Nurse Nestória Merino de Arce: pioneer in orthopedic and traumatology nursing care

Gangguan muskuloskeletal merupakan penyebab kecacatan paling umum nomor dua di dunia. Di RSU Adhyaksa gangguan muskuloskeletal banyak terjadi mulai dari kasus anak, dewasa hingga lansia. Berdasarkan hal tersebut, asuhan keperawatan ortopedi yang diberikan harus sesuai dengan standar sehingga akan dapat meningkatkan pelayanan yang diberikan. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan asuhan keperawatan ortopedi dengan tingkat kepuasan pasien di RSU Adhyaksa. Metode: metode penelitian ini bersifat kuantitatif, desain penelitian menggunakan deskriptif korelatif dengan pendekatan cross-sectional. Pengumpulan data menggunakan kuesioner yang sudah dilakukan uji validitas sebelum digunakan. Sampel penelitian ini sebanyak 65 responden dengan teknik pengambilan sampel menggunakan total sampling. Analisis data menggunakan uji chi square. Hasil: Diketahui terdapat 87,7% pasien mempersepsikan asuhan keperawatan ortopedi telah dilaksanakan dengan baik serta 86,6% pasien menyatakan puas terhadap layanan yang diberikan. Pada analisis lanjut disimpulkan bahwa terdapat hubungan yang bermakna antara asuhan keperawatan ortopedi dengan kepuasan pasien ortopedi (p: 0,001, α: 0,05). Asuhan keperawatan oropedi yang baik berpeluang 22 kali terhadap kepuasan pasien dibanding asuhan keperawatan yang kurang baik (95% CI OR: 3,82; 127,78). Diskusi: Penelitian ini mendukung temuan penelitian lain yang menyatakan bahwa asuhan keperawatan yang baik akan meningkatkan kepuasan pasien terhadap mutu layanan keperawatan. Pelayanan yang baik akan membuat pasien merasa puas terhadap asuhan keperawatan yang diberikan. Kesimpulan: Penelitian ini menyimpulkan adanya hubungan yang bermakna antara asuhan keperawatan ortopedi dengan Tingkat kepuasan pasien. Penelitian ini merekomendasikan bahwa dibutuhkan penelitian lanjutan dengan desain intervensi berkaitan dengan peningkatan mutu asuhan keperawatan sehingga kepuasan pasien dapat semakin meningkat.Kata Kunci: asuhan keperawatan ortopedi, kepuasan pasien, perawat Correlation Between Orthopedic Nursing Care and Patient Satisfaction Levels at Adhyaksa General Hospital ABSTRACT Musculoskeletal disorders are the second most common cause of disability worldwide. At Adhyaksa General Hospital, these disorders frequently occur across age groups, from children to the elderly. Based on this, orthopedic nursing care provided should align with standards to enhance service quality. Objective: To identify the correlation between orthopedic nursing care and patient satisfaction levels at Adhyaksa General Hospital. Methods: This quantitative study used a descriptive correlational design with a cross-sectional approach. Data were collected using a validated questionnaire. The sample comprised 65 respondents selected through total sampling. Data analysis was conducted using the chi-square test. Results: The findings indicate that 87.7% of patients perceive orthopedic nursing care as well-executed, and 86.6% report satisfaction with the services provided. Further analysis concluded a significant correlation between orthopedic nursing care and orthopedic patient satisfaction (p: 0.001, α: 0.05). High-quality orthopedic nursing care was found to increase the likelihood of patient satisfaction by 22 times compared to lower-quality care (95% CI OR: 3.82; 127.78). Discussion: This study supports previous findings, indicating that good nursing care enhances patient satisfaction with the quality of nursing services, as positive care experiences contribute to patient satisfaction. Conclusion: The study concludes a significant correlation between orthopedic nursing care and patient satisfaction levels. It recommends further research with an intervention design focused on improving nursing care quality to further enhance patient satisfaction.Keywords: Orthopedic Nursing Care, Patient Satisfaction, Nurse

