Academic literature on the topic 'Orthopaedic nurse practitioner'

IntroductionIntramuscular injections (IMI) remain a frequent practice in mental health. The available guidelines for IMI in mental health only focus on the technical side of the practices. Moreover, no recent update has been performed to improve practice of IMI in mental healthObjectivesTo assess a formalized consensus agreement regarding the best practice concerning IMI in mental health and to develop practice guidelines.MethodsA two-round Delphi method was used. The scientific committee consisted in one psychiatrist, one orthopaedic surgeon, one infection control practitioner, one hospital pharmacist, one mental health nurse, one nurse exploring care relationship and one nurse educator. From literature review, each expert proposed specific recommendations. The panel experts were asked to rate the appropriateness and the applicability in current practice of each recommendation on a 9-point Likert scale. Panel members were recruited in five mental health institutions. The first round questionnaire was emailed to each respondent on February 2020 and the second one on June. Propositions were considered appropriate and applicable in current practice if the median was >=7. Agreement among experts were judged by the statistical measure of the Interpercentile RangeResultsFrom the first round, 46 recommendations were retained by 49 nurses. 27 propositions were retained after this second round by 32 nurses. The scientific committee added 12 other recommendations because of their importance in the literature and clinical practice.ConclusionsThis study provides consensus-based recommendations on IMI in mental health. Nursing staff need to be educated about the new guidelines from both the theoretical and clinical perspectivesDisclosureNo significant relationships.

Introduction: Geriatric-orthopaedic co-management models can improve patient outcomes. However, prior reports have been at large academic centers with “closed” systems and an inpatient geriatric service. Here we describe a Geriatric Fracture Program (GFP) in a mixed practice “pluralistic” environment that includes employed academic faculty, private practice physicians, and multiple private hospitalist groups. We hypothesized GFP enrollment would reduce length of stay (LOS), time to surgery (TTS), and total hospital costs compared to non-GFP patients. Materials and Methods: A multidisciplinary team was created around a geriatric Nurse Practitioner (NP) and consulting geriatrician. Standardized geriatric focused training programs and electronic tools were developed based on best practice guidelines. Fracture patients >65 years old were prospectively enrolled from July 2018 – June 2019. A trained biostatistician performed all statistical analyses. A p < 0.05 was considered significant. Results: 564 operative and nonoperative fractures in patients over 65 were prospectively followed with 153 (27%) enrolled in the GFP and 411 (73%) admitted to other hospitalists or their primary care provider (non-GFP). Patients enrolled in the GFP had a significantly shorter median LOS of 4 days, compared to 5 days in non-GFP patients (P < 0.001). There was a strong trend towards a shorter median TTS in the GFP group (21.5 hours v 25 hours, p = 0.066). Mean total costs were significantly lower in the GFP group ($25,323 v $29085, p = 0.022) Discussion: Our data shows that a geriatric-orthopaedic co-management model can be successfully implemented without an inpatient geriatric service, utilizing the pre-existing resources in a complex environment. The program can be expanded to include additional groups to improve care for entire geriatric fracture population with significant anticipated cost savings. Conclusions: With close multidisciplinary team work, a successful geriatric-orthopaedic comanagement model for geriatric fractures can be implemented in even a mixed practice environment without an inpatient geriatrics service.

