Orthopaedic Nursing最新文献

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.

While nurses record pain scores relatively infrequently, hospital-based patients may be more available to routinely document their own pain scores to complement the data collected by nurses. This study compared patient self-recorded versus nurse-recorded pain scores in postsurgical orthopaedic patients to better understand the discrepancies between the two sets of scores and inform future treatment strategies. Orthopaedic trauma service patients were enrolled in this study and asked to fill out a pain report, which was compared to nurse-recorded pain scores. Analyses were performed to assess if patient-recorded and nurse-recorded pain scores were significantly different and if patient-recorded pain scores added useful information to nurse-reported pain scores. Data from 20 patients were available for analysis after 506 individuals were screened. On average, patient-recorded pain scores were more frequently reported than nurse-recorded pain scores. Differences between patient self-recorded and nurse-recorded pain scores were statistically nonrandom and exhibited notable patterns in most of the patients analyzed. These differences were clinically significant 44.3% of the time during which the nurse-recorded and patient self-recorded pain scores overlapped. More frequent self-reporting of postsurgical pain scores in orthopaedic patients reveals statistically nonrandom and clinically significant deviations from nurse-recorded pain scores, suggesting that capturing patient-reported postsurgical pain is an important opportunity to collect information to support the overall medication strategy.