Journal of Orthopaedic Nursing - Articles in Press

The nurses’ role in educating, counselling and preparing parents to care for a child with Developmental Dysplasia of the Hip (DDH) - Corrected Proof

Eileen Causon — 2009-11-23

Summary: Infants can be affected by a number of musculo-skeletal conditions at birth. One of the most common is Developmental Dysplasia of the Hip (DDH). DDH is thought to occur in utero, during birth, and also during infancy and childhood.DDH is a condition that involves a hip joint that is unstable, subluxated, or completely dislocated. This can include a range of conditions from mild malformation of the acetabulum to a dislocation that cannot be reduced. It can be caused by a combination of factors that include hereditary factors, hormonal, and positioning in the uterus due to breech position and multiple births and oligohydramnios. Nurses caring for infants with DDH should have knowledge of the pathophysiology of this condition, and be able to relate it to the treatment interventions and care that is given.The importance of detection cannot be over emphasised, as the risk of developing osteonecrosis and osteoarthritis of the hip into adult life is increased if DDH is left untreated. Along with chronic pain and poor mobility the lifelong implications can be disastrous. There is also a risk of the development of avascular necrosis (AVN) not only in the affected hip, but also the contralateral hip, resulting directly from the treatment given to correct the deformity [Read, H.S., Evans G.A., 2002. Avascular necrosis as a complication in the management of developmental dysplasia of the hip. Current Orthopaedics 16(3), 205–212].The treatment for DDH can consist of surgical and non-surgical methods depending on severity. These can include various methods of abduction of the hip using splints and casts, ultrasoundmonitoring, and surgery such as pelvic and femoral osteotomies to enable correction of the problem.The nurses’ role in educating, counselling and preparing parents to care for a child with DDH is very important. The psychological impact on parents from discovering their child is not as physically perfect as they were expecting has to be considered. In the author’s own workplace, an orthopaedic clinic, nurses meet children and their parents diagnosed and treated for DDH during pre operative assessment, in the plaster room and in consultation with the doctor. As a profession it is essential that nurses have the knowledge and understanding of the condition to fulfil this role [Hart, E.S., Albright, M.B., Rebello, G.N., Grottkau, B.E., 2006. Developmental dysplasia of the hip. Nursing implications and anticipatory guidance for parents. Orthopaedic Nursing 25(2), 100–109].

So what! if a pneumatic tourniquet is used intraoperatively: A study of neurovascular assessment practices of orthopaedic nurses - Corrected Proof

Siobhan Murphy, Caroline O Connor — 2009-11-20

Summary: Pneumatic tourniquets are used world wide to provide a bloodless surgical field for a variety of extremity surgeries. However, their use is not without potential for complications such as superficial skin injury and deep tissue injury. This national study of orthopaedic nurses in Ireland aimed to determine orthopaedic nurse’s actual practices in caring for patients following surgical procedures where pneumatic tourniquets were used. A quantitative descriptive exploratory study of 69 experienced orthopaedic nurses reported finding skin insults beneath tourniquet cuff sites as well as extremity pain, stiffness and swelling. This study concludes that orthopaedic nurses have a key role in the detection and reporting of potential pneumatic tourniquet complications and makes recommendations for practice.

The Bone and Joint Decade in Canada: A look back and a look forward - Corrected Proof

L.L. Mandzuk, D.E. McMillan, E.R. Bohm — 2009-11-19

Summary: The Bone and Joint Decade was declared by the World Health Organization in the year 2000 with Canada following in 2002. As we move towards the end of the Bone and Joint Decade, it is important to recognize not only the accomplishments that have been made but also what may lie ahead for bone and joint health. Canada, specifically Manitoba, has made progress in wait time initiatives and has made many steps forward in this regard.

Quality of life issues for patients following traumatic brachial plexus injury – Part 2 research project - Corrected Proof

Beverley Wellington — 2009-11-19

Summary: Small but significant numbers of adults sustain a traumatic brachial plexus injury, often resulting in devastating disability affecting their physical and psychological well being. There is limited evidence of qualitative research available and this paper reports on a study that considers the patient’s own experience of living with this injury. Patients were selected using purposive sampling from those who were on the database for the Scottish National Brachial Plexus Injury Service. Five patients were finally selected and data collected using semi-structured audio taped interviews and field notes. Similar themed categories were identified from the experiences described by the patients including employment, pain, body image and sexuality/emotions.Recommendations include timely and ongoing pain management reviews and initial counselling sessions for all new patients.