Background: Assessment of mortise stability is paramount in determining appropriate management of ankle fractures. Although instability is readily apparent in bimalleolar or trimalleolar ankle fractures, determination of instability in the isolated Weber B fibula fracture often requires further investigation. Prior authors have demonstrated poor predictive value of physical examination findings such as tenderness, ecchymosis, and swelling with instability. The goal of this study is to test the validity of a new clinical examination maneuver, the lateral drawer test, against the gravity stress view (GSV) in a cohort of patients with Weber B fibula fractures. Secondary goals included assessing pain tolerability of the lateral drawer test, as well as testing interobserver reliability. Methods: Sixty-two patients presenting with isolated fibula fractures were prospectively identified by an orthopaedic nurse practitioner or resident. Three nonweightbearing radiographic views of the ankle as well as a GSV were obtained. Radiographs were not visualized before conducting the lateral drawer test. Two foot and ankle fellowship–trained orthopaedic surgeons performed and graded the lateral drawer test. Radiographs were then examined and medial clear space (MCS) was measured. Visual analog scale (VAS) pain scores were obtained before and after testing. The results of the lateral drawer test were compared with radiographic measurements of MCS on GSV. A cadaveric experiment was devised to assess interobserver reliability of the lateral drawer test. Results: Thirty (48%) of 62 consecutively enrolled patients demonstrated radiographic instability with widening of the MCS ≥5 mm on GSV. When correlated with MCS measurement, the lateral drawer test demonstrated a sensitivity of 83%, specificity of 97%, positive predictive value (PPV) of 96%, and negative predictive value (NPV) of 86%. There was a strong correlation between the lateral drawer test grade and amount of MCS widening (Spearman correlation ρ = 0.82, P < .005). Patients tolerated the maneuver well with an average increase of 0.7 on the VAS pain scale. Testing of 2 observers utilizing the cadaveric model demonstrated a Cohen’s Kappa coefficient of 0.7 indicating moderate interobserver agreement. Conclusion: The lateral drawer test demonstrates high sensitivity, specificity, PPV, and NPV with moderate interobserver reliability compared with the MCS on GSV in patients presenting with Weber B fibula fractures. Although further external validation is required, the lateral drawer test may offer an adjunct tool via physical examination to help determine mortise stability. Level of Evidence: Level II, Prospective Cohort Study.

Category: Trauma; Ankle Introduction/Purpose: Assessment of mortise stability is paramount in determining appropriate management of ankle fractures. While instability is readily apparent in bimalleolar or trimalleolar ankle fractures, determination of instability in the apparent isolated Weber B fibula fracture often requires further investigations such as stress radiography. While several authors have previously demonstrated poor predictive value of physical examination findings such as tenderness, ecchymosis and swelling with instability, no previous investigation has examined the ability of a translational test to determine deltoid ligament injury. The goal of this study is to test the validity of a novel clinical test, the lateral drawer test, in determining mortise instability in a cohort of patients with Weber B fibula fractures. Methods: Patients presenting with isolated fibula fractures were prospectively identified by an orthopaedic nurse practitioner or resident. Three views of the ankle as well as gravity stress views (GSV) were obtained. Prior to examining radiographs, two foot & ankle fellowship-trained orthopaedic surgeons (JYK, CPM) performed and graded the lateral drawer test. (Grade 0: no instability/symmetric to contralateral ankle, Grade I: translation < 5mm, Grade II: translation >= 5mm) While the surgeons were made aware of the presence of a Weber B fibula fracture, radiographs were not visualized prior to conducting the drawer test. Medial clear space (MCS) was measured. VAS pain scores were obtained before and after testing. The results of the lateral drawer test results were compared with radiographic measurements of MCS. Results: The study enrolled 57 consecutive patients with Weber B ankle fractures. Twenty-nine (51%) patients demonstrated radiographic instability with widening of the medial clear space >= 5 mm on GSV. When correlated with MCS measurement, the lateral drawer test demonstrated a sensitivity of 83.3%, specificity of 96%, positive predictive value (PPV) of 96% and negative predictive value (NPV) of 84% for determining instability. There was a strong correlation between the lateral drawer test grade and amount of MCS widening (⍴=0.82, p<0.001). Patients tolerated the lateral drawer test well with an average increase of 0.8 points on the VAS pain scale after testing. Conclusion: The lateral drawer test demonstrates high sensitivity, specificity, PPV and NPV for detecting instability in patients presenting with Weber B fibula fractures. While further validation is required in a larger cohort of patients, the lateral drawer test may offer an adjunct tool via physical examination to predict mortise stability.

