International Journal of Orthopaedic and Trauma Nursing最新文献

英文中文

Enhanced recovery pathways in orthopaedic and trauma care: Nursing at the centre of interdisciplinary innovation 加强骨科和创伤护理的恢复途径：跨学科创新中心的护理。

IF 2.1 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2025-11-01 Epub Date: 2025-08-05 DOI: 10.1016/j.ijotn.2025.101215

Thomas W. Wainwright , Paul McLiesh

引用次数: 0

Nurse-led intervention in deep vein thrombosis development following major orthopedic surgery: A quality improvement project 护士主导的骨科大手术后深静脉血栓形成的干预：一个质量改进项目

IF 2.1 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2025-11-01 Epub Date: 2025-10-30 DOI: 10.1016/j.ijotn.2025.101238

Chunming Yuan , Hao Wen , Xianbo Wu , Xiaorong Mao , Michael Zychowicz

Background

Deep vein thrombosis (DVT) accounts for most of thrombotic events following major orthopedic surgery. The development of DVTs increases medical costs and affects patient outcomes. Evidence suggests that ankle exercise helps to prevent DVTs after orthopedic surgery.

Method

A quality improvement project employing a quasi-experimental study design was conducted at a tertiary specialized hospitalized setting from August 2023 to January 2024. The project implemented a nurse-led evidence-based ankle exercise practice among adult patients undergoing major orthopedic surgery, aimed at evaluating the implementation process outcomes including staff adherence and agreement to the practice, and assessing patient outcome for the impact of the practice in DVT development. Nurse adherence was assessed by chart review, nurse agreement was collected using a validated Chinese version Normalization Measure Development (NoMAD) survey tool, DVT rate obtained as patient outcome was calculated via hospital information system.

Results

Nurse adherence to the evidence-based ankle exercise practice was 83 %. There were varying levels of agreement based on specific aspects of the NoMAD survey tool (100 % coherence insights; 85 % cognitive participation; 83.8 % reflexive monitoring; 68.6 % collective action). The incidence of DVT declined after the intervention introduction from 6.5 % to 4.8 % (p = .681).

Conclusions

Through this nurse-led evidence-based ankle exercise practice, we identified nurses adhered to the working process, and the DVT rate decreased in major orthopedic surgery. Further, a more rigorous study with a larger sample size might be needed to confirm the effectiveness of the ankle exercise in preventing DVT on major orthopedic surgery.

深静脉血栓形成（DVT）是骨科大手术后血栓形成的主要原因。深静脉血栓的发展增加了医疗费用并影响了患者的预后。有证据表明踝关节运动有助于预防骨科手术后的深静脉血栓形成。方法采用准实验研究设计，于2023年8月至2024年1月在某三级专科医院实施质量改进项目。该项目在接受重大骨科手术的成年患者中实施了一项由护士主导的循证踝关节锻炼实践，旨在评估实施过程的结果，包括员工对实践的遵守和同意，并评估实践对深静脉血栓形成的影响。通过图表回顾评估护士依从性，使用经过验证的中文版标准化测量发展（NoMAD）调查工具收集护士同意，通过医院信息系统计算作为患者结局的DVT率。结果护士对循证踝关节运动训练的依从率为83%。基于NoMAD调查工具的具体方面，有不同程度的同意（100%的一致性见解；85%的认知参与；83.8%的反射性监测；68.6%的集体行动）。干预后DVT的发生率从6.5%下降到4.8% （p = .681）。结论通过护士主导的循证踝关节锻炼实践，我们发现护士坚持工作流程，在骨科大手术中DVT发生率下降。此外，可能需要更严格、更大样本量的研究来证实踝关节运动在预防骨科大手术中DVT的有效性。

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引用次数: 0

From surgery to struggle: Recovery journeys after periprosthetic knee fractures 从手术到挣扎：膝关节假体周围骨折后的康复之旅

IF 2.1 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2025-11-01 Epub Date: 2025-09-22 DOI: 10.1016/j.ijotn.2025.101234

Javed Iqbal, Brijesh Sathian, Syed Muhammad Ali

引用次数: 0

Evaluating pressure injury and time of risk assessment for adults with hip fractures: A retrospective analysis 评估成人髋部骨折的压力损伤和风险评估时间：回顾性分析

IF 1.5 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2025-08-01 Epub Date: 2025-05-21 DOI: 10.1016/j.ijotn.2025.101195

Penelope Anderson , Huaqiong Zhou , Vicki Patton , John Taplin

Background

Pressure injuries are a worldwide concern for patients in the acute hospital setting. They are a common hospital-acquired complication and Australian national standards, state policies, and local procedures have been developed to reduce incidence. Risk assessment is purported to be the gold standard in prevention.

