Neurologic assessment of the orthopaedic patient

This article is a concise review of the neurologic assessment process. The neurologic assessment is composed of six components: mental state, cranial nerve, sensory system, motor system, cerebellar function, and reflexes. Accurate assessment and documentation of the neurologic status exam is essential to prevent or correct further neurologic deterioration.

Making information accessible: developing plain English discharge instructions

Discharge education has always been an important role for nurses working in acute care contexts. With the advent of case mix funding and subsequent trends towards early discharge from hospital, this educational role is assuming increasing importance. This paper addresses one aspect of a participatory action research study where a group of nurses, working in a paediatric orthopaedic ward, explored their discharge education practices and resources. The seemingly large number of post-discharge telephone queries received from parents of children treated on the ward prompted these nurses to question whether their discharge teaching practices were effective. Data collected on these telephone queries identified parental concerns regarding the care of their child at home in a plaster. This finding prompted group members to explore the ways that written information relating to care of the plaster at home might be implicated in the situation. An analysis of an existing 'home cast care' discharge instruction sheet raised issues concerning the content and language used in such resources. The paper describes the subsequent development of a plain English 'plaster care' discharge instruction sheet and argues the importance of using plain English in such resources.

Dual disabilities: when a stroke patient fractures a hip

The incidence of both hip fracture and stroke increases with age. With the increasing age of the United States population, it is expected that the orthopaedic nurse will be challenged to care for clients with the dual disabilities of hip fracture and stroke. This article discusses incidence of these disabilities, describes the pathophysiology of stroke, and uses a case study to outline specific nursing interventions for the patient with hip fracture and stroke.

Outpatient ACL surgery: the role of the home health nurse

Outpatient ACL reconstructive surgery is a recent trend in orthopaedics. The Visiting Nurse Association (VNA), a large home care agency in Northern Virginia, provides skilled rehabilitation nursing care to these patients during the immediate postoperative period. Home care nurses visit these patients upon discharge from the hospital on the day of surgery and revisit on the first postoperative day. The nurses administer injections for pain, assess and reinforce dressings, evaluate the operative extremity for circulatory and sensory changes and instruct the clients regarding postoperative protocols. Patients who have received home health nursing following ACL reconstruction have recovered successfully without rehospitalization.

Basic tools for the orthopaedic staff nurse--Part II: conflict management and negotiation

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 enlightened followers. The second of this two-part article builds on "Part I: Assertiveness" and addresses conflict management and negotiation skills that are basic to providing professional care with confidence and competence in a changing health care environment.

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.