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.
Orthopedic day surgery is common. Postoperative recovery may differ according to surgical procedures and personal factors. We studied postoperative recovery up to 2weeks after different orthopedic day surgical procedures and tried to identify possible predictors associated with recovery. Three-hundred and fifty eight patients who had undergone knee arthroscopy or surgery to the hand/arm, foot/leg or shoulder were included. Data were collected on postoperative days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale, the emotional state, physical comfort and physical independence dimensions in the Quality of Recovery-23 and a general health question. Multiple linear regression was used to explore predictors of recovery. The shoulder patients experienced significantly lower postoperative recovery and general health 1 and 2weeks after surgery compared to the other patient groups (p<0.001). Significant predictors of recovery were age, perceived health and emotional status on the first postoperative day and type of surgery. Postoperative recovery after common orthopedic day surgical procedures varies and factors influencing it need to be further explored. The impact of a patient’s emotional state on recovery after day surgery can be of particular interest in this work. Post-discharge planning needs to be tailored to the surgical procedure.
Aim: The aim of the study was to describe registered and enrolled nurses’ perceptions of how they assess patients’ pain, nutrition and skin.
Introduction: Planning for pain, nutrition and skin care management is an essential part of nursing. In Sweden, it is common that registered and enrolled nurses work together in the care of patients.
Method: Interviews with nine registered and nine enrolled nurses were analyzed using qualitative content analysis.
Results: One theme; blurring boundaries between registered and enrolled nurses regarding pain, nutrition and skin suit assessments was identified. The manifest content of interviews is described in four categories: nurse–patient interaction, using oneself as a tool, collaborating with colleagues and listening to patients’ next of kin.
Conclusion: The analysis showed a blurring of boundaries between RNs and ENs regarding pain, nutrition and skin suit assessments. How they perform their assessments conforms to a large extent. However, even if the activities are the same, the education levels of RNs and ENs are different and therefore the assessment of the patients might be different in clinical practice. Taking the results into account it is important that RNs and ENs collaborate regarding assessment of the patients’ pain, nutrition and skin suit.
The aim of the study was to describe and compare registered (RNs’) and enrolled nurses’ (ENs’) assessments of postoperative pain, risk for malnutrition and pressure ulcers in patients with hip fracture. Furthermore, the aim was to describe and compare their perceptions of using assessment tools. Thirty-four (34) RNs and forty-three (43) ENs, working on orthopaedic wards in Sweden, took part in the study. The assessments were carried out on 82 patients with hip fracture. The assessment tools included the numerical rating scale (NRS), short-form nutritional assessment tool (MNA-SF), modified Norton scale (MNS) and pressure ulcer card. Many patients were assessed to be in postoperative pain and at possible risk for malnutrition. Around 50% were assessed as being at risk for pressure ulcer formation (PU). There is a difference between RNs and ENs assessments of patients’ postoperative pain, risk for malnutrition and PU. ENs assessed to a greater degree that patients were in intense pain currently. RNs assessed to a greater degree that patients had been in intense pain in the past 24h. Single items on the tools showed differences. However, there was no statistically difference for MNA-SF screening score and MNS total score. ENs found it easier to assess postoperative pain with the NRS compared to RNs.
BACKGROUND: Effects following a hip fracture often lead to functional disabilities and increased dependence on others. Although persons sustaining a hip fracture constitute a heterogeneous group in Swedish health care, they tend to be treated as a homogenous one. AIM: The aim of this study was to reveal how previously healthy people, aged 65 years and older, described how they had adapted to daily life four months after a hip fracture. METHOD: The follow-up interviews were performed by the first author four months after the hip fracture. Data were analysed using conventional inductive content analysis. FINDINGS: The results from the interviews highlight that sustaining a hip fracture - even four months later - was seen by the participants as an interruption leading to lasting consequences for everyday life. The recovery process during this period was complex and consisted of both physical and psychological strain. Some were resigned, some strived in order to regain independence and some handled the situation by means of self-confidence and self-efficacy. CONCLUSION: Previous healthy and independently-living participants described, in different ways that the hip fracture was an interruption that still affected everyday life. The absence of psychological support may be one of the reasons for dependency after four months.
Aims and objectivesTo explore healthy older patients' perceptions of their own capacity to regain pre-fracture function in the acute phase following hip fracture surgery.BackgroundThe incidence of hip fractures is expected to increase. In Sweden, of the patients who sustain a hip fracture, 40 per cent are healthy and lived independently pre fracture. However, a hip fracture often results in declined functional outcomes for 40 per cent of these patients.DesignThe study had an explorative inductive qualitative design.MethodsSemi-structured interviews (n = 30) were conducted two to five days after hip fracture surgery. Data were analysed using manifest inductive content analysis.ResultsAs a description of patients' perception of their own capacity to regain pre-fracture function after a hip fracture, one main category emerged: To end up in a new situation with or without control. Patients expressed that they believed in recovery and thought nothing would be altered. However, since they had to adapt to the ward culture at the acute hospital, they became passive and became insecure about their future life situation.ConclusionThe attitudes of staff at the acute hospital can influence the outcome for hip fracture patients. Patients believe in recovery but do not receive psychological support to regain physical capacity.
