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Background The Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation, OPTION, project aims to progress knowledge translation vis-à-vis evidence-based bladder monitoring in orthopaedic care, to decrease the risk of urinary retention, and voiding complications. Urinary retention is common whilst in hospital for hip surgery. If not properly identified and managed, there is a high risk of complications, some lifelong and life threatening. Although evidence-based guidelines are available, the implementation is lagging. Methods Twenty orthopaedic sites are cluster randomised into intervention and control sites, respectively. The intervention sites assemble local facilitator teams among nursing and rehabilitation staff, including first-line managers. The teams receive a 12-month support programme, including face-to-face events and on-demand components to map and bridge barriers to guideline implementation, addressing leadership behaviours and de-implementation of unproductive routines. All sites have access to the guidelines via a public healthcare resource, but the control sites have no implementation support. Baseline data collection includes structured assessments of urinary retention procedures via patient records, comprising incidence and severity of voiding issues and complications, plus interviews with managers and staff, and surveys to all hip surgery patients with interviews across all sites. Further assessments of context include the Alberta Context Tool used with staff, the 4Ps tool for preference-based patient participation used with patients, and data on economic aspects of urinary bladder care. During the implementation intervention, all events are recorded, and the facilitators keep diaries. Post intervention, the equivalent data collections will be repeated twice, and further data will include experiences of the intervention and guideline implementation. Data will be analysed with statistical analyses, including comparisons before and after, and between intervention and control sites. The qualitative data are subjected to content analysis, and mixed methods are applied to inform both clinical outcomes and the process evaluation, corresponding to a hybrid design addressing effectiveness, experiences, and outcomes. Discussion The OPTION trial has a potential to account for barriers and enablers for guideline implementation in the orthopaedic context in general and hip surgery care in particular. Further, it may progress the understanding of implementation leadership by dyads of facilitators and first-line managers. Trial registration The study was registered as NCT04700969 with the U.S. National Institutes of Health Clinical Trials Registry on 8 January 2021, that is, prior to the baseline data collection.

As the current population continues to increase in age, so does the degeneration of the musculoskeletal system and the development of knee osteoarthritis. Total knee arthroplasty (TKA) will be the treatment of choice when it comes to improving physical function and decreasing pain associated with osteoarthritis of the knee. The global push for more cost-effective healthcare services has led to new models of care and payment delivery methods such as performing TKA in the ambulatory surgery center (ASC) setting. With deeply invasive surgical procedures such as TKA being done in the ASC setting, orthopaedic nurses must be mindful of best practices that will promote quality and safety while considering the importance of using current evidence to guide nursing practice when promoting appropriate patient selection and effective patient education of self-management of postoperative care pertaining to TKA being performed in the ASC setting. This is critical to consider during a time when financial profits in the ASC setting may take a front seat to the delivery of high-quality and safe patient care.

Background. Working during the coronavirus pandemic has had a significant impact on health care workers. A group of orthopaedic trainees at Royal Gwent Hospital, UK, were redeployed to intensive therapy unit for four weeks during COVID-19 pandemic. This study reviews our experience; focusing on causes of stress and anxiety, and how they were managed. The lessons learnt could be used as a framework for pre-emptive me­asures during future challenges. Material and methods. Orthopaedic registrars were divided into two groups. Seven trainees (Redeployed group) moved to ITU for four weeks to support the critical care team. The other group (Retained group) of eight registrars continued to cover orthopaedic rota. A survey was done for anxiety levels comparing the two groups at three time points during these four weeks. Results. Anxiety and stress in the ITU-redeployed group was comparatively less than the continuing group as time progressed during the redeployment. Conclusions. 1. The disruptive impact of the COVID-19 pandemic has been a source of massive stress and an­xiety for health care workers. 2. Our experience shows that stress is controllable with the correct strategies. 3. The main points are early identification of vulnerable groups, proper induction, active involvement, adequate explanation, appreciation, good communication, and available psychological support whenever needed. 4. These are essential to maintain a resilient workforce against upcoming waves of COVID-19.

Background Limited descriptions of preoperative education programs for total knee replacement (TKR) surgery are provided in the literature, and the most effective program design is currently unknown. Purpose The purpose of this qualitative study is to describe orthopaedic nurses' perceptions of preoperative education prior to TKR surgery. Methods Ten participants completed phone interviews and transcripts were analyzed qualitatively for themes among participants. Results Participants believed that preoperative education was a significant component impacting patient outcomes following surgery. Interprofessional preoperative education was valued, but pragmatic factors were identified as barriers to the inclusion of other disciplines within these programs. Education programs were constantly evolving on the basis of evidence-based practice and changes to orthopaedic protocols. Pragmatic factors influenced all aspects of program design, such as the timing and length of education sessions. Conclusions Results from this study provide descriptions of factors that influence program design and can be used to restructure education programs for improved patient outcomes.

The successful implementation of a geriatric fracture program is dependent on engaging a multidisciplinary team. The goal of these programs is to address the unique needs of patients with geriatric fracture by providing the support necessary for return to their prefracture level of activities of daily living. Identifying the key stakeholders and clarifying their role in pre- and postoperative patient support are vital to the development of such an initiative. The purpose of this article is to discuss the steps to plan and implement a geriatric fracture program in a hospital and lessons learned from our experience initiating such a program.