This study examined the association between the time of pressure injury risk assessment, the presence of a pressure injury prevention management plan, and the development of hospital-acquired pressure injury(s) in the high-risk cohort of hip fracture patients at a regional base hospital in New South Wales.

Method

A retrospective descriptive study was conducted from routinely collected data, extracted from the electronic medical record and the incident management system. Patients with hospital-acquired pressure injuries were matched to those without and comparisons were made.

Results

Four hundred and eighty patients presented with a primary diagnosis of hip fracture. Twenty-four (5 %) developed at least one pressure injury during admission. Eight (33 %) of the study group and four (16.5 %) of the comparison group had a risk assessment completed within 8 h per hospital procedure. There was no correlation between risk assessment within 8 h and development of a pressure injury. Patients who developed pressure injuries were older than those who did not (mean 86 vs 80 years, p = 0.021).

Conclusion

There was no correlation between early pressure injury risk assessment and pressure injury development for hip fracture patients. Formal risk assessment by nurses did not prevent pressure injuries in patients with high-risk presentation of hip fracture. Maximum prevention strategies should be routinely implemented by nurses.

背景：压力性损伤是世界范围内急性病患者关注的问题。它们是一种常见的医院获得性并发症，澳大利亚的国家标准、州政策和地方程序已经制定，以减少发病率。风险评估被认为是预防的黄金标准。本研究探讨了新南威尔士州一家地区基地医院髋部骨折患者高危队列中压力性损伤风险评估时间、压力性损伤预防管理计划的存在与医院获得性压力性损伤发展之间的关系。方法从电子病历和事故管理系统中提取常规收集的资料进行回顾性描述性研究。有医院获得性压力损伤的患者与没有的患者相匹配，并进行比较。结果480例患者首发诊断为髋部骨折。24例（5%）在入院时发生至少一次压伤。研究组中有8例（33%）和对照组中有4例（16.5%）在每次住院治疗的8小时内完成了风险评估。8小时内的风险评估与压力损伤的发生没有相关性。发生压伤的患者比未发生压伤的患者年龄大（平均86岁vs 80岁，p = 0.021）。结论髋部骨折患者早期压力性损伤风险评估与压力性损伤发展无相关性。护士进行的正式风险评估并不能预防髋部骨折高危患者的压伤。护士应常规实施最大限度的预防策略。

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引用次数: 0

Enhanced recovery after surgery in total joint arthroplasty: Nurses experiences of a pilot model of care 全关节置换术后增强康复：护士护理试点模式的经验

IF 1.5 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2025-08-01 Epub Date: 2025-07-07 DOI: 10.1016/j.ijotn.2025.101212

Kate Schimmelbusch , Karen Blakemore , Marisa Delahunt , Rebekah McGaw , Rebecca J. Jarden , Andrew Hardidge , Elizabeth Walkley

Background

Implementation of a fast-track model of care to support next-day discharge in joint arthroplasty can enhance the patient journey, improve nurses’ job satisfaction while also reducing length of stay.

Objectives

The objectives of this study were to explore nurses' experiences and perceptions of an Enhanced Recovery Program and develop an understanding of the contribution of the program to the delivery of care. The research question was: what are nurses’ experiences and perceptions of an enhanced recovery program?

Methods

A multidisciplinary team developed, piloted, and evaluated an Enhanced Recovery Program for hip and knee arthroplasty patients. Nurses’ experiences and perceptions of using an Enhanced Recovery Program were explored through semi-structured focus group discussion. Data were inductively thematically analysed through an iterative and reflexive process.

Findings

Eight nurses participated in the focus group in February 2025. Three themes became apparent: (1) Patient preparedness which encompassed patient education and goal setting expectations, (2) Nurses leading care including early mobilisation, multimodal analgesia, and use of a clinical pathway and (3) Nurse satisfaction resulting in perceived increased collaboration amongst the multidisciplinary team and positive workload impacts.

Conclusions

There was a consensus amongst participants that the enhanced recovery program had a positive impact on participants’ working lives and supported high quality and safe patient care.

