Osteoporosis knowledge and related factors among orthopedic nurses in Hunan province of China.

A low level of knowledge and awareness of specifics regarding osteoporosis among orthopedic nurses can compromise the quality of patient education and nursing care. There are significant variations in education levels among Chinese nurses, however, little is known about the awareness of osteoporosis among orthopedic nurses in China. The objective of this study was to assess the level of osteoporosis knowledge and identify factors that correlated with knowledge levels. A cross-sectional survey was conducted among orthopedic nurses at 13 tertiary hospitals in Hunan Province, China. Knowledge was assessed by the Osteoporosis Knowledge Assessment Test (OKAT). A total of 558 nurses completed the survey and 530 valid questionnaires were returned with a response rate of 95%. Each question had three response options of "True", "False" and "Don't know." The mean of scores from all OKAT questions was 11.4 (range 2-17; SD = 2.5). Factors associated with a better knowledge included age (36-45 years) marital status (married) and education (bachelor degree or above). Only 93 nurses (18%) had previously attended formal training regarding osteoporosis. Orthopedic nurses had moderate-to-low levels of knowledge regrading osteoporosis. The survey highlighted the potential areas for improvement, especially among younger single nurses with lower educational levels. In-depth education may contribute to improving service quality and offering better tutoring for fragility fracture patients through increased awareness and knowledge.

International scoping exercise into expertise in children's orthopaedic nursing and educational pathways.

Maintaining competence and keeping skills and knowledge in children's orthopaedic nursing alive are problematic in both the UK and Australia. The dearth of dedicated postgraduate courses for this specialty has resulted in an array of unregulated in-house training, nurses' individual educational needs not being met and potential for children with an orthopaedic problem being put at risk of not receiving optimal care. This paper reports on a travel scholarship used to compare and contrast the UK with Australia, which supported an international scoping exercise to identify nurses' beliefs regarding expertise in children's orthopaedic nursing and explore provision for maintaining pertinent knowledge and skills. Potential ways to improve support for nurses in maintaining expertise in this field of practice are discussed.

Low-Fidelity Code Blue Simulation on the Orthopaedic Unit.

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.

The experiences of patients receiving care from nursing students at a Dedicated Education Unit: A phenomenological study.

The purpose of this study is to describe how patients perceive being cared for by student nurses, in a clinical context in the form of a Dedicated Education Unit (DEU). The study has been performed with a Reflective Lifeworld Research (RLR) approach grounded in phenomenology. Lifeworld interviews were conducted with patients who had received care from student nurses on an orthopaedic DEU and data have been analysed for meanings. The findings reveal how patients experience to be carried along as a part of the students' learning process. This is described in more detail via the constituents: a mutual invitation to participate, the importance of genuine encounters, and essential support. Patients experience both a stable and a less stable care in a learning environment and it is thus essential for them to be invited to be a part of both the students' learning process and their own health process. The findings also highlight the key role of the supervisors for patients' sense of security. Finally there are indications that concepts such as DEU with a lifeworld-led didactic, based on reflection on both the patients' stories and the students' experiences, can create learning environments that support patients' health processes and also students' learning processes.

Total knee replacement pre-operative education in a Singapore tertiary hospital: A best practice implementation project.

OBJECTIVES: To increase the competency of specialist outpatient clinic nurses in the provision of pre-operative total knee replacement (TKR) education, and ensure that all patients scheduled for elective TKR received the pre-operative education package. METHODS: The project was implemented in three phases. Phase 1 entailed a baseline audit that analysed 30 randomized TKR patients who received pre-operative education. In Phase 2, the gaps and barriers in the project were discussed. Using best practice recommendations from the Joanna Briggs Institute, the project team leader collated and standardized the pre-operative education tools, which consisted of a pictorial booklet, a video and home care advice. A teaching plan guided the nurses to increase their understanding and improve practice using the education tools. The usefulness of education strategies and tools was discussed and these were improved over the proposed timeline. Phase 3 entailed a post-implementation audit to evaluate the provision of pre-operative education. RESULTS: Post implementation, nurses' competency in the provision of pre-operative TKR education increased from 18% to 91%. The number of patients who received the structured pre-operative education package increased from 27% to 50%. CONCLUSION: Overall, there was improvement in the provision of pre-operative TKR education to patients by clinic nurses using evidence-based best practice and a standardized education package.