To evaluate the implementation of advanced practice nursing in emergency care in Norway for patients with orthopaedic injuries, including hip fractures. The outcomes relate to quality of care and patient trust.A non-inferiority study comparing an advanced practice nursing care model with a standard (physician-led) care model.Data will be collected from patient records and through the Patient Trust Questionnaire, completed by patients. The data will be analysed by descriptive and inferential statistics. Funding for the research was granted in 2015 and the regional ethical committee approved the current study in February 2019.In Norway and the other Nordic countries, advanced practice nursing is still in its infancy, especially in the emergency care context. This study will evaluate advanced practice nursing in this new context.The study will add to knowledge on the quality of care provided for orthopaedic patients with minor orthopaedic injuries or hip fractures as delivered by advanced practice nurses and physicians, respectively. It will also evaluate how well-advanced practice nursing is accepted by patients in this new context.目的: 评价挪威急诊护理中对骨科伤患(包括髋部骨折患者)实施高级实践护理的情况。疗效与治疗质量和患者信任有关。 设计: 比较高级实践护理模式与标准(医师主导)护理模式的非劣效性研究。 方法: 从患者病历和患者填写的患者信任问卷中采集数据。通过描述性统计和推断性统计来分析采集的数据。于2015年拨款进行该研究,并且区域伦理委员会于2019年2月批准了该研究。 讨论: 在挪威和其他北欧国家,高级实践护理仍处于初级阶段,特别是在急救护理方面。该研究将在这一新背景下,对高级实践护理进行评估。 影响: 该研究将提高对高级实践护士和内科医生分别为骨科患者(轻微骨科损伤或髋部骨折)提供的治疗质量的认知,还将评价患者在这一新背景下如何接受高水平实践护理。.

The novel coronavirus (SARS-CoV-2) represents a rapidly evolving pandemic. Health systems are scrambling to mobilize and redeploy their medical staff in the fight against COVID-19. Orthopaedic nurse practitioners/physician assistants should be part of any redeployment strategy to address unmet needs during these unprecedented times. This article discusses redeployment considerations and strategies that utilize these providers appropriately while mitigating risks.

The purpose of this article is to describe the use of a commercially available smartphone application to solve information needs of scrub nurses in orthopedic surgery. A semistructured, focus group interview was conducted with orthopedic scrub nurses. These nurses had solved their information needs about orthopedic surgery by using a commercially available smartphone application. Because of smartphone technology's convenience, accessibility, mobility, ease of use, and use at no charge, it is worth considering in nursing practice, education, and research.

Background Opioid analgesics treat moderate to severe pain with proven analgesic efficacy, although their use is associated with dose-limiting side effects, such as constipation. Orthopaedic and trauma patients are at high risk of developing opioid-induced constipation (OIC) due to reduced mobility and increased opioid requirements to manage prolonged pain after injury. Objectives To examine the evidence base to guide clinicians on the most effective or tolerated laxative regimen for the management of OIC and nurse-initiated management of OIC. Method A review of the literature was undertaken. Databases were searched to identify studies on OIC, laxatives and nurse-initiated management. Results Laxatives do not address the underlying cause of OIC and there is currently insufficient evidence to guide clinicians on the most effective or tolerated laxative regimen for the management of OIC. The use of peripheral acting mu-opioid receptor antagonists (PAMORAs) could be considered in those for whom regular use of a combination of laxatives has not been sucessful, and nurses should take a broader role in the assessment of symptoms and response to treatment. Conclusion The important balance between adequate analgesia and minimising OIC symptoms is an ongoing challenge for clinicians, and an area of patient care where nurses could be leading management.

Pain management practice differs among hospitals in China; however, no studies have examined the association between hospital level and nursing practice of pain management.To evaluate the nursing practice of pain management in orthopedics wards of level 3 and 2 hospitals and compare the differences in pain management regulations, policies, and perceived barriers.This was a cross-sectional descriptive study.This study was conducted during the 10th International Congress of the Chinese Orthopedic Association, November 19-22, 2015.Subjects: The sample included 121 nurses from China.Quantitative research methods were used to assess pain management practice by 121 Chinese nurses as well as barriers to nursing practice.Nurses in level 3 hospitals were more likely to evaluate patients' pain intensity (85.23% vs. 65.38%, p .05) and quality (77.27% vs. 53.85%, p .05) than those in level 2 hospitals. Compared with level 2 hospitals, level 3 hospitals were more likely to participate in the Painless Orthopedics Ward program (53.41% vs. 23.08%, p .01), conduct pain management knowledge training (88.64% vs. 69.23%, p .05), and establish pain management regulations (68.18% vs. 34.62%, p .01). Level 2 hospital nurses reported a higher score for barriers than level 3 hospital nurses (3.27 vs. 2.45, p .05).Nurses from level 2 hospitals received less education on pain management and also paid less attention to and faced more restrictions for pain management than nurses from level 3 hospitals.