BackgroundPain treatment post orthopaedic care in the elderly is complicated and requires careful follow-up. Current guidelines state all patients prescribed opioids should have a plan for gradual reduction, with the treatment progressively reduced and ended if any pain remains after more than three months. How this works in primary care remains to be explored.The aim was to describe pain treatment and its follow-up in primary care of elderly patients after orthopaedic care.MethodsIn this descriptive study, medical case histories were collected for patients ≥ 75 years, which were enrolled at two rural primary care units in southern Sweden, and were discharged from orthopaedic care. Pain medication follow-up plans were noted, as well as current pain medication at discharge as well as two, six and twelve weeks later.ResultsWe included a total of 49 community-dwelling patients with medication aid from nurses in municipality care and nursing home residents, ≥ 75 years, discharged from orthopaedic care. The proportion of patients prescribed paracetamol increased from 28/49 (57%) prior to admission, to 38/44 (82%) after 12 weeks. The proportion of patients prescribed opioids increased from 5/49 (10%) to 18/44 (41%). Primary care pain medication follow-up plans were noted for 16/49 patients (33%).ConclusionsMany patients still used pain medication 12 weeks after discharge, and follow-up plans were quite uncommon, which may reflect upon lacking follow-up of these patients in primary care.

Objective To investigate the status of orthopedic rehabilitative nursing care. Methods A self-designed questionnaire on the orthopedic rehabilitative knowledge and orthopedic rehabilitative care was used to investigate 250 nurses in the orthopedics department of 10 hospitals. Results 62.45% of the 250 nurses passed the knowledge questionnaire. Nurses comprehended the basis knowledge on orthopedic rehabilitative more than the clinical knowledge; the physiological nursing care of orthopedic rehabilitative was the best, communication with patients' family members was better, and nurses payed few attentions to daily living care, psychological nursing care and following-up after the patients were discharged. Conclusions The clinical knowledge on rehabilitative nursing among the nurses needs timely enhancement, and the work of daily living care, psychological nursing care and following up should be improved. Key words: Orthopedic rehabilitation; Nursing care; Nurse

Along with the increasing of orthopedic disorders incidence, the provision of orthopedic nursing care in Indonesia is also increasing. The Indonesian National Nurses Association (INNA) has published nursing care standards as a reference for nurses in providing nursing care and standardizing nursing care terminologies. Standard-based orthopedic nursing care instruments have been developed, but their effectiveness has not been investigated in improving the quality of nursing services and patient safety. This study aimed to identify the effect of the application of 3S-based Orthopedic Nursing Care (3S-ONC) on the quality of nursing services and patient safety. Descriptive quantitative analysis using a quasi-experimental method with a pretest and posttest with control group design, involving 106 respondents (53 control, 53 intervention), recruited by purposive sampling technique. In the intervention group, nurses provided nursing care by applying the 3S-based Orthopedic Nursing Care (3S-ONC) instrument. The study showed that in both groups, most of the nurses were in the early adult category, dominated by female sex and most of them had professional education level. There were significant differences in the quality of nursing services (p 0.046; α 0.05) and patient safety (p 0.000; α 0.05) between the intervention group and the control group after the application of the 3S-ONC instrument. The 3S-ONC instrument can improve the quality of nursing services and the safety of patients with orthopedic disorders in hospitals.The 3S-ONC instrument can be considered for the development of a paper-based or computer-based nursing care documentation system to further improve the quality of nursing services and patient safety in healthcare facilities, especially in hospital.

