Interpreting measures of risk: Translating evidence into practice

Advanced practice registered nurses must have a working knowledge of statistical principles in order to provide high-quality, evidence-based care. This article presents basic concepts of risk indexes and case study examples illustrating how these measures can inform practice.

Arthritis: joints inflamed

ARTHRITIS IS a generic term for inflammatory joint disease. There are various forms of arthritis, including osteoarthritis, rheumatoid arthritis and spondyloarthritis. Arthritis can be a chronic debilitating condition or a transient effect of bacterial or viral infections. As a chronic condition, arthritis can cause loss of quality of life, disability and, with rheumatoid disease, early death. The economic burden of arthritis, in terms of management and loss of productivity due to disability, is high and set to increase with the ageing population. Recent advances in our understanding of the causes and progression of a number of forms of arthritis have raised hopes of better management and possible remission. Pharmacotherapy has moved from symptom management to addressing underlying disease processes. However, therapies that prevent or cure arthritis remain elusive. Current care for people with arthritis relies on a multidisciplinary approach and substantial pharmacological intervention. Nurses have a key role to play in guiding patients through treatment, ensuring they receive optimal therapy to reduce the impact of arthritis and its management on their lives.

Ginger Therapy for Osteoarthritis: A Typical Case

PURPOSE

To describe a treatment for osteoarthritis known as ginger therapy applied by anthroposophic nurses for a specific personality type.

BACKGROUND

Ginger has been used medicinally in Asia since ancient times to bring inner warmth. Ginger therapy is part of the tradition of anthroposophic nursing, when managing chronic inflammatory conditions such as osteoarthritis. Osteoarthritis is a progressive disease of the synovial joint tissue that primarily affects those older than 65 years, causing pain on movement.

DESIGN

A patient with specific characteristics suffering osteoarthritis received 7 consecutive days of ginger therapy by anthroposophic nurses at an integrative medical center. Two weeks after the therapy, education was given to enable self-treatment in the home for a further 24 weeks. Data were obtained using body physiological recordings, a case diary and pain scale, and self-report arthritis Health Assessment Questionnaire.

FINDINGS

Ginger therapy activated a marked relief of osteoarthritis symptoms that progressively improved over the 24 weeks, with no negative effects reported. Ginger therapy needs to be considered by nurses caring for specific personality types with osteoarthritis.

Topical Ginger Treatment With a Compress or Patch for Osteoarthritis Symptoms

AIM

This article is a report of a study evaluating changes in health status before and after topical ginger treatment for adults with moderate to severe osteoarthritis.

METHOD

In 2011, 20 adults with chronic osteoarthritis were randomly assigned to one of two groups for 7 consecutive days of topical ginger treatment by trained nurses: Group 1 received a manually prepared ginger compress and Group 2 a standardized ginger patch. Participants had the option to continue self-treatment using the ginger patch for a further 24 weeks. A brief arthritis health questionnaire was completed weekly for 3 weeks and 4 weekly for 24 weeks.

RESULTS

The mean scores for Group 1 and Group 2 show a notable decline following 1-week topical ginger treatment; scores in pain, fatigue, global effect, and functional status reduced by 48%, 49%, 40%, and 31%, respectively, whereas health satisfaction improved from 80% dissatisfied to 70% satisfied. Scores for all participants in all five domains progressively reduced over the following 24 weeks of self-treatment.

CONCLUSION

Topical ginger treatment has the potential to relieve symptoms, improve the overall health, and increase independence of people with chronic osteoarthritis.

A closer look at osteoarthritis

Osteoarthritis (OA) is the most common form of arthritis affecting 26.9 million Americans. OA is a degenerative disorder of the synovial joint that leads to pain, stiffness, and decreased function of the affected joint. An understanding of both the nonpharmacologic and pharmacologic management of OA is essential for nurse practitioners.

[Nursing care of osteoarthritic patients who require a prosthesis]

Nursing patients undergoing an operation for a prosthetic due to osteoarthritis requires the nurse to be attentive during postoperative surveillance. The nurse must provide preventative and educational care to facilitate the patient's return home.

