Effective teaching for the elderly: back to basics

Providing effective patient education is an essential part of every nurse's role. The elderly have special learning needs related to health promotion and management of chronic disease processes. Elderly orthopaedic patients require additional education related to their specific functional and rehabilitation needs. Planning and implementing effective patient education for the elderly orthopaedic patient requires knowledge of adult learning principles and knowledge of the special learning needs and teaching methods that can be adapted for this growing population. Adult learning principles and aspects of normal aging that affect learning are described in this article. Suggestions for planning, implementing, and evaluating education for patients and their families are based on the nursing process. Basic teaching tips and criteria for evaluating educational materials are included.

Surgical treatment options for cartilage defects within the knee

Injury to articular cartilage is increasingly diagnosed as a cause of knee pain. New surgical treatment options are now available to treat this clinical entity. Diagnosis is made easier by improved magnetic resonance imaging protocols that better visualize articular cartilage. On physical examination, patients at any age can have joint surface damage and primarily experience joint line tenderness and pain with activity. Treatment options include debridement of nonviable cartilage with abrasion or microfracture of the subchondral bone, transplantation of autologous osteochondral plugs, autologous chondrocyte transplantation, transplantation of cadaveric allogenic osteochondral grafts, and, for irreparable damage, total knee arthroplasty. These newer treatment options show promising early and intermediate results.

Management options for the child with spastic cerebral palsy

Knowledge of spasticity management for the child with cerebral palsy begins with understanding how cerebral palsy and spasticity are defined and related. The next step is learning what the treatment options are and how they can impact the child. There are many strategies for managing spasticity. This article focuses on pharmacologic and surgical approaches. Pharmacologic is further subdivided into medications taken by mouth, given through an injection (Botox) or delivered by a pump (baclofen). Surgery includes neurosurgical and orthopaedic procedures. Each treatment is reviewed using rationale, patient selection, delivery methodology, and management technique citing the advantages and disadvantages of each modality.

Test of a nursing intervention to promote adjustment to fibromyalgia

PURPOSE

This was a test to detect whether a 4-week cognitive behavioral nursing program was effective in increasing adjustment to fibromyalgia (FM) and if the treatment effect would last over time.

DESIGN

This was a control and treatment group experimental longitudinal study with outcome measures obtained at pretest and every 3 months for 1 year.

SAMPLE

A sample of 71 subjects continued their participation throughout the first year of the study.

FINDINGS

Treatment subjects had improved posttreatment adjustment and symptom severity compared to control subjects. When subjects with high pretest psychosocial distress (n = 5) were removed from the analysis, these findings were statistically significant.

IMPLICATIONS FOR NURSING PRACTICE

The article can provide direction for developing new comprehensive nursing intervention for patients seen with orthopaedic problems. The intervention schedule may help nurses expand their use of interventions for FM patients. Orthopaedic nurses are especially suited for this challenge.

Postoperative pain management in frail older adults

PURPOSE

To evaluate the Frail Elder Pain Management Program (FEPMP) implemented for patients who had hip fracture repairs at a community hospital in 1995. Based on standards of geriatric and pain management practice, the FEPMP included education sessions, preprinted analgesic orders, pain flow sheets, written resources, and clinical support. A Logic Model reflected the program's conceptualization.

DESIGN

Preexperimental pretest and posttest design.

SAMPLE

A random sample of 50 charts of patients aged 75 and older who had hip fracture repairs were audited from each of two periods: the preimplementation period (1994-95) and the postimplementation period (1997-98).

METHODS

A chart audit tool was developed, tested, and used. Data were analyzed using descriptive, parametric and nonparametric statistics.

FINDINGS

Surgeons' prescriptions and nurses' pain management practices improved significantly (p = .0001). Pain assessment modestly improved. Patient outcomes also improved. IMPLICATIONS FOR PRACTICE AND EDUCATION: A programmatic approach to pain management is effective for improving practice and outcomes for frail elders.

