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Postoperative delirium (POD) frequently occurs in elderly patients after major orthopedic surgery. Nurses play a key role in delivering non-pharmacological preventive interventions, but the evidence supporting their effectiveness varies. This systematic review aims to summarize current research on nursing interventions designed to reduce POD in older adults undergoing these surgeries. We followed PRISMA 2020 guidelines to conduct a systematic search in five databases (CINAHL, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and Google Scholar (as a supplementary source)) for studies published from 2010 to 2025. Eligible studies evaluated nursing-led interventions targeting delirium prevention in patients aged 65 years or older after major orthopedic surgery. Two reviewers independently screened using Rayyan [10] 529 records, reviewed full texts, and extracted data on study design, participants, interventions, and outcomes. Due to heterogeneity, a narrative synthesis approach was employed to analyze the data. Quality assessment used the Cochrane RoB 2 tool for randomized controlled trials and ROBINS-I [12] for non-randomized studies. Eight studies met inclusion criteria, including 3,018 participants. The designs comprised two randomized controlled trials, three quasi-experimental or cohort studies, two retrospective analyses, and one before-and-after study. Nurse-led multicomponent protocols, system-level interventions such as standardized orders, and single-component approaches like sensory aid management all showed statistically significant reductions in POD incidence. Absolute risk reductions ranged from 4.0% to 24.5%. Larger trials reported modest but statistically significant effects (for example, an odds ratio of 0.59 in an orthopedic subgroup), while smaller studies observed larger decreases. Variations in intervention types and outcome measures prevented meta-analysis. Nursing interventions, especially multicomponent protocols and systemic changes, may reduce postoperative delirium in older adults undergoing major orthopedic surgery. Even targeted single-component interventions suggest a potential to lower delirium rates meaningfully. Standardizing outcome measures in future studies would help enable outcome measures to enable meta-analyses and explore how best to implement these interventions in clinical settings. PROSPERO CRD420251140913. Registered 05 September 2025. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251140913.
Orthopedic hospitals are knowledge-intensive settings shaped by high procedural volume, multidisciplinary coordination, implant- and imaging-based decision-making, and extended rehabilitation pathways. However, knowledge management (KM) in orthopedic healthcare remains insufficiently synthesized. This review examined current evidence on KM in orthopedic healthcare and proposed an orthopedic-specific framework linking KM processes with patient safety and organizational performance. A structured narrative review was conducted using PubMed/MEDLINE, Scopus, Web of Science, Embase, CINAHL, and Google Scholar. Literature published from January 2020 to March 2026 was prioritized, with selective inclusion of seminal theoretical, registry, and policy sources. Eligible studies addressed hospital-based orthopedic care or related musculoskeletal, surgical, nursing, and digital health contexts relevant to knowledge capture, sharing, evidence use, implementation, patient safety, and performance. Given the heterogeneity of the included literature, findings were synthesized thematically and interpreted in relation to study characteristics, practical relevance, contextual transferability, and conceptual contribution. A total of 88 sources were included. Six recurring themes were identified across orthopedic-specific and transferable healthcare literature: KM governance; knowledge capture and codification; multidisciplinary knowledge sharing; evidence use and pathway standardization; technology-enabled KM; and implementation barriers and enablers. Orthopedic hospitals showed distinctive KM needs related to implant surveillance, perioperative coordination, rehabilitation continuity, outcome feedback, and tacit procedural expertise. This review suggests that KM may be regarded as a core component of clinical infrastructure in orthopedic healthcare. Strengthening KM may support evidence-based practice, multidisciplinary coordination, digital capability, and patient safety. Future research should prioritize orthopedic-specific KM metrics and prospective evaluation of human-centered and digital integration strategies.
