The Effect of Preoperative Education Prior to Hip or Knee Arthroplasty on Immediate Postoperative Outcomes.

There is ample research demonstrating improved patient outcomes when using an enhanced recovery program. However, the literature reporting the impact of preoperative education alone prior to hip and knee arthroplasty is conflicting. With the number of these surgical procedures expected to increase in the next few years, the identification of strategies that positively impact outcomes is important. The aim of this study was to evaluate immediate postoperative physical therapy (PT) performance following a total hip or knee arthroplasty in patients who attended a preoperative education class compared with those who did not. This study was a retrospective chart review of 707 hip and knee arthroplasty patients, comparing outcomes based on preoperative educational session attendance. Demographics, comorbidities, length of stay (LOS), discharge disposition, and PT performance were collected from the chart review. Patients who attended the preoperative education class had significantly greater ambulation distances (p < .001), greater degrees of knee flexion (p < .001), and greater degrees of hip flexion (p = .012) on postoperative Day 1. Both hip (p < .001) and knee (p < .001) patients who attended the class had a significantly shorter LOS. The cost benefit analysis indicated a savings of $921.57 in direct costs per knee arthroplasty in those who attended a class. Patients who received preoperative education had greater mobility in the immediate postoperative period and reduced LOS for both hip and knee arthroplasties. Based on this study's results, preoperative education is effective in improving outcomes and reducing the cost of hip and knee arthroplasties.

Technology in nursing education: a study of PDA use by students.

Personal digital assistants (PDAs) were first used by the public in the early 1990 s. Initially used as a device to manage personal information, these devices quickly evolved. Currently, PDAs are capable of storing and exchanging large amounts of information, which truly make them handheld computers. As such, they have great value for professional use. Health care professionals require access to ever-expanding knowledge, and PDAs or other handheld computer devices can serve as valuable tools for education, information storage and retrieval, and clinical practice. This article describes the use of PDAs by undergraduate and graduate nursing students during their educational process. A descriptive study was conducted at a small, private university school of nursing at which all nursing students receive PDAs prior to their first clinical experiences. Findings from the study indicated that students used their PDAs for both classroom and clinical activities and that drug reference software was the most frequently used software application. Information was also obtained about the facilitators and barriers to PDA use.

The impact of staffing on patient outcomes across specialty units.

OBJECTIVE: Determine the relationships between nursing staffing and specific nurse-sensitive outcomes (central line blood-associated infection, pressure ulcer, fall, medication error, and restraint application duration rates) across specialty units (cardiac and noncardiac intensive care, cardiac and noncardiac intermediate care, and medical-surgical). BACKGROUND: A number of hospital-level studies have demonstrated that lower staffing levels are associated with higher adverse patient outcomes. However, insufficient insight into unit-level staffing relationships is available. Further unit-level inquiry is necessary to fully explicate the relationships between staffing and outcomes and to provide assistance to nurse administrators as they seek to develop blueprints for staffing plans that are linked to quality outcomes. METHODS: Secondary analysis of prospective, observational data from 95 patient care units (cardiac intensive care, n = 15; noncardiac intensive care, n = 7; cardiac intermediate care, n = 18; noncardiac intermediate care, n = 12, and medical-surgical, n = 43) across 10 acute care hospitals. RESULTS: No statistically significant relationships were found between central line infection and pressure ulcer rates and staffing across specialty units. Significant inverse relationships were present between staffing and falls in cardiac intensive care, medication errors in both cardiac and noncardiac intensive care units, and restraint rates in the medical-surgical units. CONCLUSIONS: Results from this study suggest that the impact of staffing on outcomes is highly variable across specialty units; however, when present, the relationships are inversely related with lower staffing levels, resulting in higher rates of all outcomes.

Measuring nurse-sensitive patient outcomes across specialty units.

In efforts to quantify the quality of care delivered to patients within their systems, nursing administrators are being called on to both privately and publicly report nursing-sensitive outcomes for their institutions. Accurate reporting with appropriate patient population or risk adjustment is essential if the reported outcomes are to provide meaningful data to consumers and providers. At present there are no effective mechanisms available that can sufficiently adjust nursing-sensitive outcomes to assure reliable reporting. This study suggests that specialty unit classification may be one method by which nursing-sensitive outcomes can be accurately reported.