Orthopaedic nursing challenges in poly-traumatised patient management: A critical analysis of an Orthopaedic and Trauma Unit

Nursing outcomes for patients with multiple traumas and impaired physical mobility: An integrative review

PURPOSE

This research identifies nursing outcomes for patients with multiple traumas who present changes in physical mobility.

METHODS

This was a thorough literature review, following Whittemore and Knafl's method and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses´ guidelines (2005) and adopting the Oxford Center for Evidence-Based Classification Medicine-Levels of Evidence (2011). The literature search included databases from Virtual Health Library, Cochrane Library, Excerpta Medica Database, Medical Literature Analysis and Retrieval System Online, PubMed, SciVerse Scopus, The Cumulative Index to Nursing and Allied Health Literature, and Web of Science. It was conducted between October and December 2019 and updated in April 2022.

FINDINGS

Upon our first analysis of the 254 articles that could correlate to the present study, we concluded that 15 of them are of foremost relevance. The nursing outcomes found are correlated with skin care, position in hospital bed, pressure injury prevention, self-care assistance to bath, intimate, and oral hygiene, pain control, circulatory precaution, and impaired physical mobility assistance. All of these outcomes are directly or indirectly involved with the consequences of mobility impairment.

CONCLUSIONS

The main nursing outcomes of our research identified for patients with multiple traumas were related to mobility, the consequences of immobility, self-care, and skin maintenance. In conclusion, this review highlights the importance of measuring outcomes related to the provision of nursing care.

IMPLICATIONS FOR NURSING PRACTICE

The nursing outcomes classification provides results that can be used across the continuum of care to assess the patient's status after nursing interventions. It also allows for improved care for multiple trauma patients who have altered mobility, identifying the real needs of these patients.

Customized treatment protocols for patients with closed fracture in hospitals at varying coronavirus disease 2019 (COVID-19) risk

Background

To determine an optimized treatment protocol during the COVID-19 epidemic for patients with closed fracture and delayed surgery.

Methods

The epidemic data of three hospitals, randomly selected from different administrative regions of Wuhan, were analyzed retrospectively from 23 January to 31 March 2020. Changes in the number of confirmed cases per day (cumulative and new) of each region were tracked as a reflection of changing epidemic risk levels. The risk level map was drawn. The epidemic status, treatment protocols, and treatment efficiencies for patients with closed fracture in the three hospitals were compared.

Results

Overall, 138 patients with closed fracture were admitted. Each hospital had established its own protocol, according to the initial perceived risk. Based on the risk level map, over the study period, the risk levels of the three regions changed independently and were not in sync. All patients recovered and were timely discharged. No staff member was detected with COVID-19.

Conclusions

The COVID-19 risk level of each area is dynamic. To optimize medical resources, avoid cross-infection, and improve efficiency, changes in epidemic risk should be monitored. For patients with closed fracture, treatment protocols should be adjusted according to changes in epidemic risk.

A prospective comparative study of the MNA-SF and GNRI nutritional screening tools in predicting infectious complications among elderly patients over 70 years undergoing posterior lumbar arthrodesis

Malnutrition is a risk factor for postoperative infectious complications of elderly patients undergoing posterior lumbar arthrodesis. At present, there is no gold standard for nutrition screening tools. We analyzed the value of predicting infectious complications among elderly patients over 70 years undergoing posterior lumbar arthrodesis by comparing the MNA-SF and GNRI. Demographic data, anthropometric measurements, serum albumin, surgical data and the occurrence of infectious complications and LOS were collected. Mini Nutritional Assessment short form (MNA-SF), Geriatric Nutritional Risk Index (GNRI) were performed within 24 h before surgery. Multivariable logistic regression analyses were used to identify predictors of infectious complications. The discriminatory performances of GNRI and MNA-SF scores for the occurrence of infectious complications were determined by receiver operating characteristic curves (ROC) analyses and the area under the curve (AUC). The study included 252 patients with a median age of 76.82 ± 6.41 years (range 70-84 years), and 142 patients (56.3%) were female. There were no significant differences in infectious complications (p = 0.236) and LOS (p = 0.580) among different GNRI categories. 27.3% malnourished patients evaluated by the MNA-SF suffered from infectious complications and 10.1% patients at risk of malnourished had infectious complications. Those patients had statistically significant higher prevalence of infectious complications (p = 0.002) and longer LOS (p = 0.023) than well-nourished patients. Multivariable analysis revealed that preoperative malnutrition and at risk of malnourished by the MNA-SF was significantly associated with infections. The area under the curve (AUC) of MNA-SF was 0.754, which was significantly high than AUC of GNRI (0.623) (Delong's test, p = 0.033). This study demonstrated that MNA-SF is a simple and effective tool for predicting the risk of infectious complications in elderly patients undergoing posterior lumbar arthrodesis.

Does a specialised orthopaedic trauma module utilising high fidelity simulation improve student nurses' perceptions of their competence? A pilot study

BACKGROUND

Trauma is the fourth leading cause of death in the western world, and traumatic injuries are recognised as clinically challenging to care for. Orthopaedic trauma care is not standard content in pre-qualifying nursing curriculums, compounded by a dearth in specialised post-qualifying education internationally. As a result, registered nurses may not have the clinical skill set to appropriately manage patients with traumatic conditions.

