de presença como elemento constitutivo do cuidado familial. O cenário foi uma unidade de pediatria de um hospital especializado em ortopedia no município do Rio de Janeiro. Os participantes foram nove familiares/acompanhantes das crianças internadas e que foram submetidas à cirurgia. Os procedimentos metodológicos foram um formulário de caracterização dos acompanhantes e das crianças e a entrevista não-diretiva em grupo. Os dados foram analisados por meio da análise temática. O projeto foi aprovado no Comitê de Ética em Pesquisa da Escola de Enfermagem Anna Nery e Instituto de Atenção à Saúde São Francisco de Assis e no Comitê de Ética em Pesquisa da instituição coparticipante. Resultados: No pré-operatório, as reações dos familiares/acompanhantes, das crianças e da equipe foram bastante diversificadas, tendo em vista as informações da criança e seu acompanhante e também dos conhecimentos técnico-científicos da equipe. Na sala de cirurgia, os depoimentos apontaram a segurança da criança diante da presença do familiar/acompanhante. No pós-operatório, as depoentes destacaram o êxito da cirurgia e a expectativa de vida das crianças. A religiosidade e a distância da família permeiam as experiências do familiar/acompanhante durante o período perioperatório. Conclusões: A presença do familiar/acompanhante no perioperatório resulta na ampliação da interação família- criança-equipe, estabelecendo situações propícias ao cuidado centrado na criança e sua família em situações cirúrgicas, reafirmando a relevância da presença da família e a garantia do direito da criança de ter um acompanhante.

Introduction: When the child undergoes surgery, the presence of the relative conveys safety and tranquility during the perioperative period. Objectives: describe the experiences of the family member / companion of the child submitted to orthopedic surgery in the perioperative period; presence of the family member / companion of the child submitted to surgery in the perioperative period, to discuss the presence of the family member / companion in the perioperative period and its implications for nursing care practice. Method: qualitative study based on the concepts of healthy family and presence as a constituent element of family care. The setting was a pediatric unit of a hospital specialized in orthopedics in the city of Rio de Janeiro. Participants were nine relatives / companions of hospitalized children who underwent surgery. The methodological procedures were a form of characterization of the companions and the children, non-directive interview in the group. The data were analyzed by means of the thematic analysis. The project was approved by the Research Ethics Committee of the Anna Nery School of Nursing and the São Francisco de Assis Health Care Institute and the Research Ethics Committee of the co-participating institution. Results: In the preoperative period, the reactions of the family / companions, the child and the team were quite diversified considering the information of the child and his / her companion, as well as the technical-scientific knowledge of the team. In the operating room, the testimonies pointed to the child's safety in the presence of the relative / companion. In the postoperative period, the deponents highlighted the success of the surgery and the children's life expectancy. The religiosity and the experiences of the family membercompanion during the perioperative period. The presence of the family membercompanion in the perioperative results in the expansion of the family-child-team interaction, establishing situations propitious to care centered on the child and his family in surgical situations, reaffirming the relevance of family presence and the guarantee the right of the child to have an accompanying person.

Manejo y cuidados de enfermería de los dispositivos recuperadores de sangre CBCII ConstaVacTM (Stryker(R)) en el posoperatorio de cirugías traumatológicas yu ortopédicas / Nursing care management of ConstavacTM (Stryker(R)) CBII blood conservation system in postoperative trauma and orthopedic surgeries

El empleo de dispositivos de autorrecuperación sanguínea tipo CBCII ConstaVacTM Stryker(R) (CBCII) (fig. 1) ha supuesto un gran avance en el manejo y recuperación de los pacientes sometidos a cirugías traumatológicas y ortopédicas. Las múltiples ventajas que dichos dispositivos ofrecen frente a las clásicas transfusiones homólogas los han colocado como referencia en este tipo de cirugías. Debido a esto, es habitual su manejo en diversas unidades hospitalarias como quirófanos, salas de despertar, UCI o unidades de reanimación posquirúrgica. De todo ello deriva la importante necesidad para el personal sanitario de conocer su manejo adecuado y funcionamiento, con el fin de evitar durante su uso posibles contratiempos e incidencias que pudiesen anular su efectividad y, por ende, privar al paciente de todas las ventajas que estos dispositivos pueden aportarle en su proceso de recuperación

The use of Blood Recovery Systems such as CBCII ConstaVacTM (Stryker(R)) (fig. 1), has brought about a great advancement in the management and recovery of orthopedic and trauma patients undergoing surgery. The many advantages that these devices offer, compared to classic allogenic blood transfusions, have placed them as a reference for these types of surgeries. Hence, they are frequently used in several hospital units including operating theatres, recovery rooms, intensive care units and reanimation units. It is of outmost importance that the sanitary personnel is well familiarized with their proper handling and operating instructions to avoid possible setbacks and incidents that could cancel their effectiveness, depriving patients from all the advantages that these devices can bring into the recovery process

Nurses and physiotherapists' experience in mobilising postoperative orthopaedic patients with altered mental status: A phenomenological study.

