Health care needs of patients during early recovery after total knee-replacement surgery

Department of Nursing, Taoyuan Armed Forces General Hospital, Taiwan.
Journal of Clinical Nursing (Impact Factor: 1.26). 03/2010; 19(5-6):673-81. DOI: 10.1111/j.1365-2702.2009.03107.x
Source: PubMed


The aim of this study was to understand the health care needs and related factors for patients with knee osteoarthritis during the early recovery period after total knee-replacement surgery.
Knee-replacement surgery effectively relieves pain and improves mobility for patients with knee osteoarthritis. With shorter hospital stays, postoperative knee-replacement patients need guidance from medical personnel about self-care, but little is known about these patients' health care needs.
This descriptive, correlational study used a longitudinal design.
A convenience sample of 85 patients undergoing total knee-replacement surgery in northern Taiwan was interviewed before and 1-2 weeks after hospital discharge. Data were collected on participants' demographic characteristics, disease characteristics, symptom distress and health care needs.
Participants' health care needs diminished significantly after hospital discharge. Before hospital discharge, the most important need was medical personnel to help relieve postoperative pain, and health care needs were predicted by symptom distress and age. After hospital discharge, the most important need was medical personnel to help understand the conditions requiring a return visit to hospital, and health care needs were predicted by symptom distress, health care needs before discharge, age and gender.
The results of this study provide a comprehensive understanding of health care needs before and after discharge, as well as predictive factors for patients undergoing total knee-replacement surgery.
Given today's shorter hospital stays, clinicians need to prioritise health care needs indicated by predictive variables. This strategy would help optimise assessment and care management by focusing on patients' greater health care needs and by tailoring care information and skills to patients' individual needs.

