Basic tools for the orthopaedic staff nurse. Part I: Assertiveness

Organizational restructuring and expanded settings of health care delivery provide opportunities for the orthopaedic staff nurse to review basic communication tools that are useful with clients and families, managers, and other health care providers. It is critical for the staff nurse to build a repertoire of skills that support leadership and encourage enlightened followers. This two-part article addresses assertiveness, conflict management, and negotiation skills that are basic to providing professional care with confidence and competence in a changing health care environment.

Promoting normalcy in chronically ill children

Chronic orthopaedic conditions or orthopaedic conditions associated with other chronic conditions affect an estimated 150,000 children in the United States. The ultimate cost in human and financial resources depends upon the success of habilitation efforts throughout childhood. This article identifies major areas of concern to the continuing care of the child and family who must cope with chronic problems and proposes nursing approaches to resolve them.

Complications of trauma: the nurse's role in prevention

Trauma is the leading cause of death in the United States for persons less than 40 years of age. It is the fourth leading cause of death in persons of all ages. Over 60 million injuries occur annually, therefore multiply injured patients represent a large portion of hospital admissions (Cordona, Hurd, Mason, et al., 1994; Geerts, Code, Jay, et al., 1994) Due to the complexity of patient care, and the potential for complications, nurses caring for these patients must be knowledgeable of their role in the patient's management and recovery. The following case scenario represents a typical multiply-injured patient and discusses common potential complications and how the nurse can intervene to prevent these complications from occurring.

Perceptions of patients' pain: a study assessing nurses' attitudes

This study of 35 orthopaedic nurses assessed attitudes to pain and its relief. Using an anonymous questionnaire, nurses gave their views on a range of issues from what patients' expectations of post-operative pain should be, to the use and effectiveness of pain assessment tools. The findings suggest that nurses require re-education in various aspects of pain and analgesia provision to ensure that patients do not feel pain unnecessarily and receive appropriate pain relief promptly. The study recommends that pain assessment tools are used by orthopaedic nurses and that further training is required in the pharmacology of analgesic agents.

Understanding the principles of traction

As the use of traction has declined in recent years, nurses' skills in this area have consequently decreased. Standards of care for patients in traction might now be called into question. This article attempts to redress this imbalance by describing the principles behind safe and effective traction.

Innovations in patient care: changing clinical practice and improving quality

BACKGROUND

In the traditional hospital organization, administrators supply the resources while physicians determine their use. Given this dichotomy, a partnership between clinicians and hospital management is essential for efforts to enhance the quality of care while controlling costs. To foster this partnership, in 1986 the University of Rochester's Strong Memorial Hospital developed its Innovations in Patient Care (IPC) program, which several other medical centers have duplicated. CURRENT STATUS AND LOGISTICS: Hospital operating revenues of approximately $175,000 per year are provided to both fund proposals and support core IPC staff. Clinical staff submit proposals to study innovations to promote higher quality care and/or the efficient and appropriate use of diagnostic and therapeutic services. Many of the 77 projects funded to date have led to important changes in clinical practice.

CASE STUDIES

One study, whose principal investigator was assistant director of emergency medicine, showed that structured, condition-specific (for example, asthma, pharyngitis, lacerations, and isolated closed-head injury) quicksheets improved documentation of clinical findings, resource use, and clinical practice. A study organized by the leadership of surgical nursing revealed that a nursing case management model led to reductions in patient length of stay and increases in nurse satisfaction. Another study, designed by a fellow in neonatalogy, developed and tested guidelines for the use of head ultrasounds in screening very-low-birthweight infants for intraventricular hemorrhage.

CONCLUSIONS

IPC programs, which integrate well with initiatives in total quality management, can be effectively used to change clinical practice and improve the quality and efficiency of patient care.

Orthopaedic nursing: a study of its specialty status

This study attempts to clarify the distinction between orthopaedic and general nursing in response to criticism that orthopaedic nursing did not merit specialty status. The questionnaire survey asked nurses to assess a range of 76 nursing activities in terms of professional function. The results showed 36 out of the 76 activities were identified as 'highly orthopaedic'. The author emphasises that the holistic nature of nursing also applies to orthopaedic nursing and that this requires both generic and specialist skills. The implication for nurse education is that the necessary skills may need to be taught to a higher level to match a specialty status.