Gentle persuasive approaches: introducing an educational program on an orthopaedic unit for staff caring for patients with dementia and delirium.

Gentle Persuasive Approaches in Dementia Care (GPA), a curriculum originally designed for long-term care, was introduced into an acute care setting. This person-centered approach to supporting and responding to persons with behaviors associated with dementia was shown to be applicable for staff on an orthopaedic surgery unit where they had reported significant challenges and care burdens when faced with behaviors such as shouting, explosiveness, and resistance to care. Staff confidence in their ability to care for persons with behaviors increased after attending the 1-day GPA workshop, and they reported being highly satisfied with the curriculum, found it to be applicable to their practice, indicated that it was also useful for patients with delirium, and would recommend it to others. Some of the staff on the orthopaedic unit became certified GPA coaches. The passion of those champions, along with demonstrated success of the program on their unit, contributed to its spread to other units, including rehabilitation and acute medicine.

A collaborative system to improve compartment syndrome recognition.

BACKGROUND AND OBJECTIVE: Acute compartment syndrome (ACS) is a rare but serious complication of extremity injury that can cause permanent damage or death. ACS development is variable and unpredictable, and delay in recognition or treatment of ACS can lead to significant morbidity. Our objective was to create a reliable system for recognition of patients at risk and monitoring for ACS that could withstand frequent provider turnover. METHODS: Using the Model for Improvement, we identified key drivers and failure modes for 2 processes: resident and nurse practitioner proper order entry and bedside nurse proper documentation of monitoring. Interventions were tested in frequent plan-do-study-act cycles. Effective interventions were used in combination to test for sustainability. RESULTS: Proper order entry increased from 23% at baseline to 90%. Proper documentation for patients with correct orders increased from 15% to 70%. Individual interventions, including pocket card distribution, electronic medical record order set, and direct discussion by team leaders, were associated with improvement among residents but were not sustained with team turnover. Incorporating all 4 individual interventions into the on-boarding process for residents produced consistent success. Nursing documentation improved with education and maintenance of proper order entry. CONCLUSIONS: We built a reliable, sustainable system to recognize and monitor patients at risk for ACS. Interventions designed to minimally disrupt existing workflows were individually associated with improvement. We achieved sustainability through staff turnover when we incorporated the interventions into routine orientation for new staff. Hospitals can use existing orders and protocols to sustain surveillance for ACS and other acute conditions.

The development and implementation of a hospital based paediatric orthopaedic nursing transition program.

Within Australia and the rest of the world paediatric orthopaedic nursing as a subspeciality nursing workforce faces challenges due to a lack of formal education programs that support the development of knowledge. Despite these challenges the need to ensure the availability of competent and knowledgeable nursing staff to positively contribute to health care outcomes remains unchanged. Thus a need has arisen to develop locally implemented education programs. A multi-tiered paediatric orthopaedic nursing transition program which incorporates work based learning processes combined, with formal assessment components, has been designed utilising Benner's "theory of novice to expert" to facilitate the growth of experts in the clinical setting driven by the requirements of individual clinical settings. The implementation of this program has led to increased confidence in the clinical setting for nursing staff which has positively influenced the care of children and their families in the orthopaedic service.

Bringing the Institute of Medicine's report to life: developing a Doctor of Nursing Practice orthopedic residency.