The theory to practice gap (TPG) is a significant challenge in undergraduate community nursing education. Although TPG has been extensively studied in nursing education, research specifically examining these gaps in community nursing remains limited. The aim of this study is to explore the manifestations, contributing factors, and bridging strategies of the TPG in community nursing education from undergraduate nursing interns' perspectives. A qualitative study guided by the knowledge-to-action (KTA) framework. This study was conducted at a medical university in China. Fifteen undergraduate nursing interns (12 females, 3 males) who had completed their 2-3-week community practicum were recruited using purposive sampling. Data were collected through face-to-face in-depth interviews conducted from October to December 2024. All interviews were audio-recorded and analyzed using Braun and Clarke's thematic analysis method. The analysis identified three core themes: (1) gaps, manifesting in individual competencies, pedagogical aspects, and healthcare system; (2) factors, including individual aspects, environmental aspects, and systemic issues; (3) strategies, focusing on enhancing talent development, adjusting teaching plans, and building collaborative mechanisms. Notably, a majority of the respondents believe that adjusting the ratio of theoretical and practical courses, enhancing students' hands-on learning, and strengthening school-community collaborative education can quickly narrow the gap. This study found that the TPG in community nursing involves three dimensions including individual, environmental, and healthcare system, primarily influenced by factors such as the disconnect between theoretical and practical curricula, uneven teaching quality, and insufficient support from community institutions. It is recommended to increase the arrangement of practical courses in the curriculum design process and implement corresponding synchronization, and to improve educational quality through regular exchanges between teachers from both schools and communities.
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PurposeGuided by Watson's Caring Science, this study explored the humanistic care needs of hospitalized orthopedic patients and interpreted the lived meanings underlying these needs.DesignA descriptive phenomenological design was used.MethodsPurposive sampling was used to recruit 13 orthopedic inpatients from a tertiary hospital in Hebei Province, China. Data were collected through semistructured in-depth interviews and analyzed using Colaizzi's seven-step phenomenological method.FindingsNine themes were identified, covering pain management, safety and environmental needs, daily care, privacy and respect, psychological support, rehabilitation guidance, continuity of care, caring attention and support, and communication. Beyond these specific needs, the findings revealed a core lived experience of vulnerability, dependence, and threatened dignity during hospitalization. Patients sought not only symptom relief, but also humanistic care that helped them feel respected, understood, supported, and gradually move toward healing.ConclusionsOrthopedic inpatients have multidimensional humanistic care needs that reflect a holistic caring experience of body, mind, and spirit. Integrating technical care, relational care, and continuity of care may strengthen holistic nursing practice in orthopedic settings.
Cybernetics describes how systems regulate performance through feedback control by setting goals, monitoring current states, comparing against a standard, and adapting actions to reduce discrepancies. In teaching, this feedback-loop logic can be operationalized as structured cycles of goal clarification, guided information seeking, peer sense-making, and formative feedback. However, evidence on a cybernetic-based instructional approach (CBI) for undergraduate nursing achievement remains limited in low-resource higher-education settings. To compare the effects of Cybernetic-Based Instruction and the traditional lecture method on the academic achievement of undergraduate nursing students in maternal and child health nursing. A quasi-experimental, non-equivalent group pretest-posttest study was conducted among fourth-year nursing students at Bayero University, Kano, Nigeria. Two intact cohorts from successive academic sessions received the same course content over a 13-week module. The 2024/2025 cohort received CBI (objective-driven inquiry, explicit credibility appraisal, peer synthesis, and iterative instructor/peer feedback), while the 2023/2024 cohort received conventional didactic lectures (PowerPoint/whiteboard with scheduled Q&A). Achievement was measured using a 50-item Maternal and Child Health Nursing Achievement Test (MCHNAT) administered pre- and post-instruction under supervised conditions. Analyses used within- and between-group tests and ANCOVA adjusting for pretest scores (α = 0.05). Both groups improved significantly from pretest to posttest (p < 0.001). The CBI cohort achieved higher post-test scores and larger gains than the lecture cohort (73.12 ± 8.96 vs 60.62 ± 4.49; p < 0.001) and greater mean gain (31.59 ± 8.37 vs 17.94 ± 4.54; p < 0.001), and the adjusted between-group difference remained significant after controlling for baseline scores. ANCOVA confirmed a significant adjusted advantage for CBI (B = 13.13; 95% CI: 11.30-14.97; p < 0.001; partial ηp2 = 0.554; R2 = 0.605). A structured cybernetic feedback-loop approach was associated with higher short-term achievement than lecturing. Further multi-site studies should examine longer-term retention and transfer, and strengthen internal validity where feasible.
