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  • 1.
    Berg, Agneta
    et al.
    Kristianstad University, Department of Health Sciences.
    Suhonen, Riita
    Health Care District, Forssa.
    Idvall, Ewa
    Kalmar County Hospital Council.
    A survey of orthopaedic patients' assessment of care using the Individualised Care Scale2007In: Journal of Orthopaedic Nursing, ISSN 1361-3111, E-ISSN 1873-4839, Vol. 11, no 3-4, p. 185-193Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to describe orthopaedic patients’ assessments of howindividuality in patient carewas supported during specific nursing interventions and how that individuality was perceived during hospitalisation. Orthopaedic inpatients (370) fromtwo central county and two county hospitals in Sweden were surveyed using the Individualised Care Scale (ICS) during 2004/2005, (response rate 74% n = 274). The data were analysed using both descriptive and inferential statistics. Eighty-six percent of the respondents stated that it was very important to be treated as an individual or unique person and 59% experienced this type of care. The lowest rated assessments concerned the personal life situation and the highest were concerned with the clinical situation and the decisional control over care. This analysis of patient assessments of individualised nursing care can be used to implement changes to individualise care processes in orthopaedic wards. This will be useful in the evaluation of health care quality improvement, planning and personnel management.

  • 2.
    Hommel, Ami
    et al.
    Department of Orthopedics, Lund University Hospital.
    Bjorkelund, Karin B.
    Department of Health Sciences, Lund University.
    Thorngren, Karl-Göran
    Department of Orthopedics, Lund University Hospital.
    Ulander, Kerstin
    Kristianstad University College, Department of Health Sciences.
    A study of a pathway to reduce pressure ulcers for patients with a hip fracture2007In: Journal of Orthopaedic Nursing, ISSN 1361-3111, E-ISSN 1873-4839, Vol. 11, no 3-4, p. 151-159Article in journal (Refereed)
    Abstract [en]

    Due to an ageing population the numbers of patients with hip fractures are increasing. They often suffer from concomitant diseases and are therefore prone to be affected by complications such as pressure ulcers. The prevention of pressure ulcers among patients with a hip fracture is crucial. The aim of this study was to improve the quality of care and patient safety in patients with a hip fracture. A new evidence based clinical pathway was introduced to prevent hospital acquired pressure ulcers. Furthermore, the purpose was to bring attention to pressure ulcer prevention and to facilitate changes in clinical practice to improve quality of care and patient safety. A total of 478 patients with a hip fracture were consecutively included between April 2003 and March 2004. The new evidence based clinical pathway was introduced on October 1st 2003. The results from the first 210 patients in the control group and the last 210 patients in the intervention group are presented in this article. In the intervention group, hospital acquired pressure ulcers decreased by 50% (p < 0.007). It is possible to reduce the development of hospital acquired pressure ulcers among elderly patients with a hip fracture even though it is not possible to eliminate the effect of factors such as increased age and the patients’ medical status which are often the two main risk factors.

  • 3.
    Hommel, Ami
    et al.
    Department of Health Sciences, Lund University.
    Björkelund, Karin B.
    Department of Health Sciences, Lund University.
    Thorngren, Karl-Göran
    Department of Orthopedics, Lund University Hospital.
    Ulander, Kerstin
    Kristianstad University College, Department of Health Sciences.
    Differences in complications and length of stay between patients with a hip fracture treated in an orthopaedic department and patients treated in other hospital departments2008In: Journal of Orthopaedic Nursing, ISSN 1361-3111, E-ISSN 1873-4839, Vol. 12, no 1, p. 13-25Article in journal (Refereed)
    Abstract [en]

    The health care system has to deal with substantial health care costs, which are expected to continue to rise due to increasingly elderly populations. One way of saving has been a reduction of the number of beds in hospitals. The consequence is that acute patients are inappropriately admitted to non-specialized wards because of limited beds. These patients are also known as ‘‘outliers’’. In this study, consecutive patients with a hip fracture treated at the orthopaedic department (n = 273) are compared with patients treated at other departments (n = 147) according to the incidence of complications and the length of stay (LOS) before and after the introduction of an evidence-based clinical pathway. There was no medical difference between the populations. However, the strict demands of saving costs, with limited beds, have resulted not only in economic consequences with prolonged hospitalization, but also in patient suffering and the inconvenience of increased postoperative complications.Patients treated at non-specialized wards had an extra LOS of 3.7 days in the acute hospital settings and furthermore, 13.6 days of LOS including rehabilitation compared to patients treated at the orthopaedic department. In addition, we consider the implemented evidence-based clinical pathway to be successful since the number of complications was reduced. It is a major challenge to establish effective treatment and rehabilitation for patients after a hip fracture aiming to avoid complications and reduce LOS. These fragile patients with a hip fracture ought to be treated at the orthopaedic department, or at departments with geriatric and rehabilitation knowledge. Physiotherapists, occupational therapists and nurses specialising in orthopaedics and geriatricians should take an active part in the care of these patients.

  • 4.
    Idvall, Ewa
    et al.
    Kalmar County Council and Department of Medical and Health Sciences, Linköping University.
    Berg, Agneta
    Kristianstad University, Department of Health Sciences.
    Patient assessment of postoperative pain management: orthopaedic patients compared to other surgical patients2008In: Journal of Orthopaedic Nursing, ISSN 1361-3111, E-ISSN 1873-4839, Vol. 12, no 1, p. 35-40Article in journal (Refereed)
    Abstract [en]

    We used a 14-item patient questionnaire, Strategic and Clinical Quality Indicators in Postoperative Pain Management, to describe how orthopaedic patients assessed the quality of care they received. The patients highest and lowest assessments were compared to assessments by other groups of surgical patients as reported in studies being published. Our study included 300 inpatients from four different orthopaedic wards in two county councils in Sweden. Patients answered a questionnaire on the day of discharge. The response rate was 74%, and 44% of the respondents were male. Elective surgery was the main reason for admission, and the mean length of stay was 7.3 days. One of the items rated highest was that pain relief was given quickly when requested. A literature review showed that this item also received a high rating in other studies using the same patient questionnaire. The item rated lowest concerned the regular use of a pain assessment instrument, which also received a low rating from patient groups other than the orthopaedics in this study. In conclusion, we found that orthopaedic patients and other groups of surgical patients gave similar assessments concerning the highest and lowest assessments of postoperative pain management. Nevertheless, further improvement is needed.

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