The increasing number of Americans needing orthopedic health care is a growing concern given the aging population and the diminishing pool of primary and specialty care physicians. In a call to action, the Institute of Medicine's report, The Future of Nursing, advocates for innovative solutions, including the transformation of nursing education and practice, to meet the health care needs of our nation. Preparing nurse practitioners to fill this gap through the development of an orthopedic residency option within the Doctor of Nursing Practice (DNP) degree can fulfill this need. The logic model can serve as a guide to develop and evaluate such a program. The alignment between the American Association of Colleges of Nursing's DNP Essentials and the resources, curriculum, outcomes, and impact of an orthopedic residency is described so similar programs can be established to improve the access to orthopedic care by doctorally prepared nurse practitioners.

Undergraduate students in orthopedic nursing care / O estudante de graduação e a assistência em enfermagem tráumato-ortopédica / El estudiante de graduación y la asistencia de enfermería ortopédica

This study identifies some undergraduate nursing students’ imaginary manifestations concerning themselves and care delivered to patients with orthopedic and/or trauma disorders. The Social Poetics method was used and the research group was composed of 15 undergraduate students. Only the categories and subcategories exclusively related to the “student” are presented in this paper. Data revealed that care provided by orthopedic nursing students is the result of a care relationship that emerges from their sensitivity toward patients and their own knowledge, skills and attitudes. The orthopedic treatment, equipment and procedures, to which patients are submitted, cause important emotional distress for students, empathic behavior and encourage them to search for ways to minimize their patients’ pain. All the aspects that permeate care provided by orthopedic nursing students should be identified in order to enable reassessment of the teaching-learning process.

O objetivo deste estudo foi apresentar algumas manifestações do imaginário do estudante de graduação em Enfermagem, sobre si mesmo, ao prestar assistência ao paciente com distúrbios tráumato-ortopédicos. Utilizou-se o método Sociopoético e o grupo pesquisador era composto por quinze estudantes de graduação. Neste artigo estão apresentadas somente as categorias e subcategorias relacionadas exclusivamente ao “estudante”. Os dados demonstram que a assistência prestada pelo estudante em enfermagem tráumato-ortopédica é produto de uma relação de cuidado, que emerge através da sua sensibilidade para com seu paciente, e de seus próprios conhecimentos, habilidades e atitudes. O tratamento, os aparatos e os procedimentos ortopédicos aos quais o paciente é submetido geram, no estudante, importante desgaste emocional, comportamento empático e a busca por mecanismos que minimizem a dor do outro. Todos os aspectos que permeiam a assistência discente em Enfermagem Tráumato-Ortopédica necessitam ser conhecidos, para permitir reavaliação do processo ensino-aprendizagem.

El objetivo de este estudio es presentar algunas manifestaciones del imaginario del estudiante de graduación en Enfermería, sobre sí mismo, al prestar asistencia al paciente con disturbios traumatológicos ortopédicos. Se utilizó el método Socio-Poético; y el Grupo-Investigador fue compuesto por quince estudiantes de graduación. En este artículo se presentan solamente las categorías y subcategorías relacionadas exclusivamente al “estudiante”. Los datos demuestran que la asistencia prestada por el estudiante de enfermería en traumatología y ortopedia, es producto de una relación de cuidado que emerge a través de su sensibilidad para con su paciente y de sus propios conocimientos, habilidades y actitudes. El tratamiento, los aparatos y los procedimientos ortopédicos a los cuales el paciente es sometido, generan en el estudiante un importante desgaste emocional, un comportamiento empático y la búsqueda de mecanismos que minimicen el dolor del otro. Todos los aspectos que impregnan la asistencia de los alumnos de Enfermería en Traumatología y Ortopedia, necesitan ser conocidos, para permitir una reevaluación del proceso de enseñanza-aprendizaje.

Orthopaedic nurses' knowledge of delirium in older hospitalized patients.

