Pin site care: guidance and key recommendations

Pin site infection is the most common complication of external fixation, a complex orthopaedic procedure used to stabilise fractures and correct limb deformity. The care of pin sites has long been debated among healthcare professionals. It is widely acknowledged that there is a lack of high quality research in this area. In 2010 a meeting with the aim of achieving consensus about pin site care took place, funded by the Royal College of Nursing Society of Orthopaedic and Trauma Nursing. The aim was for practitioners who care for pin sites on a regular basis in adult, paediatric, hospital and community environments around the UK to explore and debate current practice. This article reports the findings of this meeting and discusses the difficulties in creating guidance on this area of practice.

[Nursing diagnoses in patients admitted by the orthopedic clinic in a surgical unit]

Descriptive and exploratory study conducted in a hospital school in Londrina, Paraná, with the objective of identifying the frequency of the main nursing diagnoses according to the North American Nursing Diagnoses Association in male patients admitted at an orthopedic ward. The sample consisted of 60 patients with an average age of 40.6 years. Data was collected through interview and physical examination. The diagnoses were interpreted based on defining characteristics, risk factors and situations. The average number of nursing diagnoses by patient was 11.5. The most frequent diagnoses were: Risk of infection, Skin integrity, Tissue integrity, Severe pain, Self-care deficit relating to bathing and basic hygiene, Impaired physical mobility, Lack of knowledge, Risk of peripheral neurovascular dysfunction. This study identified patients' needs of care and it helped to establish the relevance of different clinical focuses for orthopedic nursing.

Benchmarks for children's orthopaedic nursing

Variability in practice and quality of care for children and young people with orthopaedic conditions was identified by a network of nurses working in this specialty. Nine benchmarks were developed to help address this variability by providing support for nurses to evaluate and improve practice where necessary. The process of developing the benchmarks is described and lessons learnt are discussed, including the challenges for experts of making the nature of their work explicit. Following publication and dissemination of the benchmarks, an evaluation of their usefulness is planned.

Care of pin sites

External fixation is a key component in orthopaedic management. However, the use of metal pins or wires may result in complications, such as pin site infections. To prevent infections pin site care must include effective assessment, monitoring and cleaning of the pin site. Differing methods of pin site management in clinical practice have resulted in inconsistencies in the literature relating to best practice. This article explores some of the variations in pin site care.

[Correspondence among care prescriptions for patients with orthopedic problems and the Nursing Interventions Classification]

The objective of this work was to compare the care prescribed by nurses for orthopedic surgery patients after surgery with the interventions and activities proposed by the Nursing Interventions Classification (NIC), in order to verify its agreement. The study was carried out at the Hospital de Clinicas de Porto Alegre (a University hospital in the south of Brazil), using the mapping technique. Data on the 170 studied patients were obtained by the Computerized Nursing Prescription System. The 52 care forms related to nursing diagnosis (ND) Self-Care Deficit--bath and/or hygiene, Impaired Physical Mobility and Risk of Infection--were mapped with 33 nursing interventions, contained in 14 classes and 4 Domains. The comparison between nursing prescriptions and the interventions proposed by the NIC for the 3 ND studied evidenced there is agreement among them. We considered that the NIC may become an important source of consultation to improve and to base nursing care.

Factors influencing function and recovery following hip repair surgery

PURPOSE

Despite advances in surgical techniques and rehabilitation, many patients or individuals fail to regain their prior functional ability following hip repair surgery. The purpose of this study was to evaluate the most commonly cited predictors of successful recovery: age, balance, gender, fatigue, fall efficacy, pain, comorbidity, complications following surgery, cognitive ability, depression, and functional status prior to surgical intervention.

SAMPLE

Seventy-three persons following hip repair surgery were evaluated in an inpatient rehabilitation program and 3 months following discharge.

METHODS

This is a secondary analysis of data used in a previous study. The data analyzed in this study were from a study evaluating the impact of post surgical video-based education.

RESULTS

Balance and cognitive ability were the best predictors of functional ability 3 months following discharge from a rehabilitation setting. As to return to functional ability following discharge, balance, cognitive status, and prior functional ability were the best predictors. Men reported higher functional levels 3 months following discharge and were more likely to return to their presurgical functional level. DISCUSSION/RECOMMENDATIONS: The significant influence of balance and fatigue on functional ability highlights the need for interventions aimed at improving balance and reducing fatigue as persons recover following hip repair surgery.

The Use of Handheld Technology in Nursing Research and Practice

Use of handheld devices with electronic patient diaries (EPDs) can improve the quality of patient-reported information collected in clinical and research settings. EPDs have advantages compared with traditional paper-based instruments that include decreased data entry error and decreased time spent on data management. Orthopaedic pain management, which is often dependent on patient-reported pain levels, can benefit from the use of EPDs. A pilot survey was conducted to compare two self-report pain diary methods in shoulder surgery patients: (a) EPD or (b) paper entry. Compliance was lower in the EPD group, which was attributed to insufficient ease of use. Handheld technology can be used by nurses to improve and streamline patient care by capturing clinical data, by organizing and reporting home health services, and by providing references for evidence-based practice. Handheld technology can facilitate the transformation of clinical documentation of assessments, interventions, and outcomes into evidence-based decision making in orthopaedic nursing.