Nurses’ experiences of the encounter with elderly patients in acute confusional state in orthopaedic care

Aims/Background A multidisciplinary team (MDT) approach is a nurse-led pain management method that involves collaboration with staff from other departments. The purpose of this paper was to discuss the construction and application effect of a pain care ward in orthopedics utilizing the MDT approach. Methods A retrospective analysis of case data was conducted, selecting 90 patients with hip joint fractures who underwent hip replacement arthroplasty (HRA) at our hospital between February 2021 and February 2024. The patients were divided into two groups based on the nursing methods: a control group (n = 43), which received a conventional analgesic management program, and an intervention group (n = 47), which received the same conventional analgesic management program along with the implementation of an orthopedic pain care ward under the MDT approach. The study compared the pain knowledge and attitudes of the responsible nurses in both groups through questionnaires. Additionally, the accuracy of pain assessments and the awareness rates of patients’ pain-related health education were evaluated and compared between the two groups. Furthermore, the effectiveness of pain intervention, range of motion (ROM), and Hospital for Special Surgery (HSS) scores before and after the intervention were analyzed. The incidence of complications and overall nursing satisfaction were also compared between the two groups. Results The general knowledge, pain assessment, drug analgesia, comprehensive application, and total scores of nurses in the intervention group were significantly higher than those in the control group (p < 0.05). The accuracy rate of nurses’ pain assessments and the awareness rate of patients’ pain health education in the intervention group were 91.49% and 93.62%, respectively, both significantly higher than the 72.09% and 79.07% observed in the control group (p < 0.05). The total effective rate of pain intervention in the intervention group was 74.47%, significantly higher than the 53.49% in the control group (p < 0.05). After the intervention, both the ROM and HSS scores in the intervention group were significantly higher than those in the control group (p < 0.05). The overall incidence of complications in the intervention group was 6.38%, significantly lower than the 20.93% in the control group (p < 0.05). Finally, the total satisfaction rate with nursing care in the intervention group was 91.49%, significantly higher than the 74.42% in the control group (p < 0.05). Conclusion The construction and application of an MDT pain care ward can effectively enhance the accuracy of nurses’ pain assessments, increase patients’ awareness of pain-related health education, and improve the efficiency of pain interventions. Additionally, it can lead to better joint mobility and improved hip function, promoting the sustainable development of the pain care ward. These improvements contribute to higher patient satisfaction and enrich the quality of nursing services.

NCGNP Pioneer in Acute Care and Standards of Practice

This article summarizes the status quo of continuing care for discharged orthopedic patients in China, reviews the models of continuing care in recent years, and looks forward to the development of continuing care. It summarizes the achievements and shortcomings of the development of continuing care in orthopedics in China in recent years with the hope that the development of continuing care can further improve patients' satisfaction, enhance the sense of responsibility of nursing staff, and drive the development of hospitals and departments. Key words: Review; Hospital, orthopedics; Continuing care; Post-discharge healthcare; Progress

Kathleen D Sanford, DBA, RN, CENP, FACHE

Karlene M. Kerfoot, PhD, RN, CNAA, FAAN

Objective To improve the nursing care and shorten the patients recovery time carrying out staged and pluralism health education according to the characteristics of specific diseases.Methods Stagewise was that the health education were divided into 4 stages according to the characteristics of specific diseases,which was through the patients' hospitalization time.Diversification means to carry out the health education popularizedly,extendedly,documentedly,humanizedly,personalizedly,examplifiedly,demonstratedly,feedbackedly,and sustainably.Results After the innovational health education,the patients' master degree was 70％ on stage 1,88％ stage 2,91％ stage 3,and 96％ stage 4.After the traditional health education,the patients' master degree were 68％,80％,78％,and 89％ on the 4 stages,respectively.Conclusions The staged and pluralism health education has overcome the disadvantages of the traditional modes.It improves the nurses' health education skills,enhances the relationship between nurses and patients,reduces the complication and readmission rates after discharge,and shortens the function recovery time. Key words: Health education; Orthopedic nursing care; Stagewise; Pluralism