Pain management in patients with hip fractures is a major challenge for emergency care. The objective of this study was to evaluate whether the supplementation of pre-operative analgesia with low-dose fascia iliaca compartment block (FICB) compared with placebo would improve pain relief in patients with hip fractures.A double-blind, randomized, controlled trial was conducted on 127 patients. At hospital admission, a low-dose FICB was administered to patients with hip fractures as a supplement to regular pre-operative analgesia. Patients with and without cognitive impairment were included. The instruments used were a visual analogue scale (VAS), a numerical rating scale and a tool for behavior related pain assessment. The primary endpoint was the change in reported pain on movement from hospital admission to two hours after FICB.The intervention group showed improved pain management by mean VAS score for pain on movement compared with the control group (p = 0.002).Our results support the use of low-dose FICB as a pain-relieving adjuvant to other analgesics when administered to patients with a hip fracture.

Fatigue affects nearly half of all adults with osteoarthritis. Affected individuals report difficulty with daily functioning, requiring more time and rest during activities, feeling easily exhausted, and having to give up on social and volunteer activities known to improve quality of life. Because its etiology is poorly understood, clinical practice guidelines are unable to address management of fatigue in osteoarthritis. Elucidating a mechanism of osteoarthritis fatigue is a high priority, but few studies have identified key factors associated with fatigue in osteoarthritis. Thus, the purpose of this narrative literature review is to present the current evidence of known and potential correlates of fatigue in osteoarthritis, and synthesize our findings into a conceptual framework. The overarching goal of this work is to provide insight into areas of needed research and guide future work toward mechanistic insight of osteoarthritis fatigue. This knowledge could lead to novel nursing interventions for prevention, management, and treatment of fatigue among adults with osteoarthritis.

The ASEPSIS scoring method represents an important instrument for assessing surgical wounds for infections. The purpose of this study was to translate and validate the ASEPSIS in Greek.The ASEPSIS was translated from English to Greek, back-translated to English, and reviewed by an expert committee. Reliability and validity analyses were performed in a sample of 111 consecutive orthopaedic patients. Patients were assessed during hospitalisation (using the ASEPSIS) and at three months after discharge (by phone, through questions about wound healing).Face validity was considered to be very good. The surgical wound infection rate was 6.3% with the Centers for Disease Control and Prevention criteria and 3.6% with the ASEPSIS (i.e. score ≥21) (p 0.001). At three months, 7.4% of the participants reported they were given antibiotics for wound infection and 5.4% needed a rehospitalisation. The ASEPSIS score was correlated to the therapeutic administration of antibiotics (p = 0.001) and the need for rehospitalisation (p 0.001) during the follow-up. The inter-rater agreement was 90%.The Greek version of the ASEPSIS can be used by both surgeons and nurses. However, it should be used with caution until more studies are conducted with larger samples and in patients with different surgical procedures.

Opioids are commonly prescribed in orthopaedics for acute or chronic pain for a variety of conditions, including injury, trauma, degenerative processes, and postsurgical. Patients who are taking opioids because of a substance use disorder (SUD) are also seen in orthopaedics. Patients who are prescribed opioids are at risk of developing an opioid use disorder (OUD). Ten percent of Americans will develop an SUD, which is considered a chronic medical condition that develops due to an imbalance in brain chemistry. In studies, orthopaedic surgeons have a high rate of prescribing opioids, but this rate is decreasing along with national average due to public and provider awareness of the opioid epidemic and professional recommendations. Despite the evidence of a neurobiological cause for SUDs, stigma toward patients with SUDs and a knowledge deficit are common among healthcare professionals, including orthopaedic nurses. A harm reduction approach when working with orthopaedic patients taking opioids either prescribed or used because of an OUD can be applied to reduce the problematic effects of opioids. Harm reduction strategies are supportive to the patient and include education and prevention, adopting evidence-based treatment and communication strategies, and the use of naloxone to prevent opioid overdose.

The geriatric (≥65 years of age) population is one of the fastest growing age groups in the United States. As this number increases, so does the number of geriatric trauma patients. Because this group has higher mortality rates and requires more resources, a Geriatric Trauma Palliative Care Program was created at a Level 1 Trauma Center in Dallas, TX, to provide concurrent lifesaving therapies and primary palliative care to older adults. The trauma program implemented the American College of Surgeons (ACS) Trauma Quality Improvement Program Palliative Care Best Practices Guidelines () to better care for acute traumatic injuries as well as the specific spiritual, emotional, and psychiatric needs of the geriatric trauma palliative care patient and family. Using the guidelines, the team performed a gap analysis, carried out program development, created a palliative care pathway to guide our evidence-based practice implementation, and performed retrospective chart reviews for 3-month pre- and postimplementation analysis. Using Person's χ test and Fisher's exact test, our initial evaluation of the program showed statistically significant (p < .001) improvements in the measures related to the implementation of primary palliative care, pain and symptom management, and end-of-life care. The guidelines gave the team a consistent framework for implementing the basic competencies required to deliver primary palliative care, pain and symptom management, and end-of-life care to trauma patients.

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.

