- Email: [email protected]
Literature reviews
International Journal of Orthopaedic and Trauma Nursing (2010) 14, 58–60
International Journal of Orthopaedic and Trauma Nursing www.elsevier.com/locate/ijotn
LITERATURE REVIEWS European orthopaedic and trauma patients’ perceptions of nursing care: A comparative study Suhonen, R., Berg, A., Idvall, E., Kalafati, M., Katajisto, J., Land, L., Lemonidou, C. Schmidt, L.A., Valimaki, M. Leino-Kilpi, H., (2009) This paper reports on a research study that took place in four different European countries. This reflects the potential for orthopaedic patients to be cared for in other countries besides their own and offered the opportunity to consider the similarities and differences in patients’ perceptions of the care they received in England, Finland, Greece and Sweden. The aims of the study were to ascertain how orthopaedic and trauma nursing care is perceived in these countries and to see if there were any differences between countries in patients’ perceptions of the care they received on orthopaedic trauma wards. Such international studies which focus on quality of nursing care are rare, making this important new knowledge and thought-provoking material for discussion amongst orthopaedic and trauma nurses. It demonstrates how international links offer opportunities for learning about practice. The study was conducted in acute hospitals in all four countries and involved a total of 24 wards from which a total convenience sample of 1096 patients about to be discharged from hospital was recruited. The majority of patients had scheduled admissions – except in Greece where the majority of patients were unscheduled. For data collection, the researchers used a tool known and the ‘Schmidt Perception of Nursing Care Survey’ (SPNCS). This tool was designed in the USA to record patients’ perceptions of their nursing care and consists of four sub-concepts: ‘Seeing the Individual Patient’, ‘Explaining’, ‘Responding’ and ‘Watching Over’. The tool has been shown to have good reliability and validity and was translated into the appropriate language for each country involved in the
doi:10.1016/j.ijotn.2009.11.001
study. This paper mainly focuses on the results of the study as the methods have been described in more detail in other papers. A variety of statistical procedures were used by the researchers to analyse the data from each country and then comparisons between countries made. Differences in patient perceptions of nursing care were found between countries. In particular, the Swedish and Finnish patients rated their care most highly and the Greek patients the lowest. Inferences cannot, however, be drawn from this. Because patients appear to be more satisfied, this does not necessarily mean that care is better or worse in any given setting as culture, conditions and practices will certainly be different. The authors of this paper conclude that further research is needed to understand if the differences found between these countries were related to differences in care provided or in culture, practices and roles. The data was not collected in the same way across all four countries and the sample was a convenience sample. These issues suggest potential biases in the research. However, it is clear from this research, that the SPNCS, is an appropriate tool for studying perceptions of nursing care across orthopaedic settings and should be considered for future research in this area. Journal of Clinical Nursing 18: 2818–2829 Caring for undernourished patients in an orthopaedic setting Khalaf, A., Berggren, V., Westergren, A., (2009) Patient diet and nutrition is a frequently discussed issue in Orthopaedic and Trauma practice and there have been many studies considering the impact of undernourishment, particularly in elderly trauma patients. It is well known that nutrition affects recovery, length of stay and complication
Literature reviews rates even though a great deal is known about how undernourishment can be prevented. The issues are complex. The study reported in this paper was conducted in Sweden where undernourished patients are known as ‘the thin ones’. The findings of the study and the discussion, however, are equally applicable to practitioners working in other countries where malnourishment is a health care problem. The purpose of the study was to explore nurses’ experiences of and ethical reflections on nutritional care of undernourished patients. This was done using a qualitative approach through a series of interviews with a purposive sample of eight nurses and five nursing assistants. The interview data was analysed using content analysis of the participants’ narratives, which were very extensive and illuminated the participants’ experiences of undernourishment and ethics in orthopaedic care. In the interviews the participants referred to the undernourished patients as ‘low-fat endowed, thin, undernourished’, ‘a very thin lady’, ‘dehydrated, thin and eats poorly’ and ‘they are like small baby birds’ – this certainly has parallels with terms used in the UK and, possibly, elsewhere. Three main categories were identified in the analysis of the data. The first category, ‘to be frustrated in nursing’, included sub-categories of: ‘organization-related stress’, ‘to be exposed and lonely’, ‘experience of powerlessness and helplessness’ and ‘experience of being torn between demands and needs’. The expressed feelings of ethical conflict and being unable to make decisions due to stress and organizational factors were clearly described. Lots of patients needing help with feeding and a lack of time were significant issues, although the respondents did discuss some of the measures that were in place to help to provide good nutritional care. The participants discussed the feeling of being torn between the care demands and patient needs as well as the patients’ own desires. The second category: ‘to experience joy in nursing’ included subcategories of ‘create a trustful relationship’, ‘promote pleasure in the meal situations’, and ‘respect for each individual’s life-style and context of life’. The joy of nursing when staff felt less stressed was highlighted. When they were able to give the care that they wanted to they were able to engender trust in patients, use meal situations to encourage patients to eat and be able to provide individualised nutritional care. The third category: ‘undernourishment is taboo’ had one subcategory; ‘experience of guilt’. The authors discuss the respondent’s feelings that undernourishment occurred before admission. They
