Effects of clinical nursing pathway on the surgical site wound infection in patients undergoing knee or hip replacement surgery: A meta-analysis.

To explore the effect of clinical nursing pathway on wound infection in patients undergoing knee or hip replacement surgery. Computerised searches of PubMed, Web of Science, Cochrane Library, Embase, Wanfang, China Biomedical Literature Database, China National Knowledge Infrastructure databases were conducted, from database inception to September 2023, on the randomised controlled trials (RCTs) of application of clinical nursing pathway to patients undergoing knee and hip arthroplasty. Literature was screened and evaluated by two researchers based on inclusion and exclusion criteria, and data were extracted from the final included literature. RevMan 5.4 software was employed for data analysis. Overall, 48 RCTs involving 4139 surgical patients were included, including 2072 and 2067 in the clinical nursing pathway and routine nursing groups, respectively. The results revealed, compared with routine nursing, the use of clinical nursing pathways was effective in reducing the rate of complications (OR = 0.17, 95%CI: 0.14-0.21, p < 0.001) and wound infections (OR = 0.29, 95%CI: 0.16-0.51, p < 0.001), shortens the hospital length of stay (MD = -4.11, 95%CI: -5.40 to -2.83, p < 0.001) and improves wound pain (MD = -1.34, 95%CI: -1.98 to -0.70, p < 0.001); it also improve patient satisfaction (OR = 7.13, 95%CI: 4.69-10.85, p < 0.001). The implementation of clinical nursing pathways in clinical care after knee or hip arthroplasty can effectively reduce the incidence of complications and wound infections, and also improve the wound pain, while also improving treatment satisfaction so that patients can be discharged from the hospital as soon as possible.

Identified opportunities for gamification in the elective primary fast-track total hip and knee arthroplasty journey: Secondary analysis of healthcare professionals' interviews.

AIMS AND OBJECTIVES: To identify opportunities for gamification in the elective primary fast-track total hip and knee arthroplasty journey in order to support patients' health-related behaviour. BACKGROUND: Gamification provides an opportunity to increase engagement in a given health behaviour and, eventually, the possibility of reaching improved outcomes through continued or consistent behaviour. DESIGN: A secondary analysis. METHODS: Semi-structured interviews were conducted with 20 healthcare professionals in a single joint-replacement centre in Finland during autumn 2018. NVivo software was used for deductive and inductive coding. The open codes were also calculated. The consolidated criteria for reporting qualitative research were followed. RESULTS: Gamification opportunities were identified related to six dimensions: accomplishment, challenge, competition, guided, playfulness and social experience. Based on the frequencies of the coded content, most opportunities for gamification can be identified in the context of personalised counselling, monitoring and social support. CONCLUSIONS: Several opportunities for gamification were identified and quantified. While various needs and limitations need to be considered when developing digital gamified solutions and more research into the effectiveness of such solutions will be required, the current study opens possible future avenues for exploring the use of gamification in lower limb joint replacement journey and other specialisms. RELEVANCE TO CLINICAL PRACTICE: This study provides an important insight into healthcare professionals' views of the current state of the total hip and knee arthroplasty journey and the potential for its development. In addition, it pinpoints the biggest opportunities for gamified services in the context of personalised counselling, monitoring and social support. Despite the focus of this secondary analysis being on the arthroplasty journey, the findings can also be generalised in other surgical journeys.

Achieving Disease-Specific Care Joint Commission Certification: The Impact of Clinical Nurse Specialist Practice.

PURPOSE: The aims of this study are to describe a program to achieve disease-specific care (DSC) certification from The Joint Commission and highlight the value of the advanced practice nurse in the certification outcome. DESCRIPTION OF PROGRAM: The expertise in clinical practice, performance improvement, and leadership skills demonstrated by the clinical nurse specialist (CNS) can be instrumental in building a strong foundation for a DSC certification program. As an organization prepares for a DSC on-site review, the CNS can guide the program stakeholders in identifying gaps in care, developing action plans to meet certification standards, and preparing team members for the DSC on-site review. OUTCOME: At this Midwestern, 504-bed facility, The Joint Commission DSC certifications were achieved in 5 separate categories: diabetes, stroke, sepsis, total hip replacement, and total knee replacement. CONCLUSION: By influencing a certain patient population throughout the organization, population-focused CNSs are in a unique role to lead an interprofessional team or serve as an expert consultant in pursuing DSC certification from The Joint Commission.