Total joint replacement (TJR) is one of the most commonly performed and painful surgeries in the United States. Over the past few decades, regulatory changes increased the use of oral narcotics as a first-line treatment of this population. In the current opioid crisis, new pain management techniques and therapies have emerged. Research of current therapies, their effectiveness, and emerging best practices are discussed. Clear, thoughtful, and thorough education is an essential next step for closing the gap of the pain experience. Specifically, education of the frontline nurses, patients, and their caregivers on pain reduction techniques is essential.

Objective: To evaluate the correspondence of the terms found in nurses' and physiotherapists' records for orthopedic patients with the Nursing Outcomes Classification (NOC). Method: A descriptive study carried out in a university hospital in southern Brazil. The sample consisted of 392 records of 49 patients submitted to Total Hip Arthroplasty (THA). Data collection was retrospective in the electronic health record. Data was analyzed and compared with the NOC outcomes using the cross-mapping method. Result: The most prevalent outcomes were the following: Pain Level, Falls Occurrence and Mobility. There was sharing of outcomes between the two categories, except for Falls Occurrence and Respiratory Status. Conclusion: Standardizing nurses' and Physiotherapists' records according to the NOC can improve the quality of the clinical documentation of the outcomes of patients undergoing THA. RESUMEN Objetivo: Evaluar la correspondencia entre los términos encontrados en los registros de enfermeras y fisioterapeutas para pacientes ortopédicos con la Clasificación de Resultados de Enfermería (Nursing Outcomes Classification, NOC). Método: Estudio descriptivo realizado en un hospital universitario del sur de Brasil. La muestra consistió en 392 registros correspondientes a 49 pacientes sometidos a artroplastia total de cadera (ATC). L recopilación de datos fue retrospectiva en el registro de salud electrónico. Los datos se analizaron y compararon con los resultados de la NOC por medio del método de mapeo cruzado. Resultado: Los resultados más frecuentes son los siguientes: Nivel del dolor, Caídas y Movilidad. Hubo intercambio entre las dos categorías, a excepción de Caídas y de Estado respiratorio. Conclusión: La estandarización de los registros de enfermeras y fisioterapeutas según la NOC puede mejorar la calidad de la documentación clínica de los resultados de los pacientes sometidos a ATC. RESUMO Objetivo: Avaliar a correspondência entre os termos encontrados nos registros de enfermeiros e fisioterapeutas para pacientes ortopédicos com a Nursing Outcomes Classification (NOC). Método: Estudo descritivo realizado em um hospital universitário. A amostra foi de 392 evoluções para 49 pacientes submetidos à Artroplastia Total de Quadril (ATQ). A coleta de dados foi retrospectiva em prontuário eletrônico. Os dados foram analisados e comparados com os resultados da NOC, segundo o método de mapeamento cruzado. Resultado: Identificaram-se 10 resultados da NOC, sendo os mais prevalentes: Ocorrência de quedas, Mobilidade e Nível de dor. Houve compartilhamento de resultados entre as duas categorias, com exceção da Ocorrência de quedas e Estado respiratório. Conclusão: Padronizar os registros de enfermeiros e fisioterapeutas segunda a NOC pode aprimorar a qualidade da documentação clínica dos resultados dos pacientes submetidos à ATQ.

The purpose of this article is to describe in detail how an academic hospital system took on the challenge of deep vein thrombosis (DVT) prevention. A VTE Prevention Task Force was formed in response to an increased incidence of hospital acquired DVTs. The interdisciplinary team reviewed the literature and examined the current state of organizational venous thromboembolism (VTE) prevention to identify gaps in process, determine opportunity and approaches for practice and process improvements, and develop standardized VTE prevention protocols. The article discusses the process taken in developing a highly motivated interdisciplinary team, the implementation of a care bundle, and the highly effective educational and surveillance tools used that helped improve patient outcomes by driving down the VTE rate.

Coxa saltans, or snapping hip syndrome, is a common orthopaedic problem that can easily be diagnosed and treated when the proper evaluation and management are utilized. It is often seen in growing adolescents, athletes, and people with sudden increase in physical activity. A thorough physical examination will help decipher whether the snapping hip is intra-articular or extra-articular and will help guide treatment options. This article reviews how to perform a physical assessment and treatment options such as medications, stretching, physical therapy, articular injections, and possible surgical interventions. Complications from conservative treatments are rare, but weakness, infection, nerve damage, and atrophy may occur following surgical procedures.

Practice development enables the practitioner to develop their knowledge and allow the application of evidence based care for patients. It happens within the practitioner's own clinical practice area and enhances personal and professional growth whilst focusing on patients' specific needs. This is important with a condition such as Complex Regional Pain Syndrome (CRPS), with patients seekingaccurate and timely diagnosis and coping strategies to support them in everyday activities. This article aims to provide the practitioner with an overview of CRPS, including some information that can be used in identifying signs and symptoms of the condition to support a diagnosis. There is also an introduction to brain retraining techniques which are used in CRPS rehabilitation to restore as much physical function to the patient as possible along with restoration of body perception and ownership of the limb.