59 also expressed feelings of guilt and self-accusation, possibly leading to denial of the problem. This section of the paper is illustrated with direct quotes from the respondents that are sobering to read and highlight how uncommon it is for practitioners to discuss the issue of undernourishment because of its shamefulness and the ethical tensions. This important and relevant paper considers this issue from a nursing ethics angle in that it offers an ethical perspective to the issues that are often discussed from a more practical angle. It demonstrates the frustrations for nurses of being unable to provide the level of care they would like when time and other resources are limited, but also shows how reluctant practitioners may be to discuss the implications of this aspect of care. The paper clearly highlights how much of a problem undernourishment is and how important it is that practitioners begin to undertake that often ignored and difficult dialogue about why and how the issues need to be resolved for care to reach the quality it should do in the orthopaedic setting. Nursing Ethics 16: 5–18 Creating a therapeutic environment: A non-randomised controlled trial of a quiet time intervention for patients in acute care Gardner, G., Collins, C., Osborne, S., Henderson, A., Eastwood, M. The important role of rest and sleep in recovery from surgery and traumatic injury is well known. Ensuring that patients get enough rest and sleep is not always easy in the hospital setting where noise and constant care activity means that patients find it difficult to rest and sleep, with consequent impact on well-being. The aim of this Australian study was to assess the value of scheduling time for rest in an acute care setting and its impact on sleep, rest and health outcomes. The study was conducted as a ‘multi-centred non-randomised parallel group trial’. The research was conducted on the acute orthopaedic wards at two hospitals in Brisbane. One site was a control site and the other the experimental site where the ‘quiet-time intervention’ was implemented. The intervention included a designated quiet-time between 1400 and 1530h – involving the restriction of visitors, staff movement and treatment activities. Patient sleep and rest was promoted through comfort and pain relief interventions and reducing environmental light and noise. Data were collected over five months. A total of 299 patients were recruited – 138 on the experimental unit and 161 on the control unit. A variety
60
Literature reviews
of different statistical procedures were used to explore the differences between the two groups. The researchers studied sound levels and sleep status – showing statistical differences in the number of patients asleep and wake and that the experimental group patients experienced half the noise that the control group patients did at the stated times. Health status was studied using a questionnaire known as the SF12 although significant differences due to the intervention were not shown. Patients, staff and visitors were shown to be satisfied with the intervention on the whole. This was a quasi-experimental study, meaning that the lack of randomisation of subjects to the intervention and control places significant potential bias on the study and that it cannot be claimed that the results are as a direct consequence of the intervention. To conduct a true experiment to study these issues would be impossible in the clinical setting, so it is important that the implications of the study are considered seriously in spite of this and it seems reasonable to expect that such an intervention is beneficial in the recovery and well being of orthopaedic patients. International Journal of Nursing Studies 46: 778–786
describe the impact of those delays, to develop a flow-chart of the care process and clarify the roles of staff involved in the process of care delivery. An action research approach was used to undertake the study which initially involved describing the current care process. The team then considered how information could be gathered about performance in terms of surgical delays. Among other data, a log was kept of admissions and the times that children went to the operating theatre for surgery. Complaints about delays were also analysed. All staff on the unit were encouraged to participate in discussion. This enabled the team to have a clear picture of performance as well as the likely causes of problems and to identify changes needed to resolve some of the issues leading to some of the delays. A ‘trauma board’ was implemented to provide more detailed information about children waiting for surgery and a flowchart of responsibilities and actions was created to help staff to improve communication within the team and with the children and families. Although further work is needed to assess the impact of the changes made on waiting times and satisfaction, the study demonstrates how the principles of action research can help staff to highlight and tackle issues that are impacting on the quality of patient care.
