International Journal of Orthopaedic and Trauma Nursing - Articles in Press

A comparison between orthopaedic nurses’ and patients’ perception of individualised care - Corrected Proof

Agneta Berg, Ewa Idvall, Jouko Katajisto, Riitta Suhonen — 2012-05-21

Summary: This exploratory study compares orthopaedic nurses’ perceptions of individualised nursing care with previously published orthopaedic patients’ perceptions. Orthopaedic nurses (N=243) from one university, two central and two county hospitals working within in-patient care were surveyed using the Individualised Care Scale-Nurse (ICS-Nurse) in 2009 (response rate 74%, n=180). The data were analysed using both descriptive and inferential statistics. About 60% of the nurses stated that it was very important that the care provided is individualised in comparison with 86% of the patients as previously reported (p-value <0.001). The highest rated assessment of individualised care was the clinical situation and the lowest the personal life situation which is in line with the patients’ experiences. This result demonstrates the need of managers in healthcare organisations to redouble their efforts in the implementation of individualised care by investigating nurses’ contemporary beliefs about, and forces that hinder the provision of individualised nursing care.

Developing a nurse practitioner role for hip fracture care: A journey of challenges - Corrected Proof

Faith J. Forster — 2012-05-17

Summary: The establishment of the nurse practitioner (NP) role in the Canadian health care system has been challenged by many issues including inconsistent educational preparation, lack of sustainable funding and inadequate planning and implementation. Although the climate for NP role initiation has improved over the last decade, challenges continue for those who currently wish to initiate the role (). For successful initiation of a NP role, it is important to consider what steps are required and the potential for nurse practitioner care to influence the clinical outcomes of specialized populations.In this paper, a case example of the initiation of the NP role in the orthopedic service of a British Columbia (BC) tertiary care hospital outlines significant steps along an often difficult pathway to successful completion. The main goal of NP role initiation was to improve the clinical outcomes of the hip fracture population. Discussion includes development of the role, a description of how the role is actualized in clinical practice and the initial impact of the role on the acute length of stay of hip fracture patients. Facilitators and barriers to role initiation are discussed including strategies to overcome specific political and health care system obstacles involved in the NP role initiation. Early findings following the initiation of the NP role include a substantial decrease in acute length of stay for hip fracture patients. Results of a questionnaire that explores the perceptions of other health care professionals of the NP role 12years post initiation shows significant support for the role.

Ten years follow-up of trauma-related psychological distress in a cohort of patients with acute traumatic hand injury - Corrected Proof

Margareta Gustafsson, Jenny Windahl, Karin Blomberg — 2012-05-10

Summary: Though early psychological symptoms after an acute traumatic hand injury have been described, there remains a need for knowledge concerning the trajectory of the individual’s response over time to the traumatic event. The purpose of this study was to describe psychological distress related to the traumatic experience in a cohort of patients with acute traumatic hand injury in a 10-year perspective. Patients were recruited consecutively at a hand surgery department. Data were collected by means of mailed questionnaires one week, three months, one year and 10years after the accident. Eighty-three patients participated in all four measurements. Their experience of psychological distress related to the trauma differed significantly during the 10years (p<0.001). A quarter of the patients had symptoms indicating a risk of a psychiatric disorder one week after the accident. Most of them recovered naturally during the first three months but 10% had more persistent high level of symptoms during the first year after the accident. A few patients developed symptoms at risk level at three months and still had symptoms 10years after the accident. At three months it appears possible to identify hand-injured patients with more persistent psychological symptoms and probably in need of a psychiatric consultation.

Developing a predictive tool for post-operative delirium in orthopaedic settings in Hong Kong - Corrected Proof

2012-04-25

Summary: Aims: A prospective study was conducted to develop a Common Risk-factor Assessment Predictive Tool (CAP) for identifying factors associated with post-operative delirium (POD) in orthopaedic surgery. A high, moderate and low risk score system was developed. The incidence rate of POD was also determined.Background: POD has been reported as contributing to complications and poor outcomes, consequently affecting recovery and health-care provision.Methods: Thirteen risk factors were evaluated. Regression coefficient and odds ratios were used to determine the association of the risk factors with POD. These were then used to develop a tool. Validation of these associated risk factors was carried out to check their effectiveness in predicting the development of POD.Findings: Fifty nine of 277 patients developed POD. Four major risk factors were identified: visual impairment (p=0.011; scored as 2), cognitive impairment (p<0.001; scored as 4), urinary tract or respiratory tract infection (p=0.028; scored as 3) and use of urinary catheterisation (p=0.046; scored as 3). Using a 12-point score system the cut-off values were 4.5 (61.0% sensitivity and 85.8% specificity) and 7 (11.9% sensitivity and 95% specificity) respectively.Conclusion: The tool can predict different levels of risk for POD. Nurses can use the tool to communicate patients’ risk of POD and identify potential preventive strategies.

