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Patients with Hip Fracture: Various aspects of patient safety
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the thesis was to investigate whether patient safety can be improved for patients with hip fracture by nutritional intervention and by pharmacological treatment with cranberry concentrate. Another aim was to describe the patients’ experience of involvement in their care. The thesis includes results from four studies that include both quantitative and qualitative design. Studies I and II were intervention studies with a quasi-experimental design, with intervention and comparison groups. Study III was a randomised, double-blind, placebo-controlled trial with intervention and control groups. Study IV took a qualitative approach.

Study I showed that when patients with hip fracture received nutritional supplementation according to nutritional guidelines, from admission until five days postoperatively, fewer patients developed pressure ulcers. Study II showed that it is possible to objectively evaluate a short-term nutritional intervention through the nutritional biochemical marker IGF-1, as it was affected by a five-day high-energy regimen. The randomised controlled trial, Study III, showed that a short-term treatment from admission until five days postoperatively with cranberry as capsules does not seem to be useful in preventing positive urine cultures in female patients with hip fracture and a urinary catheter. Finally, Study IV showed that patients with hip fracture reported experiencing very little involvement in their nursing care, to the extent that fundamental aspects of nursing care went unfulfilled. Patients did not feel valued by the nurses and unbearable pain that affected rehabilitation was reported. Positive interactions with nurses, however, did encourage patients to be more active.

It is possible for every nurse to improve patient safety at bedside when caring for patients with hip fracture. Simply by increasing caloric/energy intake, it is possible to prevent pressure ulcers. It is also important to involve patients in nursing care, since the patients have experienced low or almost no involvement in care. Nurses need to see each patient as a whole person with different wishes and needs. However, certain prerequisites have to be in place to give nurses the opportunity to increase patient safety at bedside for patients with hip fracture.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. , 68 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1035
Keyword [en]
Hip fracture, patient safety, nutrition, cranberry, patient involvement, adverse event, elderly
National Category
Nursing
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:uu:diva-232825ISBN: 978-91-554-9053-9OAI: oai:DiVA.org:uu-232825DiVA: diva2:751476
Public defence
2014-11-14, Grönwallsalen, Akademiska sjukhuset, ing 70, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2014-10-24 Created: 2014-09-25 Last updated: 2015-01-23
List of papers
1. Does nutritional intervention for patients with hip fractures reduce postoperative complications and improve rehabilitation?
Open this publication in new window or tab >>Does nutritional intervention for patients with hip fractures reduce postoperative complications and improve rehabilitation?
2009 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 9, 1325-1333 p.Article in journal (Refereed) Published
Abstract [en]

 The aims were to investigate whether there were any differences between patients receiving nutritional intervention preoperatively and over five days postoperatively and patients who did not, in terms of postoperative complications, rehabilitation, length of stay and food and liquid intake. BACKGROUND: Patients with hip fractures are often malnourished at admission to hospital and they typically do not receive the energy and calories needed postoperatively. DESIGN: The design was a quasi-experimental, pre- and post-test comparison group design without random group assignment. METHODS: One hundred patients with hip fractures were consecutively included. The control group (n = 50) received regular nutritional support. The intervention group (n = 50) received nutrition according to nutritional guidelines. The outcome measures used were risk of pressure ulcer, pressure ulcers, weight, nosocomial infections, cognitive ability, walking assistance and functional ability, collected preoperatively and five days postoperatively. Each patient's nutrient and liquid intake were assessed daily for five days postoperatively. RESULTS: Significantly fewer (p = 0.043) patients in the intervention group (18%) had pressure ulcers five days postoperatively compared with the control group (36%). Nutrient and liquid intake was significantly higher (p < 0.001) in the intervention group. Median length of stay decreased from nine to seven days (p = 0.137), as did nosocomial infections, from 18-8.7% (p = 0.137). CONCLUSION: Patients with hip fractures receiving nutrition according to nutritional guidelines developed fewer pressure ulcers. This is invaluable to patients' quality of life and a major economic saving for society. RELEVANCE TO CLINICAL PRACTICE: Great benefits can be gained for the patients through modest efforts by nurses and physicians such as nutritional intervention.

Keyword
hip fractures, nurses, nursing, nutrition, older people, pressure ulcer
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-124746 (URN)10.1111/j.1365-2702.2008.02673.x (DOI)000265035000012 ()19207806 (PubMedID)
Available from: 2010-05-05 Created: 2010-05-05 Last updated: 2015-01-23Bibliographically approved
2. Increased energy intake in hip fracture patients affects nutritional biochemical markers
Open this publication in new window or tab >>Increased energy intake in hip fracture patients affects nutritional biochemical markers
2012 (English)In: Scandinavian Journal of Surgery, ISSN 1457-4969, Vol. 101, no 3, 204-210 p.Article in journal (Refereed) Published
Abstract [en]

