Application of flipped classroom based on CDIO concept combined with mini-CEX evaluation model in the clinical teaching of orthopedic nursing

BACKGROUND

After the COVID-19 epidemic, the state has paid more attention to the clinical teaching function of affiliated hospitals of colleges and universities. Strengthening the integration of medicine and education and improving the quality and effect of clinical practice teaching are critical challenges facing medical education. The difficulty of orthopedic teaching lies in the characteristics of a wide variety of diseases, strong professionalism, and relatively abstract characteristics, which affect the initiative, enthusiasm, and learning effect of nursing students. In this study, a flipped classroom teaching plan based on the CDIO (conceive-design-implement-operate) concept was constructed and practiced in the orthopedic nursing student training course to improve the effect of practical teaching, and it is convenient for teachers to implement more effective and targeted teaching in the flipped classroom of nursing education and even medical education in the future.

METHODS

Fifty undergraduate nursing students who practiced in the Orthopedics Department of a tertiary hospital in June 2017 were enrolled in the control group, while 50 undergraduate nursing students who practiced in the same department in June 2018 were enrolled in the intervention group. The intervention group adopted the flipped classroom teaching mode of the CDIO concept, whereas the control group adopted the traditional teaching mode. After finishing the department practice task, the students in the two groups completed the evaluation of theory, operation skills, independent learning ability, and critical thinking ability. They completed the evaluation of clinical practice ability in eight dimensions, including four processes of nursing procedures, humanistic care ability, and evaluation of clinical teaching quality for two groups of teachers.

RESULTS

After teaching, the clinical practice ability, critical thinking ability, autonomous learning ability, theoretical and operational performance, and evaluation of clinical teaching quality in the intervention group were significantly higher than those in the control group (all p < 0.05).

CONCLUSION

The CDIO-based teaching mode can stimulate the independent learning ability and critical thinking ability of nursing interns, promote the organic combination of theory and practice, improve their ability to comprehensively use theoretical knowledge to analyze and solve practical problems, and improve teaching effectiveness.

Effect of Comprehensive Rehabilitation Training Program in Orthopedic Nursing of Patients with Residual Limb Injury Caused by Crush

This study was developed to explore the role and application value of a comprehensive rehabilitation training (CRT) program based on the remote monitoring system of limb rehabilitation training (LRT-RM system) in the rehabilitation nursing of patients with residual limb injuries caused by crush. The LRT-RM system was constructed based on the characteristics of limb movement and using the time-domain analysis method and support vector machine (SVM). The 84 crush injury patients were selected as the research objects and divided into a control group (Con group, received conventional rehabilitation therapy) and a CRT group (received conventional rehabilitation therapy + functional training) according to different therapies, with 42 people in each group. The incidence of compound injuries and the incidence of residual limb injuries were counted and compared for patients in two groups. The differences in renal function, blood electrolytes, and biochemical indicators before and after treatment were analyzed. The MOS 36-item short-form health survey (SF-36) scale was selected to evaluate the improvement of physical and mental health of the patients before treatment and 1 month (time point (TP1)), 3 months (TP2), 6 months (TP3), and 12 months (TP4) after the treatment. It was found that, after the intervention, the values of serum creatinine (Scr), blood urea nitrogen (BUN), uric acid (UA), K+, P3+, and white blood cells (WBC) of patients in CRT group were obviously lower than those of Con group (P < 0.05), and the values of carbon dioxide combining power (CO2CP), Ca2+, hemoglobin (Hb), red blood cell (RBC), total protein (TP), and albumin (ALB) were obviously higher than the values in Con group (P < 0.05). In the CRT group, the residual limb injury rate was lower in elbow, wrist, shoulder joint, ankle joint, and toe (P < 0.05) and extremely lower in knee joint in contrast to that in the Con group (P < 0.001). The score of SF-36 was dramatically higher than that in the Con group (P < 0.05). It suggested that the CRT program based on the LRT-RM system was helpful for the rehabilitation of patients with crush injuries, and it can reduce the incidence of residual limb injuries in patients. Results of this study could provide a reference basis for the treatment of residual limb injuries caused by crush.

Orthopaedic Nursing and Heart Failure: A Review of Pathophysiology and Management

Heart failure prevalence increases with age and is one of the most common reasons for inpatient hospitalizations. There are many opportunities for orthopaedic nurses to recognize the risks and symptoms of heart failure during an episode of orthopaedic care. In the context of bundled care, the orthopaedic nurse plays a key role in the prevention and early identification of complications that can prolong hospitalization and increase hospital readmission. This article presents two cases of patients with heart failure. The pathophysiology and management of heart failure with reduced ejection fraction and heart failure with preserved ejection fraction are reviewed. Opportunities for orthopaedic nurses to impact care of patients at risk for or with heart failure are also highlighted.

A Personalized Shared Decision-Making Tool for Osteoarthritis Management of the Knee

Shared decision making (SDM) is a key component of patient-centered care where clinical evidence and the patient's preference and values are considered. Physical activity and weight loss are often recommendations in the treatment plan, especially in mild to moderate stage of osteoarthritis (OA). Movement is Life™ created an innovative SDM tool providing a framework for patient-centered discussions. The tool leverages an underlying Markov Model and represents the likely pain, activity levels, and lost productivity at three future time points. Comparing the patient's likely progression depending on treatment choices to doing nothing, the patient has an illustration of their future state. The tool provides a consistent communication pathway and may reduce disparities by addressing unconscious bias. Orthopaedic nurses can be a catalyst for change in the clinic setting by providing education, counseling, and health coaching to promote physical activity and weight management as a recommended treatment option for early OA symptom management.