Musculoskeletal US: examining the joints

Musculoskeletal ultrasound (US) is an excellent tool to diagnose muscle, tendon and ligament injuries, cystic structures and peripheral nerve compression, as well as soft tissue masses, without the risk of ionizing radiation. Musculoskeletal US is now routinely used by a growing number of rheumatology and sports medicine centres throughout UK. In standard clinical practice, US has an extremely useful application in differentiating fluid from soft tissue and identifying the severity of joint inflammation. The work described in this article was carried out to assess patients' feedback regarding the use of US guidance for intra-articular injections and/or the removal of fluid from their inflamed knee joints in a nurse-led clinic. Nineteen patients who had US-guided knee joint injection/aspiration in the clinic were asked to complete a questionnaire regarding their satisfaction with the procedure, and to rate their joint pain and patient global assessment (using numerical visual analogue scale) before the US-guided procedure, and 1 month after. Results revealed a significant improvement (p<0.001) of the joint injection outcome measures and the patients' satisfaction of the US-guided procedure. Therefore, musculoskeletal US can improve two fundamental clinical skills: the clinical diagnosis of joint inflammation, and the accuracy of joint injection/aspiration. This study supports the concept that incorporating musculoskeletal US into clinical practice leads to significant improvements in patient care. It also reveals that US-guided procedures are appreciated by patients.

Osteoarthritis 2: pain management and treatment strategies

Osteoarthritis (OA) is a painful, progressive joint disorder. This article discusses pharmacological management of OA, such as non-steroidal anti-inflammatory drugs and opioids, and non-pharmacological management, including weight reduction, acupuncture and joint replacement surgery. The third part, to be published online, will cover the physical, psychological and social impact of OA.

Osteoarthritis 1: Physiology, risk factors and causes of pain

Osteoarthritis (OA) is a synovial joint disorder characterised by pain, stiffness, and restricted function. It is often classed as a degenerative disease because the affected joints deteriorate over time. This article, the first in a three-part series, describes the complex pathophysiology and causes of pain in OA, risk factors, and how it is diagnosed.

The impact of nurse prescribing on patients with osteoarthritis

Osteoarthritis (OA) is now considered one of the ten most disabling diseases in developed countries and it is estimated that worldwide, 18% of women and 9.6% of men aged over 60, suffer from OA. It is, therefore, vital to take into consideration the demographics of this disorder, including the health needs of this age group and associated problems, such as reduced mobility or immobility and the inability to perform everyday tasks associated with chronic pain. Older patients, however, are sometimes able to accept their condition and adopt a positive outlook towards their OA as a coping strategy. This association with and acceptance of pain by the patient as a normal part of the ageing process may compromise the patient's ability to undertake activities of daily living and impact their psychological wellbeing.

Effect of a virtual pain coach on older adults' pain communication: a pilot study

A randomized posttest-only double blind design was used to pilot test the effect of a virtual practitioner pain communication coach on older adults' communication of their osteoarthritis pain. Baseline pain intensity and pain interference with activities were measured using the Brief Pain Inventory Short Form. Thirty older adults watched a video of a practitioner describing important osteoarthritis pain information followed by either a virtual practitioner coach, a video practitioner coach, or no coach. Participants were next asked, via a videotaped health care practitioner, to orally describe their pain as if speaking to their own practitioner. The amount of important distinctive pain information described by the older adults was audiotaped, transcribed, content analyzed, and summed using a priori criteria from the American Pain Society osteoarthritis pain management guidelines. Older adults described M=6.3 (SD=3.17), M=3.0 (SD=2.08), and M=5.2 (SD=2.40) items of important pain information as a result of the virtual coach, video coach, and no coach conditions, respectively; F(2,25)=3.17, p=.06, η²=.01. Older adults who practiced talking with the virtual coach described more than one additional item of important pain information. The clinically significant group difference supports the need to test the intervention in a randomized clinical trial. The virtual coaching and education intervention might enable older adults to communicate their pain management information more effectively to their practitioners.

Pain at Midlife

Although menopause is a normal developmental milestone through which all women pass, the transition has been long associated with chronic pain conditions that may be more accurately viewed as secondary to aging. Clinicians need to understand management of pain problems women may experience. This article examines pain syndromes including headache, back pain, osteoarthritis, pelvic pain, vulvo-vaginal pain, and burning mouth syndrome.

