European orthopaedic and trauma patients' perceptions of nursing care: a comparative study.

AIM: To compare English, Finnish, Greek and Swedish orthopaedic and trauma patients' perceptions of nursing care received during hospitalisation. BACKGROUND: Patient perceptions are important when evaluating nursing care delivery. Evaluations usually take place sub-nationally though European citizens may be treated throughout the European Union. International comparative studies are possible because of the universal nature and philosophical roots of quality in nursing care. They are needed to assist in improving care outcomes. DESIGN: A cross-sectional, comparative study design was used. METHOD: The Schmidt Perception of Nursing Care Survey was used to obtain data from orthopaedic and trauma patients in acute hospitals in four countries: Finland (n = 425, response rate 85%), Greece (n = 315, 86%), Sweden (n = 218, 73%) and UK (n = 135, 85%). Data were first analysed using descriptive statistics, then between-country comparisons were computed inferentially using a one-way analysis of variance and a univariate analysis of covariance. RESULTS: Between-country differences were found in patients' perceptions of the nursing care received. Over the whole Schmidt Perception of Nursing Care Survey the Swedish and Finnish patients gave their care the highest assessments and the Greek patients the lowest. The same trend was seen in each of the four sub-scales: Seeing The Individual Patient, Explaining, Responding and Watching. Responding was given the highest assessments in each participating country and Seeing the Individual Patient the lowest except in Greece. CONCLUSIONS: Further research is needed to consider whether the between-country differences found are caused by differences between cultures, nursing practices, roles of healthcare personnel or patients in the different countries. The Schmidt Perception of Nursing Care Survey is suitable for the assessment of European orthopaedic and trauma patients' perceptions of nursing care received during hospitalisation. RELEVANCE TO CLINICAL PRACTICE: The results are useful in evaluating and developing nursing care in hospitals from different European countries.

Building a bone & joint program: nursing leads the way in developing a cost-effective, quality-driven program in a community hospital setting.

The face of joint replacement surgery is changing quickly. An aging, more active population, combined with technological advances in orthopaedic devices and care, has resulted in a growing number of physicians recommending joint replacement surgery as a proactive intervention and not one of last resort for those with debilitating joint disease. Given the current trend and the anticipated increase in surgical volume associated with it, the need for an evidence-based, comprehensive, and well-coordinated Bone & Joint Program to provide patients and their families with the highest quality of care was clear. This is an article about how Hallmark Health System, 370-bed, community-based hospital system, north of Boston, MA, utilized the expertise of a skilled nurse to lead the way. Now, just over a year old and using an interdisciplinary team approach, the Bone & Joint Program at Hallmark Health is already returning dividends in patient satisfaction and in the hospital's bottom line.

Bone metabolism and disease--K/DOQI impact on nurses and dietitians.

Earlier monitoring and treatment of elevated phosphorus and PTH prior to initiation of dialysis may prevent the development of bone disease. We can no longer be complacent or content with patients having a calcium-phosphorus product of 70 or phosphorus of 6.0. When we strive for the recommended optimal levels and goals and work toward these new goals we will improve our patient outcomes. We must be vigilant and have an increased intensity of focus on bone metabolism as part of the total patient care. The entire team serves to provide ongoing education and encouragement throughout the continuum of care with the CKD client.

Challenges for nephrology nurses in the management of children with chronic kidney disease.

An important treatment goal for pediatric nephrology caregivers is the optimization of a child's capacity for normal growth and development. However, the physiologic and metabolic derangements associated with chronic kidney disease (CKD) significantly alter these processes, creating important challenges in the care of affected children. Evidence-based clinical practice guidelines support early recognition and treatment of CKD-related complications to improve growth and development and, ultimately, quality of life for children with this chronic condition.

Uncertainty in illness. An integrative review.

The purpose of this article is to report an integrative review of uncertainty in the illness experience, describe the uncertainty in illness theory, and to discuss the importance of assessing the appraisal of uncertainty experienced in illness with individuals and families faced with illness.

[Disorders requiring nursing care and the period before recognized as needing nursing care (active life expectancy) in relation to nursing care insurance].