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    • "Hemşire TDP hastalarının uyumunu incelerken, değişen süreçleri değerlendirerek etkili uyum olup olmadığını değerlendirir. Sonuç olarak hastaların planlanan EHA'nı sürdürebilmeleri, GYA'ni ve rollerini yerine getirebilmeleri, kesintiye uğrayan sosyal yaşamalarına dönmeye istekli olmaları, memnuniyet ifadeleri, komplikasyon gelişmemesi, yeniden yatışların olmaması gibi çıktılar proteze uyum sağlandığını gösteren belirleyicilerdir (Ouellet ve ark., 2003; Roy 2009; Santy 2001; Su ve ark., 2010). Sonuç olarak; RUM'ne göre yapılandırılmış sürekli bakımın TDP hastalarının bakımına bütüncül bakış açısı sağlayabileceği ve ekip anlayışını geliştireceği düşünülmektedir . "
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    ABSTRACT: Patients With Total Knee Replacement Recently the increase in the surgeries of the total knee prothesis and the changes in the health systems require a multidimensional care for the patients beyond an acute care. Patients encounter with many problems in various processes and need a continuity of care provided by a multidisciplinary team. As adaptation to the prothesis composes the basis of the care for the patients who underwent a total knee replacement, structuring the care that will be provided to the patients according to the Roy Adaptation Model will improve the patient results by systematizing the nursing process and testing this model in this patient group will contribute to the nursing science. In this paper, continuous care provided to the patients with total knee replacements through Roy Adaptation Model was analyzed. Key Words: Knee prosthesis, Continuity of care, Roy Adaptation Model. Günümüzde total diz protezi ameliyatının artması ve sağlık sistemindeki değişimler; hastalara akut bakımın ötesinde çok yönlü bir bakım sağlamayı gerektirmektedir. Hastalar farklı süreçlerde birçok sorunla karşılaşmakta ve multidisipliner ekibin yürüttüğü sürekli bakıma gereksinim duymaktadırlar. Total diz protezi hastaları için proteze uyum sağlama bakımın temelini oluşturduğundan, hastalara uygulanacak sürekli bakımın Roy Uyum Modeli’ne göre yapılandırılması; hemşirelik sürecinin sistematize edilmesini sağlayarak hasta sonuçlarını geliştirecek, bu hasta grubunda modelin test edilmesi hemşirelik bilimine katkı sağlayacaktır. Bu makalede total diz protezi hastalarının Roy Uyum Modeli rehberliğinde sürekli bakımı analiz edilmiştir.
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    • "In a survey conducted at Gentofte University Hospital in 2011, 96% out of 86 patients identified 1–7 physical postoperative health problems two to three weeks after undergoing TKA (unpublished observations by the researcher responsible for this trial). The health-related information given during the admission course has been difficult to transfer to the home settings [8], and following discharge the patients have needed further guidance [9]. Although the problems were apparent, the patients were reluctant to contact health professionals due to a belief that their problems were too insignificant to bother health care providers with [10]. "
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    ABSTRACT: Background: Due to shorter hospitalization, patients have to take responsibility for their rehabilitation period at a very early stage. The objective of this trial is to study the effects of two treatment schemes following total knee arthroplasty: conventional treatment following discharge from hospital and early follow-up by telephone consultations in addition to conventional treatment following discharge from hospital. The ultimate aim is to increase the effectiveness of the treatment by improving patients' health status, promote self-efficacy, and reduce the number of acute visits to the orthopaedic outpatient clinic during the rehabilitation period. Method/design: The design is a randomized un-blinded parallel group clinical trial conducted at the Department of Orthopaedic Surgery, Gentofte Hospital, the Capital Region of Denmark. In total, 116 patients will be allocated by an external randomization program to 2 groups: an intervention group following usual treatment after discharge supplemented by a nurse managed structured follow-up consultation conducted by telephone 4 and 14 days after discharge from hospital and a control group following treatment as usual. The consultations are structured by key subjects relevant to assess the health status according to the VIPS-model (the Swedish acronym for the concepts Well-being, Integrity, Prevention and Safety). The content of the consultations can vary according to the patients´ individual situations and needs. All consultations are conducted by the researcher responsible for the trial. The effect is measured 1, 3, 6 and 12 months post-surgery. The primary outcome is self-reported physical function measured by The Western Ontario and McMaster Universities Arthritis Index. Secondary outcomes are self-reported health-related quality of life, general self-efficacy and the number of acute visits to the orthopaedic outpatient clinic. Discussion: The result of this trial is expected to provide new knowledge to support the development of targeted and effective follow-up after total knee arthroplasty in order to improve the patients´ health-related knowledge and skills of being able to take actively part in their illness and improve their health status. Trial registration: NCT01771315.
    BMC Nursing 05/2014; 13(1):14. DOI:10.1186/1472-6955-13-14
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    ABSTRACT: To generate information on how telephone follow-up consultations, structured by nursing status according to the VIPS-model, functioned after total knee arthroplasty. The objectives were to unfold the content of the telephone follow-ups according to the structure for nursing status and to explore the patients' views of the telephone follow-ups. The length of stay in hospital following total knee arthroplasty has fallen markedly, and patients now have to be responsible for their recovery from a very early stage. After discharge, patients may experience a variety of health problems. A clinical trial was conducted to evaluate the effect of telephone follow-up, and information on how the telephone follow-ups functioned is relevant for implementation into clinical practice. A qualitative design was used. One hundred and four case reports from telephone follow-up consultations and individual interviews with 10 patients formed the data material. Content analysis was used for the analysis. The content of the telephone follow-ups included dialogues relating to all key subjects for nursing status except 'culture/spirituality'. The structured Telephone follow-up was valued by total knee arthroplasties patients as representing a holistic approach and providing adequate information, counselling and support after discharge to home. Three categories were identified with regard to the patients' views: 'A means for reflection and provision of adequate information and counselling', 'Supportive' and 'Not the only resource for support and counselling'. Nursing status according to the VIPS model is a comprehensive structure to identify the need for counselling, information and support after total knee arthroplasty. The structured telephone follow-ups were valued for representing a holistic approach and providing adequate information, counselling and support after discharge to home. Conducting telephone follow-up with a holistic approach demands specialised and broad nursing experience. Postdischarge follow-up is important. © 2015 John Wiley & Sons Ltd.
    Journal of Clinical Nursing 07/2015; DOI:10.1111/jocn.12905 · 1.26 Impact Factor