实施快速通道护理模式以支持关节置换术的次日出院，可以缩短患者的旅程，提高护士的工作满意度，同时缩短住院时间。目的本研究的目的是探讨护士对强化康复计划的经验和看法，并了解该计划对提供护理的贡献。研究的问题是：护士对强化康复计划的经验和看法是什么？方法一个多学科团队开发、试点并评估了髋关节和膝关节置换术患者的增强康复计划。通过半结构化的焦点小组讨论，探讨了护士使用增强康复计划的经验和看法。通过迭代和反身过程对数据进行归纳性主题分析。结果：2025年2月有8名护士参加了焦点小组。三个主题变得明显：(1)患者准备，包括患者教育和目标设定期望；(2)护士领导护理，包括早期动员、多模式镇痛和临床途径的使用；(3)护士满意度，导致多学科团队之间的协作增加，并对工作量产生积极影响。结论：参与者一致认为，增强康复计划对参与者的工作生活有积极影响，并支持高质量和安全的患者护理。

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引用次数: 0

The importance of specialist orthopaedic nursing education 浅谈骨科专科护理教育的重要性

IF 1.5 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2025-08-01 Epub Date: 2025-06-02 DOI: 10.1016/j.ijotn.2025.101204

Jennie Walker (Dr)

引用次数: 0

Impact of obesity on outcomes after total hip and knee replacement: A study on hospital length of stay and readmission rates in NHS Scotland 肥胖对全髋关节和膝关节置换术后预后的影响：苏格兰NHS住院时间和再入院率的研究

IF 2.1 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2025-08-01 Epub Date: 2025-08-06 DOI: 10.1016/j.ijotn.2025.101216

Wissem Tafat , David McDonald , Marcin Budka , Thomas W. Wainwright

Introduction

Obesity presents significant challenges in the perioperative management of patients undergoing total hip replacement (THR) and total knee replacement (TKR). This study investigates the association between BMI and the outcome measures length of stay and 30-day readmission rate, among National Health Service (NHS) patients in Scotland.

Methods

This analysis included data from 50,751 patients who underwent THR or TKR between July 2019 and February 2025. BMI was categorised into six groups then further divided into two categories: “Not Obese” and “Obese”. LOS was classified as short or long. The analysis included a statistical method to visualise the relationship between BMI and the outcomes and logistic regression models that incorporated additional factors to assess their association with the outcomes.

Results

Patients with a BMI ≥40 had a longer mean length of stay (LOS) of 3.44 days and a median of 3 days, compared to a mean of 3.02 days and a median of 2 days among those with BMI <40 (p < 0.001). The odds of experiencing a prolonged hospital stay increased progressively with BMI thresholds: odds ratios were 1.43 for BMI ≥40, 1.53 for BMI ≥45, and 1.89 for BMI ≥50 (all p < 0.001). Patients with higher BMI, particularly those classified as Super Obese, demonstrated elevated 30-day readmission rates, reaching up to 17.5 %.

Conclusion

Higher BMI, especially in the morbidly and super obese ranges, is associated with extended hospital stays and increased 30-day readmission rates following THR and TKR.

肥胖症是全髋关节置换术（THR）和全膝关节置换术（TKR）患者围手术期管理的重大挑战。本研究调查了BMI与苏格兰国民健康服务（NHS）患者住院时间和30天再入院率之间的关系。该分析包括2019年7月至2025年2月期间接受THR或TKR的50,751例患者的数据。BMI被分为六组，然后进一步分为两类：“不肥胖”和“肥胖”。LOS分为短期和长期。分析包括一种统计方法来可视化BMI和结果之间的关系，以及包含其他因素的逻辑回归模型来评估它们与结果的关系。结果BMI≥40患者的平均住院时间（LOS）为3.44天，中位数为3天，BMI≥40患者的平均住院时间（LOS）为3.02天，中位数为2天(p <；0.001)。随着BMI阈值的增加，住院时间延长的几率逐渐增加：BMI≥40的优势比为1.43，BMI≥45的优势比为1.53，BMI≥50的优势比为1.89(均p <；0.001)。BMI较高的患者，特别是那些被归类为超级肥胖的患者，30天再入院率升高，达到17.5%。结论较高的BMI与THR和TKR术后住院时间延长和30天再入院率增加有关，尤其是在病态和超肥胖范围。

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引用次数: 0

Do pre- and post- rehabilitation influence hospital length of stay and patient recovery following total hip replacement in the UK? A systematic scoping review and Delphi study 在英国，术前和术后康复是否影响全髋关节置换术后的住院时间和患者康复？一个系统的范围审查和德尔菲研究

IF 1.5 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2025-08-01 Epub Date: 2025-06-14 DOI: 10.1016/j.ijotn.2025.101209

Rebecca Willis , Rania Edris , Sally Akehurst , Francesco V. Ferraro

Pre-operative rehabilitation is an effective means of reducing Length of Stay (LoS), but little evidence is available on its influence on Total Hip Replacement (THR) patients. Hence, a review of UK-based experimental studies to evaluate the effect of physical therapy on LoS was performed. Subsequently, a narrative synthesis was employed to develop a three-round Delphi study targeting UK clinicians. The review and Delphi results showed that patients had higher satisfaction with education clinics, but nurse-led assessment and physiotherapist education were not superior to standard pre-operative practices. The Delphi highlighted the challenges and benefits of (p)rehabilitation and provided suggestions for THR best practices. In conclusion, the study shows that there is a lack of evidence on the effectiveness of (p)rehabilitation on LoS; further research is recommended into education, (p)rehabilitation and patient self-efficacy interventions to enhance THR patients' pathways.