Self-management of osteoarthritis: A culturally-specific Chronic Care Model for South Asians - Corrected Proof

Gurpreet Dhatt, Peggy Simpson, Valerie MacDonald — 2012-03-07

Abstract: Osteoarthritis (OA) is the most common and frequently disabling of the joint disorders. By age 75years, 85% of the population has either radiographic or clinical evidence of OA. For many people, OA is chronic, progressively painful and impedes mobility and diminishes quality of life. Developing effective programs for managing OA is a health care imperative.The Chronic Care Model is an approach to improving chronic illness care and is based on four pillars: self management, decision supports, delivery system design and information systems. The CCM has been widely tested and found to improve patient care and outcomes ().Immigration from South Asian (SA) countries has increased ethnic diversity in cities world wide. Family systems, beliefs and values held by immigrants influence their interactions, perceptions and experiences in managing osteoarthritis. The purpose of this paper is to introduce the reader to the South Asian culture and the Chronic Care Model applied to osteoarthritis management. The Chronic Care Model may be a useful tool to guide the planning of culturally appropriate health care services for this population.

Corrected Proof

Beverley Wellington — 2012-03-05

Patient teaching is an important component in providing effective care and encompasses a variety of situations whether it is teaching a patient about their medications, wound care, signs and symptoms to be aware of or discharge advice to assist the patient at home. Patients are increasingly discharged earlier and this increases the need for instruction and advice which will provide them with the necessary information to help them recover and reduce the risk of re-admission.

Corrected Proof

Rosemary Masterson — 2012-03-02

This is the first edition of this book written by three authors with nursing experience from a variety of specialities, namely orthopaedics, care of the elderly and acute and critical care.

Predictive factors for in-hospital stay and complications after hip fracture - Corrected Proof

Panagiota P. Copanitsanou, Joseph Liaskos, Theodoros C. Tsarouchas — 2012-02-17

Abstract: Background: There are a number of factors, such as preoperative Length Of hospital Stay (LOS), that effect treatment outcomes following proximal hip fracture. Much of this is not completely understood.Objective: To determine whether co-morbidities, complications and patients’ abnormal laboratory findings at admission have an effect on LOS and related complications during hospitalization for hip fracture treatment in a Greek hospital.Design: Prospective observational descriptive study.Setting: A high volume orthopedic ward of a general hospital in Greece, from March to October 2008.Patients: In total, 253 consecutive patients hospitalized for hip fracture treatment in an orthopedic ward of a large Greek hospital were included in the study. All complications, LOS and parameters of clinical history and treatment were recorded.Results: The mean age of the sample was 79.68years. Only 29.3% of the patients were operated within the first 2days, as the mean preoperative LOS was 3.71days, leading to a total LOS of 9.68days. Preoperative LOS increases somewhat in patients with heart failure and previous cerebrovascular accident. LOS increases when patients present with cardiac complications, respiratory complications, fever and anemia. Complications correlate with the type of patients’ co-morbidities. Abnormal laboratory findings at admission correlate to the type of preoperative complications.Discussion: LOS, mortality and complication rates in the study hospital are comparable to the findings reported in the literature.

Comparison of care process and patient outcomes after hip-fracture surgery in acute-care hospitals in Japan and the United States - Corrected Proof

Akiko Kondo, Brenda K. Zierler, Hiroshi Hagino — 2011-09-02

Abstract: Aim: To compare the care processes and outcomes during hospitalisation of hip-fracture patients in Japan and the United States as well as to examine the relationship between care processes, postoperative complications and mortality.Methods: This was a retrospective multi-site study. Data were collected from three hospitals in Japan and two in the USA. Participants (⩾65years) had undergone hip-fracture surgery in one of these hospitals from August 2005 to September 2007. A mail survey was conducted for collecting data on outcomes after discharge.Results: The number of days before surgery and before initial ambulation after surgery was significantly longer in Japan than in the USA. After adjusting for patient characteristics, the incidence of complications was significantly higher in the USA. General anaesthesia delayed the postoperative day on which patients first got out of bed; blood transfusions were significantly associated with a higher incidence of complications. The type of surgery and delayed postoperative day on which patients first got out of bed were significantly associated with higher mortality.Conclusions: Incidence of complications was significantly higher in the USA. An extremely short length of hospital stay because of a prospective payment system may degrade the quality of care and patient outcomes.