The proportion of orthopedic patients experiencing breakthrough pain (BTP) is as high as 82.5%, which can result in fear and activity avoidance in patients, thereby hindering recovery. This project aimed to promote evidence-based practices for the assessment and management of BTP in orthopedic patients. This project was guided by JBI Evidence Implementation Framework. We conducted an evidence-based practice project to assess and manage BTP in the orthopedic department of a tertiary hospital in China. The project adopted an audit and feedback approach across seven distinct phases. Ten audit criteria were developed for baseline and follow-up audits to assess program effectiveness. The project also used the JBI Practical Application of Clinical Evidence System (JBI PACES) and the JBI Getting Research into Practice (GRiP) method for implementation. At baseline, only one criterion-routine pain screening using the Numeric Rating Scale within 8 hours of admission-met the best practice standard. The other nine criteria showed deficiencies. The research team analyzed the gaps and identified six barriers based on these results. Strategies to address these barriers were designed and implemented. In follow-up audit 1, the compliance rates improved for all but Criterion 1. In follow-up audit 2, the compliance rates decreased to varying degrees for all but Criterion 1 compared with the first follow-up audit. In both follow-up audits, the frequency of BTP was significantly reduced compared to the baseline audit (p < 0.05). Using evidence-based strategies guided by the JBI Evidence Implementation Framework, this project improved compliance with pain assessment practices and reduced BTP episodes among orthopedic patients. http://links.lww.com/IJEBH/A599.
Despite established ethical principles, a critical synthesis of how informed consent deficiencies, leading to costly malpractice lawsuits in elective orthopedic surgery, relate to medico-legal outcomes, documentation pitfalls, and team roles is lacking. This scoping review aimed to investigate the status of obtaining informed consent by the treatment team in elective orthopedic surgeries and the related legal consequences. Following the Arksey & O'Malley framework update by Levac et al., we conducted a comprehensive search across PubMed, Scopus, Web of Science databases, and the Google Scholar search engine. Studies focusing on informed consent, legal factors, and the treatment team in elective orthopedic procedures were included in this review. Data were charted and analyzed using thematic analysis for qualitative synthesis, supplemented by quantitative summary statistics. Qualitative analysis identified four themes: documentation patterns, legal factors, cultural considerations, and risk mitigation strategies. Findings showed frequent documentation gaps (13%-32% of forms lacked specific complications). Nerve injury was the most common cause of lawsuits (46%-56%). In lumbar fusion, 24% of claims cited failure to obtain consent. US compensation averaged $871 093, vastly exceeding European figures. Patient recall of complications was poor (22.5%) but improved to 48% with written aids. The informed consent process in elective orthopedics faces systematic challenges, including inconsistent documentation, high litigation risk, and inadequate patient understanding. To reduce legal exposure and promote safety, implementing evidence-based, procedure-specific consent forms, interdisciplinary team training, and culturally competent communication is recommended. Addressing these requires coordinated policy reform at institutional and educational levels.
Orthopedic sports medicine plays a critical role in maintaining the physical health and overall well-being of boys and men. However, with sports participation comes the potential for injury. Specialized medical attention is needed for appropriate diagnosis and treatment of these injuries. This article provides an overview of several common sports-related acute and overuse orthopedic injuries with an emphasis on the male patient. The scope is intentionally limited to select injuries with high prevalence and clinical significance in physically active boys and men, including growth plate fractures, overuse injuries, anterior cruciate ligament tears, rotator cuff injuries, and osteoarthritis exacerbations. This article categorizes these select injuries by developmental stage-childhood (5-12 years), adolescence (13-18 years), young adulthood (19-35 years), middle adulthood (36-50 years), and older adulthood (51 years and older)-to guide nurse practitioners in delivering evidence-based, age-appropriate orthopedic care. Age- and sex-specific considerations are paramount. By highlighting male-specific injury patterns and treatment needs, this article supports improved outcomes and long-term musculoskeletal health in this often-understudied population.
To evaluate the effectiveness of abdominal massage in preventing postoperative constipation among orthopedic surgery patients based on evidence from randomized controlled trials. Systematic review of randomized controlled trials. A systematic search was conducted in PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar databases for studies published in Turkish or English between 2014 and 2024. The methodological quality of the included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Randomized Controlled Trials. A total of 4,517 records were identified, and five studies met the inclusion criteria and were included in the review. The included studies consistently demonstrated that abdominal massage significantly reduced constipation symptoms, increased bowel movements, and improved patients' quality of life. Although the timing, frequency, and duration of massage interventions varied across studies, all reported positive outcomes. Patients who received abdominal massage experienced earlier bowel movements and reduced reliance on laxatives compared with those receiving routine care. Abdominal massage appears to be an effective, safe, and promising non-pharmacological intervention for preventing and managing postoperative constipation in orthopedic surgery patients. By promoting bowel function, it may contribute to enhanced patient comfort and recovery. Further high-quality studies are needed to establish standardized protocols regarding the optimal timing, frequency, duration, and technique of abdominal massage in postoperative care.