Comparison of two bowel treatments to prevent constipation in post-surgical orthopaedic patients - Corrected Proof

Loren Madsen, Cathy Magor, Barbara A. Parker — 2009-11-16

Summary: Introduction: In major orthopaedic surgical procedures the combination of opioid analgesia for pain control and disruptions in mobilisation post-operatively can cause constipation. In order to prevent or relieve constipation in this patient group a post-operative bowel protocol is required. This study compares the use of two treatments to address constipation in this patient group. The results provide information for nursing staff to determine the most effective bowel management protocol for orthopaedic patients.Aim: To compare the effectiveness of Macrogol 3350 with electrolytes (Movicol®) with a standard bowel treatment in reducing constipation in orthopaedic patients.Methods: Patients admitted for elective total knee and total hip replacement surgery were randomly allocated to one of two treatment groups. Treatment group 1 received the standard bowel protocol of Coloxyl and Senna®. Patients allocated to treatment group 2 received Macrogol 3350 with electrolytes (Movicol®). Each treatment commenced on Day 1 post-operation. Bowel movements and associated abdominal symptoms such as flatus, pain and nausea were recorded daily.Results: Patients taking Macrogol 3350 with electrolytes (Movicol®) experienced a bowel movement earlier in the post-operative period (2–4days vs 3–6days; P=0.001). No significant difference in self-reported gastrointestinal symptoms was found between groups.Conclusions: The findings from this study provide data that may assist in a more effective bowel treatment for post-operative orthopaedic patients.

Corrected Proof

Julie Santy — 2009-10-05

The following three reviews are focussed on two classic and one relatively new text aimed at medical students but of considerable interest to the orthopaedic trauma practitioner. They demonstrate a range of different degrees of focus.

Nurses’ perceptions of how job environment and culture influence patient handling - Corrected Proof

G. Talley Holman, Kathy J. Ellison, S. Maghsoodloo, Robert E. Thomas — 2009-07-15

Summary: This article is two of a two part series examining the people and environment associated with patient handling. The approach used was that of an occupational injury investigation of a job class, which incorporates defining in the task, environment, tools, and worker health status. Hence, the objective of this study was to evaluate nurses’ perceptions of how healthcare organization, environment, and culture influence a patient transfer. For this purpose, a postal survey was designed to collect data from Alabama nurses who had been registered in the state for at least one year. The potential participant pool included 1000 nurses randomly selected from the 49,000 registered. The return rate of 10% was expected based on nursing literature. One hundred and one surveys were returned with 86 being complete. Results showed nurses perceive bathroom transfers as being most difficult with 3 of the 4 significant transfers being associated with this location. Further, nurses reported they spend approximately 20% of their time performing patient handling tasks. Responses on job culture suggests in patient handling situations most nurses will place a patient’s safety above their own, which is expected given the core concepts of healthcare, but represents a shift from other industries involving manual material handling. Further, over 40% of nurses stated sprains, strains and sore backs are just part of the job. Significant factors shown to influence patient handling were the patient’s size and weight and understaffing. Reasons given for not using patient handling equipment were an emergency did not allow for time, equipment was unavailable, or the size, shape and/or congestion of space did not allow for use. Overall, responses suggest nurses are well educated regarding patient handling as it is a large part of the everyday job. However, job demands and culture often influence nurses to place patient safety ahead of their own. This suggests patient handling remains a problem that still needs to be addressed to find a proper balance between patient and provider safety before significant long-term advances are realized.Significance to healthcare: Nurses constitute the largest proportion of the healthcare industry’s workforce. Understanding job factors that impact the health and subsequent working life of this employee group is essential in order to sustain the contributions of nurses as the demands on the healthcare system increase with an aging population.

