Conducive environments reduce sleep disturbances and improve sleep quality: a quality improvement project.

AIM: The current implementation project aimed to improve patients' sleep quality in a hospital by implementing targeted interventions to reduce sleep disturbances. METHODS: The Silent Night project was implemented in two general units of an academic tertiary hospital. The project comprised three phases: preimplementation, implementation, and postimplementation. Patient surveys were administered to obtain patients' perspectives on the sources of noise disturbances at night. Noise-monitoring machines were installed in two wards to obtain objective data on noise levels at night. Concurrently, data were collected on noise-generating activities that were observed. RESULTS: The overall quality of sleep reported by patients improved by 17% (from 73.5 to 88.9%). Patients' survey reported reduced noise disturbances from direct care activities, environmental noise and medical equipment alarms. The mean noise level in the orthopedics unit reduced significantly from 57.04 to 55.22 dB with a corresponding decrease in noise generating activities by 60% (from 362 to 144). In the geriatric unit, the mean noise level increased from 51.36 to 53.12 dB but is within the National Environmental Agency's permissible noise level of 55 dB even though the noise generating activities reduced significantly by 92.2% (from 954 to 74). CONCLUSION: The 'Silent Night' project has successfully reduced noise disturbances generating from environment and nursing care activities and improved patients' sleep quality in the hospital. Sharing sessions regarding sources of noise and the 'Silent Night' poster promoted the awareness of noise disturbances in healthcare professionals, visitors, and patients.

British Orthopaedic Association's Standards for Trauma (BOAST): Care of the older or frail patient with orthopaedic injuries.

Managing elderly, frail patients with orthopaedic injuries, remains a challenge. Their poor bone stock and associated comorbidities makes this special cohort of patients unique in terms of their needs and the risk of developing complications. Published on line in 2019 (www.boa.ac.uk/uploads/assets/04b3091a-5398-4a3c-a01396c8194bfe16/the%20care%20of%20the%20older%20or%20frail%20orthopaedic%20trauma%20patient.pdf) the British Orthopaedic Association's Standards for Trauma focusing on the care of the older or frail patient with orthopaedic injuries, provides a contemporary guide for the holistic management of the spectrum of injury and pre-existing needs of this population.

Preoperative Education for Total Knee Replacement: A National Survey of Orthopaedic Nurses.

BACKGROUND: Preoperative education aids in reducing the incidence of poor outcomes after total knee replacement (TKR) and increasing patient readiness for discharge home but is not well described in the literature. PURPOSE: The purpose of the study is to describe the current design of preoperative education for TKR across the United States. METHODS: A large, national sample of orthopaedic nurses completed an online survey to describe preoperative education at their facilities. RESULTS: Most participants provided preoperative education as part of interprofessional teams in either a group format or combined group and individual education. Verbal instruction was the most common educational delivery method, followed by written instruction. Education typically lasted between 1 and 1.5 hours, was delivered in a single session, and included a variety of topics. CONCLUSION: Results of this study describe preoperative educational practices and can support future research to improve patient outcomes following TKR surgery.

International Nursing: Use of a Commercially Available Smartphone Application to Solve Information Needs of Orthopedic Scrub Nurses.

The purpose of this article is to describe the use of a commercially available smartphone application to solve information needs of scrub nurses in orthopedic surgery. A semistructured, focus group interview was conducted with orthopedic scrub nurses. These nurses had solved their information needs about orthopedic surgery by using a commercially available smartphone application. Because of smartphone technology's convenience, accessibility, mobility, ease of use, and use at no charge, it is worth considering in nursing practice, education, and research.

Caregivers' knowledge and practice toward pressure ulcer prevention in national orthopedic hospital, Enugu, Nigeria.

INTRODUCTION: Globally, nurses are known to care for hospitalized patients and the presence or absence of pressure ulcers is being regarded as a performance measure of quality nursing care. The study aims to determine the knowledge and practice of caregivers towards pressure ulcer prevention for hospitalized patients in National Orthopaedic Hospital, Enugu. METHOD: A cross sectional descriptive survey design was adopted among eighty-five (85) caregivers who met the inclusion criteria and participated in the study. Ethical approval and informed consent of participants was obtained before data collection using a pre-tested semi-structured questionnaire and checklist. Descriptive analysis and Chi-square statistical test was used to test for association between variables. RESULT: Results revealed poor knowledge 67.3% of pressure ulcer prevention among caregivers. Inadequate staffing 93.5%, heavy workload 92.9%, were highest perceived barriers to pressure ulcer prevention. The test of hypothesis showed that there is a significant relationship between years of service of caregivers and knowledge of pressure ulcer P = 0.000. CONCLUSION: It was concluded that in-service training, recruitment of more staff and ensuring availability of the necessary equipment are some of the important steps to improve nurses' knowledge and practice regarding prevention of pressure ulcer.