Healthcare professionals' proposed eHealth needs in elective primary fast-track hip and knee arthroplasty journey: A qualitative interview study.

AIMS AND OBJECTIVES: To examine the lived experience of healthcare professionals providing care for patients with total hip and knee arthroplasty and to understand healthcare professionals' proposed eHealth needs in elective primary fast-track hip and knee arthroplasty journey. BACKGROUND: There is little evidence in nursing literature to indicate how to develop new eHealth services to support surgical care journeys. Evidence is particularly lacking regarding the development of eHealth solutions. DESIGN: This was a qualitative interview study. METHODS: Semi-structured interviews were conducted with four surgeons, two anaesthesiologists, ten nurses and four physiotherapists in a single joint replacement centre during autumn 2018. The data were analysed using an inductive content analysis method. NVivo qualitative data analysis software was used. The COREQ checklist for qualitative studies was followed. RESULTS: Our research addressed the gap in evidence by focusing on the four main parts of the patient journey in the selected context. Analysis of the data revealed nine main categories for the proposed eHealth needs: eligibility criteria, referrals, meeting the Health Care Guarantee, patient flow, postdischarge care, patient counselling, communication, transparency of the journey and receiving feedback. In addition, the requirements and further development needs for eHealth solutions were generally identified. CONCLUSIONS: From the point of view of healthcare professionals, eHealth solutions have huge potential in supporting the elective primary fast-track hip and knee arthroplasty journey. However, it is important to acknowledge that these needs may be very different depending on the technological and organisational environment in question. RELEVANCE TO CLINICAL PRACTICE: More effective use of information and communication technologies is needed for organisational optimisation resulting in a streamlined pathway, better access to healthcare services, improved outcomes and an improved patient experience. These results can be used in the development of new eHealth solutions to support surgical care journeys and patient education.

A Nurse Navigator Program Is Effective in Reducing Episode-of-Care Costs Following Primary Hip and Knee Arthroplasty.

BACKGROUND: Alternative payment models for total hip arthroplasty (THA) and total knee arthroplasty (TKA) have incentivized providers to deliver higher quality care at a lower cost, prompting some institutions to develop formal nurse navigation programs (NNPs). The purpose of this study was to determine whether a NNP for primary THA and TKA resulted in decreased episode-of-care (EOC) costs. METHODS: We reviewed a consecutive series of primary THA and TKA patients from 2015-2016 using claims data from the Centers for Medicare and Medicaid Services and Medicare Advantage patients from a private insurer. Three nurse navigators were hired to guide discharge disposition and home needs. Ninety-day EOC costs were collected before and after implementation of the NNP. To control for confounding variables, we performed a multivariate regression analysis to determine the independent effect of the NNP on EOC costs. RESULTS: During the study period, 5275 patients underwent primary TKA or THA. When compared with patients in the prenavigator group, the NNP group had reduced 90-day EOC costs ($19,116 vs $20,418 for Medicare and $35,378 vs $36,961 for private payer, P < .001 and P < .012, respectively). Controlling for confounding variables in the multivariate analysis, the NNP resulted in a $1575 per Medicare patient (P < .001) and a $1819 per private payer patient cost reduction (P = .005). This translates to a cost savings of at least $5,556,600 per year. CONCLUSION: The implementation of a NNP resulted in a marked reduction in EOC costs following primary THA and TKA. The cost savings significantly outweighs the added expense of the program. Providers participating in alternative payment models should consider using a NNP to provide quality arthroplasty care at a reduced cost.

Bone Cement Implantation Syndrome: Key Concepts for Perioperative Nurses.