Background and Aims: We have previously shown that nutritional guidelines decreased the incidence of pressure ulcers in hip fracture patients. In the present study, we evaluate whether the nutritional biochemical markers S-IGF-1 (Insulin-like Growth Factor 1), S-Transthyretin and S-Albumin are affected by patients' energy intake, and whether the markers are useful as predictors of postoperative complications. Material and Methods: Quasi-experimental design, with one intervention and one control group, as well as pre- and post-study measurements. Eighty-eight hip fracture patients were included: 42 in the control group and 46 in the intervention group. The control group received regular nutritional support pre- and postoperatively, while the intervention group received nutritional support that followed new, improved clinical guidelines from admission to five days postoperatively. S-Albumin, S-Transthyretin, C-Reactive Protein (S-CRP) and S-IGF-1 were analysed at admission and five days postoperatively as well as complications like pressure ulcer and infection. Results: The intervention group had a significantly higher energy intake; for example, 1636 kcal versus 852 kcal postoperative day 1. S-IGF-1 levels decreased significantly in the control group, while no decrease in the intervention group. S-Albumin and S-Transthyretin decreased and S-CRP increased significantly in both groups, indicating that those markers were not affected short-term by a high-energy intake. There was no correlation between short-term postoperative complications and S-IGF-1, S-Transthyretin or S-Albumin at admission. Conclusion: The results of our study showed that S-IGF-1 can be used as a short-term nutritional biochemical marker, as it was affected by a five-day high-energy regimen. However, neither S-IGF-1, S-Transthyretin or S-Albumin were useful in predicting postoperative complications within five days postoperatively.

Keyword
Nutrition therapy, hip fracture, Insulin-Like Growth Factor 1, albumin, prealbumin, postoperative complications
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-184494 (URN)000309332500011 ()
Available from: 2012-11-08 Created: 2012-11-07 Last updated: 2015-01-23Bibliographically approved
3. Cranberry juice concentrate does not significantly decrease the incidence of acquired bacteriuria in female hip-fracture patients receiving urine catheter: a double-blind randomised trial
Open this publication in new window or tab >>Cranberry juice concentrate does not significantly decrease the incidence of acquired bacteriuria in female hip-fracture patients receiving urine catheter: a double-blind randomised trial
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background

Urinary tract infection (UTI) is a common complication among patients with hip fractures. Receiving an indwelling urinary catheter is a risk factor for developing UTIs. Treatment of symptomatic UTIs with antibiotics is expensive and can result in the development of antimicrobial resistance. Cranberries (lat. Vaccinium macrocarpon Ait.)  are thought to prevent UTI. There is no previous research on this potential effect in patients with hip fracture who receive urinary catheters.

Aim

To investigate whether cranberry capsules given pre- and postoperatively are useful in preventing hospital-acquired UTIs in female patients with hip fracture and urinary catheter.

Design

Randomised, placebo-controlled double-blind trial.

Method

Female patients, age 60 years and older, with hip fracture were recruited (n=227). The patients were randomised to receive cranberry (n=113) or placebo (n=114) capsules daily, from admission to the ward, until five days postoperatively. Urine cultures were obtained at admission and at five and 14 days postoperatively. In addition, EQ-5D assessments were performed and patients were screened for UTI symptoms.

Result

There was no difference between the groups in the proportion of patients with postoperative positive urine cultures. When excluding patients with positive cultures at admission, patients with antibiotic treatment during follow-up, and patients that did not adhere to the protocol, there was a trend towards a protective effect of cranberry treatment against hospital-acquired UTIs ; e.g. 36% (n=33) in the control group vs. 22%  (n=41) in cranberry group (p=0.17) at 5 days postoperatively.

Conclusion

Cranberry concentrate does not seem to have an effect in preventing UTI in female patients with hip fracture and indwelling urinary catheter.

 

Keyword
Urinary tract infection, cranberry, hip fracture, elderly, randomised
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-232824 (URN)
Available from: 2014-10-01 Created: 2014-09-25 Last updated: 2015-01-23
4. Hip-fracture patients’ experience of involvement in their care: A qualitative study
Open this publication in new window or tab >>Hip-fracture patients’ experience of involvement in their care: A qualitative study
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Little is known about how hip-fracture patients experience involvement in their own nursing care. Yet understanding this is essential in order to both meet patient expectations and ensure delivery of high-quality nursing care. The aim of the study was to describe how elderly hip-fracture patients experienced their involvement in the nursing care they received while in the orthopaedics ward. A descriptive design with a qualitative interview approach was used.

Semi-structured interviews were conducted with16 hip-fracture patients, 14 days postoperative in 2012. Systematic Text Condensation was used to analyse the data collected. The findings reveal six themes: 1) experiencing severe pain, 2) feeling dependent on the nurses, 3) feeling they were not valued, 4) poor organisation, 5) positives and negatives of sharing a room with fellow patients, and 6) positive interactions with nurses that encouraged the patient. Hip-fracture patients reported experiencing very little involvement in their nursing care, to the extent that fundamental aspects of nursing care went unfulfilled. Patients did not feel valued by the nurses. Most patients described experiencing unbearable pain during their stay in the orthopaedics ward despite the existence of evidence-based and established guidelines for pain management. The result of this study indicates that there is much to do on a number of levels in the health care system to improve patient involvement in nursing care.

Keyword
patient involvement, hip fracture, nursing care, elderly, geriatric, qualitative, interview.
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-232823 (URN)
Available from: 2014-10-01 Created: 2014-09-25 Last updated: 2015-12-13

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