Background Hip fractures are described to have a significant impact on patients' well-being and different fast-track concepts could result in a reduction of the patient's psychological and emotional reactions before pre- and intrahospital care. Aims and objectives This study aimed to elucidate perceived situations of significance experienced by patients with hip fracture during the prehospital- and in-hospital care. Design The study used a qualitative approach using a critical incident technique (CIT), 14 patients with hip fractures were included. Methods All informants had undergone surgery for a hip fracture, were able to communicate in Swedish and had no cognitive impairment. Results The main area Oscillating between being satisfied and to endure a new demanding situation emerged from five categories: Pain and pain management, Feeling fear and satisfaction in perioperative care, Experiencing continuity in care, Considering information and Felling confirmed. Conclusion Experiences of prehospital care shows a positive impact though the patients experienced this part of the pathway professionally. However, the patients described critical incidents according to their experiences of pain seems to have significant damagingly impact on the patients' well-being. The patient also describe a sense of uncertainty in their individual involvement of care.

Orthopaedic nurses care for a range of patients with comorbid conditions, but because of the implementation of Rapid Response Teams, rarely do orthopaedic patients experience cardiac or respiratory arrest. Rapid Response Teams decrease emergent arrest situations on nursing units by intervening to treat clinical deterioration or move patients to a higher level of care prior to cardiac or respiratory arrest. Orthopaedic nurses still need to be prepared to act emergently with basic life support skills, which are only renewed every 2 years. Review of actual code blue events and the implementation of low-fidelity code blue simulation may improve comfort levels and performance of basic life support skills. The purpose of this article is to describe how educators designed a low-fidelity mandatory annual code blue simulation exercise for nurses to help increase confidence when faced with the rare cardiac or respiratory arrest emergency. The low-fidelity code blue simulation has been repeated annually and has been an effective exercise for orthopaedic nurses.

Sickle cell disease (SCD) is a group of inherited disorders caused by a mutation of the hemoglobin gene, resulting in the formation of abnormal, sickle-shaped red blood cells. It is a lifelong condition characterized by anemia, vaso-occlusion, and decreased blood flow to vital tissues. Sickle cell disease affects every major organ and significantly reduces life expectancy of the affected individuals. Patients with SCD are at an increased risk for developing musculoskeletal complications that decrease quality of life and contribute to the significant burden of the disease. Understanding these complications, as well as the genetics, pathophysiology, and epidemiology of SCD, will assist orthopaedic nurses in providing evidence-informed care.

It is important to be properly evaluated for shoes to avoid complications. Ill-fitting shoes can lead to pathologies in different populations. The focus of this article is to review the components and function of a basic athletic-type shoe, general shoe-fitting techniques, and selecting appropriate footwear for various populations including those with diabetes, elderly, and females. Poorly fitting shoes can exacerbate structural foot deformities. Unevenly distributed plantar pressures and wear can lead to ulcerations in diabetic populations. Resources and transportation may impact the elderly population when obtaining new shoes. Esthetics is of superior consideration for females. The Brannock Device measurements are important to ensure a correct fit in guiding shoe selection. The orthopaedic nurse should be able to recognize foot ailments caused by ill-fitting shoe gear. Seeking the advice of a podiatrist should be considered before purchasing shoes.

Aims and objectives To develop and test a clinical tool to guide nurses' assessment of postoperative patients for Deep Vein Thrombosis. Background Preventing venous thromboembolism in hospitalised patients is an international patient safety priority. Despite high-level evidence for optimal venous thromboembolism prophylaxis, implementation is inconsistent and the incidence of Deep Vein Thrombosis remains high. Methods A two-stage sequential multi-method design was used. In stage 1, the STOPDVTs tool was developed using a review of the literature and focus groups with local clinical experts. Stage 2 involved pilot testing the tool with 38 surgical nurses who conducted repeated assessments on a prospective sample of 50 postoperative orthopaedic patients. Results Stage 1: The focus group members who were members of the nursing leadership team agreed on eight local and systemic signs and symptoms that should be included in a nursing patient assessment tool for early Deep Vein Thrombosis. Local symptoms were pain in the limbs, calf swelling and tightness, changes in the affected limb's skin temperature. Systemic signs included in the tool were as follows: increased shortness of breath, increased respiratory and heart rates, and decreased oxygen saturation. Stage 2: The STOPDVTs tool had acceptable face and content validity, the agreement between the expert nurse and surgical nurses on assessments of individual signs and symptoms varied between 44%-94%. Surgical nurses were less likely than the expert nurse to identify signs indicative of Deep Vein Thrombosis. Conclusion Despite finding the STOPDVTs clinical assessment tool was a useful guide for nursing assessment, surgical nurses often underestimated the potential importance of clinical signs. The findings reveal a gap in nursing knowledge and skill in assessing for Deep Vein Thrombosis in postoperative orthopaedic patients. Relevance to clinical practice This study identified a possible risk to patient safety related to under-recognition of the signs and symptoms of possible Deep Vein Thrombosis (DVT) in postoperative orthopaedic patients. The findings demonstrate the feasibility of developing and implementing a protocol for consistent screening by nurses for possible DVT in the postoperative period.