Category: Ankle; Trauma Introduction/Purpose: Assessment of mortise stability is paramount in determining appropriate management of ankle fractures. While instability is readily apparent in bimalleolar or trimalleolar ankle fractures, determination of instability in the apparent isolated Weber B fibula fracture often requires further investigations such as stress radiography. While several authors have previously demonstrated poor predictive value of physical examination findings such as tenderness, ecchymosis and swelling with instability, no previous investigation has examined the ability of a translational test to determine deltoid ligament injury. The goal of this study is to test the validity of a novel clinical test, the lateral drawer test, in determining mortise instability in a cohort of patients with Weber B fibula fractures. Methods: Patients presenting with isolated fibula fractures were prospectively identified by an orthopaedic nurse practitioner or resident. Three views of the ankle as well as gravity stress views (GSV) were obtained. Prior to examining radiographs, two foot & ankle fellowship-trained orthopaedic surgeons (JYK, CPM) performed and graded the lateral drawer test. (Grade 0: no instability/symmetric to contralateral ankle, Grade I: translation < 5mm, Grade II: translation >= 5mm) While the surgeons were made aware of the presence of a Weber B fibula fracture, radiographs were not visualized prior to conducting the drawer test. Medial clear space (MCS) was measured. VAS pain scores were obtained before and after testing. The results of the lateral drawer test results were compared with radiographic measurements of MCS. Results: The study has thus far prospectively enrolled 14 consecutive patients with Weber B ankle fractures. Six (43%) patients demonstrated radiographic instability with widening of the medial clear space >= 5 mm on GSV. When correlated with MCS measurement, the lateral drawer test demonstrated a sensitivity of 83.3%, specificity of 100%, positive predictive value (PPV) of 100% and negative predictive value (NPV) of 88.9% for determining instability. There was a strong correlation between the lateral drawer test grade and amount of MCS widening (⍴=0.82, p=0.0003). Patients tolerated the lateral drawer test well with an average increase of 1.6 on the VAS pain scale after testing. Conclusion: The lateral drawer test demonstrates high sensitivity, specificity, PPV and NPV for detecting instability in patients presenting with Weber B fibula fractures. While further validation is required in a larger cohort of patients, the lateral drawer test may offer an adjunct tool via physical examination to predict mortise stability.

Background: There is commonality amongst the definition and characteristics of Nurse Practitioner (NP)/Advanced Practice Nurse (APN) role and practice internationally in terms of education, practice standards and regulation; operationally there is variability. The NP role has been implemented internationally; at least 70 countries are considering some form of APN role.ICN/APN network 2012 cited in(1) NPs provide advanced clinical care and were implemented as part of health service reform to improve access and timeliness of healthcare.(2) Whilst much has been written on advanced practice nursing roles per se, there has been little focus specifically on the orthopaedic nursing context. This review will focus on orthopaedic nurse practitioners (ONP) in an international context. Objective: To appraise and synthesise the best available evidence on the experience and effectiveness of the role and practice of ONPs. Inclusion Criteria: Types of Participants ONP/APN in acute care or sub-acute orthopaedic settings. Types of Interventions Interventions of ONP specific care. Phenomena of Interest The experience of becoming or being an ONP in relation to role development, role implementation and (ongoing) role evaluation. Types of Studies This comprehensive systematic review looked at both quantitative and qualitative studies together with narrative text and opinion papers. Quantitative study designs included in this review included observational cohort/case control studies and descriptive case report/series. Phenomenology was the qualitative study design included. Mixed method studies were also included in this review. Types of Publications The textual component of this review considered publications of expert opinion, discussion papers, position papers and other relevant text where there existed a particular focus on the ‘orthopaedic’ aspect of NP practice. Types of Outcomes A range of outcome measures were included but were not limited to primary patient outcomes: occasions of service/numbers seen, length of stay (LOS), wait times, patient satisfaction, readmission, and other patient encounter data or relevant nurse-sensitive outcome data that characterised ONP practice. Secondary and related outcomes data relative to process indicators/outcomes such as: NP satisfaction, key stakeholder (other health