ABSTRACT
The aim of this article is to elevate the standard of ward-based routine care by informing readers about the prevention and management of muscular contractures post-cerebrovascular accident (CVA). Musculoskeletal complications can develop at any time during the acute or latter stages of stroke care and rehabilitation; therefore, it is imperative that all nurses understand the importance of correct limb placement and some of the detrimental complications that can occur. By placing more onus on therapeutic positioning and earlier mobilisation, nurses, working alongside allied health professionals, can significantly improve morbidity-related outcomes.
Subject(s)
Contracture/nursing , Contracture/prevention & control , Patient Care Planning , Rehabilitation Nursing/methods , Stroke Rehabilitation , Stroke/nursing , Contracture/etiology , Humans , Patient Positioning/nursing , Stroke/complicationsABSTRACT
BACKGROUND: The transparency criteria of the German statutory health insurance on joint contracture prevention have led to controversies about the appropriate assessment, prevention and treatment as well as to various actions in nursing practice. However, appropriate nursing assessments and proven treatment options are lacking so far. It is unclear whether textbooks on nursing reflect these uncertainties. METHODS: Search for textbooks on nursing through internet-based search engines and publisher registers, data extraction by one investigator and control by a second. RESULTS: A total of 35 textbooks with contributions on joint contractures were identified of which 25 included a definition, causes/risk factors are presented in 32 textbooks and assessments are presented in 5 books. Most often positioning into a physiological or functional neutral position and passive moving of limbs are recommended as passive prophylaxis. Recommended therapeutic and preventive options do not differ. None of the textbooks reflect that there is a lack of scientific knowledge on the subject. CONCLUSION: Textbooks on nursing do not deal with complete and scientific sound information on joint contractures.
Subject(s)
Contracture/diagnosis , Contracture/nursing , Education, Nursing/methods , Nursing Assessment/methods , Nursing Care/methods , Terminology as Topic , Textbooks as Topic , Contracture/epidemiology , Evidence-Based Medicine , GermanyABSTRACT
Burns often result in extensive scars which can change the body aesthetically and/ or functionally. Rapid scarring is a sign of a good prognosis. Preventative actions such as hydration, compression, massage, posture and splints help to prevent or contain the negative evolution of pathological scars.
Subject(s)
Burns/nursing , Cicatrix/nursing , Adolescent , Adult , Age Factors , Burns/physiopathology , Child , Child, Preschool , Cicatrix/prevention & control , Cicatrix, Hypertrophic/nursing , Cicatrix, Hypertrophic/physiopathology , Contracture/nursing , Contracture/physiopathology , Cross-Sectional Studies , Female , France , Humans , Infant , Male , Middle Aged , Prognosis , Skin Transplantation/nursing , Wound Healing/physiology , Young AdultABSTRACT
Scars can be functionally or socially disabling. Many patients affected therefore request corrective surgery. The list of surgical techniques is long and the most frequently-used solutions are well-known.
Subject(s)
Cicatrix/nursing , Cicatrix/surgery , Cicatrix/classification , Cicatrix/psychology , Contracture/classification , Contracture/nursing , Contracture/psychology , Contracture/surgery , Cooperative Behavior , Esthetics , Humans , Interdisciplinary Communication , Keloid/classification , Keloid/nursing , Keloid/psychology , Keloid/surgery , Quality of Life/psychology , Plastic Surgery Procedures/nursing , Plastic Surgery Procedures/psychology , Skin Transplantation/nursing , Skin Transplantation/psychology , Surgical Flaps/surgery , Wound Healing/physiologySubject(s)
Activities of Daily Living/classification , Contracture/nursing , Disability Evaluation , Nursing Assessment/methods , Quality of Life/psychology , Activities of Daily Living/psychology , Aged , Contracture/prevention & control , Contracture/psychology , Germany , Humans , Reference Standards , Social Adjustment , Social EnvironmentSubject(s)
Geriatric Nursing/standards , Mass Media , National Health Programs/standards , Public Opinion , Quality Indicators, Health Care/standards , Accidental Falls/prevention & control , Aged , Contracture/nursing , Contracture/prevention & control , Germany , Homes for the Aged/standards , Humans , Nursing Homes/standards , Pressure Ulcer/nursing , Pressure Ulcer/prevention & control , Quality Assurance, Health Care/standards , Restraint, Physical/standards , Restraint, Physical/statistics & numerical data , Utilization ReviewABSTRACT
Caring for patients who are recovering from severe burns is not common in most rehabilitation settings. Nursing challenges include patients' physical and psychological changes and their high care demands. Harborview Medical Center, a regional level 1 burn and trauma center in Seattle, Washington, accepted these nursing challenges and developed a successful plan of care consistent with current evidence. This article describes Harborview Medical Center's trauma rehabilitation nursing experiences while caring for patients with burns. Our experiences may assist other rehabilitation units that serve patients with burns. Says one burn survivor: "Nurses make a huge difference in recovery, as they are there 24 hours a day. It is their touch, their caring, and their listening that aid the patient in his journey from fire victim to burn survivor."