Registered nurses and enrolled nurses assessments of postoperative pain and risk for malnutrition and pressure ulcers in patients with hip fracture - Corrected Proof

Carina Bååth, Bodil Wilde-Larsson, Ewa Idvall, Marie Louise Hall-Lord — 2009-07-14

Summary: The aim of the study was to describe and compare registered (RNs’) and enrolled nurses’ (ENs’) assessments of postoperative pain, risk for malnutrition and pressure ulcers in patients with hip fracture. Furthermore, the aim was to describe and compare their perceptions of using assessment tools. Thirty-four (34) RNs and forty-three (43) ENs, working on orthopaedic wards in Sweden, took part in the study. The assessments were carried out on 82 patients with hip fracture. The assessment tools included the numerical rating scale (NRS), short-form nutritional assessment tool (MNA-SF), modified Norton scale (MNS) and pressure ulcer card. Many patients were assessed to be in postoperative pain and at possible risk for malnutrition. Around 50% were assessed as being at risk for pressure ulcer formation (PU). There is a difference between RNs and ENs assessments of patients’ postoperative pain, risk for malnutrition and PU. ENs assessed to a greater degree that patients were in intense pain currently. RNs assessed to a greater degree that patients had been in intense pain in the past 24h. Single items on the tools showed differences. However, there was no statistically difference for MNA-SF screening score and MNS total score. ENs found it easier to assess postoperative pain with the NRS compared to RNs.

WITHDRAWN: New oral anticoagulants to revolutionise Venous Thromboembolism (VTE) management - Corrected Proof

Ricky Autar — 2009-05-29

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Structured discharge education improves early outcome in orthopedic patients - Corrected Proof

Bela Ben-Morderchai, Amir Herman, Hana Kerzman, Angela Irony — 2009-03-20

Summary: Background: Optimally efficacious patient education at discharge is a challenge for medical staff, patients and the patients’ families. The unique fears and concerns associated with discharge to the community and the self-care of orthopaedic patients must be dealt with as well. The instructions given at the time of discharge could influence the perception of and overall satisfaction levels of patients when related to their hospital experience.Objective: To assess the impact of structured, compared to standard patient education, at the time of hospital discharge.Methods: Orthopaedic patients given structured (n=47, Group 1) or standard (n=48, Group 2) instructions at discharge were compared. The nurses used specially designed booklets containing relevant questions and answers to guide them in providing instructions to Group 1. Six weeks after discharge, all patients were interviewed via the telephone regarding their satisfaction levels in relation to their hospitalisation, pain management, functional status and compliance with follow-up visits.Results: Group 1 patients had fewer pain complaints (23, 48%) compared to Group 2 (34, 70.8%). Their follow-up compliance was also higher (44, 93.6% versus 37, 77.1%) and they reported greater satisfaction from the nurse–patient communication and discharge instructions (19.4 and 11.5) than Group 2 (17.8 and 9.7). The number of unplanned medical visits (to emergency services or general practitioners) after discharge was similar for both groups. Group 1 had better functional status as measured by activity of daily living and instrumental activity of daily living indices.Discussion: Structured patient education at discharge offers an easily implemented alternative to standard instructions and improves patient satisfaction, pain management, compliance with follow-up and better functional status.

Modern pneumatic tourniquets in orthopaedic nursing practice - Corrected Proof

Siobhan Murphy, Caroline O’Connor — 2008-12-09

Summary: Pneumatic tourniquets are used in over 1 million surgical cases annually in North America [McEwen, J., 2005. Retrieved 2.10.2006 “Complications and preventative measures”. ]. There is a paucity of nursing literature about the complications and preventative measures in relation to pneumatic tourniquet use. Pneumatic tourniquets may be used in surgical and nonsurgical settings to establish a bloodless field for extremity surgery and anaesthetic procedures. Nevertheless, their use may induce injuries that are commonly transient and even unnoticeable but some are permanent. Injuries vary depending on the inflated pressure, the duration of inflation and the physical status of the patient. Current evidence based research has predominantly come from medical research. This article outlines the historical background, relevant physiological changes induced by tourniquet during surgery and issues of nursing management relevant to orthopaedic nursing to prevent and reduce tourniquet injury.