AIMS

To understand pre-qualifying student nurses' perceptions of their own competence in orthopaedic trauma care and understand if utilisation high fidelity simulation improves confidence, knowledge and application of theory.

METHODOLOGY

A small-scale qualitative pilot study utilising purposive sampling, designed to inform the development of a larger longitudinal study. A 5-point likert scale questionnaire with options for qualitative comments was administered after 8 weeks of a specialised module culminating in a high-fidelity simulation and in-depth debrief session. Thematic analysis was conducted.

FINDINGS

All students found that the module improved their confidence and knowledge in their skills set. The high-fidelity simulation was found to be an effective learning environment to translate theory to practice.

CONCLUSIONS

Specialised orthopaedic trauma training is effective in improving student nurses' knowledge and perceived competence in trauma care. High fidelity simulation is a valuable teaching tool to develop student's skill sets in complex scenarios and support application of theory to practice.

Safety of the patient in an emergency situation: perceptions of the nursing team

OBJECTIVE

To know the perception of nursing professionals about the essential aspects to provide safe care to polytraumatized patients in emergency services.

METHOD

Descriptive and mixed study, performed with a focus group and projective techniques. The sample was made of seven nursing professionals. Data analysis took place through the Interface de R pour Analyses Multidimensionnelles de Textes et de Questionneires and SPSS 22.0 softwares.

RESULTS

Based on the analysis of participants' speeches, three content partitions emerged in the Descending Hierarchical Classification. 1) Structure: need for changes; 2) The process: safe actions by the nursing team; and 3) Care free from damage as the sought result.

CONCLUSION

Patient safety in emergency situations must rely on a proper environment and an organized sector, good conditions to transport patients, use of routines and protocols, identification and organization of the beds.

Clinical practice and nursing management of pre-operative skin or skeletal traction for hip fractures in elderly patients: a cross-sectional three-institution study

BACKGROUND

Femoral fractures are a major healthcare problem worldwide. One of the most difficult issues is their preoperative care, which is still managed by either skeletal or skin traction in some countries, including Italy. These issues are discussed and compared with the contemporary literature.

OBJECTIVE

This study aims to analyse the distribution of these treatment options within the orthopaedic community and the reasons for their use, as well as to identify how this may impact nursing care in terms of pain management, hygiene care, venous thromboembolism (VTE)prophylaxis and prevention of pressure ulcers.

DESIGN

For this cross-sectional study, a 12-item survey was administered to the nursing staff, consultants and residents of the Orthopaedic Units in three different hospitals in NorthEastern Italy. The questionnaire investigated the routine use of skeletal or skin traction for the preoperative management of hip fractures in those settings.

FINDINGS

136 surveys were completed, providing a response rate of 87.74%. Preoperative traction for hip fractures was still in use in the three hospitals, mainly applied by experienced surgeons for subtrochanteric fractures. Pain management, VTE and pressure ulcer prevention were perceived as worse only with skeletal traction, while hygiene was described as more difficult with both skeletal and skin traction.

CONCLUSIONS AND RECOMMENDATIONS

Based on the data and the literature revision, skin or skeletal traction for patients with proximal femoral fractures should be discouraged as standard practice. This is supported widely in the international literature, and consideration of knowledge translation strategies should be made to refine current practice in these settings.

Validação de protocolos gráficos para avaliação da segurança do paciente politraumatizado

Resumo Objetivo: Validar o conteúdo e a aparência dos protocolos gráficos para avaliação da estrutura, processo e resultado do cuidado seguro de enfermagem ao paciente politraumatizado em situação de emergência. Métodos: Estudo metodológico e quantitativo. Para a coleta de dados, aplicou-se a técnica de Delphi em duas rodadas (Delphi I e Delphi II). A amostra do Delphi I consistiu em 15 juízes e o Delphi II arrolou 13 juízes. Considerou-se válidos aqueles itens dos protocolos com Índice de Validação de Conteúdo (IVC) maior que 0.78 e consenso de mais de 70,0% na técnica de Delphi. Os dados foram analisados por meio de estatística descritiva e inferencial (Teste de Wilcoxon e Binomial). Adotou-se o ρ-valor ≤ 0,05 para a significância estatística. Além disso, aplicou-se o Alfa de Cronbach (α) para avaliar a consistência interna dos protocolos. Considerou-se confiável aquele item que apresentasse o α ≥ 0,7. Resultados: Todos os requisitos de avaliação dos protocolos alcançaram concordância entre os juízes superior a 80,0%, bem como todos os itens alcançaram níveis de avaliação estatisticamente significativos. Ao final do Delphi II, os três protocolos se apresentaram expressivamente válidos (estrutura [IVC = 0,92]; processo [IVC = 0,96]; e, resultado [IVC = 0,96]) e confiáveis (estrutura [α = 0,95]; processo [α = 0,95]; e, resultado [α = 0,89]). Conclusão: Atingiu-se a validação de conteúdo e de aparência dos protocolos integralmente, assim como, a validação interna com exímio.