Bone cement implantation syndrome (BCIS) is a potentially fatal complication of orthopedic surgeries that use cement. The symptoms of BCIS occur primarily during femoral fracture repairs, but this complication has been reported in a wide variety of cemented procedures. Clinical presentation of this syndrome begins as a cascade with hypoxia and hypotension; if it is not reversed, it ends with right-sided heart failure and cardiac arrest. This syndrome usually occurs at cementation, prosthesis insertion, joint reduction, or tourniquet deflation, and should be treated with aggressive resuscitation and supportive care. This article provides a comprehensive explanation of bone cement, the identification and management of BCIS, and the roles of the perioperative team in the event of cardiopulmonary collapse. It includes a case study that can be used as an educational tool for simulation, mock drills, or staff meetings; it also may be used as a framework for creating policies.

Walk patients through total hip arthroplasty.

Osteoarthritis is the most common cause for hip pain. Total hip arthroplasty (THA) can relieve pain and enhance mobility and quality of life for patients with arthritic hip pain. The focus of this article is THA in patients with osteoarthritis using Mr. H's case as an illustration. It reviews indications and contraindications for THA and other treatment options as well as nursing care for patients undergoing THA.

Does physiotherapy prehabilitation improve pre-surgical outcomes and influence patient expectations prior to knee and hip joint arthroplasty?

INTRODUCTION: Evidence supporting physiotherapy prior to hip or knee replacement for decreasing pain and improving function pre and post-operatively is equivocal. This observational cohort study used a mixed-methods approach to investigate whether 8 weeks of physiotherapy led exercise and education ('prehabilitation') would change pain and functional outcomes prior to surgery, and if patients' expectations and satisfaction post-surgery were influenced. METHODS: Participants awaiting THR or TKR were recruited (n = 75). Fifty two opted into the 'prehabilitation' group while twenty three opted for usual care. The prehabilitation group included a 45 min exercise and 15 min education session twice weekly for 8 weeks. All participants completed the WOMAC, NRS, Health Thermometer, 5xSTS and TUG outcome measures. Data were collected before and after prehabilitation and 6 weeks after surgery. Qualitative data were collected from 22 participants via telephone interviews and analysed inductively. RESULTS: Both groups improved post surgery. The prehabilitation group showed statistically significant improvements in all outcome measures after prehabilitation (pre-surgery). Participants' felt prehabilitation prepared them well for surgery and influenced expectations post-operatively. Group education talks and the experience of friends and family appeared highly valued information sources. CONCLUSION: Prehabilitation improved patients' pain and function before hip or knee replacement surgery.

Actual and perceived nursing workload and the complexity of patients with total hip arthroplasty.

BACKGROUND: Little is known about the relation between patient complexity and nursing care of total hip arthroplasty (THA) patients. To improve patient care and hospital logistics, the aim of this study is to gain insight into the relation between patient complexity and the nursing staff's actual and perceived workload at an orthopedic ward during admission for a THA. DESIGN: Prospective cohort study of 45 THA patients in the year 2014. Duration and type of nursing care activities were recorded during the first postoperative morning. A questionnaire was used to analyze the perceived workload of the nursing staff. Both actual and perceived workload were analyzed for their relation with patient complexity, expressed in the American Society of Anesthesiologists (ASA) score, Charlson comorbidity index (CCI), Katz Activities of Daily Life score (Katz-ADL) and Body Mass Index (BMI). RESULTS: No relation was found between actual workload and measures for patient complexity. The perceived workload of the nursing staff was related to two complexity measures: ASA (r=0.71; p<0.001) and CCI (r=0.65; p=0.002). CONCLUSION: Patient comorbidity is related to the perceived workload of the nursing staff during admission for a THA. Patient complexity is not related to actual workload. This study gives a first insight into the relation between patient comorbidity and nursing staff workload, to try to improve staffing numbers at the ward as well as patient care in the process.

Evaluation of a nurse-led intervention to improve adherence to recommended guidelines for prevention of venous thromboembolism for hip and knee arthroplasty patients: A quasi-experimental study.

