Community ambulation before and after hip fracture: a qualitative analysis

Purpose.?This qualitative study explored mobility levels around the home and in the community before and after hip fracture.

Methods.?Twenty-four people receiving rehabilitation after hip fracture were interviewed using an in-depth semi-structured format: 12 who were receiving rehabilitation as inpatients, and 12 who had been discharged home from inpatient rehabilitation and were continuing therapy as outpatients. The recorded interviews were transcribed and coded independently by two researchers. From these codes themes were developed.

Results.?Before their fracture, participants were independent about their houses, but their level of community ambulation had been reducing over recent months or years, often associated with another health problem. Participants who had returned home after inpatient rehabilitation for hip fracture reported much reduced levels of mobility both in their house and in the community compared with their pre-fracture performance. This reduced level of mobility was associated with psychological factors (fear, lack of confidence, frustration), physical factors (pain, the presence of another health problem) and social/environmental factors (reliance on daughter, and car). The level of optimism expressed by people receiving inpatient rehabilitation contrasted with the pessimism of those receiving outpatient rehabilitation.

Conclusions.?Patients living back in the community after hip fracture described a reduced level of functioning and a pessimism that contrasted with the optimism expressed by people who were still in the inpatient phase of rehabilitation. These findings, and the importance of psychological factors and social support, may be considered when designing rehabilitation strategies to support the successful transition of people to their community after hip fracture.     

老年髋部骨折患者术后功能锻炼护理需求的质性研究

目的 了解老年髋部骨折患者术后功能锻炼主要影响因素及其护理需求的内容,为护理人员开展术后功能锻炼健康教育提供帮助。方法 2020年6月-8月采用质性研究中的现象学研究方法,对在复旦大学附属中山医院进行髋部骨折手术后1-3天的老年患者进行半结构式深度访谈,采用现象学分析方法进行资料分析。结果 老年髋部骨折术后患者对于术后功能锻炼知识存在缺乏、对疾病产生负性情绪,对功能锻炼存在诸多问题及需求。 结论 护理人员可根据研究所得出的护理需求对患者提供相应的干预措施,促进患者开展功能锻炼,加快患者肢体功能的康复,提高生活质量及护理满意度。     

高龄髋部骨折病人行髋关节置换术的围术期康复护理

总结56例75岁以上高龄髋部骨折病人行髋关节置换术的围术期康复护理措施,包括心理护理、术前的评估、术后预防感染、体位护理、疼痛护理、并发症预防护理和康复锻炼等,认为加强围术期康复护理可明显提高病人的生存质量.     

老年髋部骨折患者术后家庭康复与社会支持的关系研究

目的调查髋部骨折术后患者社会支持状况与家庭康复的相关性。方法采用社会支持评定量表,上门随访82名老年髋部骨折术后患者家庭康复现状和社会支持状况,分析其相关性。结果老年髋部骨折术后患者出院后客观支持得分为3.62±0.97,主观支持为19.22±3.79分,支持利用程度为12.78±3.63分。Harris髋关节评分与社会支持总分、主观支持和支持利用二个维度呈正相关;FIM与社会支持总分和主观支持维度呈正相关(P<0.01)。结论良好的家庭关系是促进老年骨折患者康复的重要因素,护士应帮助患者提高社会支持水平,从而提高其生活质量。     

老年髋部骨折术后病人抑郁及康复状况的研究

目的调查老年髋部骨折病人术后的抑郁状况,并探讨抑郁对其康复状况及生活质量的影响。方法选取北京市某三级甲等医院7l例髋部骨折术后复查的老年病人,应用老年抑郁量表调查病人的抑郁情况,应用Barthel指数、Harris髋关节功能评分评价病人的身体康复状况,应用健康状况问卷调查病人的生活质量状况。结果髋部骨折术后老年病人的抑郁发生率为39．44％。抑郁组的Barthel指数、Harris髋关节功能评分和健康状况评分（除外躯体疼痛和情感职能）均低于非抑郁组（P〈0．0l或P〈0．05）。结论老年髋部骨折术后病人抑郁发生率较高,抑郁会影响病人的术后康复状况。     

微信随访对髋关节置换术出院患者康复影响的Meta分析

目的 综合评价微信随访对髋关节置换术出院患者康复的影响.方法 检索CNKI、VIP、万方医学、CBM、PubMed、Web of Science、Cochrane library等国内外文献库,查找国内外关于微信随访髋关节置换术患者院后康复效果的研究,通过RevMan 5.3软件进行数据分析.结果 纳入研究14篇,包含...     