A study of a pathway to reduce pressure ulcers for patients with a hip fracture - Corrected Proof

Ami Hommel, Karin B Bjorkelund, Karl-Göran Thorngren, Kerstin Ulander — 2008-12-09

Summary: Due to an ageing population the numbers of patients with hip fractures are increasing. They often suffer from concomitant diseases and are therefore prone to be affected by complications such as pressure ulcers. The prevention of pressure ulcers among patients with a hip fracture is crucial. The aim of this study was to improve the quality of care and patient safety in patients with a hip fracture. A new evidence based clinical pathway was introduced to prevent hospital acquired pressure ulcers. Furthermore, the purpose was to bring attention to pressure ulcer prevention and to facilitate changes in clinical practice to improve quality of care and patient safety. A total of 478 patients with a hip fracture were consecutively included between April 2003 and March 2004. The new evidence based clinical pathway was introduced on October 1st 2003. The results from the first 210 patients in the control group and the last 210 patients in the intervention group are presented in this article. In the intervention group, hospital acquired pressure ulcers decreased by 50% (p<0.007). It is possible to reduce the development of hospital acquired pressure ulcers among elderly patients with a hip fracture even though it is not possible to eliminate the effect of factors such as increased age and the patients’ medical status which are often the two main risk factors.

An evaluation of the quality of nursing care in orthopaedic units - Corrected Proof

Lay-Lan Lee, Nanly Hsu, Shu-Chuan Chang — 2008-12-09

Summary: The purpose of this study was to evaluate the quality of nursing care of three categories of orthopaedic patients and compare the quality scores on four objectives and 24 sub-objectives. The four main objectives were:One hundred and eighty orthopaedic patients were randomly selected from two orthopaedic units of the teaching hospital in the eastern region of Taiwan. The quality monitor tools were modified from Orthopaedic Nursing Care Quality monitor tools developed by . Results showed the mean quality achievement percentage scores of the main objectives were 85.91%, 85.84%, 80.11%, and 89.47%, respectively. The priority in achievement of nursing care objectives and the plan of nursing care were higher than the physical needs of the patient and the psycho-social-culture-spiritual needs of the patient. The use of this tool to evaluate the quality of nursing care will assist administrators and educators to identify the strengths and weakness in the delivery of nursing care.

NICE guidelines on reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients undergoing surgery - Corrected Proof

Ricky Autar — 2008-12-09

Summary: Venous thromboembolism (VTE) is most preventable and unacceptably over 25,000 people die of VTE annually in England. The scale of VTE mortality prompted the UK Department of Health to charge the National Institute for Health and Clinical Excellence (NICE) with the task of developing a national guideline for “reducing the risk of VTE in high risk surgical patients”. The VTE guideline development group was tasked to review the effectiveness of methods of prophylaxis in patients undergoing high risk surgical procedures and make recommendations on the most clinically and cost effective measure to reduce VTE in such populations. Systematic reviews and meta-analyses of published randomized trials of mechanical and pharmacological prophylaxis for VTE, as determined by objective methods of screening were primarily considered. Other inclusion criteria comprised of randomised clinical trials of specific types of major surgery deemed to be associated with high incidence of VTE. The studies compared a single method of prophylaxis with nil or another strategy. Clinical trials of mechanical devices used as an adjunct to pharmacological methods were also scrutinised.All prophylactic strategies reduce the risk of developing post operative DVT compared to no prophylaxis. However, all pharmacological interventions are associated with an increased risk of bleeding. As mechanical methods demonstrate similar efficacy and risk reduction to pharmacological methods and without bleeding complications, they are recommended as first choice of venous thromboprophylaxis. It is also acknowledged that adding a mechanical device to low molecular weight heparin or unfractionated heparin in some high risk patients reduces the risk of postoperative DVT more significantly.

A critical study of a 100-year-old patient receiving a dynamic hip screw - Corrected Proof

Daniel Griffith — 2008-12-09

Summary: This care study critically examines the care given to one elderly female patient on an orthopaedic trauma unit following a dynamic hip screw insertion for a fracture of the neck of femur. It examines the patient history, mode of injury, choice of and delivery of both medical and nursing care. Issues include the choice of nursing model and the influence of government policy on care delivery, stemming from the National Service Framework for Older People and Essence of Care. The work finally calls for the introduction of an adapted nursing model within the speciality of orthopaedic trauma.