AIMS AND OBJECTIVES: To measure adherence to a nurse-led evidence-based venous thromboembolism prevention programme (intervention) compared to usual care in hip and knee arthroplasty patients and associated clinical outcomes. BACKGROUND: Venous thromboembolism morbidity and mortality of hospitalised patients is a major concern for health professionals. Venous thromboembolism prevention guidelines have been developed; however, adherence to guidelines is variable. PARTICIPANTS: There were 410 potential participants who were adult patients that were booked for elective hip or knee arthroplasty at the two study sites during a 2-year period (2011-2013). Of these, 27 did not meet the inclusion criteria, and the remainder were eligible for inclusion in the study (intervention site n = 196 and control site n = 187, total population n = 383). METHODS: This study adopted a quasi-experimental design, using an intervention and control study site, conducted in two private hospitals in a regional area in Australia. RESULTS: The intervention group had a mean compliance score of 11.09, higher than the control group score of 7.19. This is equivalent to a compliance rate of 85% and 55%, respectively, and indicates that adherence at the study site was significantly higher. Patient adherence and outcomes in the postdischarge period were not significantly different between the study sites. CONCLUSION: This study demonstrated a nurse-led intervention achieved high adherence with translating evidence-based guidelines into routine patient care for hip and knee arthroplasty patients. Nurses can be critical to implementing clinical practice guidelines and adopting preventive programmes in acute care to improve patient outcomes and reduce postoperative venous thromboembolism in arthroplasty patients. RELEVANCE TO CLINICAL PRACTICE: This research demonstrates the capacity of nurses to lead the translation of evidence-based practice guidelines for prevention of venous thromboembolism into routine patient care.

The efficacy of high volume of local infiltration analgesia for postoperative pain relief after total hip arthroplasty under general anaesthesia - A randomised controlled trial.

BACKGROUND AND AIM: Research regarding patients undergoing total hip arthroplasty (THA) has shown no significant difference in postoperative pain with or without the use of local infiltration analgesia (LIA). The aim was to evaluate whether intra-operative LIA with Ropivacaine in patients undergoing THA under general anaesthesia reduces postoperative pain. METHOD: A randomised, placebo-controlled trial. Forty patients undergoing elective primary THA under general anaesthesia were allocated to an intervention group (RG) who received 150 ml of LIA or a placebo group (CG) who received 150 ml of saline solution. RESULTS: There were no differences in demographic data or duration of anesthesia. The total mean dose of morphine given was 16 ± 12 mg (RG) and 13 ± 9 mg (CG) (p=0.238). Pain scores (Numeric rating scale, NRS) on arrival at the PACU (time 0) were Md 1 in the RG groupvs Md 5 in the CG group (p = 0.026). During the first 2 h the Md NRS values in the RG group were ≤3 whereas the Md values in the CG were ≥3. No significant differences in NRS were found at 1-6 h after arrival at the PACU. CONCLUSION: Our study suggests that there is a positive effect of LIA on pain scores within the first hour postoperatively in patients undergoing elective primary THA under general anaesthesia.

Enquanto a cirurgia não chega: a experiência dos pacientes na fila de espera de Artroplastia total de quadril / While the surgery does not come: the experience of the patients waiting for Total Hip Arthroplasty