A nursing approach to pain in older adults

Persistent pain is a barrier to healthy aging. Nurses are in a unique position to assist older adults with pain to remain active and promote their well-being. Barrett's (1998) power-as-knowing participation-in-change theory can help nurses appreciate the contributions older people make, and mutually explore with them their options and choices regarding pain and their lifestyle.

[Arthrosis treatment. Nursing intervention]

This article presents the case of a patient suffering from arthrosis residing in an elderly home and who is being treated mainly with pharmaceuticals. Due to that patient's incapacity an integral nursing intervention plan was proposed; for this plan, an evaluation was carried out by the agency, the deficit, the self-care needs and requirements, and a treatment plan integrated basically of educational action plans was developed. The theoretical reference which provides the framework for this entire process is Orem's Theory of Self-Care. By means of this intervention, medical professionals hope to improve the life quality for this kind of patient and to highlight the importance that educational action plans have in the treatment of patients.

Osteoarthritis in older adults: current treatments

Although there is no cure for osteoarthritis, numerous treatments are available for symptom relief. Pharmacological treatments primarily focus on pain relief; however, in older adults there is continuing concern related to the risk of side effects and interactions with other medications. In contrast, non-pharmacological treatments, such as exercise, joint protection, and stress reduction, provide symptom relief with few side effects. In addition, alternative treatments such as nutritional supplements, herbal preparations, acupuncture, and tai chi are being investigated for their efficacy. Nurses should encourage patients to use a combination of treatments that provide optimum symptom relief with the fewest side effects.

A theoretical model for preventing osteoarthritis-related disability

Osteoarthritis (OA) affects many aspects of life for affected individuals. Effective interventions to prevent and restore function must be based upon an understanding of what contributes to OA and its associated disabilities. A hypothetical OA disability model built upon the previous work of Nagi (1991), Verbrugge and Jette (1994), the International Classification of Functioning of World Health Organization (World Health Organization, 2001), and other scientific findings is proposed. The model includes a main disease pathway, which describes the sequence of events from OA-associated impairments to disabilities. Contextual factors influencing the process include individual characteristics, psychological state, coping style, comorbidities, social support, and physical environment. The model provides a useful conceptual framework for understanding the OA disability process from a biopsychosocial perspective and for guiding rehabilitation nursing interventions in OA care.

Evaluating the Effects of an Educational Symposium on Knowledge, Impact, and Self-Management of Older African Americans Living With Osteoarthritis

The purpose of the study1 was to determine the effects of a 1-day educational symposium on knowledge, impact, and self-management of older African Americans living with osteoarthritis (OA). A 1-group pre- and posttest design was employed. The educational symposium was the intervention variable. Speakers were experts in the field of arthritis care. Participants were recruited from a community senior center. Participants completed the Short Form of the Arthritis Impact Management Scales (AIMS2-SF), the Summary of Arthritis Management Methods (SAMMS), and a 6-question Knowledge Test about OA before the symposium. The knowledge test was administered again at the completion of the program. Posttesting of the AIMS2-SF and SAMMS occurred 3 months later to assess changes in arthritis impact and self-management strategies. Knowledge scores increased significantly immediately following the symposium. The AIMS2-SF subscales of Affect, Symptom, and Physical Function decreased significantly 3 months after the symposium indicating that arthritis had less impact on participants after the conference. Participants also reported using more self-management methods 3 months after the event. The results of this pilot study indicate that this symposium was effective in increasing participants' knowledge of OA, improving self-management, and decreasing the impact of OA on daily function. The small sample size and preexperimental design limit generalizability.

A pilot study of health education via a nurse-run telephone self-management programme for elderly people with osteoarthritis

We conducted a pilot study of a nurse-run telephone self-management programme for elderly people with osteoarthritis (OA). Thirty-two subjects, aged 60 years or more, with a diagnosis of OA were recruited from two hospital rheumatology clinics and were randomized to a control or intervention group. The intervention group received six weekly mailings of OA health education modules, a relaxation audio-tape and six weekly 45 min follow-up telephone self-management sessions. There was a 100% compliance rate in the intervention group, and all subjects completed baseline and three-month interviews; one subject in each group was lost to six-month follow-up. There were no significant differences in self-management between the control and intervention groups. However, at three months there were improvements in the intervention group (relative to baseline) on some outcome measures. The results suggest that the telephone may be a useful tool for reinforcing health-promoting activities for patients.