BACKGROUND: Delirium is a serious health issue experienced by many hospitalized older adults following orthopaedic surgery. Nurses often do not recognize delirium, attributing symptoms to normal changes associated with aging or dementia. OBJECTIVES: To (a) describe orthopaedic nurses' baseline knowledge about delirium in orthopaedic patients, particularly those aged 65 years, (b) test the effectiveness of an educational intervention based on nationally recommended guidelines, and (c) describe factors associated with differences in (1) nurses' baseline knowledge about delirium and (2) the effectiveness of the educational intervention. METHODS: A pretest-posttest study design, using an educational evidence-based intervention. RESULTS: Regardless of education, years of experience, or shift worked, orthopaedic RNs had difficulty with questions related to recognition of delirium, predisposing, and precipitating risk factors, and medications that can contribute to delirium. The educational intervention was effective and scores significantly improved from baseline following the intervention. CONCLUSIONS: Baseline knowledge assessment confirmed orthopaedic nurses' lack of understanding of delirium. The 1-hr educational intervention, based on nationally recommended standards, improved the nurses' knowledge and could be useful in orthopaedic nursing continuing education.

Undergraduate students in orthopedic nursing care.

This study identifies some undergraduate nursing students' imaginary manifestations concerning themselves and care delivered to patients with orthopedic and/or trauma disorders. The Social Poetics method was used and the research group was composed of 15 undergraduate students. Only the categories and subcategories exclusively related to the "student" are presented in this paper. Data revealed that care provided by orthopedic nursing students is the result of a care relationship that emerges from their sensitivity toward patients and their own knowledge, skills and attitudes. The orthopedic treatment, equipment and procedures, to which patients are submitted, cause important emotional distress for students, empathic behavior and encourage them to search for ways to minimize their patients' pain. All the aspects that permeate care provided by orthopedic nursing students should be identified in order to enable reassessment of the teaching-learning process.

A lucky break. Interview by Alison Moore.

Patients in Leicester with minor fractures are now seen by a specialist nursing team, reducing the time patients have to wait for treatment.

Improving clinical outcomes with continuous passive motion: an interactive education approach.

Orthopaedic nursing often involves the use of equipment, and nurses may learn about the use of equipment on the job in informal ways. Staff may have difficulty attending in-services, may be off during quick informal in-services, or may not use equipment for a period of time after an in-service. Due to lack of knowledge, inconsistency in the implementation of ordered therapies resulting in poor outcomes, including pressure wounds and patient dissatisfaction, frequently occurs. Using continuous passive motion therapy as an example, an interactive educational approach to equipment training is presented. Such an approach helps formalize equipment training, provides a standard approach to implementing ordered therapy, provides references for staff after in-services, and improves patient outcomes.

O imaginário do estudante de graduação sobre o cuidado em enfermagem traumato-ortopédica / Graduation students’ imaginary about orthopedic nursing care

O objetivo desta pesquisa é desvelar manifestações do imaginário do estudante de graduação em Enfermagem sobre os cuidados prestados por ele ao paciente hospitalizado com distúrbios traumato-ortopédicos. A tese que se propõe, é que, para fins de formação do enfermeiro, o cuidado em Enfermagem Traumato-Ortopédica deve ser entendido como produto de áreas de interrelação entre o estudante, o paciente e o cuidado, onde esses elos são fortes e indissociáveis e o ensino da assistência em Enfermagem Traumato-Ortopédica só existe como tal, quando são consideradas todas as partes interligadas. Utilizou-se o método Sociopoético e os dados foram produzidos por um Grupo-Pesquisador compostos por dezesseis estudantes do sexto período curricular do curso de Graduação em Enfermagem de uma universidade pública na cidade do Rio de Janeiro. Os resultados demonstraram que cuidar em Enfermagem Traumato-Ortopédica gera grande impacto no aluno, produto do sofrimento do seu paciente e da complexidade do cuidado na especialidade. O estudante reconhece que presta um cuidado de qualidade, humanizado, holístico, que transcende o físico e inclui o psicossocial, o espiritual e o ambiente, além de ser comprometido, ético, responsável e solidário, e que este é diferente daquele prestado pelas equipes de saúde. Todos os sentidos corporais e o coração são usados, plenamente, pelo estudante no processo de cuidar em Enfermagem Traumato-Ortopédica. O reconhecimento do paciente e de seu familiar, à qualidade do seu cuidado, produz satisfação e reforço positivo à dedicação e aos esforços empreendidos...