The aim of the study was to compare the effects of a preoperative position splint and skin traction on pain, comfort, complications, and satisfaction with the treatment and care for patients with hip fracture.This randomized trial was conducted with a total of 68 patients with hip fracture in a tertiary care hospital in Turkey. Preoperatively, a position splint was applied to the patients in the intervention group (n = 34) and skin traction was applied to patients (n = 34) in the control group. Outcomes studied were pain, comfort, satisfaction and complications.Mann-Whitney U Test showed a significant difference between the position splint group and skin traction group regarding pain severity after the application (p .05). A significant difference was demonstrated between the two groups concerning comfort levels after the application (p .05). The position splint group was significantly more satisfied with the treatment and care than the control group in the later period after the application (p .05). The number of preoperative complications in the position splint group was significantly fewer than that of the skin traction group in the preoperative period (p .05).Preoperative position splint application in patients with hip fracture relieved pain and complications and increased comfort and satisfaction with treatment and care.

Background and aim Research regarding patients undergoing total hip arthroplasty (THA) has shown no significant difference in postoperative pain with or without the use of local infiltration analgesia (LIA). The aim was to evaluate whether intra-operative LIA with Ropivacaine in patients undergoing THA under general anaesthesia reduces postoperative pain. Method A randomised, placebo-controlled trial. Forty patients undergoing elective primary THA under general anaesthesia were allocated to an intervention group (RG) who received 150 ml of LIA or a placebo group (CG) who received 150 ml of saline solution. Results There were no differences in demographic data or duration of anesthesia. The total mean dose of morphine given was 16 ± 12 mg (RG) and 13 ± 9 mg (CG) ( p = 0.238 ). Pain scores (Numeric rating scale, NRS) on arrival at the PACU (time 0) were Md 1 in the RG groupvs Md 5 in the CG group ( p = 0.026). During the first 2 h the Md NRS values in the RG group were ≤3 whereas the Md values in the CG were ≥3. No significant differences in NRS were found at 1–6 h after arrival at the PACU. Conclusion Our study suggests that there is a positive effect of LIA on pain scores within the first hour postoperatively in patients undergoing elective primary THA under general anaesthesia.

Objective: This study was aim to examine orthopedic nurses’ experiences in postoperative pain management. Material and Methods: The study was carried out adopting the qualitative descriptive research method. The study was conducted with nurses working in orthopedics and traumatology clinic (n=16) in June 2014. The sampling criterion for nurses is to be working in orthopedics and traumatology clinic for at least six months. Therefore, two focus groups were interviewed. The interviews were recorded and the average duration of voice recordings was 60 minutes. Content analysis was used as a data analysis instrument. This study was approved by the ethics board and the university hospital. Results: Nurses participating in the study are aged between 22 and 38 years (28.30±4.20), 93.75% of them are female and 93.75% are university graduates. As a result of the content analysis conducted on the interviews, two main themes have been identified: “Decision Makers in Pain Management” and “Barriers in Pain Management”. Decision makers in pain management main theme includes the sub-themes of nurses’ observations and experiences (tacit knowledge), use of various resources and patients' preference. The barriers in the management of pain are the beliefs and prejudices of nurses, lack of cooperation between team members, nurses’ lack of knowledge and patients’ experiences. Conclusion: Nurses stated that they were influenced by their experiences in pain management and from various resources such as internet. In addition, there is a lack of knowledge regarding pharmacological and non-pharmacological treatment methods among the factors that prevent pain management. Training plans for nurses on pain management, narcotic analgesics and non-pharmacological nursing interventions may be recommended. It is also recommended to develop team work on pain management and to establish institutional policies., Amaç: Bu çalışmanın amacı, ortopedi hemşirelerinin postoperatif ağrı yönetimindeki deneyimlerini incelemekti. Gereç ve Yöntemler: Araştırma, tanımlayıcı nitel araştırma yöntemiyle yapılmıştır. Haziran 2014 tarihinde ortopedi ve travmatoloji kliniğinde çalışan (n:16) hemşire ile görüşülmüştür. Örnekleme alınma kriteri ortopedi ve travmatoloji kliniğinde altı aydır görev yapıyor olmaktır. Veriler, iki odak grup görüşmesi ile toplanmıştır. Görüşmelerin ses kaydı alınmış ve ortalama 60 dakika sürmüştür. Verilerin analizinde içerik analizi kullanılmıştır. Araştırma için üniversite hastanesinden, etik kuruldan izin alınmıştır. Bulgular: Çalışmaya katılan hemşirelerin yaşı 22-38 (28,30±4,20) yıl arasında değişmekte olup, %93.75’i kadın, %93.75 üniversite mezunudur. Görüşmelerin içerik analizi sonucunda iki ana tema belirlenmiştir: “Ağrı Yönetiminde Karar Verdiriciler” ve “Ağrı Yönetiminde Engeller”. Ağrı yönetiminde karar verdiriciler ana temasının alt temaları; hemşirenin gözlem ve deneyimleri (örtük bilgi), çeşitli kaynak kullanımı, hasta tercihi olarak belirlenmiştir. Ağrı yönetiminde engeller temasının alt boyutları ise hemşirelerin inanç ve ön yargıları, ekip üyeleri arasındaki işbirliği eksikliği, hemşirelerin bilgi eksikliği, hastaların tercihleri olarak belirlenmiştir. Sonuç: Hemşireler ağrı yönetiminde deneyimlerinden ve internet gibi farklı kaynaklardan etkilenerek karar verdiklerini belirtmişlerdir. Ayrıca ağrı yönetimini engelleyen faktörler arasında farmakolojik ve nonfarmokolojik tedavi yöntemi hakkında bilgi eksikliğinin olduğu da çalışmada saptanmıştır. Hemşirelere ağrı kontrolü, narkotik analjezikler ve nonfarmokolojik hemşirelik girişimleri konusunda eğitim planlanması önerilebilir. Ayrıca ağrı yönetimi ile ilgili ekip çalışmasının geliştirilmesi ve kurum politikalarının oluşturulması önerilmektedir.

