Rebecca Jester

The experience of patients with rheumatoid arthritis admitted to hospital.

OBJECTIVE To describe the experiences of patients with rheumatoid arthritis (RA) when admitted to hospital. METHODS A selected sample of 9 women with RA of at least 3 years duration, who had experienced at least 5 days of inpatient care within the previous 2 years, underwent unstructured interviews in this qualitative, phenomenological study. Information from the interviews was analyzed using Colaizzis 6 procedural steps. RESULTS Five major themes emerged from the study: uncertainty during the first admission to hospital; the process of becoming an experienced patient on subsequent admissions; the evident experience and knowledge of staff; the effect, both positive and negative, of other patients; and the loss of privacy. CONCLUSION These findings throw important new light on the experience of patients with RA receiving inpatient rheumatologic care and have the potential to significantly advance nursing practice within rheumatology.

Advancing practice in rehabilitation nursing

Ch 1. The Rehabilitation Process. Ch 2. The Role of the Specialist Nurse Within Rehabilitation. Ch 3. Rehabilitation Settings. Ch 4. Psychological Issues in Rehabilitation. Ch 5. Evaluating Rehabilitation Services. Ch 6. Preparing and Supporting Informal Carers. Ch 7. Rehabilitation of Orthopaedic Patients. Ch 8. Stroke Care. Ch 9. Rehabilitation of Patients with an Acquired Brain Injury or a Degenerative Neuromuscular Disorder. Ch 10. Supporting People with Long-term Conditions. Ch 11. Rehabilitation of Patients with Spinal Cord Injury. Ch 13. The Way Forward

Oxford handbook of orthopaedic and trauma nursing

1. Introduction 2. Musculoskeletal anatomy and physiology 3. Assessment of the musculoskeletal system 4. General Principles of Care 5. Complications 6. Musculoskeletal conditions 7. Elective Interventions 8. Musculoskeletal Trauma Care 9. Injury Management 10. Regional musculoskeletal injuries

Clinical assessment in trauma and orthopaedic nursing

The emergence of the extended role within nursing has in recent years become common place in clinical settings such as orthopaedics and trauma within the health service in the United Kingdom and in many other countries around the world (Kaasalainen et al., 2010; Sheer and Wong, 2008). Physical examination and assessment have traditionally been seen as a medical undertaking. However, nurses are now increasingly crossing traditional healthcare boundaries in order to cope with the demands placed on healthcare services. The Scottish Executive (2005) suggests that nursing is in a state of rapid change and now, as never before, the scope exists for nurses to develop their careers in response to service demands, professional aspirations, policy drivers and, most importantly, patient need. The acquisition of new knowledge, skills and attitudes, which help improve the patient’s experience and ensure patient safety, also enables nurses to observe their professional legal, ethical and regulatory framework (Scottish Executive, 2004). This ‘new frontier’ has been embraced by many nurses and one Delphi study of nurse practitioners conducted in Glasgow reported that all participants believed that their ability to practice physical examination skills made a positive contribution to the quality of patient care, retention of staff and job satisfaction (McElhinney, 2010). The researcher further reported that over 42% of the study participants, with an educational attainment that ranged from diploma to Master’s level, stated that they lacked confidence in their ability to physically examine the musculoskeletal system. A further study concluded that one of the problems associated with health sciences education is that of overcrowded curricula (Giddens, 2007), suggesting that further education such as stand-alone modules or modules as part of a degree or masters pathway may give practitioners room to hone their skills in a specialty. Despite the findings of this study there has been an unprecedented increase in the number and type of advanced practice roles, particularly in the acute care setting (Bryant-Lukosius et al., 2004; Hamric et al., 2013; Royal College of Nursing, 2012). This series of papers aims to provide an overview of the fundamentals of patient assessment and principles of orthopaedic physical examination required to achieve a comprehensive musculoskeletal assessment. From your examination you will be guided in deciding on appropriate diagnostic tests and investigations and be able to provide a clear baseline for comparison should the patient’s physical condition alter. This introductory paper discusses the principles of musculoskeletal assessment with subsequent papers providing region-specific assessment guidance. To become competent in * Corresponding author. E-mail address: Sandra.flynn@nhs.net (S. Flynn) International Journal of Orthopaedic and Trauma Nursing (2015) 19, 162–169

A new quality of life consultation template for patients with venous leg ulceration

OBJECTIVE Chronic venous leg ulcers (CVLUs) are common and recurrent, however, care for patients predominantly has a focus which overlooks the impact of the condition on quality of life. The aim of this study was to develop a simple, evidence-based consultation template, with patients and practitioners, which focuses consultations on quality of life themes. METHOD A nominal group was undertaken to develop a new consultation template for patients with CVLUs based on the findings of earlier qualitative study phases. RESULTS A user-friendly two-sided A4 template was designed to focus nurse-patient consultations on the quality of life challenges posed by CVLUs. CONCLUSION CVLUs impact negatively on the quality of life of the patient but this receives inadequate attention during current consultations. This new template will help to ensure that key concerns are effectively raised, explored and addressed during each consultation. DECLARATION OF INTEREST The NHS West Midlands Strategic Health Authority funded this study. The authors have no conflicts of interest to declare.

