The effects of a care map for total knee replacement patients.

AIMS: The aim of this study was to establish and evaluate the effectiveness of a care map for total knee replacement patients. BACKGROUND: Bureau of National Health Insurance in Taiwan is about to launch a diagnosis-related group. This major reform has seriously affected the running of medical institutions, which are facing unprecedented management pressure. DESIGN: A quasi-experimental control group design was carried out. METHODS: Eighty-three patients were recruited, with 39 experimental group patients received nursing care based on a care map, while 44 patients who were in control group received routine nursing care. An interdisciplinary team designed the care map, which included items required for patient care from outpatient to postdischarge. RESULTS: (1) The mean age of patients was 72·73 (SD 8·42) years. Mean length of stay was 4·92 (SD 0·77) days for the experimental group and 7·09 (SD = 1·09) for the control group. Difference between groups was significant (t = -10·285, p < 0·001). The medical cost for the experimental group was less than that for the control group (t = -6·03, p < 0·001). (2) The self-care efficacy score before discharge for the experimental group was higher than that for the control group (t = 5·90, p < 0·001). (3) Significant improvements were observed in activities of daily living for both groups with the passage of time after discharge (F = 229·034, p < 0·001), and the experimental group was better than the control group (F = 40·895, p < 0·001). The instrumental activities of daily living abilities of both groups were also significant improvements with the passage of time after discharge (F = 46·568, p < 0·001), and the experimental group was better than the control group (F = 32·163, p < 0·001). CONCLUSIONS: A care map for total knee replacement patient can shorten length of stay, save medical cost and improve patient's functional recovery. RELEVANCE TO CLINICAL PRACTICE: Results of this study can be used as a basis for practical implementation of care map in total knee replacement patients.

Music therapy for patients receiving spine surgery.

AIMS AND OBJECTIVES: The aim of this study was to evaluate the effects of music therapy on anxiety, postoperative pain and physiological reactions to emotional and physical distress in patients undergoing spinal surgery. BACKGROUND: Surgery-related anxiety and pain are the greatest concern of surgical patients, especially for those undergoing major procedures. DESIGN: A quasi-experimental study design was conducted in a medical centre in Taiwan from April-July 2006. METHODS: Sixty patients were recruited. The study group listened to selected music from the evening before surgery to the second day after surgery. The control group did not listen to music. Patients' levels of anxiety and pain were measured with visual analogue scales (VAS). Physiological measures, including heart rate, blood pressure and 24-hour urinalysis, were performed. RESULTS: The average age of the 60 patients was 62·18 (SD 18·76) years. The mean VAS score for degree of anxiety in the study group was 0·8-2·0, compared with 2·1-5·1 in the control group. The mean VAS score for degree of pain in the study group was 1·7-3·0, compared with 4·4-6·0 in the control group. The differences between the two groups in VAS scores for both anxiety (p = 0·018-0·001) and pain (p = 0·001) were statistically significant. One hour after surgery, the mean blood pressure was significantly lower in the study group than in the control group (p = 0·014), but no significant differences were found between the two groups in urine cortisol (p = 0·145-0·495), norepinephrine (p = 0·228-0·626) or epinephrine values (p = 0·074-0·619). CONCLUSIONS: Music therapy has some positive effects on levels of anxiety and pain in patients undergoing spinal surgery. RELEVANCE TO CLINICAL PRACTICE: Complementary music therapy can alleviate pain and anxiety in patients before and after spinal surgery.