A longitudinal study of quality of life and functional status in total hip and total knee replacement patients.

BACKGROUND: Primary total hip and primary total knee surgeries are commonly performed to improve patients' quality of life and functional status. AIM: This longitudinal retrospective study (N = 851) examined self-reported quality of life and functional status over the preoperative and postoperative periods: 12 months prior to surgery, one month prior to surgery and 12 months following surgery. METHODS: A linear mixed effects model was used to analyze the changes in quality of life and functional status over the sampling period. RESULTS: Patients in the convenience sample reported improvements in quality of life and functional status utilizing the SF-12 and Oxford Hip and Oxford Knee, although differences were noted by procedure and gender. Total hip patients tended to demonstrate greater improvement than total knee patients and males reported higher levels of physical and mental quality of life as well as functional status when compared to females. Of particular note was that mental health scores were consistently lower in both total hip and total knee replacement patients across the perioperative period and up to one year postoperative. CONCLUSION: This study identifies an opportunity for health care providers to proactively address the mental health of total hip and total knee replacement patients throughout their joint replacement trajectory.

The pain experience of inpatients in a teaching hospital: revisiting a strategic priority.

For hospital executives and clinicians to improve pain management, organizations must examine the current pain experience of in-patients beyond simply measuring patient satisfaction. The aim of this study was to quantify the prevalence of pain among adult in-patients and the degree of interference pain had on daily activities. A descriptive, cross-sectional study was undertaken in a 530 bed tertiary care, teaching hospital in central Canada. A convenience sample (N = 88) of adult medical-surgical patients completed the Short Form-Brief Pain Inventory survey. Pain prevalence was 70.4%. The mean pain severity score was 3.76 (standard deviation, SD = 2.88) and mean pain interference score on daily activities was 4.56 (SD = 3.93). The most frequently identified site of pain was the lower extremities (n = 15, 28%). Women had higher mean scores on pain "right now" compared to men (p < 0.05). The sample majority (n = 81) indicated hospital staff asked about the presence of pain. Seventy-nine percent (n = 57) reported hospital staff "always" did everything they could to help manage pain. Eighty-four percent (n = 61) selected "always" or "usually" to describe their ability to be involved in deciding pain treatments. The mean pain relief score from treatments was 61% (SD = 34.79). Significant positive correlations were found between pain intensity ratings and pain interference on all daily activities (p < 0.001). Pain prevalence remains high with a significant relationship between pain and activities of daily living. The study provides baseline data to direct future initiatives at improving pain management.

From anxiety to enthusiasm: facilitating graduate nursing students' knowledge development in science and theory.

Knowledge development of theory can be challenging for graduate nursing students when they experience deficits related to theoretical foundations, evaluation, or application. This article recounts the experiences of the students and course facilitator with a graduate-level nursing science and theory course, which required critical analysis of a concept, theory critique, and poster presentation. The idea for this article was generated when the students realized the profound importance of nursing theories and their applicability to practice and research. Students' anxiety gave way to enthusiasm with the implementation of teaching and learning strategies based on adult learning theory. Knowles' four characteristics of adult learners are discussed in relation to the experiences of the students and course facilitator. These characteristics include learners' wish to be self-directed, need to bring life experiences to their learning, recognition of their social and occupational role competencies, and need to take a more immediate, problem-solving approach to their learning.