术前康复是减少住院时间（LoS）的有效手段，但其对全髋关节置换术（THR）患者影响的证据很少。因此，我们对英国的实验研究进行了回顾，以评估物理治疗对LoS的影响。随后，采用叙事综合来开发针对英国临床医生的三轮德尔菲研究。回顾和德尔菲结果显示，患者对教育诊所的满意度较高，但护士主导的评估和物理治疗师教育并不优于标准的术前实践。Delphi强调了(p)康复的挑战和益处，并为THR的最佳实践提供了建议。总之，本研究表明，缺乏证据表明(p)康复对LoS的有效性；建议进一步研究教育，(p)康复和患者自我效能干预，以加强THR患者的途径。

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引用次数: 0

Corrigendum to “Postoperative recovery in orthopedic surgery: Exploring the roles of pain intensity, opioid consumption, pain catastrophizing, and emotional distress” [Int. J. Orthopaedic Trauma Nurs. 57 (2025) 101185] “骨科手术术后恢复：探讨疼痛强度、阿片类药物消耗、疼痛灾难化和情绪困扰的作用”的勘误[j]。[j] .中华骨科杂志，2004,12(5):357 - 357。

IF 2.1 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2025-08-01 Epub Date: 2025-08-26 DOI: 10.1016/j.ijotn.2025.101220

Heba Khalil , Abedalmajeed Shajrawi , Fatma Refaat Ahmed , Wegdan Bani-Issa , Nabeel Al-Yateem , Loai Abu Shahrour , Alham Al-Sharman , Muhammad Arsyad Subu , Richard Mottershead , Ahmed Mohammad Al-Smadi , Khalil Yousef

引用次数: 0

To lose weight or to weight the loss? Insights into the use of the body mass index in preoperative assessment before major orthopaedic surgery 是减肥还是加重体重？大骨科手术前体重指数在术前评估中的应用

IF 1.5 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2025-08-01 Epub Date: 2025-05-17 DOI: 10.1016/j.ijotn.2025.101192

Matteo Briguglio , Marialetizia Latella , Claudio Cordani , Stefano Petrillo , Francesco Langella , Riccardo Cecchinato , Pedro Berjano , Fabrizio E. Pregliasco , Robert G. Middleton , Thomas W. Wainwright

The ERAS (Enhanced Recovery After Surgery) guidelines in major orthopaedic surgery do not address the issue of managing excess body weight in patients scheduled for hip and knee replacement or lumbar fusion. This aspect is relevant to practice due to the increasing number of obese individuals and to some evidence suggesting higher complication rates in patients with excess weight. There is a debate on whether obesity defined by the body mass index, i.e. the ratio of weight to squared height, can guide surgical eligibility and whether losing excess weight preoperatively can actually lead to better outcomes. In this practice development article, we explore opposing perspectives on the value of a high BMI as an indicator of increased preoperative risk and discuss the potential consequences of losing weight prior to a major orthopaedic surgery. The aim is to promote a conscious management of individuals with excess body fat based on the patient's overall health rather than BMI alone. In the absence of strong evidence on what is best to do, it is reasonable to suggest that any prehabilitation initiatives should not focus on a rigid weight loss mandate but on a multidisciplinary, multimodal, and personalised approach that does not necessarily include a reduction in body weight.

骨科大手术的ERAS（术后增强恢复）指南并没有解决计划进行髋关节和膝关节置换术或腰椎融合术患者体重过重的问题。这方面与实践有关，因为肥胖个体数量不断增加，一些证据表明超重患者的并发症发生率更高。关于体重指数（即体重与身高的平方之比）定义的肥胖是否可以指导手术资格，以及术前减掉多余的体重是否真的能带来更好的结果，目前存在争议。在这篇实践发展文章中，我们探讨了关于高BMI作为术前风险增加指标的价值的对立观点，并讨论了大型骨科手术前减肥的潜在后果。其目的是促进对身体脂肪过多的个体进行有意识的管理，这是基于患者的整体健康状况，而不仅仅是BMI。在缺乏强有力的证据证明什么是最好的情况下，我们有理由建议，任何康复计划都不应侧重于严格的减肥任务，而应侧重于多学科、多模式和个性化的方法，而不一定包括减轻体重。

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