A Fluorescent Zn(II) Coordination Polymer: Sensitive Detection of Cr2O72- in Water and Prevention Activity On the Deep Vein Thrombosis in Orthopedic Nursing

A novel coordination polymer (CP) based on Zn(II) of [Zn(tptc)_0.5(bpy)(H₂O)]_n (1) was synthesized through utilizing the 2,2'-bipyridine (bpy) chelating N donors and p-terphenyl-2,2'',5'',5'''-tetracarboxylate acid (H₄tptc) as the co-ligands. The measurements of the fluorescence were implemented for the complex 1 in solution and solid state, and the result reveals that 1 has a strong fluorescence and it is a sensory material with great development space to determine the trace Cr₂O₇^2- (with the detection limit of 36 ppb) in the water solutions via applying the fluorescence quenching effect. As the common disease in the orthopedic nursing, the deep vein thrombosis was the objective in this research. The weigh and length of the thrombus in the animals were measured and analyzed. In addition to this, the inflammatory response in the deep vein thrombosis animal was evaluated by RT-PCR. Molecular docking results indicate that only the carboxyl group could provide polar oxygen atoms for the formed hydrogen bonds to the protein.

Patient-reported symptoms of 'calm', 'irritated' and 'infected' skeletal external fixator pin site wound states; a cross-sectional study

OBJECTIVE

To explore the frequency, severity and variances in patient-reported symptoms of calm, irritated and infected skeletal pin sites.

METHODS

A cross-sectional within-subjects repeated-measures study was conducted, employing a self-report questionnaire. Patients (n = 165) treated with lower limb external fixators at 7 English hospitals completed a designed questionnaire. Three sets of retrospective repeated-measures data were collected relating to calm, irritated and infected pin sites.

RESULTS

Significant differences were revealed between each of the three pin site states (calm, irritated & infected) in the degree of: redness, swelling, itchiness, pain, wound discharge, heat/burning, shiny skin and odour. In relation to difficulty or pain using the affected arm or leg, difficulty weight bearing on the leg, nausea and/or vomiting, feeling unwell or feverish, shivering, tiredness/lethargy and disturbed sleep, significant differences were demonstrated between infected and irritated states and infected and calm states, but not between irritated and calm.

CONCLUSIONS

The findings provide greater depth of understanding of the symptoms of pin site infection and irritation. Patients may be able to differentiate between different pin site states by comparing the magnitude of the inflammatory symptoms and the presence of other specific symptoms that relate solely to infection and no other clinical state. The irritated state is probably caused by a different pathological processother than infection and may be an indication of contact dermatitis.

Does Hospital-at-Home Make Economic Sense? Early Discharge Versus Standard Care for Orthopaedic Patients

Hospital-at-home has been promoted as a potentially effective means of replacing costly inpatient care with cheaper domiciliary care. We studied three hospital-at-home schemes in West London providing intensive home care for early discharge orthopaedic patients, comparing their costs with those of standard inpatient care.

Although costs per day of hospital-at-home care were lower than those of inpatient care, the schemes appeared to increase the total duration of orthopaedic episodes, so that the costs of standard care, per episode, were lower than those of hospital-at-home.

While hospital-at-home may offer considerable future potential, substitution of home care for inpatient care will not necessarily save resources.

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

INTRODUCTION AND BACKGROUND

Trauma is the most frequent cause of death in people under 40 years old. It is an important problem not only because of the high mortality but also because of the consequential disability that can lead to serious economic consequences.

STUDY AIMS

This descriptive, comparative study investigates the definitive management of poly-traumatised patients in an Italian Orthopaedic Ward in order to highlight its strengths and weaknesses in comparison with the most recent literature. This has led to the development of a pre-established algorithm for evaluation, preventive care and management of the poly-trauma patient and a flow-chart for improved patient care.

RESEARCH METHODS

A five-step observational and exploratory approach was employed in this study which critically analysed the nursing management of 60 multiple trauma patients admitted to our Orthopaedic Unit from April 2013 to October 2014.

RESULTS

The findings highlight the need for adherence to plans of care, which can be approached by a shared management of poly-trauma patients that involves the medical team, the patient and his family/caregiver.

DISCUSSION

The protocols and guidelines in use in our Orthopaedic and Trauma Unit are in line with European standards, although there is still margin for improvement. The study has led to the development of an algorithm that allows health professionals to have reference values for the care of polytrauma patients.

CONCLUSIONS AND RECOMMENDATIONS

This study demonstrates the use of theoretical and practical tools for the evaluation and management of poly-traumatised patients during their hospital stay. We recommend the use of both proposed tools: the general algorithm and the flow-chart for the management of the poly-trauma patient, as they allow identification of barriers and facilitators related to the implementation of international guidelines, currently well-defined for Emergency Departments but not yet for Orthopaedic Units.

Introducing on-ward volunteers to work with patients with dementia

This article reports on an evaluation of the effect of an on-ward volunteer service in an acute orthopaedic ward with a number of dementia patients. A mixed-methods evaluation was undertaken in 2012. This included interviews with individuals who have strategic, management, operational and clinical roles in the voluntary organisation and the NHS trust, focus group discussions with volunteers, non-participant observations of practice and focused conversations with ward staff. The service had a positive effect on patient experience. Patients were engaged through a variety of activities and enjoyed the volunteers' presence. Staff valued the initiative because they could see the difference that it made to patients and their own working lives. The lessons learned from the evaluation can inform the development of similar initiatives elsewhere and are relevant, given the emphasis in healthcare policy to improve patient experience.

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.