A qualitative study of patients' experiences before, during and after surgical treatment for periprosthetic knee joint infection; "I assumed it had to be like that ".

BACKGROUND: Periprosthetic joint infection (PJI) of the knee is associated with extended hospital stay, high doses of antibiotics, lengthy rehabilitation, and pain. Standard treatment is a two-stage procedure comprising two surgeries and two hospitalizations. To facilitate exploration of patients' perspectives, the qualitative study presented here was an adjunct to a Danish randomized controlled trial comparing one-stage and two-stage revision surgery. AIM: To explore patient experiences, before, during and after hospitalization and surgical treatment with one- or two-stage revision for PJI of the knee. MATERIAL AND METHODS: Qualitative, semi-structured telephone interviews were conducted with 10 individuals who had undergone either one- or two-stage revision because of PJI. Thematic analysis was employed. RESULTS: The essence of the findings was that the infection was a transition point in a possible life-changing illness. The three themes representing this comprised: 1) physical, 2) psychological, and 3) social implications. Each theme is further illuminated with subthemes. CONCLUSIONS: Infection is a transition point in a possible life changing illness. Late diagnosis and delayed treatment are major issues. Individuals suffer from pain, weight loss, fatigue, and reduced mobility as well as dependency on family members, leading to psychological challenges including depression. IMPLICATIONS FOR CLINICAL PRACTICE: Patients with PJI of the knee could be better informed, educated and involved before and during treatment. Information is needed not only about the physical consequences, but also the psychological and social consequences. More patient involvement and inter-professional and care sector coordination is important when caring for patients with PJI.

Using the SSKIN care bundle to prevent pressure ulcers in the intensive care unit.

Pressure ulcers develop when the skin and underlying tissues are subjected to pressure, friction and/or shear, and, in many cases, moisture. These factors lead to impaired blood supply and injury to the skin and underlying tissues. Patients being cared for in intensive care units are particularly at risk of pressure ulcers because they often lack the ability to change position independently. Also, their consciousness and sensory perception are impaired due to sedation and anaesthesia, diminished circulation and malnutrition. This article examines pressure ulcer prevention in this vulnerable group of patients and outlines the five-step SSKIN (surface, skin inspection, kinetics/keep moving, incontinence/moisture, nutrition/hydration) pressure ulcer prevention care bundle.

Empowerment of whom? The gap between what the system provides and patient needs in hip fracture management: A healthcare professionals' lifeworld perspective.

AIMS AND OBJECTIVES: To use a Habermasian lifeworld theoretical perspective to illuminate a treatment gap for hip fracture patients in a Danish university hospital to guide future healthcare services. BACKGROUND: Most healthcare systems focus on systematised guidelines to help reduce hospital length of stay in response to increasing demand because of the ageing of the global population. For patients with hip fractures, a previous study demonstrated that there is a lack of patient empowerment and a gap between patients' needs and wishes and what was provided by the healthcare system. DESIGN: In this follow-up study, the previous findings were introduced to a mixed group of health professionals (HPs) who participated in focus group discussions (n = 3, with a total of 18 HPs). METHODS: Data were analysed using qualitative content analysis. By analysing the discourse of the discussions using Habermas' perspective, the lack of patient-empowerment was illuminated and facilitated, describing it in terms of the gap it creates in communicative actions between HPs and patients. RESULTS: Information and education of patients in systematised pathways, such as those for patients with hip fractures, are dominated by a biomedical discourse. Patients are overwhelmed by the psycho-social implications of the hip fracture, leaving them in a shock-like state of mind. CONCLUSION: Empowerment of patients should involve empowerment of HPs by providing them with skills to support patients in a shock-like state of mind. There is also a need to provide HPs with a more individually targeted means of informing and educating patients.

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.

Nursing care of fragility fracture patients.

The challenge of caring for patients with fragility fractures is particularly acute for nursing teams who are in short supply and work with patients following fracture on a 24 h basis, coordinating as well as providing complex care. This paper considers the role of nurses within the orthogeriatric team and highlights the value of effective nursing care in patient outcomes. It explores the nature of nursing for patients with fragility fracture with a focus on the provision of safe and effective care and the coordination of care across the interdisciplinary team. It also highlights the need for specific skills in orthopaedic and geriatric nursing as well as specialist education.