Este estudo tem como objetivo geral conhecer o significado que tem para a pessoa a experiência de aguardar na fila de Artroplastia total de quadril. E como objetivos específicos: analisar o significado que tem para a pessoa a experiência de aguardar na fila de Artroplastia total de quadril e propor um plano de cuidado de enfermagem para assistir o paciente que se encontra na fila baseado na teoria de enfermagem de Joyce Travelbee. Estudo do tipo descritivo com abordagem qualitativa, aprovado pelos Comitês de Ética em Pesquisada UERJ e da Instituição campo de coleta de dados, com os seguintes pareceres: CAAE 79594817.8.0000.5282 e 79594817.8.3001.5273, respectivamente. Foi desenvolvido em um Instituto especializado em traumatologia e ortopedia na cidade do Rio de Janeiro com 17 participantes, sendo sete mulheres e dez homens, na faixa etária de 31 a 80 anos. A coleta de dados ocorreu nos meses de março e abril de 2018, onde foram realizadas as entrevistas no referido Instituto. Para tratamento dos dados, utilizou-se a análise de conteúdo delineada por Bardin, emergindo quatro categorias e seis subcategorias: I- Minha vida antes do comprometimento articular; II- Mudanças na vida frente à limitação articular (Limitações físicas que causam restrição na vida; Modificações na rotina após a doença e Limitações socioafetivas geradas pela doença); III- Sentimentos vivenciados enquanto a cirurgia não vem (Sentimentos vivenciados ao receber o diagnóstico cirúrgico; Sentimentos vivenciados enquanto espera pela cirurgia e Sentimentos vivenciados pelo paciente quando ele é chamado para realizar a cirurgia); IV- Recursos utilizados para gerenciamento dos efeitos da doença enquanto a cirurgia não vem (Família como rede de apoio; Crença religiosa como suporte frente à espera e Busca de tratamentos para amenizar os efeitos da doença). Análise dos resultados se deu à luz da teoria de enfermagem de Joyce Travelbee. Os principais resultados evidenciam que os pacientes precisaram aguardar de 3 a 10 anos pela cirurgia e esse tempo os afetou tanto física quanto psicologicamente, com a piora da dor, aumento das limitações físicas, afastamento do convívio social e prejuízo emocional, trazendo implicações para o cuidado de enfermagem sob a ótica da teoria de Joyce Travelbee. Conclui-se que o tempo de espera prolongado pode afetar integralmente a saúde do paciente, sendo necessário criar estratégias como um acompanhamento por telemonitoramento com vistas a acolher as demandas desses pacientes durante o tempo de espera, favorecendo assim, a redução de danos à saúde.

This study has as general purpose to know the meaning that has for the person the experience of waiting for Total hip arthroplasty. And as specific goals: to analyze the meaning that has for the person the experience of waiting for Total hip arthroplasty and to propose a nursing care plan to assist the patient who is waiting for surgery based on the nursing theory of Joyce Travelbee. It s a descriptive study with a qualitative approach, approved by the Research Ethics Committees UERJ and the Institution data collection field, with the following opinions: CAAE 79594817.8.0000.5282 and 79594817.8.3001.5273, respectively. It was developed in an Institute specialized in traumatology and orthopedics in the city of Rio de Janeiro with 17 participants, being seven women and ten men, in the age group of 31 to 80 years. The data collection took place in March and April of 2018, where the interviews were held at the mentioned Institute. For the data treatment, the content analysis outlined by Bardin was used and four categories and six subcategories emerged: I- My life before the joint involvement; II- Changes in life in the face of joint limitation (Physical limitations that cause restriction in life; Modifications in routine after illness and Socio-affective limitations generated by the disease); III- Feelings experienced while surgery does not come (Experienced feelings when receiving the surgical diagnosis; Feelings experienced while waiting for surgery and Feelings experienced by the patient when he is called to perform the surgery); IV- Resources used to manage the effects of the disease while the surgery does not come (Family as a support network; Religious belief as support in front of waiting and Search for treatments to mitigate the effects of the disease). Analysis of the results was given in light of the nursing theory of Joyce Travelbee. The main results show that patients had to wait from 3 to 10 years for surgery and this time affected them both physically and psychologically, with worsening of pain, increased physical limitations, withdrawal from social life and emotional impairment, with implications for care from the perspective of Joyce Travelbee theory. It is concluded that prolonged waiting time can affect the patient's health, and it is necessary to create strategies such as telemonitoring to meet the demands of these patients during the waiting time, thus favoring the reduction of health damage.

Banho pré-operatório em pacientes submetidos à artroplastia do quadril:: ensaio clínico randomizado / Preoperative bath in patients submitted to hip arthroplasty: randomized clinical trial