Clinical assessment of the orthopaedic and trauma patient

Clinical assessment and, specifically, physical examination and requesting of clinical investigations in trauma and orthopaedics have been traditionally seen as the role of medical staff or physiotherapists. Over the last decade, however, there have been a significant number of nurses working within the speciality who have been integrating the role of clinical assessment/examination into their practice on a regular basis. This has been synonymous with the proliferation of specialist and advanced nursing roles ranging from the Advanced Trauma Nurse Specialist conducting assessments of Airway, Breathing, Circulation, Disability & Exposure (A–E assessment) to quickly identify life threatening issues in emergency care through to working with patients with chronic orthopaedic problems that require a more staged approach to assessment, often building a picture over the course of several consultations in conjunction with results of clinical investigations. However, clinical assessment is not confined to specialist and advanced roles, but is an important skill set for every nurse working in any trauma and orthopaedic setting. In my own position as a part-time Advanced Nurse Practitioner working with patients who undergo hip and knee arthroplasty, a major part of my role is assessment of patients within the outpatient department. This includes history taking, physical examination of the patients’ hips and knees and joints below and above to check for referred symptoms. My role also involves requesting and interpreting clinical investigations such as x-rays, MRI scans, Metal Artefact Resonance Scans and blood investigations for metal ions (cobalt and chromium levels) and other blood tests to exclude either early superficial infection or late deep sepsis. I have also been involved, for many years, in the development anddelivery of degree andpostgraduate level modules and courses in advanced health and clinical assessment for nurseswho are advancing their roles within trauma and orthopaedics. I have learnt from these experiences that nurses can develop these skills to a very high level and this is supported by a growing evidence base. I have also found that in the beginning nurses are quite reluctant to undertake physical examination procedures such as gait assessment, assessing range of movement (R.O.M.), palpation and special diagnostic examinationprocedures. This has always caused me both a degree of surprise and amusement because nurses in the role of caring for patients are always “examining patients” but we just do not use that language. We use the skills of observation and inspection all the time to detect changes and either deterioration or improvement in a patient’s condition. For example, we palpate or “feel” for changes in the shape and size of patients’ limbs if we suspect oedema or DVT. Nurses also tell me they have never taken a history! I can guarantee that every single nurse reading this editorial takes patient histories all the time as an integral part of their practice. Again, we do not use the terminology “history taking” or “consultation”. When your patient wakes in the night complaining of acute pain you inevitably “take a history”; When did it start? How severe is it? Is it localised or diffuse? and What mayhaveexacerbated thepain? This is knownas “eliciting the chief complaint” and you do it all the time. Based on this experience and in discussion with nursing colleagues in our speciality we thought our readership would find it very useful to have a dedicated series of papers within the journal focusing on clinical assessment of the orthopaedic and trauma patient. We also hope that it will give readers an evidence base and more confidence in structuring and conducting patient assessments and, ultimately, this will improve patient care. International Journal of Orthopaedic and Trauma Nursing (2015) 19, 119–120

Chronic venous leg ulcer care: Putting the patient at the heart of leg ulcer care. Part 1: exploring the consultation

This article, the first of two, summarises a study that explored the lived experiences of patients with leg ulcers and the impact of this condition on their quality of life. The study had four study phases; phases 1 and 2 employed qualitative methods and are reported here. Initially, unstructured interviews were held; these revealed significant issues for the patients including the dominance of pain, issues relating to exudate and odour, social isolation and psychological effects. A checklist based on these issues was completed by the researcher during observations of routine care for these same patients; this revealed the extent and depth to which these matters were addressed. On many occasions, significant issues were not disclosed or explored during consultations. These findings confirmed that participants with chronic venous leg ulcers have concerns far beyond wound care.

The development of an evaluation framework for a Hospital at Home service

Purpose – The purpose of this paper is to share good practice with interested professionals, commissioners and health service managers regarding the development of an evidence-based approach to evaluation of an integrated care service providing acute level care for patients in their own homes in South London called the Guys and St Thomas’ @home service. Design/methodology/approach – A literature review related to Hospital at Home (HH) schemes was carried out with an aim of scoping approaches used during previous evaluations of HH type interventions to inform the development of an evaluation strategy for @home. The results of the review were then applied to the Donabedian conceptual model: Structure; Process; and Outcome and contextualised to the population being served by the scheme to ensure a robust, practical and comprehensive approach to evaluation. Findings – Due to the heterogeneity of the studies it was not possible to conduct a systematic review or meta-analysis. In total, 28 studies were identifi...