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: Osteoarthritis (OA) is a chronic disease which affects a significant number of people during working life and retirement. The principle symptoms of OA are pain, stiffness, and potentially reduced movement and function of the affected joint. In severe OA the ability to engage in work or social activity may be restricted and as a result, the health-related quality of life of the patient may be affected. There are a variety of approaches which can be implemented to manage symptoms, including the use of orthoses, exercise programmes or in severe cases, arthroplasty. It is important that emphasis is placed on patient empowerment and shared decision-making with regard to managing symptoms and preserving or improving function or the affected joint(s).
    British journal of nursing (Mark Allen Publishing) 03/2011; 20(2):81-5. DOI:10.12968/bjha.2011.5.3.123
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