Subject(s)
Burns/nursing , Evidence-Based Nursing , Patient Care Planning/organization & administration , Rehabilitation Nursing , Academic Medical Centers , Adult , Bandages , Body Image , Burn Units , Burns/psychology , Burns/rehabilitation , Caregivers/education , Contracture/nursing , Cross Infection/nursing , Edema/nursing , Humans , Male , Nutrition Therapy/nursing , Pain Management/nursing , Risk Factors , WashingtonSubject(s)
Clinical Competence/legislation & jurisprudence , Contracture/nursing , Employee Performance Appraisal/legislation & jurisprudence , Expert Testimony/legislation & jurisprudence , Persistent Vegetative State/nursing , Quality Indicators, Health Care/legislation & jurisprudence , Disability Evaluation , Eligibility Determination/legislation & jurisprudence , Female , Germany , Humans , Insurance Coverage/legislation & jurisprudence , Middle Aged , National Health Programs/legislation & jurisprudence , Nursing Homes/legislation & jurisprudence , Persistent Vegetative State/classification , Total Quality Management/legislation & jurisprudenceABSTRACT
Contractures constitute a health problem in mobility-restricted geriatric patients. Contractures are clinically important due to their impact on functional outcome. Prophylactic interventions seem to be indispensable. We performed a systematic review studying the interventions used to prevent immobility-related contractures in the geriatric long-term care. The efficacy and safety of preventive methods was assessed. Electronic literature searches covered the databases PubMed, PEDro, CINAHL and the Cochrane Library (May 2010). Eligibility criteria for studies were: Investigation of an intervention aimed to prevent contractures, conducted in a geriatric and long-term care setting, inclusion of participants aged>65 years. The primary search focused on RCTs, systematic reviews und meta-analysis published between 1990 and May 2010 in English or German. The included studies were analysed and evaluated by one author while a second author checked the results. Methodological quality was critically evaluated using internationally accepted criteria. Eight studies met the inclusion criteria. Prophylactic interventions comprise mobility-encouraging and position-supportive interventions. Mobility-encouraging interventions aim to prevent contractures and immobility, for example offering range-of-motion exercises. Position-supportive interventions are transformations of motion and position, which are conducted with nurses' support. Due to limited methodological quality of these studies, the efficacy of certain measures remains unclear. Further studies on contracture prophylaxis investigating patient-relevant outcomes, interventions' adverse effects and costs are required.
Subject(s)
Contracture/nursing , Contracture/prevention & control , Geriatric Nursing , Aged , Contracture/etiology , Humans , Motor Activity , Physical Therapy Modalities/nursing , Risk FactorsABSTRACT
Caring for patients who are recovering from severe burns is not common in most inpatient rehabilitation settings. Nursing challenges include patients' physical and psychological changes and their high care demands. Harborview Medical Center (HMC), a regional Level 1 burn and trauma center in Seattle, WA, accepted these nursing challenges and developed a successful plan of care consistent with current evidence. This article describes HMC's nursing experiences while caring for patients with burns. Our experiences may assist other rehabilitation units that serve burn patients. Says one burn survivor: "Nurses make a huge difference in recovery, as they are there 24 hours a day. It is their touch, their caring, and their listening that aids the patient in his journey from fire victim to burn survivor."
Subject(s)
Burns/nursing , Burns/rehabilitation , Hospital Units , Rehabilitation Nursing/methods , Acute Disease , Adult , Bandages , Blister/etiology , Blister/nursing , Burns/complications , Burns/psychology , Burns/surgery , Contracture/etiology , Contracture/nursing , Edema/etiology , Edema/nursing , Humans , Male , Patient Participation/methods , Rehabilitation Nursing/instrumentation , Skin Transplantation/nursing , Skin Transplantation/rehabilitation , Social Support , Wound Infection/nursing , Wound Infection/prevention & controlSubject(s)
Burn Units/organization & administration , Burns/nursing , Adaptation, Psychological , Adolescent , Aftercare , Bandages , Burns/psychology , Child , Child, Preschool , Cicatrix, Hypertrophic/nursing , Cicatrix, Hypertrophic/psychology , Contracture/nursing , Contracture/psychology , Critical Care/methods , Education , Equipment and Supplies, Hospital/supply & distribution , Facility Design and Construction , Germany , Humans , Infant , Patient Care Team/organization & administration , Psychotherapy , Resuscitation/nursingSubject(s)
Colostomy/adverse effects , Contracture/etiology , Contracture/nursing , Skin Care/methods , Drainage/instrumentation , Drainage/methods , Drainage/nursing , Equipment Design , Fecal Incontinence/surgery , Female , Humans , Lipectomy , Middle Aged , Nurse Clinicians , Nursing Assessment , Reoperation , Skin Care/instrumentation , Skin Care/nursingABSTRACT
Muscle rigidity and spasms occur with neurological disease and may contribute to contractures and shortening of muscle fibers that can interfere with motor behaviors, such as ambulation, or activities of daily living, such as combing hair, feeding or dressing. The neuromuscular technique (NMT) and muscle energy technique (MET) are nursing interventions that can reduce pain and muscle rigidity, lengthen muscle fibers and increase range of motion necessary for normal motor behavior. Nurses can use these techniques in patients with acute neurological diseases and those recovering in rehabilitation and long-term care settings. With some neurological diseases, muscle rigidity, increased muscle tone and muscle spasms reduce the range of motion of joints and the quality of movement. These changes often lead to contractures and impairments in performing daily tasks or ambulating, and thus, to loss of independence. Soft tissue manipulation can be used to reduce muscle tension and spasms, reduce pain and enhance the range of motion of joints whose function depends on the involved muscles. Soft tissue manipulation may also improve movement during specific tasks. Although the muscle relaxation achieved with manipulation techniques is primarily short-term, long-term effects occur. This article describes two techniques of soft tissue manipulation, their mechanisms of action, assessment and implementation. A case study is used to illustrate application of the techniques and possible long-term effects.