A survey of orthopaedic patients’ assessment of care using the Individualised Care Scale - Corrected Proof

Agneta Berg, Riitta Suhonen, Ewa Idvall — 2008-12-09

Summary: The aim of the study was to describe orthopaedic patients’ assessments of how individuality in patient care was supported during specific nursing interventions and how that individuality was perceived during hospitalisation. Orthopaedic inpatients (370) from two central county and two county hospitals in Sweden were surveyed using the Individualised Care Scale (ICS) during 2004/2005, (response rate 74% n=274). The data were analysed using both descriptive and inferential statistics. Eighty-six percent of the respondents stated that it was very important to be treated as an individual or unique person and 59% experienced this type of care. The lowest rated assessments concerned the personal life situation and the highest were concerned with the clinical situation and the decisional control over care. This analysis of patient assessments of individualised nursing care can be used to implement changes to individualise care processes in orthopaedic wards. This will be useful in the evaluation of health care quality improvement, planning and personnel management.

New writer award winners 2006 - Corrected Proof

2008-12-09

CONA Travel Award 2007 - Corrected Proof

2008-12-09

Spread the word not infections - Corrected Proof

Rosemary Masterson, Gerry Tuohy — 2008-12-09

Prevention of infection is a topical issue at present with many causes cited as contributing to its development such as lack of hand washing, lack of adherence to a uniform policy, the use of unclean white coats and unrestricted visiting hours. A recently launched web site in Ireland (www.ratemyhospital.ie) allows patients to comment on any aspect of their hospital stay e.g. in relation to food standards/selection, hygiene practices such as hand washing, cleanliness of the bathrooms and clinical areas and staff behaviour. This has put the prevention of infection in the spotlight from a patient’s perspective with hand hygiene topping the agenda.

Society Information - Corrected Proof

2008-12-09

9th National Orthopaedic Nurses Conference, Cappagh, Dublin 2007 - Corrected Proof

Brenda McCarthy — 2008-12-09

The Cappagh Orthopaedic conference is renowned for its contribution to orthopaedic nursing knowledge in Ireland. Delegates from all over the country travel to the national orthopaedic hospital to gain further knowledge and to network with fellow orthopaedic nurses. This year was no exception, the conference was interesting, informative and professional with that friendly welcoming ethos that Cappagh is famous for. Many aspects of nursing care were discussed (nursing input in joint register, neurovascular assessment tools, DVT prevention to highlight a few).

Diary - Corrected Proof

2008-12-09

Literature reviews - Corrected Proof

2008-12-09

Corrected Proof

Bryan Smith — 2008-12-09

This ‘pocket sized book’ was developed as a quick reference guide for surgeons performing total Knee Replacements and medical students who are developing an ‘expertise’ in total knee arthroplasty. It is a shorter version of a similar book, ‘Surgical Techniques in Total Hip Arthroplasty’, by the same American authors. Unfortunately, the vast majority of references included in this 2006 book are now 10 years out of date. This said, for those who have an interest in knee arthroplasty and a curiosity regarding the technical aspects of the procedures, this book will make interesting reading.

Corrected Proof

David Pinnock — 2008-12-09

This slim American volume is a review of adverse events associated with a wide range of spinal surgery. Topics are discussed logically in terms of surgical approach (anterior or posterior) and level of the spinal column. The authors advise on actions to avoid these complications and how to manage them when they occur.

Policy reviews - Corrected Proof

2008-12-09

Nurse training during world war two - Corrected Proof

Lois M. Barr, Chris Knight — 2008-12-09

Summary: The previous article in this series considered some of the major characters in nursing and the military background to orthopaedic and trauma care. Nurses have always cared for military personnel and victims of war in the field of conflict, and continue to do so today. However, the world wars of the last century created large numbers of casualties globally. The 1939–1945 war in particular brought war into the lives of ordinary people within the UK, particularly in industrialised cities. Those whom experienced this era are today’s senior citizens, many we see requiring surgery on our orthopaedic and trauma wards. In the following article, Lois Barr reflects on life as a student nurse in Glasgow during these perilous times.