A infecção de sítio cirúrgico (ISC) é um grande desafio para o paciente, equipe e instituições de saúde. Um fator de risco importante na patogênese das infecções cirúrgicas ortopédicas refere-se à pele do paciente. O banho do paciente com soluções antissépticas, no pré-operatório é recomendado como medida para reduzir o risco de ISC, apesar das controvérsias. O objetivo deste estudo foi avaliar o efeito da intervenção de enfermagem, banho pré-operatório, utilizando as soluções de gluconato de clorexidina a 4%, PVP-I degermante a 10% e sabão sem antisséptico, na prevenção de ISC, em pacientes submetidos à cirurgia eletiva de artroplastia do quadril e estimar a frequência de reações alérgicas causadas pelo uso das soluções. Estudo do tipo ensaio clínico, randomizado, controlado, com mascaramento do pesquisador, paciente e estatístico, utilizando dois grupos de intervenção (clorexidina; PVP-I) e um controle (sabão sem antisséptico). A amostra foi composta por 162 pacientes adultos, submetidos à cirurgia eletiva de artroplastia total do quadril, entre agosto/2015 e outubro/2017, sem infecção no local cirúrgico e alergia às soluções e não portadores nasais de Staphylococcus aureus. A randomização foi realizada por um programa de computador. Utilizados os critérios de descontinuidade de tratamento e a análise por intenção de tratar. Cada grupo foi composto por 54 pacientes. Na consulta de enfermagem os pacientes foram orientados pela enfermeira pesquisadora a tomarem dois banhos: na véspera da cirurgia no domicílio e no dia da cirurgia no hospital. O banho no hospital foi realizado por profissional de enfermagem. Para o banho o paciente recebia um envelope pardo fechado contendo o frasco da solução sorteada, quatro esponjas e um manual que orientava sobre o procedimento. O desfecho primário foi ISC e os pacientes foram monitorados até 90 dias de pós-operatório por meio de telefonemas e nas consultas de egressos ambulatorial. O programa Statistical Package for the Social Sciences (SPSS), versão 19.0, foi utilizado para análise dos dados. O efeito aos tratamentos foi medido comparando os grupos intervenção e controle por meio da incidência de ISC, risco relativo, redução absoluta de risco. As características clínicas/epidemiológicas/cirúrgicas foram similares entre os pacientes nos três grupos. A incidência de ISC em cada grupo foi 5,5% (3/54) [IC95% 1,2-15,4]. A taxa de infecção superficial foi 4,9% e profunda 0,6%. O tempo médio para o surgimento das infecções foi 19 dias (DP ± 7,4). Não houve diferença estatística significativa entre os grupos (p=1,00). Um paciente apresentou reação alérgica com o uso da solução de PVP-I. A taxa de adesão aos dois banhos foi de 99,4% (161/162). Os resultados corroboram recentes revisões sistemáticas que não encontraram diferença nas taxas de infecção cirúrgica quando o banho pré-operatório foi realizado com soluções antissépticas ou sabão. A consulta de enfermagem no pré-operatório pode impactar a taxa de infecção profunda na cirurgia eletiva de artroplastia do quadril. O uso de soluções antissépticas pode ocasionar reações alérgicas na pele do paciente, durante o banho e precisa ser monitorada. É necessário cautela ao recomendar o banho pré-operatório com solução antisséptica como estratégia para reduzir infecção de sítio cirúrgico. A orientação do paciente no pré-operatório de cirurgia eletiva de artroplastia do quadril, quando realizada pelo enfermeiro, pode melhorar a qualidade do cuidado prestado ao paciente cirúrgico. Clinical Trials nº NCTO3001102 (AU)