Emergence delirium (ED) is a postanesthetic phenomenon more frequently observed in children, typically presenting as altered awareness and behavioral disturbances. While research has primarily focused on the hyperactive subtype of ED, emerging evidence highlights the under-recognized hypoactive subtype. Despite its high occurrence in various pediatric surgeries, ED in orthopedic contexts remains insufficiently studied, particularly regarding subtype characteristics and associated risk factors. Observational, cross-sectional study involved secondary data analysis. A total of 200 children were included. ED was evaluated on the basis of the Traditional Chinese version of the Cornell Assessment of Pediatric Delirium (CAPD-TC) while patients were in the postanesthesia care unit (PACU). Factors associated with pediatric ED were examined through binary logistic regression analysis. ED incidence was 48.0% on arrival in the PACU and subsequently decreased over time. Among the ED cases, 80.2% were hyperactive and 17.7% were hypoactive. The duration of hypoactive ED was significantly longer than that of hyperactive ED (median: 21.5 vs 10.1 min, P = 0.003). Postoperative pain (odds ratio [OR] = 1.21, 95% confidence interval [CI]: 1.03 to 1.43) and laryngeal mask airway use under general anesthesia (OR = 3.03, 95% CI: 1.47 to 6.26) were significantly associated with CAPD-TC-positive ED symptoms after adjustment for covariates. The high incidence of ED on arrival in the PACU underscores the necessity of recognizing factors associated with ED and effectively allocating clinical resources. Hyperactive ED was the most common ED subtype, although the hypoactive subtype was characterized by a longer duration. These findings indicate that clinicians should monitor vital signs as well as consciousness recovery and associated risks.
The number of patients with mild traumatic brain injury (TBI) receiving oral anticoagulation is increasing. Up-to-date diagnostic and treatment algorithms are missing in Austria. The aim of this survey is to collect and analyse Austria-wide data on the care of this patient group. The survey was carried out using "Jotform" between 27 November 2023 and 31 January 2024, asking questions relating to the diagnosis and treatment of patients with mild TBI receiving antithrombotic therapy. Patient groups comprising individuals with alcohol addiction and hemophilia were incorporated as well with a view to the paucity of available literature on these groups. The survey was sent to all orthopedic-traumatological and neurosurgical departments in Austria. 39 of 67 (58.2%) orthopedics & traumatology departments and 4 of 10 (40%) neurosurgery departments participated in the survey. The share of departments reporting routine submission of different patient groups to cranial computed tomography (CCT) was 38 (95%) for patients taking antiplatelet agents, 39 (97.5%) departments for patients taking vitamin K antagonists (VKAs), 39 (97.5%) for patients taking direct oral anticoagulants (DOACs), 11 (27.5%) for patients with alcohol addiction, and 28 (70%) for patients with known hemophilia. Considering the separate groups of patients not living in a nursing facility vs. those living in a nursing facility, inpatient admission occurred for 63% vs. 44% of patients taking antiplatelet agents, for 78% vs. 61% of patients taking VKAs, 80.5% vs. 63.4% of patients taking DOACs, 17.1% vs. 17% of patients with alcohol addiction, and 51.2% vs. 43.9% of patients with hemophilia. Statistically significant regional differences in inpatient admission were found in the group with hemophilia (living and not living in a nursing facility) as well as in the group with DOAC intake (living in a nursing facility). Regional differences in the treatment of the studied patient groups exist within Austria, particularly regarding in-house admission of patients. An up-to-date guideline would be desirable to enable the best possible patient care while taking the increasing resource scarcity into account.