To evaluate the effectiveness of a discharge‐planning programme for hip fracture patients

Aims and objectives. This study aimed to evaluate the effectiveness of a comprehensive discharge‐planning service for hip fracture patients, including length of stay, functional status, self‐care knowledge and quality of life (QOL). Background. Hip fractures are the most devastating result of osteoporosis. Care of these patients from the moment they enter the hospital until discharge and postdischarge is a challenging task, requiring a coordinated approach by an interdisciplinary team. Design. An experimental design was used. Methods. Fifty hip fracture patients were recruited from a medical centre in Taipei, Taiwan and randomly divided into two groups. The control group received routine discharge nursing care and the experimental group received comprehensive discharge planning. After patient admission, researchers assessed discharge‐planning needs, provided discharge nursing instruction, coordinated services and determined discharge placement based on assessment results. Results. (i) Mean age of 50 hip fracture patients was 78·75 (SD 6·99) years. Mean length of stay was 6·04 (SD 2·41) days for the experimental group and 6·29 (SD 2·17) for the control group. Difference between groups was not significant (t = ?0·394, p = 0·696). (ii) The self‐care knowledge of the experimental group was higher than that of the control group (F = 11·569, p = 0·001). (iii) Significant improvements were observed in functional status of both groups at three months postdischarge, with no significant differences observed between groups. However, the functional status of experimental group patients showed a slightly better trend than that of the control group. (iv) At three months postdischarge, QOL of experimental group patients was better than control group patients. Conclusions. A comprehensive discharge‐planning service can improve hip fracture patients’ self‐care knowledge and QOL. Relevance to clinical practice. Results of this study can be used clinically as a basis for practical implementation of discharge‐planning services in fracture patients.     

术后早期康复锻炼处方对股骨颈骨折患者髋关节功能康复的影响

目的探讨术后早期康复锻炼处方在股骨颈骨折患者术后髋关节功能康复中的应用。方法将采用术后早期康复锻炼处方的40例股骨颈骨折患者设为观察组,将采用术后常规护理的40例股骨颈骨折患者设为对照组,比较2组术后的疼痛情况、康复积极性以及恢复情况。结果观察组术后1 d、3 d、5 d、7 d的疼痛评分低于对照组,术后康复积极性高于对照组,差异有统计学意义(P<0.05)。观察组的住院时间短于对照组,术后髋关节功能评分、生活能力评分以及髋关节功能优良率高于对照组,差异有统计学意义(P<0.05)。结论术后早期康复锻炼处方能够提高股骨颈骨折患者术后康复锻炼的积极性,促进髋关节功能的恢复。     

乳腺癌病人康复期间真实体验的质性研究

目的了解和描述乳腺癌病人康复期间的内心真实体验，为乳腺癌康复期病人心理护理提供依据。方法采用质性研究的现象学研究方法，对6例乳腺癌康复期病人进行深入访谈。结果乳腺癌病人康复过程中的真实体验为：①情绪消极；②家庭社会角色的改变；③消极的应对方式；④康复信息的需求；⑤医疗费用负担过重；⑥生命价值的体验。结论护理人员应深入了解乳腺癌康复期病人的真实内心感受和心理需求，深化整体护理内涵，以期为病人提供针对性和有效的心理护理。     

A National Health Service Hospital's cardiac rehabilitation programme: a qualitative analysis of provision

Aim. This paper reports a study examining the effectiveness of a London National Health Service Trust Hospital's cardiac rehabilitation programme, from the perspectives of healthcare professionals and patients. Background. Cardiovascular disease is the world's leading cause of death and disability. Substantial research has reported that, following a cardiac event, cardiac rehabilitation can promote recovery, improve exercise capacity and patient health, reduce various coronary artery disease risk factors and subsequently reduce hospitalization costs. Despite these findings and the introduction of the National Service Framework for Coronary Heart Disease, there is wide variation in the practice, management and organization of cardiac rehabilitation services. Methods. A purposeful sample of three postmyocardial infarction patients registered on the selected hospital's cardiac rehabilitation programme, coupled with 11 healthcare professionals were selected. The patients acted as individual case studies. The authors followed all three patients through phase III of their cardiac rehabilitation programme. The research attempted to explore the roles and procedures of a London hospital's cardiac rehabilitation programme through an interpretative framework involving qualitative research methods. Participant observation and in‐depth semi‐structured interviews were the instruments used to collect data. Findings. Whilst the healthcare professionals were enthusiastic about coronary heart disease prevention, the London NHS trust hospital's cardiac rehabilitation programme had several barriers, which reduced the programme's success and prevented it from achieving National Service Framework targets. The barriers were complex and mainly included service‐related factors, such as lack of professional training, weak communication between primary and secondary care and confused roles and identities. Conclusion. Although the study has immediate relevance for the local area, it highlighted issues of more general relevance to cardiac rehabilitation and secondary prevention programme development, such as communication and role and identity perceptions in a multi‐professional working environment and the need to develop a formal training programme for cardiac rehabilitation healthcare professionals. Relevance to clinical practice. The results of this study highlight the need for increased investment, improved planning and the introduction of a comprehensive training programme for healthcare practitioners in cardiac rehabilitation. Implementation of these actions may reduce many of the service limitations and barriers that currently surround cardiac rehabilitation programmes.     