Opioid induced constipation management in orthopaedic and trauma patients: treatment and the potential of nurse-initiated management.

BACKGROUND: Opioid analgesics treat moderate to severe pain with proven analgesic efficacy, although their use is associated with dose-limiting side effects, such as constipation. Orthopaedic and trauma patients are at high risk of developing opioid-induced constipation (OIC) due to reduced mobility and increased opioid requirements to manage prolonged pain after injury. OBJECTIVES: To examine the evidence base to guide clinicians on the most effective or tolerated laxative regimen for the management of OIC and nurse-initiated management of OIC. METHOD: A review of the literature was undertaken. Databases were searched to identify studies on OIC, laxatives and nurse-initiated management. RESULTS: Laxatives do not address the underlying cause of OIC and there is currently insufficient evidence to guide clinicians on the most effective or tolerated laxative regimen for the management of OIC. The use of peripheral acting mu-opioid receptor antagonists (PAMORAs) could be considered in those for whom regular use of a combination of laxatives has not been sucessful, and nurses should take a broader role in the assessment of symptoms and response to treatment. CONCLUSION: The important balance between adequate analgesia and minimising OIC symptoms is an ongoing challenge for clinicians, and an area of patient care where nurses could be leading management.

Understanding the integration of family caregivers in delirium prevention care for hospitalized older adults: A case study protocol.

AIM: To understand family caregiver involvement in delirium prevention care for older adults hospitalized for orthopaedic surgery hospitals and family caregiver integration by nurses. DESIGN: Multiple-case study. METHODS: The model of Care Partner Engagement was selected as theoretical framework. Eight cases will comprise an older adult hospitalized a family caregiver and a ward nurse. They will be recruited with a non-probability sampling on two orthopaedic surgery wards in two hospitals. Semi-structured interviews with participants will be audiotaped. Sociodemographic data will be collected. These data, researcher field notes and interview transcripts will be subjected to within- and across-case thematic analysis. Regional ethics committee approved the study protocol in August 2018. DISCUSSION: The study will allow surgical nursing teams to gain a better understanding of the issues and possibilities regarding family caregiver integration in delirium prevention care for older adults.

Summary: NAON's Best Practice Guideline, Total Hip Replacement (Arthroplasty).

This article summarizes the Best Practice Guideline for Total Hip Replacement (Arthroplasty) recently released by the National Association of Orthopaedic Nurses (NAON). The summary highlights the process of content development utilizing a systematic literature review and resulting recommendations for nursing care strategies throughout the patient care continuum. The authors of the Best Practice Guideline are expert nurses working in Joint Commission Disease Specific Certified clinical settings. The Summary concludes reminding readers of the purpose and focus of the guideline to enhance clinician knowledge and to improve patient care pathways and, ultimately, patient outcomes.

Nurse Practitioners in Orthopaedic Surgical Settings: A Review of the Literature.

PURPOSE: The purpose of this article was to conduct an extensive literature review of nurse practitioners (NPs) in orthopaedic surgical settings to delineate whether a need exists for NPs in these settings. BACKGROUND: Due to physician shortages and changes in healthcare, patients are experiencing difficulty accessing orthopaedic surgeons. To meet this need, NPs are becoming an essential part of the multidisciplinary orthopaedic team in Level 1 trauma hospitals. RESULTS: Nurse practitioners are qualified and competent to work in a variety of orthopaedic settings including preoperative clinics, primary care orthopaedic clinics, and pre-/postoperative care within the hospital. The benefits of NPs in orthopaedic surgical settings includes increased access to care, improved team communication, decreased length of stay, improved quality of care, and improved patient satisfaction. Moreover, NPs meet patient needs while surgeons are operating, and have a positive impact on resident surgeon education. CONCLUSION: A need exists for NPs in orthopaedic surgical settings to both improve access to healthcare for patients and reduce the burden on orthopaedic surgeons.

Pain Management by Nurses in Level 2 and Level 3 Hospitals in China.

