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.

Traction basics: Part IV. Traction for lower extremities

Traction is a treatment modality used for the reduction or immobilization of fractures or dislocations. It is used to maintain alignment; decrease muscle spasms, relieve pain; correct, lessen, or prevent deformities, expand joint spaces before surgery; promote rest to diseased or injured body parts; and promote exercise. Nurses need a working knowledge of the various types of traction along with its rationale, correct setup, and maintenance. They must become familiar with potential complications and use nursing diagnoses to work with patients to strive to achieve expected patient outcomes.

Nutritional aspects of the orthopaedic trauma patient

The metabolic response to trauma is related to a variety of factors, including severity of injury, age, and previous state of health and nutrition (Cardona et al., 1994). This article addresses nutritional considerations of an orthopaedic trauma patient. A case study has been developed with common findings associated with malnutrition, including postoperative infection. Three concepts are discussed: (a) pretrauma nutritional status, (b) post-trauma metabolism, and (c) nutritional assessment parameters. A brief comment on nursing diagnoses related to nutrition concludes this article.

Reliability of the Barlow and Ortolani tests for neonatal hip instability

OBJECTIVE

To investigate if those responsible for screening for neonatal hip instability are using acceptable manual hip stress tests as described by Ortolani and Barlow.

METHOD

A video camera was used to record the technique of 35 personnel who were responsible for screening. They examined both a baby and a simulator. The study comprised five groups, classified by experience and practice: senior orthopaedic surgeons, senior paediatric staff, junior paediatric staff, nurses, community staff.

RESULTS

The seven authors together with six independent expert observers viewed the video and marked the performance with the aid of a specially designed proforma. Although there was some variation between these expert observers, the results showed differences in the scores obtained by the different groups of examiners over all aspects of the test procedure.

CONCLUSION

Video recording for critical analysis and feedback is a useful technique in this situation. Overall, the results suggest that testing for neonatal hip instability was inadequate. A variety of hip stress manoeuvres were being performed. The ability of each subject to perform satisfactory tests seemed to depend on their experience and education. More "hands on" training and experience of testing might provide the necessary competency for screening.

An OWAS-based analysis of nurses' working postures

The working postures of Dutch nurses (n = 18) in an orthopaedic ward and a urology ward were observed using the Ovako Working posture Analysis System (OWAS). During observation, both working postures and activities were recorded. A specially developed computer program was used for data analysis. By means of this program, it was possible to calculate the working posture load for each activity and the contribution of a specific activity to the total working posture load. This study shows that some activities of the nurses in both wards were performed with poor working postures. In the orthopaedic (resp. urology) ward two (resp. one) out of 19 observed postures of parts of the body were classified as Action Category 2. Moreover, 20% (resp. 16%) of the so-called typical working postures was classified in Action Category 2. This suggests, that in both wards working postures that are slightly harmful to the musculoskeletal system, occur during a substantial part of the working day. Differences between both wards with respect to working posture load and time expenditure were determined. Activities causing the workload to fall into OWAS higher Action Categories were identified. The data show that poor working postures in the nursing profession not only occur during patient handling activities but also during tasks like 'administration'. Focusing on patient-handling (i.e., lifting patients) in order to determine the load on the musculoskeletal system would therefore lead to an underestimation of the total working posture load of nurses.

Orthopaedic nursing research priorities: a Delphi study

Research has been an integral component of the mission of the National Association of Orthopaedic Nurses. Operationalization of this component of the mission has included a national research committee, funding of research grants, offering of educational sessions that highlight research methodology as well as research findings, and the formalization of a research editor position within Orthopaedic Nursing. The National Center for Nursing Research has recognized that the individual specialty nursing organizations have a role to play in determining priorities for that specialty. Consequently, NAON has been queried as to its research emphasis. This article presents the study conducted by NAON's Research Committee to determine research priorities within orthopaedic nursing.

Traction basics: Part I

Traction is a treatment modality used for the reduction or immobilization of fractures or dislocations. It is used to maintain alignment, decrease muscle spasms, relieve pain, correct, lessen or prevent deformities, expand joint spaces prior to surgery, promote rest to diseased or injured body parts and to promote exercise. Nurses need a working knowledge of the various types of traction along with its rationale, correct setup, and maintenance. They must become familiar with potential complications and use nursing diagnoses to work with patients to strive to achieve expected patient outcomes.

Latex allergy requires attention in orthopaedic nursing

Latex allergy has increased among high risk groups dramatically in recent years. Health care providers need to develop mechanisms to identify patients who are latex allergic, educate patients and families about latex allergy, and minimize exposure to latex products for high risk populations within their setting. Labeling of latex contents by manufacturers would facilitate recognition of latex products. Refined testing may increase the ability to predict latex allergy response. Until more is known about this phenomenon, clinicians need to be diligent in their efforts to meet the needs of the latex-sensitive patient and protect the patients who are at high risk to develop latex sensitivity.

Developing and evaluating printed education materials: a prescriptive model for quality

Nurses are frequently called upon to develop and evaluate printed education materials (PEMs) in their role as patient educators. This article describes the use of the Evaluating Printed Education Materials (EPEM) model as a prescriptive guide and quality standard for developing new PEMs or critiquing existing ones. Outlined in the five phases of the model are a series of nursing, learning, and instructional design principles that are intended to increase the relevance, readability, and comprehensibility of PEMs for the patients and families who use them. The patient-centered focus of the model makes it applicable across nursing specialty areas and care settings. Examples of how the model can be used in the care of orthopaedic patients are presented.

An introduction to urinary incontinence

Urinary incontinence is most frequently associated with the elderly, particularly women, and is often thought of as inevitable. However, orthopaedic nurses encounter incontinence as a response to alterations in orthopaedic health. This article reviews the types of urinary incontinence, with emphasis on those which may most directly result from orthopaedic problems. It will also help the nurse differentiate between types of incontinence in a way that will clarify appropriate interventions.