professional) satisfaction, knowledge, LOS, cost benefit were considered. Search Strategy: Both published and unpublished English language studies were considered from individual database inception and searched up to December 2012. The search was repeated in early 2013 to ensure no recent papers had been published. A three step search strategy was employed for each component of this review. Methodological Quality: All retrieved studies and opinion papers were assessed by two independent reviewers using the standardised Joanna Briggs Institute critical appraisal tools. Any disagreements that arose between the reviewers were resolved through discussion, or with a third reviewer. Data Collection Quantitative data was extracted using the JBI-MAStARI tool. The data extracted included details about the interventions, populations, study methods and outcomes of significance to the review question. Qualitative data was extracted using the JBI-QARI tool. The data extracted included details about the methodology, method, phenomena of interest, participants, data analysis and relevant findings. Textual data was extracted using JBI-NOTARI tool. The data extracted included the type of text, stated allegiance or position, setting, geographical and cultural influences and messages and conclusions located within the publication. Data Analysis/Synthesis: Quantitative data was analysed using JBI-MAStARI. Meta-analysis of the quantitative data was not possible due to a lack of clinical and statistical heterogeneity; findings were presented in narrative format including tables to aid in data representation. As only one qualitative study was included, meta-synthesis by meta-aggregation was not possible. Textual data were synthesised using the Joanna Briggs Institute approach of aggregation using JBI-NOTARI. Results A total 31 studies and publications were included in the review. Nineteen quantitative studies were included, 10 comparable cohort and 9 descriptive studies. Seven broad review outcomes measures were identified: Three of which were patient related (primary) outcomes and three nurse related (secondary) outcomes. Three sub category patient-related outcomes focussed on (1) specialist care interventions, (2) patient satisfaction/acceptance, (3) wait times and access to care. Another four sub category nurse-related or process-related review outcomes focussed on (4) education, (5) length of stay, (6) other cost-related issues and (7) barriers. One unpublished qualitative thesis discussed four themes: (1) having knowledge, (2) being in and outside the role, (3) being an advocate and (4) being in control with decision making & anticipation as sub themes. The author concluded that advanced practice is a continuum. Eleven text and opinion publications were included where 39 conclusions were identified. From these conclusions eight categories emerged and three synthesised findings. The synthesised findings related to ‘Duality’, ‘Role & Relationships’ at a personal, organisational and professional level with an emphasis on collaboration, and ‘Moving Forward’ with an emphasis on resources needed to support the NP in this. Conclusions: The findings of this comprehensive review demonstrate the experience and effectiveness of NPs in orthopaedic settings is influenced by multiple factors from within and external to the individual. Overall the results derived from quantitative evidence indicated that NPs in orthopaedic settings provide comparable care when compared to conventional methods of health care delivery. However the results showed better outcomes in specific units where care is led by Clinical Nurse Specialists, NP management of distal radius fracture, and NP screening for developmental hip dysplasia. Decreased length of stay, improved patient wait times & access and patient satisfaction were demonstrated across the evidence, generally. Caution is required however when interpreting the results due to the lower quality of study designs. The qualitative and textual evidence demonstrated that the role of the ONP is multidimensional with confidence, knowledge and experience as essential elements to deal with complex and challenging situations. The experience of becoming or being an ONP is relational and collaborative at a personal, organisational and professional level. A ‘duality’ of purpose for ONP’s emerged from the textual evidence with interplay between benefits and barriers to ONP practice. Barriers as an outcome emerged from both quantitative and textual evidence. The experience of ONP is characterised by moving forward along a continuum – where the continuum represents the entire journey/career/professional life of the NP. From the comprehensive evidence on the effectiveness and experience of NPs in orthopaedic settings this review identified four ‘shared findings’ across the evidence base: Acceptance, Collaboration, Education/Knowledge/Experience, Duality.
Thesis (M.Clin.Sc.) (Research by Publication) -- University of Adelaide, School of Translational Health Science, 2015.