A discharge planning program in orthopaedics: experiences in implementation and evaluation

The acute care orthopaedic registered nurse plays a key role in assessing and communicating the continuing care needs of patient's and their families, coordinating community resources, and formulating a timely discharge plan to maximize rehabilitation and recovery. Developing and maintaining a staff nurse's discharge planning knowledge and skills can be a challenging endeavor. Discharge Planning Coordinators at a tertiary medical center developed and implemented a Discharge Planning Mentorship Program, an educational pilot program designed to enhance the knowledge and skill level of select nurses in the orthopaedic specialty practice, thus maximizing expert resources at the bedside. Program implementation and evaluation of role preparation, practice changes, and actualization challenges are discussed in this article. Overall, participants demonstrated increased skill in articulating and problem solving a patient's postdischarge needs, devised creative strategies to enhance communication between multiple levels of care, and developed a greater knowledge of community resources and reimbursement mechanisms for continuing care.

Managing delirium and agitation in elderly hospitalized orthopaedic patients: Part I--Theoretical aspects

Managing behavioral disorders such as delirium and agitation while simultaneously attending to the acute needs of elderly patients is a challenge that confronts orthopaedic nurses on a daily basis. This will only increase in frequency and complexity as the new century dawns. Delirium and agitation affect morbidity, mortality, length of stay, and costs--in short, outcomes. To manage and care for these patients, orthopaedic nurses must first update their knowledge of acute disorders that can disrupt mental status and behavior, and the effects of systemic events on brain function. With the knowledge of the pathophysiology of delirium and agitation, nurses then need to refine their assessment and intervention skills. This article describes the phenomena of agitation and delirium in the elderly acute orthopaedic patient, outlines current perceptions regarding pathophysiology, and offers guidelines for prevention and intervention. An algorithm has been developed that can assist with the identification of at-risk individuals, causes of delirium, and early assessments in the acute care setting.

Moderate-intensity exercise: for our patients, for ourselves

Even more than the general population, orthopaedic patients suffer from multiple consequences of immobility. Fortunately, most of these patients are physically able to participate in some degree of moderately intense exercise. Helping the orthopaedic patient initiate and adhere to a moderately intense exercise routine is a nursing challenge. This challenge is even more difficult because as nurses, we are often expecting our patients to make a lifestyle change that we have been unable or unwilling to make ourselves. Understanding the health-related benefits that can be derived from participation in moderately intense exercise routines and the recommended guidelines for exercise frequency and intensity is a first step toward initiating a fitness routine. Using information acquired from research, nurses can assess for specific facilitators and barriers to exercise participation. This assessment data can then be used to individualize plans for exercise that meet the fitness needs of our patients and ourselves.

Nursing roles in orthopaedic joint correction in haemophiliac patients

The roles of nurses in 16 orthopaedic joint corrections of 14 haemophilia A patients (eight severe, six moderate) are described. The patients' ages ranged from 10 to 37 years with a mean age of 17 years and 4 months. The nursing tasks could be divided into three stages. The first is preoperation, the nurse acting as care provider on a team of experts involved in planning the corrective surgery for the affected joints; and as a counsellor for preparing the patients and family members to cope with the challenging operation. The second is intraoperation, the nurse having the role of care provider, giving factor concentrate either by bolus injection (seven episodes) or continuous infusion (nine episodes). The third is postoperation, as a comprehensive care provider, giving cryoprecipitate and/or factor concentrate and monitoring bleeding doses, and as a trainer, teaching the patients how to dissolve blood components and self-venepuncture with aseptic technique. Home treatment for early bleeding was given for 11 episodes, while 6-month prophylaxis was given for five. The accomplishment of these different roles required good communication and nurturing skills, a well-adjusted personality and a warm and positive attitude. The successful performance of nursing roles allows the haemophiliac patients to have a near-normal quality of life.

Pain and hip fracture outcomes for older adults

PURPOSE

To determine if postoperative pain is a predictor of functional outcomes for elderly hip fracture patients who were previously independent ambulators (with or without assistive device).

DESIGN

Prospective comparative survey design.

SAMPLE

Convenience sample. 85 hip fracture patients age 65 years or older from two Midwestern urban hospital orthopaedic units.

METHODS

Subjects were interviewed between day 2 and 5 (M = 2.6) postoperatively and again 2 months postoperatively. Independent variables of cognitive status and pain status were measured using the Folstein Mini Mental State Exam (MMSE) and two pain measures, the Verbal Descriptor Scale (VDS) and Ferrell's Pain Experience Interview (FPEI). The dependent variable, functional outcome, was measured using the degree of assistance required for basic ADLs from Jette's Functional Status Index (FSI).