Collaboration: the solution to multidisciplinary care planning

Case management is a patient care delivery system that is transforming health care in the 1990s. The key to its success is its primary tenet of collaboration among all disciplines. Case management enhances communication among all disciplines and coordinates patient care services. Multidisciplinary action plans have been developed as a tool for the multidisciplinary team, to guide health care practitioners toward the highest quality, cost-effective care possible. At Beth Israel Medical Center in New York City, the Multidisciplinary Care Model has proven successful on both the Orthopaedic and Rehabilitation services.

Nursing or chiropody? Nurses' attitudes to toe nail trimming

1. Trimmed toe nails make an important contribution to the rehabilitation of patients recovering from orthopaedic treatment by eliminating a source of discomfort. 2. Twenty-two nurses in orthopaedic care completed questionnaires about their attitudes toward this aspect of patient hygiene. 3. The majority felt it was part of the work of podiatrists but could be done by nurses in special circumstances. 4. The main deterrents to nurses undertaking toe nail trimming were fear of causing damage to patients' feet and lack of confidence about technique.

Reducing orthopaedic hazards of the computer work environment

The rate of repetitive strain injuries (RSI) in the workplace is rising at an alarming rate. People using computers and working at keyboards for long periods of time are particularly at risk. Prevention of orthopaedic injuries can make the work environment less stressful and more productive as well as help to avoid needless human suffering and costly medical and legal bills. Knowledge of the causes of RSI and preventive measures to reduce orthopaedic hazards of the computer work environment is important for orthopaedic nurses.

Walking through gait analysis

As medical technology advances, the assessment of complex tasks such as walking is becoming easier. Today's clinical gait analysis laboratory provides the essential tools for the quantification of pathologic gait patterns. Dynamic joint motion, muscle activity, and the forces acting on the body are documented via complex computer and camera systems. The information gained from the gait analysis is essential to the understanding of each individual's unique gait pattern. Gait analysis provides both the patient and the physician with valuable information that can be used to plan better treatment regimens.

Pharmacologic management of acute pain in the orthopaedic patient

Postoperative pain remains undertreated. Barriers to adequate postoperative analgesia include lack of knowledge regarding pain and its management, inadequate assessment, preconceived notions by nurses and physicians regarding pain and addiction, and the continued use of PRN administration of medications instead of active intervention on a scheduled basis. Knowledge regarding the physiology of pain provides nurses with information necessary to control pain. Pharmacologic management includes the use of nonopioids, opioids, and various adjuvant drugs. Principles regarding the use of these analgesics guide the nurse to use these drugs to their greatest effect. The special needs of the very young and the elderly must also be considered.

Electrolytes and their relationship to normal and abnormal muscle function

Electrolytes are essential to normal skeletal muscle contraction and are thought to play a role in muscle fatigue. Excess accumulation of ammonia and hydrogen ions after strenuous bouts of physical activity are thought to slow muscle contractions and decrease muscle tension development. Certain disease states cause abnormal levels of such electrolytes as calcium, magnesium, potassium, or sodium. Excessively high or low levels of these ions in the serum are associated with symptoms such as muscle weakness or cramping. Nurses should know the effects of abnormal electrolyte levels on muscle function in the assessment and treatment of their patients.

Bursitis and tendinitis

"Joint pain" may be a chief complaint reported by patients who are suffering from bursitis or tendinitis. Both disorders can develop in various joints throughout the body, but this article emphasizes the heel area since it is a common site for both disorders. Also addressed are the essential diagnostic features, general medical management, and nursing issues relevant to these disorders.

Aerobic dance injuries

Aerobic dance has taken the spotlight as one of the most popular forms of exercise in America. The benefits of a well developed, comprehensive program include an increase in strength, flexibility, and endurance while promoting a healthy cardiovascular system. Orthopaedic nurse clinicians frequently come in contact with aerobic dance participants before and after injury occurs. This article discusses the occurrence of aerobic dance injuries, treatment, and prevention.