An exploratory study of Maltese patients’ perceptions of their preparation for total joint replacement at the pre-admission clinic - Corrected Proof

Reggie Aquilina, Donia Baldacchino — 2008-12-09

Summary: Patient education has become an integral part of the pre-operative preparation for patients especially through the introduction of pre-admission clinics (PACs) for elective surgery. However, it is important to continue exploring the patient’s perceptions about these clinics so as to identify their effectiveness from the patient’s point of view. This study reports the findings of a qualitative study using semi-structured interviews carried out with 30 patients following joint replacement surgery in a Maltese General Hospital.Analysis identified two main themes:This paper uses transcript extracts to illustrate further the categories that emerged within the main themes. The findings continue to provide further indications about the usefulness of providing patient information in a manner that retains patient dignity and respect, motivates, and addresses the patient’s individualised needs through an energising interaction. However, it also emerged that nurses need to be skilled and trained in the way they educate patients as some participants verbalised apprehension about the information provided. Seven ‘D’s are identified as aspects that need to be considered in ensuring effective PACs.

The experience of families with the home care of children after spinal fusion surgery - Corrected Proof

Anelise Santo, Kim Tanguay, Margaret Purden — 2008-12-09

Summary: The lack of evidence on appropriate discharge planning preparations, specifically for spinal fusion surgery patients, has led the orthopaedic nursing team to ask: How can we better prepare families to care for their child following discharge home? A descriptive case study design was used. A non-probability, convenience sample of English speaking parents was selected. Inclusion criteria included parents of children up to 18 years of age who had spinal fusion surgery.Six mothers participated in the study. Although mothers stated that the overall experience of caring for their child at home was generally good, the care-giving tasks they faced were complex and time consuming. The hospital discharge and home care experience comprised two main themes: challenges and resources. The results highlight the complex reasoning and behavioural processes required of caregivers. Mothers perceived that they were expected to be proficient caregivers to their child; however, they also felt that some of these expectations were beyond their level of expertise. Mothers developed information seeking strategies as a way to address their learning needs. Clinical implications such as starting the discharge process earlier, incorporating teaching at the bedside, and recognizing the special needs of out-of-town families were discussed.

Developing annotated bibliographies for pain management – A tool for education, collaboration and research development - Corrected Proof

Pat Schofield, Paula Smith, Barry Aveyard — 2008-12-09

Summary: The purpose of this paper is to present the process of developing an annotated bibliography as a tool for education and research. The authors of the paper will describe the process and demonstrate the findings from two recently completed bibliographies around pain in the older adult and pain in the terminal stages of palliative care. The benefits of this type of project will be discussed. Both bibliographies have been developed by a team of researchers within the University of Sheffield and are available for students to access as an educational tool. From the work collated within the bibliographies, the research team have been able to identify two research proposals that have been submitted for funding.

The true cost of health care associated infection - Corrected Proof

Mark Cole — 2008-12-09

The cost of health care associated infection (HCAI) should not be considered merely in terms of money, although it is an immense drain on limited health care resources. Nursing in particular has been singled out to carry the brunt of media comments about dirty wards and practices. The image of the nurse has become tarnished in several senses over this issue. The following comments are one nurse expert’s views on the current dilemma.

Nursing contributions to mobilizing older adults following total hip replacement in Ireland - Corrected Proof

Mary O’Sullivan, Eileen Savage — 2008-12-09

Summary: Little is known on the nursing contributions to the mobilising of older adults following hip replacement surgery. This paper presents the findings from a study on nurses’ views of the contributions they make to the mobilising of older patients recovering from total hip replacement. A specific focus was laid on pain management and interpersonal care. The results show that Irish nurses reject mechanistic models of care in favour of contemporary approaches. The work of other authors is discussed extensively.