FINDINGS

Pain with movement was significantly higher than pain at rest (p < .0001). Mental status, pain report with movement (during hospital interview), illness severity, and age accounted for 51% of the variance in functional outcomes 2 months postoperatively.

CONCLUSIONS

Undertreated postoperative pain contributes to poor functional outcomes.

IMPLICATIONS FOR NURSING PRACTICE

Pain assessment of postoperative older patients should be conducted during movement. Efforts to reduce postoperative pain severity in the immediate postoperative period may yield better functional outcomes months later.

Did you check your nursemaid's elbow?

Imagine a parent innocently swinging around a toddler ... a yank on an outstretched arm to keep a preschooler from falling ... a caregiver attempting to move a reluctant child by dragging the child by the hand ... a helping hand to lift a young child up over the curb or a high step. None of these activities is ever intended to hurt a child, yet the result of these specific activities send many children with anxious parents and caregivers to emergency departments and unscheduled pediatrician appointments each year. Nursemaid's elbow, also known as a pulled elbow or a subluxated radial head, may result from the specific activities described above and is the most common dislocation injury handled by pediatricians. Most commonly occurring in the 1-year to 4-year old age group, nursemaid's elbow is easily treated and generally has no long-term sequelae.

Staff views on orthopaedic patients' accommodation

Alternative accommodation to traditional wards may be suitable for some orthopaedic patients. Doctors and nurses in this study had different views about patient accommodation. Little reference to patient choice was made by either doctors or nurses. Further research is needed on different staff groups regarding factors influencing discharge decision-making.

[Corporality in an orthopedics clinic scenario]

The study features the author's lived experience of phenomenological enlightenment in which she pursued to operate Polak's (1996) concepts of Nursing and Care, which have corporality as a reference. It describes the living experiences of four clients hospitalized in an Orthopedics and Trauma Unit of an School Hospital of Curitiba's metropolitan area, according to Polak's caring process moments, which are: perception; discovery and dialogue; building of new knowledge; and implementation of caring actions. It was noticed that the concepts are feasible on practical situations.

Creating an effective poster presentation

One way to build knowledge in nursing is to share research findings or clinical program outcomes. The dissemination of these findings is often a difficult final step in a project that has taken months or years to complete. One method of sharing findings in a relaxed and informal setting is a poster presentation. This method is an effective form for presenting findings using an interactive approach. The milieu of a poster presentation enables the presenters to interact and dialogue with colleagues. Guidelines for size and format require that the poster is clear and informative. Application of design helps to create visually appealing posters. This article summarizes elements of designing and conducting a poster presentation.

Management of lower extremity riding lawn mower injuries in children

Eight children are injured by riding lawn mowers every day. The child, usually a bystander or passenger on the mower, can sustain life-threatening and limb-threatening injuries. Multidisciplinary care must be available to manage the numerous issues presented by the unique circumstance of a child with a severe injury in the acute and chronic settings. Whether the limb is salvaged or amputated, the ultimate goal is optimal functional outcome for the patient. We have developed a team approach to address these injuries from their onset until patient maturity, maximizing our ability to achieve this goal.

Practical primary pediatric orthopedics

Pediatric orthopedic problems often puzzle the primary health provider and worry families. A thorough orthopedic history and examination by the primary care provider is all that is necessary to determine whether a problem requires further evaluation and referral. This article addresses a practical approach to common orthopedic problems, assessment, and management strategies from the specialist perspective. A general description of developmental dysplasia of the hip, foot misalignments, tibial torsion, toe-walking, genu varum (bowlegs), growing pains, sprains and fractures, and the child with a limp is provided. Management strategies before and after orthopedic referral are presented.

Tips for writing a NAON research grant proposal

This article is intended to help the novice nurse researcher prepare a research grant proposal for the National Association of Orthopaedic Nurses (NAON). It summarizes the grant guidelines and describes each component of the research proposal. The components include the abstract, statement of the problem, literature review, purpose, design, methodology, timetable and budget. NAON's research priorities are included as well as contact information for the organization and tips for survival.