Most patients admitted in the hospital requiring skilled nursing care are at risk for adverse events or complications from their conditions and treatments. They require close observation during their hospital stays, and care providers must be prepared to detect and intervene quickly when complications occur. Orthopaedic patients are a unique surgical patient population in that their underlying physical conditions, operative locations, and comorbidities can place them at higher risk for complications or adverse events than many other surgical patients. Orthopaedic patients are usually admitted to general acute care surgical units where there are no monitoring devices and the staffing ratios are less intense. In the event that a higher level of surveillance is needed, current practice is to transfer the patient to a care area with telemetry or hardwired monitoring capability, which can result in deviation from the orthopaedic care pathway. In this article, we describe the implementation of best care practices that combine lower nurse to patient ratios, innovative and effective patient education, and continuous surveillance using novel technology in an orthopaedic unit. Data demonstrate that this multifaceted approach to high-quality orthopaedic care has contributed to better patient outcomes.

Exploring the incidence and nature of nursing-sensitive orthopaedic adverse events: A multicenter cohort study using Global Trigger Tool

This report is a case of a healed proximal intertrochanteric femur fracture nonunion in an ancient Nubian adult female, approximately 58 years old at the time of death, from the Tombos archaeological site in present day northern Sudan. Tombos was founded as an Egyptian colonial town during the New Kingdom Period (14001070 BC). The individual was radiocarbon dated to 1114-910 BC and also exhibited healed fractures of the left proximal humerus and ribs. There was shortening and mild atrophy of the right femur compared to the left; radiographs demonstrated a varus deformity of the proximal femur with associated retroversion. Bone density analysis revealed that the tissue mineral density z-score for this individual was −0.798, with the z-score for Tombos females 15–24 years old being 0.396, or a total difference of 1.194. This indicates that the individual was osteopenic but not osteoporotic prior to demise. This is an important case as it occurred approximately 3000 years ago and is the oldest known reported case of a healed intertrochanteric hip fracture in the archaeological literature. Archaeological cases of intertrochanteric hip fractures are rare, with none previously reported from the BC era. The timing of these multiple fractures is unknown, but all healed before the demise of the individual. Thus, there must have been considerable care afforded to such an individual to minimize the morbidities associated with nonoperative care of such a fracture. If all these fractures occurred at the same time due to a traumatic, accidental injury, the Modified Injury Severity Score (MISS) would be 25. Modern day trauma resuscitation and orthopaedic care gives an estimated mortality for such a MISS score of 28% for those <50 years old. It is likely that this individual's high socioeconomic status allowed for intensive nursing care which likely decreased the morality risk.

BackgroundFirst-line managers have a unique role and potential in encouraging the use of evidence-based clinical practice guidelines (CPGs) and thus serve the provision of safe patient care. In acute and planned hospital care, effective yet safeguarded nursing procedures are a necessity. Little is currently known about how first-line managers engage in supporting the adoption of evidence-based nursing care and about what barriers and enablers there are for implementation of CPGs in the orthopaedic care context.PurposeTo investigate first-line managers’ experience of clinical practice guideline implementation in orthopaedic care.MethodsThis qualitative interview study included 30 first-line nursing and rehabilitation managers in 17 orthopaedic units in Sweden. A deductive content analysis, with the Ottawa Model of Implementation Leadership as a guide, was employed.ResultsTo the first-line managers, any guideline implementation required them to balance contexts, including their outer context (signified by the upper-level management and decision-makers) and their inner context, including staff and patients in their unit(s). Acting in response to these contexts, the managers described navigating the organization and its terms and conditions; using relations-, change-, and task-oriented leadership, such as involving the staff; motivating the change by emphasizing the patient benefits; and procuring resources, such as time and training. Even though they knew from past experience what worked when implementing CPGs, the first-line managers often encountered barriers within the contexts that hampered successful implementation.ConclusionsAlthough first-line managers know how to effectively implement CPGs, an organization’s terms and conditions can limit their opportunities to fully do so. Organizational awareness of what supports and hinders first-line managers to offer implementation leadership can enhance opportunities to alter behaviours and conditions for the benefit of CPG implementation.Trial registrationThe study was registered as NCT04700969 with the U.S. National Institutes of Health Clinical Trials Registry on 8 January 2021.