Waiting for surgery after orthopaedic trauma Beringer, A., Hagan, L. Goodman, H. Waiting times for urgent trauma surgery are often discussed in the literature. The impact on well-being of children waiting for surgery following orthopaedic trauma is significant; leading to additional pain, stress and anxiety for children and their families and long pre-operative fasting times, which can be detrimental to recovery. The aim of this UK research was to study the delays in children receiving surgery for orthopaedic trauma, to
Paediatric Nursing 21: 34–37 Julie Santy Co-Editor International Journal of Orthopaedic and Trauma Nursing University of Hull, Hull, England E-mail address: [email protected]
Available online at www.sciencedirect.com
International Journal of Orthopaedic and Trauma Nursing www.elsevier.com/locate/ijotn
LITERATURE REVIEWS European orthopaedic and trauma patients’ perceptions of nursing care: A comparative study Suhonen, R., Berg, A., Idvall, E., Kalafati, M., Katajisto, J., Land, L., Lemonidou, C. Schmidt, L.A., Valimaki, M. Leino-Kilpi, H., (2009) This paper reports on a research study that took place in four different European countries. This reflects the potential for orthopaedic patients to be cared for in other countries besides their own and offered the opportunity to consider the similarities and differences in patients’ perceptions of the care they received in England, Finland, Greece and Sweden. The aims of the study were to ascertain how orthopaedic and trauma nursing care is perceived in these countries and to see if there were any differences between countries in patients’ perceptions of the care they received on orthopaedic trauma wards. Such international studies which focus on quality of nursing care are rare, making this important new knowledge and thought-provoking material for discussion amongst orthopaedic and trauma nurses. It demonstrates how international links offer opportunities for learning about practice. The study was conducted in acute hospitals in all four countries and involved a total of 24 wards from which a total convenience sample of 1096 patients about to be discharged from hospital was recruited. The majority of patients had scheduled admissions – except in Greece where the majority of patients were unscheduled. For data collection, the researchers used a tool known and the ‘Schmidt Perception of Nursing Care Survey’ (SPNCS). This tool was designed in the USA to record patients’ perceptions of their nursing care and consists of four sub-concepts: ‘Seeing the Individual Patient’, ‘Explaining’, ‘Responding’ and ‘Watching Over’. The tool has been shown to have good reliability and validity and was translated into the appropriate language for each country involved in the
doi:10.1016/j.ijotn.2009.11.001
study. This paper mainly focuses on the results of the study as the methods have been described in more detail in other papers. A variety of statistical procedures were used by the researchers to analyse the data from each country and then comparisons between countries made. Differences in patient perceptions of nursing care were found between countries. In particular, the Swedish and Finnish patients rated their care most highly and the Greek patients the lowest. Inferences cannot, however, be drawn from this. Because patients appear to be more satisfied, this does not necessarily mean that care is better or worse in any given setting as culture, conditions and practices will certainly be different. The authors of this paper conclude that further research is needed to understand if the differences found between these countries were related to differences in care provided or in culture, practices and roles. The data was not collected in the same way across all four countries and the sample was a convenience sample. These issues suggest potential biases in the research. However, it is clear from this research, that the SPNCS, is an appropriate tool for studying perceptions of nursing care across orthopaedic settings and should be considered for future research in this area. Journal of Clinical Nursing 18: 2818–2829 Caring for undernourished patients in an orthopaedic setting Khalaf, A., Berggren, V., Westergren, A., (2009) Patient diet and nutrition is a frequently discussed issue in Orthopaedic and Trauma practice and there have been many studies considering the impact of undernourishment, particularly in elderly trauma patients. It is well known that nutrition affects recovery, length of stay and complication
Literature reviews rates even though a great deal is known about how undernourishment can be prevented. The issues are complex. The study reported in this paper was conducted in Sweden where undernourished patients are known as ‘the thin ones’. The findings of the study and the discussion, however, are equally applicable to practitioners working in other countries where malnourishment is a health care problem. The purpose of the study was to explore nurses’ experiences of and ethical reflections on nutritional care of undernourished patients. This was done using a qualitative approach through a series of interviews with a purposive sample of eight nurses and five nursing assistants. The interview data was analysed using content analysis of the participants’ narratives, which were very extensive and illuminated the participants’ experiences of undernourishment and ethics in orthopaedic care. In the interviews the participants referred to the undernourished patients as ‘low-fat endowed, thin, undernourished’, ‘a very thin lady’, ‘dehydrated, thin and eats poorly’ and ‘they are like small baby birds’ – this certainly has parallels with terms used in the UK and, possibly, elsewhere. Three main categories were identified in the analysis of the data. The first category, ‘to be frustrated in nursing’, included sub-categories of: ‘organization-related stress’, ‘to be exposed and lonely’, ‘experience of powerlessness and helplessness’ and ‘experience of being torn between demands and needs’. The expressed feelings of ethical conflict and being unable to make decisions due to stress and organizational factors were clearly described. Lots of patients needing help with feeding and a lack of time were significant issues, although the respondents did discuss some of the measures that were in place to help to provide good nutritional care. The participants discussed the feeling of being torn between the care demands and patient needs as well as the patients’ own desires. The second category: ‘to experience joy in nursing’ included subcategories of ‘create a trustful relationship’, ‘promote pleasure in the meal situations’, and ‘respect for each individual’s life-style and context of life’. The joy of nursing when staff felt less stressed was highlighted. When they were able to give the care that they wanted to they were able to engender trust in patients, use meal situations to encourage patients to eat and be able to provide individualised nutritional care. The third category: ‘undernourishment is taboo’ had one subcategory; ‘experience of guilt’. The authors discuss the respondent’s feelings that undernourishment occurred before admission. They