Factors determining blood transfusion in patients undergoing total knee arthroplasty: Cross-match or group and save? - Corrected Proof

Kenneth Cheng, Andrew Christie, Clark Dreghorn — 2008-12-09

Summary: The aim of this study was to examine clinical characteristics of patients undergoing elective total knee arthroplasty to ascertain whether it is possible to identify subjects at high risk of post-operative transfusion.

Factors affecting length of stay following total knee replacement: A clinical practice audit - Corrected Proof

Anne McGinley — 2008-12-09

Summary: There is an emphasis on discharging patients as quickly as possible after surgery due to current United Kingdom (UK) government policies and for other reasons such as reducing the risk of acquiring infection in hospital and reducing the cost to the trust associated with longer length of stay. The target post-operative length of stay (LoS) at the study hospital, as agreed by the multidisciplinary team, is 5 days or less. An audit of 34 patients was undertaken, over a 3-month period, to see if the orthopaedic department was meeting this target, to examine whether the target was realistic and to highlight any areas that affected achievement of the target. The findings showed that more than half of the patients (68%) achieved the target LoS with the main reason for delayed discharge being dizziness and/or feeling unwell after surgery. Implications for patients and nursing staff, the Trust and future studies will be discussed.

Corrected Proof

Bryan Smith — 2008-12-09

This is a ‘pocket sized’ reference book that considers the main drugs that are prescribed for musculoskeletal conditions. Written for the non-medical prescriber this book identifies a number of key points for the practitioner. The first chapter discusses the law and accountability, followed by a chapter on safe prescribing that includes a couple of checklists for the prescriber. Subsequent chapters examine groups of medication from analgesics to disease modifying anti-rheumatic drugs (DMARD’s) and corticosteroids to osteoporosis medication. The authors do acknowledge that the prescribing arena is constantly changing and that the information offered in this book needs to be considered alongside emerging legislation and drug updates. Information is evidence graded in accordance with the UK Royal College of Physicians guidelines.

Corrected Proof

Peter Davis — 2008-12-09

Increasingly programmes of education are relying on electronic (e)-learning as part of their methods of teaching and learning strategies. This has many advantages for the learner but can also be quite daunting for the beginner. This book is for the relative novice to help them get to grips with e-learning and make the most of it. The many readable chapters take the reader gently and informatively through the trials and tribulations of mastering the new.

A patient’s experience of orthopaedic care - Corrected Proof

Brenda Rush — 2008-12-09

Summary: This paper describes personal experiences in a part of my life involving health care services. I begin by telling you the story of my relationship with Arthur, the relevance of which will become clear later. I end by asking you to consider some learning points from my experience.

Modern pneumatic tourniquets in orthopaedic nursing practice - Corrected Proof

Duncan Robert Bayne, Ankur N. Pandya — 2008-12-09

We enjoyed the comprehensive review article Murphy, S., O’Connor, C., 2007. Modern pneumatic tourniquets in orthopaedic nursing practice. Journal of Orthopaedic Nursing 11 (3–4), 224–228 and agree that the widespread use of tourniquets for limb surgery is an area for ongoing vigilance and practice development.

Implementing and running a fracture liaison service: An integrated clinical service providing a comprehensive bone health assessment at the point of fracture management - Corrected Proof

Gavin Clunie, Sonya Stephenson — 2008-12-09

Summary: The importance of screening adults who have fragility, atraumatic or low impact fractures for underlying osteoporosis has been highlighted in recent British Orthopaedic Association Guidelines and by The American Orthopaedic Association’s ‘Own the Bone’ initiative. Fracture Liaison Services are an efficient way of managing patient screening in a population at high risk of osteoporosis. How a service might be devised, constructed and run in an acute Orthopaedic Unit is illustrated by reference to our own experience, in a UK Hospital serving a population of 320,000 and informed from our own audit data. We discuss the way that varying patient screening thresholds can be considered to focus resources and aim to provide information for those planning a Fracture Liaison Service within an Orthopaedic Unit. We also emphasise the existence of previously-undiagnosed occult conditions (in addition to osteoporosis) in patients <75 years old presenting with fracture but disclosed by routine detailed laboratory tests.