BACKGROUND: Pain management practice differs among hospitals in China; however, no studies have examined the association between hospital level and nursing practice of pain management. AIMS: To evaluate the nursing practice of pain management in orthopedics wards of level 3 and 2 hospitals and compare the differences in pain management regulations, policies, and perceived barriers. DESIGN: This was a cross-sectional descriptive study. SETTING: This study was conducted during the 10th International Congress of the Chinese Orthopedic Association, November 19-22, 2015. PARTICIPANTS: Subjects: The sample included 121 nurses from China. METHODS: Quantitative research methods were used to assess pain management practice by 121 Chinese nurses as well as barriers to nursing practice. RESULTS: Nurses in level 3 hospitals were more likely to evaluate patients' pain intensity (85.23% vs. 65.38%, p < .05) and quality (77.27% vs. 53.85%, p < .05) than those in level 2 hospitals. Compared with level 2 hospitals, level 3 hospitals were more likely to participate in the Painless Orthopedics Ward program (53.41% vs. 23.08%, p < .01), conduct pain management knowledge training (88.64% vs. 69.23%, p < .05), and establish pain management regulations (68.18% vs. 34.62%, p < .01). Level 2 hospital nurses reported a higher score for barriers than level 3 hospital nurses (3.27 vs. 2.45, p < .05). CONCLUSIONS: Nurses from level 2 hospitals received less education on pain management and also paid less attention to and faced more restrictions for pain management than nurses from level 3 hospitals.

STOPDVTs: Development and testing of a clinical assessment tool to guide nursing assessment of postoperative patients for Deep Vein Thrombosis.

AIMS AND OBJECTIVES: To develop and test a clinical tool to guide nurses' assessment of postoperative patients for Deep Vein Thrombosis. BACKGROUND: Preventing venous thromboembolism in hospitalised patients is an international patient safety priority. Despite high-level evidence for optimal venous thromboembolism prophylaxis, implementation is inconsistent and the incidence of Deep Vein Thrombosis remains high. METHODS: A two-stage sequential multi-method design was used. In stage 1, the STOPDVTs tool was developed using a review of the literature and focus groups with local clinical experts. Stage 2 involved pilot testing the tool with 38 surgical nurses who conducted repeated assessments on a prospective sample of 50 postoperative orthopaedic patients. RESULTS: Stage 1: The focus group members who were members of the nursing leadership team agreed on eight local and systemic signs and symptoms that should be included in a nursing patient assessment tool for early Deep Vein Thrombosis. Local symptoms were pain in the limbs, calf swelling and tightness, changes in the affected limb's skin temperature. Systemic signs included in the tool were as follows: increased shortness of breath, increased respiratory and heart rates, and decreased oxygen saturation. Stage 2: The STOPDVTs tool had acceptable face and content validity, the agreement between the expert nurse and surgical nurses on assessments of individual signs and symptoms varied between 44%-94%. Surgical nurses were less likely than the expert nurse to identify signs indicative of Deep Vein Thrombosis. CONCLUSION: Despite finding the STOPDVTs clinical assessment tool was a useful guide for nursing assessment, surgical nurses often underestimated the potential importance of clinical signs. The findings reveal a gap in nursing knowledge and skill in assessing for Deep Vein Thrombosis in postoperative orthopaedic patients. RELEVANCE TO CLINICAL PRACTICE: This study identified a possible risk to patient safety related to under-recognition of the signs and symptoms of possible Deep Vein Thrombosis (DVT) in postoperative orthopaedic patients. The findings demonstrate the feasibility of developing and implementing a protocol for consistent screening by nurses for possible DVT in the postoperative period.

MACRA and the Quality Payment Program: How Does It Relate to Orthopaedic Nursing?

The introduction of 2017 also brought with it the beginning of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) legislation related to the Quality Payment Program (QPP), in addition to alternative payment models and the merit-based incentive payment system. The successful implementation of the QPP within the specialty of orthopaedics will rely heavily on the active involvement of orthopaedic nurses when it comes to improving quality, lowering costs, and incorporating value. It is important for orthopaedic nurses to understand the QPP and the role it plays in determining value-based payment of orthopaedic care delivery, in addition to how the structure of the QPP correlates with nursing diagnoses and respective plans of care delivery.

Orthopaedic Snafus: When Adverse Events Happen in Orthopaedics.

The potential for adverse events exists when treating and managing orthopaedic patients in the intraoperative or postoperative environments, especially when it comes to falls, surgical site infections, venous thromboembolism, and injuries to nerves and blood vessels. Orthopaedic nurses play a vital role in the promotion and use of evidence-based interventions to decrease the incidence of these adverse events, improve quality of care, and minimize the financial burden related to these adverse events.