Surgical site infections (SSI) are a major challenge for the patient, staff, and health institutions. An important risk factor in the pathogenesis of orthopedic surgical infections refers to the patient's skin. The patient's bath with antiseptic solutions in the preoperative period is recommended as measure to reduce the risk of SSI, despite controversies. The objective of this study was to evaluate the effect of the nursing intervention, preoperative bath, using 4% chlorhexidine gluconate solutions, 10% PVP-I and non-antiseptic soap in the prevention of SSI in patients submitted to elective hip arthroplasty surgery and the frequency of allergic reactions caused by the use of the solutions. Randomized, controlled clinical trial with masking of the researcher, patient and statistician using two intervention groups (PVP-I, chlorhexidine) and one control (non-antiseptic soap). The sample was consisted of 162 adult patients undergoing elective total hip replacement between August/2015 to October/2017, without infection at the surgical site and allergy solutions and non-nasal carriers of Staphylococcus aureus. The randomization was performed by a computer program. The criteria for treatment discontinuity and intention-to-treat analysis were used. Each group consisted of 54 patients. In nursing consultation patients were instructed by the research nurse to take two baths: the day before the surgery at home and the day of the surgery in the hospital. The bath in the hospital was performed by a nursing professional. For the bath the patient received a closed brown envelope containing the bottle of the solution drawn, four sponges, and a manual that guided about the procedure. The primary outcome was ISC and the patients were monitored up to 90 postoperative days by phone calls and outpatients visits. The Statistical Package for Social Sciences (SPSS), version 19.0, was used for analysis of the data. The effect on treatments was measured by comparing intervention and control group by incidence of ISC, Relative Risk and Absolute Risk Reduction. Clinical/epidemiological/surgical characteristics were similar among the patients of the three groups. The incidence of SSI in each group was 5.5% (3/54) [IC95% 1,2-15,4]. The superficial infection rate was 4.9% and deep 0.6%. The mean time to onset of infection was 19 days (SD ± 7.4). There was no statistically significant difference between the groups (p = 1.00). One patient presented an allergic reaction with the use of the PVP-I solution. The rate of adherence to the two baths was 99.4% (161/162). The results of this study corroborate recent systematic reviews that found no difference in surgical infection rates when the preoperative bath was performed with antiseptic solutions or soap. The preoperative nursing consultation may impact the rate of deep infection in elective hip arthroplasty surgery. The use of antiseptic solutions may cause allergic reactions on the patient's skin during bathing and needs to be monitored. Caution is required when recommending the preoperative bath with antiseptic solution as a strategy to reduce surgical site infection. The orientation of the patient in the preoperative period of elective hip arthroplasty surgeries performed by the nurse can improve the quality of care provided to the surgical patient. Clinical Trials nº. NCTO3001102..(AU)

Acompanhamento por telefone de idosos submetidos a cirurgias de coxa e quadril: Estudo-piloto / Monitoring for elderly subject phone to thigh and hip for surgery: Pilot study / Acompañamiento por teléfono de ancianos sometidos a cirugías de muslo y cadera: Estudio piloto

Este estudo-piloto analisa o acompanhamento por telefone comparado ao tratamento convencional em idosos no pós-operatório de cirurgias de coxa e quadril. Observou-se uma redução sob o ponto de vista clínico entre a primeira e a última avaliação para "perda do apetite sem náuseas", "dificuldade para movimentar-se" e "fadiga". Houve tendência de queda da "dor" e da "infecção pós-operatória no local da incisão". As atividades de intervenção exercidas através do telefone mostram-se acessíveis à população, com boa adesão e baixo custo.

This pilot study analyzes the telephone follow-up compared to the conventional treatment in the elderly in the postoperative period of thigh and hip surgeries. He observed a clinical reduction between the first and last evaluation for "loss of appetite without nausea," "difficulty to move" and "fatigue". There was a tendency for "pain" and "postoperative infection at the incision site to drop." Intervention activities carried out through the telephone are accessible to the population, with good adherence and low cost.

Este estúdio-piloto analiza el seguimiento por teléfono comparado al tratamiento convencional en ancianos en el postoperatorio de cirugías de muslo y cadera. Se observó una reducción desde el punto de vista clínico entre la primera y la última evaluación para "pérdida del apetito sin náuseas", "dificultad para moverse" y "fatiga". En la mayoría de los casos, se observó un aumento de la mortalidad por rotavirus en el momento de la vacunación.

Hip and knee arthroplasty - patient's experiences of pain and rehabilitation after discharge from hospital.

BACKGROUND: Fast-track clinical pathways for hip and knee arthroplasty is being implemented in several western countries. The treatment entails patient involvement, optimal pain management, intensive mobilization and early discharge. Limited research has been carried out on patient's experiences after discharge. PURPOSE: The purpose of the study is to describe how patients experience pain and manage the rehabilitation process the first six weeks after discharge. METHOD: The study followed a qualitative descriptive design. Semi-structured interviews were conducted with 12 participants three months after discharge from hip or knee arthroplasty. FINDINGS: Patients experienced varying degrees of pain the first three to five weeks after discharge. Walking-training and sleep were affected by pain or stiffness in joints and muscles, and several needed help from family members to perform activities of daily living (ADL). Several participants would have like more individualized information about pain and exercises before discharge. Some experienced that the municipal care services failed to follow up on issues related to pain. CONCLUSION: The study illuminates that patients may need more individualized and adapted information prior to discharge, as well as more multidisciplinary follow-up by doctors, physiotherapists and possibly home care nurses. We recommend more studies examining how patients experience pain and rehabilitation during the first weeks after completing arthroplasty.