There continues to be a lack of knowledge in the overall management of pin site crusts for orthopaedic clinicians to make evidence-based decisions on their retention or removal. The goal of pin site care is to reduce, or where possible, prevent pin site infection. Understanding the role of pin site crusts in the management of the pin site and prevention of pin site infection is important. The aim of this systematic integrative review is to explore the effectiveness of pin site crusts as a biological dressing versus the removal of pin site crusts in pin site care and prevention of pin site infection. Three electronic databases were used to conduct a systematic search. The methodologies of five studies that met inclusion criteria were appraised using the Mixed Method appraisal Tool. Findings reveal that pin site crusts have similar properties to that of a dressing, as the crusts are able to act as a barrier between the insertion site of the pin and external environment, which can reduce infection. Additional high-quality evidence is required to solidify the effectiveness of pin site crusts as a biological dressing.

// Si-Kai Liu 1, * , Yan-Li Song 1, * , Wen-Yuan Ding 1, 2 , Da-Long Yang 1 , Lei Ma 1 and Si-Dong Yang 1 1 Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei Province, China 2 Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Shijiazhuang, 050051, Hebei Province, China * These authors have contributed equally to this work Correspondence to: Wen-Yuan Ding, email: dingwyster@126.com Si-Dong Yang, email: sidongyang@hebmu.edu.cn Keywords: intervertebral disc degeneration; elderly patients; lower-limb rehabilitation gymnastics; orthopedic nursing; postoperative rehabilitation Received: September 16, 2017 Accepted: November 13, 2017 Published: November 28, 2017 ABSTRACT Objectives: The purpose of this study was to explore the effect of systematic lower-limb rehabilitation training in elderly patients undergoing lumbar fusion surgery due to serious degenerative intervertebral disc diseases. Results: At the 1st week after surgery, clinical rehabilitation effect in intervention group was better regarding lower-limb muscle strength, lower-limb DVT, VAS score, and ODI, as compared with control group (all p < 0.05). During the first two weeks after surgery, satisfaction rate in intervention group was higher than that in control group. However, there was no significant difference at last follow-up after surgery when comparing intervention group to control group. Materials and Methods: We retrospectively collected medical records of elderly patients (aged ≥ 60 yrs) undergoing lumbar fusion surgery between 01/2013 and 01/2015 in our department. Some of the identified patients randomly underwent postoperative systematic training of lower-limb rehabilitation gymnastics (intervention group, n = 240), the others not (control group, n = 300). During postoperative period, intervention group received lower-limb rehabilitation gymnastics treatment for 3 months, but control group did not. All patients were routinely asked to return hospital for a check in the 1st postoperative week, as well as the 2nd week, the 1st month, and the 3rd month. Clinical outcomes were evaluated by scoring lower-limb muscle strength, detecting lower-limb deep venous thrombosis (DVT), visual analogue scale (VAS) score, lumbar JOA score, Oswestry disability index (ODI) questionnaire, and performing satisfaction survey. Conclusions: In early postoperative stage, systematic lower-limb rehabilitation training can effectively speed up the recovery, beneficial to reducing lower-limb DVT and increasing patient satisfaction rate.

Background: The visual analog scale (VAS) is considered a reliable and validated measure of patient-reported acute pain. Patient-reported outcome measures are becoming the standard of care throughout the orthopedic community, but interpretation and clinical applications are still under investigation. The aim of the current study was to compare preoperative patient-reported VAS scores reported at the same visit to nursing staff and the treating surgeon. Our hypothesis was that there would be no difference in the scores reported. Methods: This study is a retrospective cohort of 201 consecutive foot and ankle patients treated by a single surgeon. The patients were asked to rate their pain intensity by the nursing staff and then by the surgeon using a standard horizontal VAS 0 to 10, from “no pain” to the “worst pain.” Differences in reported pain values were analyzed. Results: The results demonstrate that patients reported higher pain scores to the surgeon in 81% of the encounters, nursing staff 8%, and equal 11%. On average, the VAS score reported to the surgeon was significantly ( P < .05) higher than that reported to the nursing staff. Conclusion: The current study found a statistically significant higher patient-reported pain score to the treating surgeon compared to the nursing staff. While the exact cause is unclear, the discrepant pain scores call into question the validity of the VAS, considered a fifth vital sign and standard outcome measure in an outpatient clinic setting. Level of Evidence: Level III, comparative study.