Discharge planning in mental healthcare settings: A review and concept analysis

To ensure a safe transition of mental health patients from hospital to community settings, greater attention is being given to discharge planning. However, assessing the quality of discharge planning has been challenging due to wide variations in its definition. To facilitate evaluation of discharge planning, its meaning in the mental health literature was systematically explored. This concept analysis is part of a larger study to develop an instrument to measure the quality of discharge planning processes in mental health care. Walker and Avant's (2011) concept analysis approach was adopted to provide a comprehensive definition of discharge planning. Electronic databases and grey literature were searched and analysed according to Grant and Booth's (2009) systematic search and review process. Literature published between 1900 and 2018 was reviewed. Forty‐nine articles meeting the inclusion criteria were included in the analysis. Discharge planning is a complex, multifaceted concept with six defining attributes: comprehensive needs assessment; collaborative, patient‐centered care; resource availability management; care and service coordination; discharge planner role; and a discharge plan. Discharge planning begins with the initial rapid assessment and symptom stabilization of a patient on admission, coincides with treatment planning, and is associated with hospital readmissions and continuity of care. The mental health literature was reviewed to analyse different interpretations of discharge planning. The conceptual definition provided can assist healthcare providers, organizational leaders, and policymakers to design and implement effective discharge planning policies and guidelines. Providing clarity regarding discharge planning also provides a critical foundation for developing an instrument.     

Case study of hip fracture in an older person

PURPOSE: To discuss proximal femoral (hip) fractures as the leading cause of hospitalization for injuries among older persons, using a case example that illustrates not only the orthopedic injury but also how an older person's chronic problems complicate the acute event. DATA SOURCES: Extensive review of scientific literature on the conditions discussed, supplemented by the case study. CONCLUSIONS: Hip fractures in older adults can present multiple challenges to care when complicated by preexisting or coexisting conditions. This case of an older man with a hip fracture emphasizes the resuscitation priorities for the patient found after a "long lie" and the impact of chronic alcoholism and malnutrition, which lead to serious complications. IMPLICATIONS FOR PRACTICE: Careful physical and psychosocial assessment is important for determining the presenting problem and comorbid conditions. Priorities for postoperative management of hip fracture and its complications guide the nurse practitioner through the successful return of the patient to the community.     

骨折联络服务理念在老年骨质疏松性髋部骨折术后患者中的应用效果

目的 观察骨折联络服务(FLS)理念在老年骨质疏松性髋部骨折术后患者中的应用效果.方法 选取2018年1月至2020年1月我院收治的108例老年骨质疏松性髋部骨折患者作为研究对象,按照入院日单双号分为对照组(单号入院,65例)及观察组(双号入院,43例).对照组采用传统的术后康复管理,观察组采用FLS理念术后康复管理....     

老年髋部骨折病人心理护理与功能康复护理研究

[目的]探讨对老年髋部骨折病人实施心理护理、功能康复护理的效果。[方法]将83例行手术治疗的老年（年龄≥60岁）髋部骨折病人分为观察组和对照组,对照组行常规护理,观察组在常规护理的基础上给予心理护理、功能康复护理。[结果]出院时两组病人焦虑（SAS）得分比较,差异有统计学意义（P〈0.05）。术后对两组病人随访12个月,观察组显效率明显高于对照组（P〈0.05）。[结论]对老年髋部骨折病人进行心理护理、功能康复护理,病人治疗期间焦虑情绪明显改善、远期疗效好。     

The impact of psychological factors in recovery following surgery for hip fracture

Purpose. To increase awareness of psychological factors in recovery from hip fracture and to describe strategies that can be used to help patients in the process of recovery.

Method and results. Psychological theory, case examples and clinical observation are used to propose three frameworks for understanding the psychological factors which can impede recovery. Indication of key strategies for assessment and intervention which can be used in rehabilitation services is provided.

Conclusions. An understanding of the psychological factors which can impede recovery in hip fracture is important for all professionals involved in rehabilitation. Psychologists can provide consultation and support for staff working in physical rehabilitation and can work directly with cases where there is complexity. There is still relatively little known about this important area and further research is needed to provide a clear evidence base.     

The impact of psychological factors in recovery following surgery for hip fracture

Purpose. To increase awareness of psychological factors in recovery from hip fracture and to describe strategies that can be used to help patients in the process of recovery.

Method and results. Psychological theory, case examples and clinical observation are used to propose three frameworks for understanding the psychological factors which can impede recovery. Indication of key strategies for assessment and intervention which can be used in rehabilitation services is provided.

Conclusions. An understanding of the psychological factors which can impede recovery in hip fracture is important for all professionals involved in rehabilitation. Psychologists can provide consultation and support for staff working in physical rehabilitation and can work directly with cases where there is complexity. There is still relatively little known about this important area and further research is needed to provide a clear evidence base.