Nursing Care of the Patient Undergoing an Anterior Approach to Total Hip Arthroplasty.

The anterior, anterolateral, direct lateral, transtrochanteric, and posterior techniques have historically been the surgical approach to a total hip arthroplasty; however, a forthcoming technique called the direct anterior approach has been demonstrated to produce many patient and physician quality outcomes. These favorable outcomes can include shorter hospital stay, earlier mobility and functionality, decreased medical costs, and increased patient satisfaction scores. Appropriate nursing care during the preoperative, intraoperative, and postoperative phases is essential. The purpose of this article is to describe the nursing care for a patient undergoing a direct anterior approach to hip arthroplasty.

Interventions of the nursing diagnosis "Acute Pain" ­ Evaluation of patients' experiences after total hip arthroplasty compared with the nursing record by using Q-DIO-Pain: a mixed methods study / Interventionen zur Pflegediagnose "Akute Schmerzen" ­ Evaluation der schmerzlindernden Pflege bei hospitalisierten Patientinnen und Patienten nach Hüftendoprothesenversorgung im Vergleich zur Pflegedokumentation mittels Q-DIO-Pain: eine Mixed Methods Studie.

Background: Pain affects patients' rehabilitation after hip replacement surgery. Aim: The study aim was to compare patients' responses, on their received pain relieving nursing interventions after hip replacement surgery, with the documented interventions in their nursing records. Method: A mixed methods design was applied. In order to evaluate quantitative data the instrument "Quality of Diagnoses, Interventions and Outcomes" (Q-DIO) was further developed to measure pain interventions in nursing records (Q-DIO-Pain). Patients (n = 37) answered a survey on the third postoperative day. The patients' survey findings were then compared with the Q-DIO-Pain results and cross-validated by qualitative interviews. Results: The most reported pain level was "no pain" (NRS 0 ­ 10 Points). However, 17 ­ 50 % of patients reported pain levels of three or higher and 11 ­ 22 % of five or higher in situations of motion / ambulation. A significant match between patients' findings and Q-DIO-Pain results was found for the intervention "helping to adapt medications" (n = 32, ICC = 0.111, p = 0.042, CI 95 % 2-sided). Otherwise no significant matches were found. Interviews with patients and nurses confirmed that far more pain-relieving interventions affecting "Acute Pain" were carried out, than were documented. Conclusions: Based on the results, pain assessments and effective pain-relieving interventions, especially before or after motion / ambulation should be improved and documented. It is recommended to implement a nursing standard for pain control.

The effects of the empowerment education program in older adults with total hip replacement surgery.

AIMS: To measure the effectiveness of an education empowerment program on primary (self-efficacy and self-care competence) and secondary outcomes (Activities of Daily Life, mobility, depressive mood and quality of life) for older adults with total hip replacement surgery. BACKGROUND: Degenerative arthritis is a common and serious chronic illness that impacts the quality of life of older adults. As joints continue to degenerate and the hip damaged by arthritis, activities of daily life will be difficult to perform due to severe hip pain and joint stiffness. Therefore, hip replacement surgery should be considered and effective nursing care should be provided to improve the recovery of older adults. DESIGN: A prospective randomized control trial. METHODS: A trial was conducted from September 2013 - May 2014 in two hospitals in northern Taiwan. 108 participants were random assigned to either the education empowerment group or in the comparison group. The researchers collected baseline data at admission and outcomes on the day of discharge, one month after and three months after the discharge. RESULTS: After the interventions, the education empowerment group participants demonstrated significantly higher self-care competence and self-efficacy and lower depressive inclinations compared with those in the comparison group. Participants in both groups significantly improved on activities of daily life, mobility and quality of life over the course of the interventions. CONCLUSION: This education empowerment intervention was very effective in enhancing participants' outcomes. Moreover, involving both older adults and their caregivers for the participation this program is recommended for a greater impact.