Older Adults with Osteoarthritis: Psychological Status and Physical Function

The purpose of this study was to identify how sociodemographic characteristics such as age, race, and socioeconomic status; psychosocial factors of hardiness, health promotion practices, and social support; health status; and pain are related to the ability of older, community-residing individuals with osteoarthritis (OA) to maintain psychological equilibrium and physical function. A total of 81 older adults with OA completed a survey that included a sociodemographic data form, a hardiness scale, a measure of health promoting practices, and five subscales from the Arthritis Impact Measure Scale 2 on social support, general health status, pain, and psychological status and physical function. Analyses using multiple regression showed that hardiness, pain, and social support were significant contributors to psychological status and physical function and, respectively, accounted for 53% and 54% of the variance. By knowing about OA and being aware of factors that contribute to maintaining independence in individuals with OA, nurses can provide expert help to aging individuals.

Effect of music on chronic osteoarthritis pain in older people

BACKGROUND

Osteoarthritis is the most common degenerative disease in humans. It usually begins in middle age and is progressive. Chronic pain in older people presents a significant obstacle in maintaining function and independence. Previous studies have shown that music can improve motivation, elevate mood, and increase feelings of control in older people.

PURPOSE

The purpose of this randomized clinical trial was to examine the influence of music as a nursing intervention on osteoarthritis pain in elders.

METHOD

Data were collected using the short form of the McGill Pain Questionnaire with 66 elders suffering from chronic osteoarthritis pain. Differences in perceptions of pain were measured over 14 days in an experimental group who listened to music for 20 minutes daily and a control group who sat quietly for 20 minutes daily. All participants completed the Short Form McGill Pain Questionnaire (SF-MPQ) on day 1, 7, and 14 of the study.

RESULTS

Results of t-tests indicated that those who listened to music had less pain on both the Pain Rating Index on day 1 (P = 0.001), day 7 (P = 0.001) and day 14 (P = 0.001) and on the Visual Analogue Scale on day 1 (P = 0.001), day 7 (P = 0.001) and day 14 (P = 0.001), when compared with those who sat quietly and did not listen to music. A repeated measure analysis of variance controlling for pretest measures demonstrated a significant decrease in pain among experimental group participants when compared with the control group on the pain descriptor section of the SF-MPQ (P = 0.001) and the visual analogue portion of the SF-MPQ (P = 0.001).

CONCLUSION

Listening to music was an effective nursing intervention for the reduction of chronic osteoarthritis pain in the community-dwelling elders in this study.

Holding on self-caring with osteoarthritis

As women age, they frequently have increasing difficulties with physical functioning associated with osteoarthritis (OA). An understanding of how elderly adults care for their health is necessary to assist older women to live independently. Self-care of five community-dwelling women with OA was investigated through an interpretative descriptive study. A phenomenologic and naturalistic inquiry framework was used. Interviews were conducted using an interview guide. Deconstruction and reconstruction by constant comparison were used for analysis. Participants told stories categorized as Holding On to Present Self, Holding On to Ableness, Holding On to Being Interested and Being Interesting, Holding On By Seeking to Know, and Holding On by Purposefully Choosing and Acting. Older women with OA may have strengths of self-caring, including positive appraisal of their OA and capabilities, maintenance and development of skills, and remaining interested in the world. Health professionals can support clients by assessing strengths and difficulties and helping clients modify activities and to find resources necessary for independent living.

Revision total hip arthroplasty

Endoscopic visualization and pneumatically-powered ballistic chisels that can be used to remove cement and cementless prostheses are recent developmental improvements for revision total hip arthroplasty (THA). Use of these new tools facilitates the revision procedure, reduces tissue trauma, and may reduce surgical time. Understanding the anatomy of the hip joint, pathophysiology that leads to the need for joint replacement, and the implant selection process can assist perioperative nurses in caring for and teaching patients who require revision THA and their family members. This article describes implant choices based on the type of bone deformity present and the use of the ballistic chiseling system during revision THA. Potential postoperative complications also are described.