PURPOSE: To measure the state of health of the elderly population, active and dependent life expectancies were calculated based on the number of people needing nursing care. For this purpose, active life expectancy was defined as the period before nursing care was recognized by insurers as being required. Moreover, to cast light on disorders requiring nursing care, age-adjusted nursing time needed for different ailments per ten thousand elderly population was calculated. SUBJECTS AND METHODS: Subjects were those 65 years or over living in Taihaku-ku, Sendai City, recognized as needing nursing care by nursing care insurers. The period before being recognized as needing nursing care was calculated using the Sullivan method, and termed the active life expectancy. Dependent life expectancy = life expectancy - active life expectancy. The number of those needing nursing care caused by each disorder diagnosed by attending physicians, was also age-adjusted by the reference population and multiplied by the nursing time needed for each level of nursing, resulting in the age-adjusted nursing time needed per ten thousand elderly population. RESULTS: Those recognized as needing nursing care were 7.5% (7.7% after age adjustment) of the male elderly population, and 12.5% of the female population (10.7% after age adjustment). For men, the active life expectancy was 16.1 years for the age of 65, 9.2 years for 75 and 4.4 years for 85, while the dependent one was 2.0-2.1 years for all ages. For women, the active life expectancy was 19.3 years for the age of 65, 11.1 years for 75 and 4.8 years for 85, while the dependent one was 4.6-5.3 years. The age-adjusted nursing time needed per ten thousand elderly population was 874 hours for men and 1,125 hours for women: of the time 51% was for men with cerebrovascular disease (40% for cerebral infarction), 11% for men with dementia; 37% for women with cerebrovascular disease (26% for cerebral infarction), 20% for women with skeletal diseases, 18% for women with dementia. CONCLUSIONS: The active life expectancy for women is longer than for men, by 3.7 years for the age of 65, by 2.3 years for 75 and by 0.5 years for 85. The dependent life expectancy for women is also longer than for men, by 3.2 years for the ages of 65 and 75 and by 2.6 years for 85. Thus, nursing prevention is an urgent issue, especially for women. The disorders requiring particularly long age-adjusted nursing time are carebrovascular disease (particularly cerebral infarction), dementia and skeletal disorders (particularly among women).

Use of telehealth for chronic wound care: a case study.

Use of telehealth in wound care continues to expand as technology is enhanced and clinicians become more familiar with use of the new technology as a supplement to usual care. This article describes the Telehealth Wound Care Program implemented at Mount Sinai Hospital Home Health Agency and Mount Sinai Hospital Wound Care Center. Results of the wound care provided for one patient are included in the case study described in this article. The authors note the many benefits of telehealth as an adjunct to usual therapy in wound care.

Orthopaedic complications of childhood neurofibromatosis.

Neurofibromatosis is a genetically transmitted, multisystemic disorder characterized by abnormalities of the skin, nervous tissue, and bone. Many of the serious problems associated with this disease are orthopaedic in nature. The treatment and plan of care for a child with neurofibromatosis must be comprehensive and consistent. Nursing care should address the developmental, physical, and emotional needs of the child, as well as the psychologic concerns and educational needs of the child and parents.

Orthopaedic complications of childhood neurofibromatosis.

Neurofibromatosis is a genetically transmitted, multisystemic disorder characterized by abnormalities of the skin, nervous tissue, and bone. Many of the serious problems associated with this disease are orthopaedic in nature. The treatment and plan of care for a child with neurofibromatosis must be comprehensive and consistent. Nursing care should address the developmental, physical, and emotional needs of the child, as well as the psychologic concerns and educational needs of the child and parents.

Imaging of the orthopaedic patient: implications for primary care.

Pain in the skeleton is the foundation on which this article is based. Patients with musculoskeletal pain are frequently seen in primary care. There are many diagnostic imaging studies available to aid the practitioner in formulating and confirming a working diagnosis. This article offers specific guidelines for ordering imaging studies for common orthopaedic problems. The authors take into consideration costs and reliability of tests with each recommendation. The trend in many cases is to order magnetic resonance imaging scans rather than traditional radiographs. The indications for the commonly requested studies are reviewed.

Assessment of the surgical adult orthopaedic client with Down syndrome.

The life expectancy of individuals with Down syndrome has increased with as many as 80% reaching age 50. Nurses should be knowledgeable about the needs of the hospitalized adult orthopaedic client with Down syndrome so that an appropriate plan of preoperative and postoperative nursing care can be developed and implemented.