Nurses' perceptions of multidisciplinary team work in acute health-care

Multidisciplinary teamwork is viewed as one of the key processes through which care is managed in the British National Health Service, and yet is often viewed as one of the most problematic. Working in a multidisciplinary team requires many skills, which involves understanding not only one's own role but also the role of other professionals. The aim of this study was to explore nurses' perceptions of multidisciplinary teamwork in acute health-care. Nineteen nurses were interviewed using the critical incident approach to obtain their perceptions of multidisciplinary teamwork. Direct observation was conducted to record interactions between nurses and health-care professionals in multidisciplinary teams. In total, 14 meetings were attended in elder care and orthopaedics and seven in acute medicine. The findings of this study identified three barriers that hindered teamwork: (i) differing perceptions of teamwork; (ii) different levels of skills acquisitions to function as a team member; and (iii) the dominance of medical power that influenced interaction in teams. Thus, education establishments and nursing managers need to ensure that the acquisition of team-playing skills is an integral part of continued professional development.

The perioperative implications of obstructive sleep apnea

Patients with obstructive sleep apnea provide significant challenges to the perioperative team. This disorder is often undiagnosed and coexists with other disease processes such as hypertension, congestive heart failure, and cor pulmonale. The prevalence of obesity in American society suggests that an increasing number of patients with sleep apnea will present for surgery. During the perioperative period, life-threatening problems can occur during anesthetic induction and emergence. The pathophysiology of obstructive sleep apnea is reviewed here along with the anesthesia implications of this disease process. Members of the perioperative team need to be aware of the implications of sleep apnea so that surgical outcomes can be optimized.

Hip fractures--a joint effort

More than 350,000 hip fractures occur in the United States every year, and the number will double by 2050 as baby boomers advance in age. Hip fractures remain one of the most common injuries of the geriatric cohort, where 9 of 10 patients with a hip fracture are 65 years of age or older and have multiple medical problems. A coordinated approach to care that emphasizes early ambulation, prevention of complications, and patient/family involvement is essential. This article describes the efforts of a interdisciplinary team to develop and implement a hip fracture protocol that directs the care of patients from admission in the emergency room to a planned discharge. The ideal process of care is driven by quality measures and evidence-based practice consisting of early medical screening, early surgical intervention and ambulation, physical therapy, deep vein thrombosis prophylaxis, and appropriate discharge planning.

Outcomes measurement for patients with low back pain

Outcomes tracking provides a systematic method of monitoring treatment effectiveness and efficiency. A familiarity with outcome measures for the patient with low back pain is very important for clinicians working in orthopaedic settings, where patients with lumbar pain are prevalent. The clinician must be able to evaluate and choose appropriate measurement tools, and understand the clinical meaning of measurements to successfully employ these instruments. The purposes of this article are to review measurement instruments and to offer practical guidelines for selection and use of outcome measures for this population. The reliability, validity, sensitivity to change, and utility of common outcome measures are discussed. An overview of generic, disease-specific, and patient-specific tools is provided, with specific commentary on the use of the SF-36, SF-12, Oswestry, Roland Morris, and patient-specific tools. Practical guidelines for utilizing outcome measures in clinical practice and the overall benefits of outcomes tracking are highlighted.

The effect of music listening on acute confusion and delirium in elders undergoing elective hip and knee surgery

This study was undertaken to determine the effect of music on elders undergoing elective hip and knee surgery who experience acute confusion and delirium postoperatively. Postoperative confusion and delirium in elders often cause complications that negatively effect recovery. Music listening was introduced as an intervention to an experimental group. Nurses documented episodes of acute confusion and delirium experienced by elders postsurgically. Scores from a readiness-to-ambulate profile to determine if patients were cognitively ready for postoperative therapy were evaluated. There was a significant decrease in the number of episodes of postoperative confusion among those in the experimental group compared with those in the non-listening control group. In addition, the experimental group had significantly higher scores on the readiness-to-ambulate profile than the control group. These findings indicate that music listening is an effective nursing intervention that can be used to decrease acute postoperative confusion and delirium in elders undergoing elective hip and knee surgery.

Unique issues in pediatric spinal cord injury

Spinal cord injuries are devastating events, and they are particularly tragic when they affect children or adolescents who have barely had an opportunity to experience life. Of the approximately 10,000 individuals who sustain spinal cord injury each year in the United States, 3% to 5% occur in individuals younger than 15 years of age and approximately 20% occur in those younger than 20 years of age (Nobunaga, Go, & Karunas, 1999). Because of the growth and development inherent in children and adolescents and the unique manifestations and complications associated with spinal cord injuries, management must be developmentally based and directed to the individual's special needs (Vogel, 1997). The many unique facets of pediatric spinal cord injuries are addressed in this article. They clearly delineate the need for care that is responsive to the dynamic changes that occur with growth and development. The multidisciplinary team, combined with a focus on family-centered care, is essential in pediatric spinal cord injuries.

Understanding and meeting the needs of farmers with amputations

BACKGROUND

Despite the hazardous nature of the occupation, farmers who sustain serious permanently disabling injuries return to the physical labor of production agriculture. It is estimated that amputations account for 11% of all major farm-related injuries.

PURPOSE

This report describes the process of reentry to farm work of farmers across the United States who experienced above-the-wrist traumatic amputations.

SAMPLE

Interviews with 16 farmers revealed the unique features of the work and world view of these workers who labor in the fields.

FINDINGS

The occupational recovery process included questioning, analyzing, and "getting along." Prostheses and formal rehabilitation programs were viewed as minimally helpful. Suggestions and resources that may be helpful for the orthopaedic nurse to assist this high-risk work group are included.