First-line treatment for osteoarthritis. Part 2: Nonpharmacologic interventions and evaluation

Because of the chronic nature of osteoarthritis, nonpharmacologic interventions provide the client with self-care strategies that may lessen pain, improve physical functioning, and increase independence and sense of control. Nonpharmacologic interventions include exercise, rest and joint protection, heat and cold, hydrotherapy, therapeutic touch, acupuncture/acupressure, biofeedback, hypnotherapy, cognitive-behavioral techniques, activity and home maintenance modification, nutrition, and transportation interventions. Most of these therapies are very useful for nurses as independent interventions. Suggestions for evaluation of interventions are made.

First-line treatment for osteoarthritis. Part 1: Pathophysiology, assessment, and pharmacologic interventions

While surgical interventions often relieve severe pain for those with osteoarthritis (OA), there are thousands of patients with this common and disabling condition who do not receive surgery. Pharmacologic and nonpharmacologic interventions may offer a reduction in pain and improvement in physical functioning. To help patients with OA, nurses should conduct thorough assessments based on pathophysiology, and plan appropriate care with the patient. In this first article of a two-part series, the pathophysiology and classification of OA are presented. Assessment factors are discussed, and pharmacologic interventions are presented. Part 2 of this series, to run in the November/December issue, will focus on nonpharmacologic interventions and evaluation.

Pain management practices of nurses caring for older patients with osteoarthritis

Osteoarthritis is a prevalent chronic illness in older people. Management of the ensuing pain is of critical importance in preventing disability and maintaining independence. This qualitative study explored the pain management techniques used by 10 RNs working in home health nursing. Four categories emerged from the interview data: knowing how to assess, knowing about pain treatments, trying but frustrated, and needing more knowledge. These categories were reduced into two constructs: Understanding Pain and Wanting to Provide Good Nursing Care. Clinical implications included supplementing pain management strategies by adding to the assessment base, expanding pain management techniques, and increasing knowledge about aging processes and pain control.

Living with hurting and difficulty doing: older women with osteoarthritis

Osteoarthritis (OA) is the most common rheumatologic health problem of older adults. Developing a greater understanding of what it is like to live with this chronic, progressive, and frequently unsuccessfully treated condition is necessary to improve evidence-based nursing care to support independent living. Eighteen women aged 65 to 92 years participated in narrative descriptive research based on naturalistic-framework and qualitative-analysis methods. Data were the transcribed narratives of the participants, field notes of observations and impressions, theoretical memos, coded units of the narratives, and categories noted. Deconstructions and reconstructions of the narratives led to the meaning of "Being With OA," with intermediate categories, "Living With Hurting" and "Living With Difficulty Doing." Recommendations included nursing interventions based on individual problems and strengths and further studies of older adults with chronic health problems.

The efficacy of therapeutic touch for improving functional ability in elders with degenerative arthritis

The purpose of this Rogerian study was to determine whether therapeutic touch improved functional ability in elders with arthritis as compared to routine treatment and progressive muscle relaxation. Eighty-two non-institutionalized elders were randomly assigned to therapeutic touch or progressive muscle relaxation treatments. Subjects served as their own control for 4 weeks, then received six treatments at 1-week intervals. Pain, tension, mood, and satisfaction improved after therapeutic touch and progressive muscle relaxation. Hand function improved after therapeutic touch; walking and bending improved after progressive muscle relaxation. Functional ability was significantly different between the two groups for mobility and hand function. Lower scores (indicating better function) were attained by the therapeutic touch group.

Living with osteoarthritis: insiders' views

The purpose of this phenomenological study was to explore the day-to-day experiences of older people with symptomatic osteoarthritis (OA) and to discover if people in different socioeconomic strata differ in the ways in which they manage OA. Data were collected through semistructured interviews with 20 respondents. The following four themes emerged from the data: refusing to give up, pragmatism toward treatment strategies, staying in charge, and tangible caring. Respondents more advantaged in socioeconomic status differed from less advantaged respondents in problems reported, treatments preferred, and causes of OA identified. Understanding the different ways people experience and live with OA and the importance of tailoring interventions to individual circumstances is essential to effective nursing management.

Perspectives on the nursing management of osteoarthritis

Osteoarthritis is a daily presence in the lives of almost 16 million older people. Without expert nursing care, functional health status and the ability to manage independently may be dramatically altered. Nursing parameters include pain control, medication assessment, use of exercise, diet, joint protection, and attention to the psychosocial factors that affect both pain and disability. Patient education with regular, periodic follow-up is a vital part of successful long-term management.