BACKGROUND: A major goal of care for orthopaedic surgical patients is the achievement of their pre-morbid functional level or at least an improvement of their functional ability. However, patients with altered mental status can significantly impact this and other outcomes and influence the delivery of care. Patient mobilisation is a role shared by both nurses and physiotherapists. AIMS: To enhance the understanding of nurses and physiotherapists' experience in mobilising postoperative orthopaedic patients with altered mental status. METHOD: Three nurses and three physiotherapists were recruited using purposive sampling. Data was collected through interviews and analysed using Burnard's 14 stages of thematic content analysis. RESULTS: Four main categories emerged from the study: altruism, interprofessional specialist practice, patient dynamics and challenges. Nurses and physiotherapists' experience have more similarities than differences under the four categories. CONCLUSION: Nurses and physiotherapists experience numerous challenges from both patient and resources related factors such as environment, staffing and time limitations; safety risks to patient and staff; and communication barriers due to patient's altered mental state. While tensions and variations in priorities of care delivery exist between the two groups, interdisciplinary collaboration of both professional groups was clearly evident and enabled optimisation of mobilisation goals for this patient population and revealed more similarities than differences in their experience. Patient and staff safety takes precedence over mobilisation and safety risks in this patient group can be mitigated by adequate resources, competence, and teamwork.

Translation, adaptation and psychometric validation of the Good Perioperative Nursing Care Scale (GPNCS) with surgical patients in perioperative care.

AIM: To test the psychometric validity of the Good Perioperative Nursing Care Scale (GPNCS), a self-administered questionnaire, following translation and adaptation. INTRODUCTION: Patients' satisfaction with and experience of nursing care in orthopaedic or perioperative settings are currently not routinely measured and few standardized patient-reported experience measurement tools exist for these settings. MATERIALS AND METHODS: Cross-sectional survey. The 34-question, seven-factor questionnaire was translated, adapted, and face-validated; the translated version was then validated with a group of surgical patients in perioperative settings. The internal consistency of the translated version was validated and tested using confirmatory factor analysis combined with Cronbach's alpha. RESULTS: In the orthopaedic department of a regional public hospital, 361 acute, traumatic and elective surgical patients were screened for eligibility; 215 were included. The full-scale model fit estimates were moderate. Factor loadings typically ranged from 0.65 to 0.97, except for the questions concerning Technical Skills (0.38-0.63) and Nursing Process (0.28). The Cronbach's alpha value for the total scale score was 0.92, with subfactors ranging from 0.72 to 0.87. CONCLUSION: Providing evidence for quality, or lack thereof, the Danish version of the GPNCS is a valid tool for measuring surgical patients' experiences with perioperative nursing care. The electronic version proved practical. RELEVANCE TO CLINICAL PRACTICE: The validated Danish version of the tool will help healthcare professionals to identify areas of nursing care that need improvement, facilitate international benchmarking of units and enable comparison of care quality, nationally and internationally.

How lack of physiotherapist out-of-hours led to nurses developing their role: A UK case study.

The aim of this article is to share the experience of how a multi-disciplinary team worked together to develop the nursing role to incorporate the practitioners supporting mobilisation of a patient. The role developed nurses' competence, ensuring that the information and instruction patients received were consistent between therapists and nursing staff, but also supported the Enhanced Recovery Programme (2010). There were issues with the level of therapy support, especially out of hours. The team agreed a vision together, with a solution to the problem on how the mobilisation of patients post-surgery could be achieved. This would ensure postoperative complications were reduced and that there was continuity in education for the patients. This experience is an example of how staff can be empowered to provide patients with a positive experience through challenging practices and behaviours and resulting in innovative practice and role development.

Predictors of Nurses' Intentions to Administer As-Needed Opioid Analgesics for Pain Relief to Postoperative Orthopaedic Patients in the Acute Care Setting.

BACKGROUND: Patients undergoing orthopaedic surgery experience severe postoperative pain that is frequently undertreated. No study was found that examined the predictors of nurses' intentions to administer as needed (PRN) opioid analgesics for postoperative pain relief. PURPOSE: The purpose of this study was to determine what constructs from the Integrated Behavioral Model (IBM) can predict nurses' intentions to administer PRN opioid analgesics for pain relief to hospitalized postoperative orthopaedic patients. METHODS: A nonexperimental, cross-sectional quantitative format was used. The sample consisted of 800 nurses. Data collection was done by survey. RESULTS: Path analysis revealed the significant predictors of nurses' intention to administer opioid analgesics to be self-efficacy (ß= 0.15), normative beliefs (ß= 0.21), and salience (importance) of the behavior (ß= 0.25). CONCLUSION: The study showed that the IBM constructs are useful for predicting intentions toward performance of a professional behavior. The inclusion of self-efficacy, underlying beliefs, and salience of the behavior was new and unique contributions to the existing body of knowledge.

Effects of Aroma Gargling, Cold Water Gargling, and Wet Gauze Application on Thirst, Halitosis, and Sore Throat of Patients After Spine Surgery.

This study compared and examined the effects of aroma gargling, cold water gargling, and wet gauze application on thirst, halitosis, and sore throat in patients after spine surgery. A quasiexperimental pretest/posttest control group design was employed. Samples were total 70 patients (aroma gargling: 24 samples, cold gargling: 24 samples, and wet gauze: 22 samples) after spine surgery in K Hospital in Seoul, Korea. The aroma gargle solution as an experimental intervention was prepared by blending peppermint, tea tree, and lemon oils at a ratio of 1:2:2. A 60 cc of aroma gargle solution was used 3 times for 15 to 20 seconds. The visual analog scale was used to measure the degrees of thirst and sore throat, and a portable device was used to examine the degree of halitosis. There were significant differences in the degrees of thirst, halitosis, and sore throat according to interaction between group and duration. In the comparison among 3 groups, aroma gargling provided better oral health by decreasing thirst, halitosis, and sore throat for patients with spine surgery. Aroma gargling can be utilized as an effective nursing intervention for decreasing thirst, halitosis, and sore throat for patients with spine surgery in clinical practice. Results suggest, therefore, that health professionals should consider an array of methods including aroma gargling for patients after spine surgery.