This paper describes a collaboration between orthopaedic nurses in Myanmar (Burma) and Australia. It aims to explores how that collaboration began and how it can grow and has grown. The unique needs and challenges of healthcare delivery in developing nations are discussed. Understanding these unique needs and challenges is vital in tailoring strategies to provide orthopaedic nurses in those countries with resources that are suitable to assist them in providing the highest level of quality care to their patients. The authors hope that this example may inspire other orthopaedic nurses and organisations around the globe to participate in this type of activity with the understanding that it benefits all those involved, nurses from both developed and developing countries, as well as improving patient care.

Patients’ and their significant others’ education during the perioperative phase is an important and challenging aspect of care. This study explored the content of education provided by nurses to arthroplasty patients and their significant others. Data were collected with the Education of Patients–NURSE content (EPNURSE-Content), Received Knowledge of Hospital Patient (RKhp), and Received Knowledge of Significant Other (RKso) scales. The results showed that the content of education emphasized biophysiological and functional needs, differed between countries, and was related to how physically demanding nurses found their job to be and the amount of education provided. There is congruence between the received knowledge of patients and their significant others in relation to the content of education provided by nurses. The findings can support nurses in developing aid material for patients and significant others explaining the nature of education and advising them what to expect and how to optimize their participation in the process.

Background Few studies have looked at longer term functional outcomes of rapid rehabilitation (physical therapy in the postanesthesia care unit on the day of surgery) for patients undergoing total knee arthroplasty. Purpose The purpose of this interdisciplinary study (physical therapy and nursing) was to assess the effect of a rapid rehabilitation program on inpatient length of stay (LOS) and functional recovery. Methods Functional outcomes were measured by the Knee Injury Osteoarthritis Outcome Score presurgically and at 4 and 12 weeks postoperatively and by progression along a physical therapy rehabilitation pathway. Results Experimental group LOS was significantly shorter than the control group (p = .0261). Multilevel regression modeling showed that KOOS and physical therapy clinical pathway score trajectories did not differ significantly between groups. Patients receiving rapid rehabilitation were 2.5 (95% CI [0.958, 6.53]) times more likely to have a positive physical therapy rehabilitation trajectory than patients in the control group. Conclusion Findings validated earlier study results in terms of LOS; however, further research is needed to assess the effect of rapid rehabilitation on longer term functional outcomes.

The potential for adverse events exists when treating and managing orthopaedic patients in the intraoperative or postoperative environments, especially when it comes to falls, surgical site infections, venous thromboembolism, and injuries to nerves and blood vessels. Orthopaedic nurses play a vital role in the promotion and use of evidence-based interventions to decrease the incidence of these adverse events, improve quality of care, and minimize the financial burden related to these adverse events.

The lack of individualised care in orthopaedic regimes is often explained by the extended use of patient pathways and clinical guidelines. The aim of this study was to illuminate orthopaedic nurses' perceptions and experiences of providing individual nursing care for older patients in standardised fast-track programmes after total hip or knee replacement. Ten semi-structured interviews were conducted with orthopaedic nurses in orthopaedic wards at three Danish hospitals between April and June of 2015. Data were analysed using manifest and latent content analysis according to Graneheim and Lundman. The main theme of the overall interpretation was Orchestrating care through the fast-track perspective, accompanied by three sub-themes: Identifying and legitimising relevant individual care in the fast-track programme, Struggling to fit all patients in the fast-track programme and Justifying individualised care-related actions in the fast-track programme. The study concluded that, even though the nurses struggled to comply with the programme, they still found themselves compromising their nursing care and ethics to follow the standardised regime. There is a need to establish more specific inclusion criteria to maintain the effective elements in the programme and to facilitate nurses' opportunities to offer individual care, thereby ensuring that fragile patients have access to other possibilities.

PubMedID: 28096004 Pain assessment has a key role in relief of the postoperative pain. In this study, we aimed to examine the effect of the Standard Pain Assessment Protocol (SPAP), which we developed based on acute pain guidelines, on pain level, and analgesic consumption. The study population consisted of a total of 101 patients who had arthroscopic shoulder surgery. The routine pain assessment was administered to the control group, while the SPAP was administered to the study group. The routine pain therapy of the clinic was administered to the subjects from both groups based on the pain assessment. Throughout the study, pain was assessed nearly two times more in the study group (p < 0.001) and the mean pain levels were lower at 8th–11th hours in the study group (p < 0.001). Pain assessment was not performed after 12th hour despite the severe pain in the control group, and, therefore, analgesia was administered at irregular intervals or was not administered at all. However, the hours of analgesic administration were found to be more regular according to the pain levels of the patients in the study group. In conclusion, the SPAP reduced the pain level by providing regular analgesia when used in combination with regular pain assessment. Perspective This article highlights the appropriate assessment for patients with surgical pain. In majority of literature on the subject, the authors emphasize the importance of Standard Pain Assessment Protocol to provide adequate pain relief. © 2016 Elsevier Inc.