Orthopaedic Nursing最新文献

One of the most painful orthopedic surgeries reported is total knee arthroplasty (TKA). Pain management protocols for patients who have had a TKA include enhanced recovery after surgery (ERAS) and multimodal analgesia (MMA) to help decrease opioid consumption. Cryoneurolysis is another method to add preoperatively to this regimen to help patients experience lower pain levels and increase mobility at a faster rate. Non-narcotic methods, such as cryoneurolysis, may give patients improved pain control without adverse effects. The objective of this evidence-based practice project is to examine the impact of adding cryoneurolysis to a Total Joint Replacement Program, specifically the TKA patients. This project supported the objective that patients who have preoperative cryoneurolysis reported more pain control and increased range of motion after having a TKA when compared to standard care.

This single-blind controlled clinical trial compared the effectiveness of rhythmic breathing and music therapy in managing pain, anxiety, heart rate, and blood pressure in patients following orthopedic surgery. A total of 90 patients were recruited from the orthopedic departments of Shahid Chamran Hospital, Shiraz, after orthopedic surgery on the lower limb. Patients were randomly assigned to the intervention and control groups. The rhythmic breathing group practiced breathing techniques for 20 minutes postsurgery, while the music therapy group listened to their chosen instrumental music for the same duration. The control group received no specific intervention. Pain intensity, anxiety levels, pulse rate, and systolic and diastolic blood pressure decreased in both the rhythmic breathing and music therapy groups compared to the control group at both 12 and 24 hr postsurgery (p < .05). The comparison of results between the music therapy and rhythmic breathing groups showed no significant differences in pulse rates or blood pressure (p > .05). Rhythmic breathing was notably effective for pain reduction, while music therapy significantly decreased anxiety levels. These results suggest that integrating nonpharmacological interventions can improve postoperative care and recovery, warranting further research on their long-term benefits and clinical applications.

Patient navigation and care coordination have similar outcomes. The navigator role is necessary for integrated patient-centered care. The National Association of Orthopaedic Nurses conducted informal surveys to understand the nurse navigator role and develop educational resources. A gap exists in understanding orthopaedic nurse navigator knowledge and tasks. The aim of this article is to define the knowledge and tasks necessary for orthopaedic nurse navigators. A survey was developed, tested, and disseminated to individuals who identified as orthopaedic nurse navigators. Ninety-three participants were included in the analysis. Full-time nurse navigators are orthopaedic certified, baccalaureate-prepared registered nurses. Ninety-five percent or more of respondents identified eight knowledge areas and 35 core tasks performed by orthopaedic nurse navigators. This study identified educational topics to be included in orthopaedic nurse navigator education and knowledge and tasks that should be included in orthopaedic nurse navigator position descriptions.

The number and cost of spine surgeries have increased over the past decade. Despite the evidence indicating that Enhanced Recovery After Surgery (ERAS) interventions decrease the stress response to surgery and improve patient outcomes, perioperative interventions for spine surgeries continue to vary across facilities nationwide. A multidisciplinary, evidence-based quality improvement (QI) project was implemented in a community-based acute care facility to address an identified gap in best practice. The Agency for Healthcare Research and Quality has determined ERAS protocols are the gold standard in perioperative care. Preexisting ERAS interventions did exist at the facility, but a complete ERAS protocol was not being utilized. Spine patients were receiving preoperative education, a consult with the pre-anesthesia testing clinic, a balanced anesthetic technique, antibiotics, and chlorhexidine gluconate wipes. A preoperative oral carbohydrate drink, and oral acetaminophen and gabapentin were added to make a complete ERAS bundle. This QI project found a statistically significant reduction in total morphine milligram equivalents required in the post-anesthesia recovery unit (PACU). Patients had improved comfort, which was not statistically significant in the PACU, with reduced need for postoperative nausea and vomiting medications. The length of stay in the PACU increased slightly but was not statistically significant. This QI ERAS bundle is evidence that the use of multimodal analgesia and oral carbohydrate combined with preexisting ERAS spine interventions reduce patients' total amount of narcotics and improve their overall comfort. Individually, these interventions do not appear impactful, but patient outcomes are positively impacted when bundled.

Optimizing pain management has been shown to improve outcomes in adults undergoing orthopaedic procedures, especially in patients older than 65 years. The purpose of this quality improvement project was to determine if listening to music would impact pain scores among adult patients in a 48-bed orthopedic surgery unit. Patients admitted with an orthopedic diagnosis were encouraged to listen to prerecorded music daily, with a goal of 20-30 min. Study results showed that music listening was clinically and statistically significant. The mean baseline numeric rating score of 6.63 (SD = 2.84) reduced to 4.91 (SD = 2.84) after the intervention (p = .001). Participants also reported that music listening helped with falling asleep and resting, decreasing anxiety, and relaxing. Adding complementary therapies like music listening to pharmacological modalities leads to better acute postoperative pain management and decreases the need for additional pain medications including opioids.