59 also expressed feelings of guilt and self-accusation, possibly leading to denial of the problem. This section of the paper is illustrated with direct quotes from the respondents that are sobering to read and highlight how uncommon it is for practitioners to discuss the issue of undernourishment because of its shamefulness and the ethical tensions. This important and relevant paper considers this issue from a nursing ethics angle in that it offers an ethical perspective to the issues that are often discussed from a more practical angle. It demonstrates the frustrations for nurses of being unable to provide the level of care they would like when time and other resources are limited, but also shows how reluctant practitioners may be to discuss the implications of this aspect of care. The paper clearly highlights how much of a problem undernourishment is and how important it is that practitioners begin to undertake that often ignored and difficult dialogue about why and how the issues need to be resolved for care to reach the quality it should do in the orthopaedic setting. Nursing Ethics 16: 5–18 Creating a therapeutic environment: A non-randomised controlled trial of a quiet time intervention for patients in acute care Gardner, G., Collins, C., Osborne, S., Henderson, A., Eastwood, M. The important role of rest and sleep in recovery from surgery and traumatic injury is well known. Ensuring that patients get enough rest and sleep is not always easy in the hospital setting where noise and constant care activity means that patients find it difficult to rest and sleep, with consequent impact on well-being. The aim of this Australian study was to assess the value of scheduling time for rest in an acute care setting and its impact on sleep, rest and health outcomes. The study was conducted as a ‘multi-centred non-randomised parallel group trial’. The research was conducted on the acute orthopaedic wards at two hospitals in Brisbane. One site was a control site and the other the experimental site where the ‘quiet-time intervention’ was implemented. The intervention included a designated quiet-time between 1400 and 1530h – involving the restriction of visitors, staff movement and treatment activities. Patient sleep and rest was promoted through comfort and pain relief interventions and reducing environmental light and noise. Data were collected over five months. A total of 299 patients were recruited – 138 on the experimental unit and 161 on the control unit. A variety
60
Literature reviews
of different statistical procedures were used to explore the differences between the two groups. The researchers studied sound levels and sleep status – showing statistical differences in the number of patients asleep and wake and that the experimental group patients experienced half the noise that the control group patients did at the stated times. Health status was studied using a questionnaire known as the SF12 although significant differences due to the intervention were not shown. Patients, staff and visitors were shown to be satisfied with the intervention on the whole. This was a quasi-experimental study, meaning that the lack of randomisation of subjects to the intervention and control places significant potential bias on the study and that it cannot be claimed that the results are as a direct consequence of the intervention. To conduct a true experiment to study these issues would be impossible in the clinical setting, so it is important that the implications of the study are considered seriously in spite of this and it seems reasonable to expect that such an intervention is beneficial in the recovery and well being of orthopaedic patients. International Journal of Nursing Studies 46: 778–786
describe the impact of those delays, to develop a flow-chart of the care process and clarify the roles of staff involved in the process of care delivery. An action research approach was used to undertake the study which initially involved describing the current care process. The team then considered how information could be gathered about performance in terms of surgical delays. Among other data, a log was kept of admissions and the times that children went to the operating theatre for surgery. Complaints about delays were also analysed. All staff on the unit were encouraged to participate in discussion. This enabled the team to have a clear picture of performance as well as the likely causes of problems and to identify changes needed to resolve some of the issues leading to some of the delays. A ‘trauma board’ was implemented to provide more detailed information about children waiting for surgery and a flowchart of responsibilities and actions was created to help staff to improve communication within the team and with the children and families. Although further work is needed to assess the impact of the changes made on waiting times and satisfaction, the study demonstrates how the principles of action research can help staff to highlight and tackle issues that are impacting on the quality of patient care.
Waiting for surgery after orthopaedic trauma Beringer, A., Hagan, L. Goodman, H. Waiting times for urgent trauma surgery are often discussed in the literature. The impact on well-being of children waiting for surgery following orthopaedic trauma is significant; leading to additional pain, stress and anxiety for children and their families and long pre-operative fasting times, which can be detrimental to recovery. The aim of this UK research was to study the delays in children receiving surgery for orthopaedic trauma, to
Paediatric Nursing 21: 34–37 Julie Santy Co-Editor International Journal of Orthopaedic and Trauma Nursing University of Hull, Hull, England E-mail address: [email protected]
Available online at www.sciencedirect.com