Weight bearing orders after hip fracture surgery: A quality assurance project - Corrected Proof

Joyce A. Mammel, Jenna L. Haugen, Richard E. Buckley — 2008-12-09

Summary: Hip fractures are common injuries that occur primarily in the elderly. For many, it means a loss of their prior level of mobility, or the permanent loss of the ability to live independently. The mortality rate is high; approximately 30% at one year [SIGN: Scottish Intercollegiate Guidelines Network, 2002. Prevention and Management of Hip Fracture in Older People: A National Clinical Guideline. SIGN Executive: Royal College of Physicians, Edinburgh]. Although many aspects of care for the hip fracture patient is evidence based, there is still uncertainty regarding weight bearing status after surgical fixation. This paper outlines a quality assurance project that was conducted in Calgary, Alberta, Canada, to review local practice regarding weight bearing orders after hip fracture fixation, primarily with the use of screws or nails, and compare that to what is suggested in the literature.

22nd International Conference and Exhibition of the Royal College of Nursing Society of Orthopaedic and Trauma Nursing (RCN SOTN), Llandudno, UK 2008 - Corrected Proof

Jean Rogers — 2008-12-09

This year was the first time that the annual RCN SOTN conference had been organised jointly by the Elsevier and the Journal of Orthopaedic Nursing and The RCN SOTN. This turned out to be a recipe for success. Delegates were ‘dazzled’ by the ‘Diamonds are Forever’ theme, looking at continuity and change in orthopaedic and trauma nursing. This was also a fitting way to celebrate the Diamond Jubilee of the National Health Service in the UK. Delegates travelled from far and wide to attend the conference with the aim of gaining and enhancing their knowledge and to network with fellow orthopaedic practitioners.

Orthopaedic nursing in the 1960s – The end of tuberculosis? - Corrected Proof

Jenifer A Booth — 2008-12-09

Summary: Previous articles in this series have described the care of war casualties in the 1940’s and Polio in the 1950’s. Throughout both these periods another infectious disease was the cause of prolonged periods of hospitalization for children and adults. This disease was Tuberculosis (TB). In the 1960’s, as described in this account, these patients were hospitalized for months and often years. Despite advances in drug therapy the principles for the care of these patients formed the basis for much of the orthopaedic nurse training of that period. This personal account reflects on some of the specifics of care from almost half a century ago.

Establishing reliability and validity of a constipation risk assessment scale - Corrected Proof

Janice P. Richmond, Marion E. Wright — 2008-12-09

Summary: Introduction: Constipation presents as a predominant problem within health care, particularly within oncology. Previous publications have reviewed the literature and identified risk factors for constipation. Subsequently a constipation risk assessment scale was developed and subjected to content and face validity analysis.Study purpose: The primary purpose of this paper was to test the reliability of the instrument and further assess the validity of this tool.Reliability analysis: Tests for stability, equivalence and internal consistently demonstrated that the tool was stable over the passage of time, provided equivalent results when different raters used the tool and that the scale was homogenous.Validity analysis: Content and face validity analysis had been performed and outlined in a previous paper. Construct validity was established by contrasting constipated and non-constipated subjects. Subsequently a convenience sample of patients attending for their first cancer treatment, determined the predictive value of the tool. Concurrent validity was established by comparing nurses’ judgements on subjects’ risk of constipation to the category of risk given to each subject by the tool.Conclusion: This research has developed a reliable and valid instrument for constipation risk assessment for use in clinical practice. Ultimately this research extended theory on constipation to the predictive level and produced a comprehensive quantifiable method for assessing risk of constipation.

Selected abstracts from the 22nd Royal College of Nursing Society of Orthopaedic and Trauma Nursing International Conference, Llandudno, North Wales 25–27 September 2008 - Corrected Proof

2008-12-09

What does it mean to be indifferent in the UK? - Corrected Proof

Helen Laverty — 2008-12-09

Uncaring? Unresponsive? Apathetic? Unsympathetic? Uninterested? Unconcerned? Unmoved? And I guess as caring professionals we would not want to see any of these labels attached to our practice or profession. Why then as a health care community in the United Kingdom (UK) are we still reeling from the findings of ‘Death by Indifference’ ()?