Background: Hip fractures are described to have a significant impact on patients' well-being and different fasttrack concepts could result in a reduction of the patient's psychological and emotional reactions before pre- and intrahospital care. Aims and objectives: This study aimed to elucidate perceived situations of significance experienced by patients with hip fracture during the prehospital-and in-hospital care. Design: The study used a qualitative approach using a critical incident technique (CIT), 14 patients with hip fractures were included. Methods: All informants had undergone surgery for a hip fracture, were able to communicate in Swedish and had no cognitive impairment. Results: The main area Oscillating between being satisfied and to endure a new demanding situation emerged from five categories: Pain and pain management, Feeling fear and satisfaction in perioperative care, Experiencing continuity in care, Considering information and Felling confirmed. Conclusion: Experiences of prehospital care shows a positive impact though the patients experienced this part of the pathway professionally. However, the patients described critical incidents according to their experiences of pain seems to have significant damagingly impact on the patients' well-being. The patient also describe a sense of uncertainty in their individual involvement of care.
BACKGROUND: Hip fractures represent a major clinical burden for patients. Studies on the effect of preoperative carbohydrate loading before different surgical interventions have shown promising results but have not been tested in patients with hip fracture.
AIM: This study aimed to investigate the effects of preoperative oral carbohydrate drinks on the postoperative energy intake and incidence of complications after hip fracture surgery.
METHOD: This was a pilot study using a quasi-experimental design with a control group and an intervention group.
RESULT: The number of patients affected by more than one complication was higher in the control group than in the intervention group. According to the logistic regression analysis, the risk of any postoperative complication was reduced by approximately 50% OR (95% CI) 0.508 (0.23-1.10) in patients in the IG compared to those in the CG (p = 0.085).
CONCLUSION: The result of this pilot study indicated that using preoperative carbohydrate drinks can decrease the number of postoperative complications in patients with a hip fracture. Furthermore, the number of patients who meet their energy needs during the first three days postoperatively might increase. More research is needed to confirm the effect of preoperative carbohydrate drinks.
This paper provides those who care for orthopaedic patients with evidence-supported international perspectives about acute nursing care of the older adult with fragility hip fracture. Developed by an international group of nurse experts and guided by a range of information from research and clinical practice, it focuses on nurse sensitive quality indicators during the acute hospitalisation for fragility hip fracture. Optimal care for the patient who has experienced such a fracture is the focus here. This includes in this part:
Pain
Delirium
and in the second, subsequent, part
Pressure Ulcers
Fluid Balance/Nutrition
Constipation/Catheter Associated Urinary Tract Infection
Vigilant nursing assessment and prompt intervention may prevent the development of the complications we discuss. If they do occur and are identified early on, they may resolve with appropriate and timely nursing management.
This “tool kit” has been developed under the auspices of the International Collaboration of Orthopaedic Nursing (ICON) a coalition of national associations of orthopaedic nursing (www.orthopaedicnursing.org).Previous article in issue
The second part of this paper provides those who care for orthopaedic patients with evidence-supported international perspectives about acute nursing care of the older adult with fragility hip fracture. Developed by an international group of nurse experts and guided by a range of information from research and clinical practice, it focuses on nurse sensitive quality indicators during the acute hospitalisation for fragility hip fracture. Optimal care for the patient who has experienced such a fracture is the focus. This includes (in the first, earlier, part):
and in this part
This “tool kit” has been developed under the auspices of the International Collaboration of Orthopaedic Nursing (ICON) a coalition of national associations of orthopaedic nursing (www.orthopaedicnursing.org).
As orthopaedic nurses we believe that we possess specialist orthopaedic knowledge and skills that are used daily to deliver effective care to our patients. In the acute care setting this care has been traditionally delivered in specialist orthopaedic wards or units. Recently, in some settings, the number of these speciality wards has decreased and the care of patients with orthopaedic injuries or illnesses has been moved to more generic wards, either surgical or medical. The motivation for this change may be rationalisation of service delivery, decreased number of beds or a belief that the needs of orthopaedic patients no longer require care delivered by specialist nurses.
Background: To achieve successful rehabilitation after hip fracture and meet patient needs it is important to listen to how individual patients perceive their situation.
Purpose: The aim of this study was to explore how patients with hip fractures experience the time after hospitalization.
Methods: A qualitative study was performed, data were analyzed using content analysis and included a total of 14 patients who had undergone surgery for a hip fracture.
Results: The result comprised two main themes, In the hands of others, and A new unfamiliar life. These included in total nine categories.
Conclusions: Not all patients received adequate pain management or were treated in a professional way by the health system. Interventions targeting an improved care trajectory which include all care providers, the person with the hip fracture and their significant others are needed. Further research is needed to reveal the reasons for uneven/differing care.
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.