This study aimed to develop a systematic framework for the clinical transformation and application of Best Practice Guidelines (BPGs) in Chinese healthcare contexts, thus providing a reference for the implementation of evidence-based nursing reform and practice. From October to December 2024, a preliminary framework was developed based on a knowledge translation model, a systematic literature review, and 10 years of implementation experience as a Best Practice Spotlight Organization® (BPSO®) at Dongzhimen Hospital, Beijing University of Chinese Medicine. The preliminary framework was then refined through qualitative interviews with 12 multidisciplinary experts. Subsequently, from January to April 2025, the content validity of the preliminary framework was evaluated by 15 multidisciplinary experts using the Content Validity Index (CVI). Following this, the framework was revised and finalized through a focus group discussion involving 13 experts. In April 2025, this framework was implemented in the Department of Orthopedics at Dongzhimen Hospital, Beijing University of Chinese Medicine, taking pain management as the clinical application scenario. A total of 12 participants, including clinical physicians, nursing staff and methodological experts, were recruited to evaluate its clinical applicability and implementation feasibility. The expert consultation results indicated good content validity of the framework, with an overall CVI of 0.88. The final framework comprises three concentric rings. The inner ring comprises three types of products derived from integrating Chinese and Western medical evidence-namely, evidence-based nursing protocols, locally adapted patient guidelines, and patient decision aids. The middle ring represents a seven-step, full-cycle implementation pathway that covers problem identification, evidence localization, barrier/facilitator assessment, intervention selection/adaptation/implementation, process monitoring, outcome evaluation, and sustainability maintenance. The outer ring comprises nine targeted intervention functions, including education, persuasion, incentivization, coercion, training, restriction, environmental restructuring, modeling, and enablement. In the preliminary application to orthopedic pain management, qualitative interviews revealed three themes: the three-ring structure provided clear guidance; the selection criteria for evidence products in the inner ring need further clarification; the intervention functions of the outer ring require more targeted practical guidance for implementation. The framework developed in this study demonstrates strong scientific rigor and practical feasibility for BPG transformation in settings featuring integrative medicine, while preserving both evidence-based standards and the characteristics of traditional Chinese medicine (TCM). This framework can serve as both a theoretical and practical reference for healthcare institutions and researchers seeking to efficiently adapt international guidelines and promote standardized, evidence-based nursing practice.
Patients with orthopedic injuries frequently utilize online resources to seek information that could be proactively addressed through anticipatory guidance from their healthcare provider. A gap in the literature exists regarding the information orthopedic patients seek from the internet to meet their educational needs. To ascertain the topics and reasons for seeking orthopedic information from online sources. This cross-sectional study utilized the online orthopedic subreddit called "r/brokenbones" to examine patients' reasons for seeking online help, the varying aspects and emotional tone of the posts, and the background of patients/responders. Data from 195 posts demonstrated that most inquiries centered around recovery and progress expectations. The primary reason for posting was a concern or need for advice, followed by the request for general information. The underlying emotional tone of the posts was one of concern or worry. Given that patients increasingly turn to the internet for information, modern healthcare teams must recognize the role of online forums in patient experience and develop strategies for educating and communicating more effectively.
To identify subgroups of older adults with hip fractures who are more likely to experience delayed discharge from acute orthopedic hospitalization to postacute rehabilitation and to examine the impact of such delays on adverse events and short-term outcomes. Retrospective cohort study conducted between 2018 and 2022 at a large tertiary hospital in north-central Israel. The study included 474 adults aged ≥65 years hospitalized for hip fracture surgery and eligible for postacute rehabilitation (inpatient or home-based). Analyses evaluated predictors of delayed discharge from acute orthopedic hospitalization to postacute rehabilitation. We examined adverse events occurring after rehabilitation approval and before acute hospitalization discharge (infections, falls, and in-hospital mortality), early postdischarge outcomes (re-hospitalization and re-operation), and hospitalization costs . Delayed discharge occurred in 61.4% of patients, with a mean delay of 3.5 days. In unadjusted analyses, delayed discharge was associated with higher rates of infections, falls, and mortality. In multivariable models adjusting for age and rehabilitation pathway, delayed discharge remained independently associated with healthcare-acquired infections (OR=3.09, 95% CI: 1.62-5.90, p<.001), but not with mortality. Referral to inpatient rehabilitation was also independently associated with infection risk (OR=2.21, 95% CI: 1.10-4.45, p=.026). Early identification of patients at risk for delayed transition to postacute rehabilitation may support proactive discharge planning, infection prevention strategies, and coordinated care across settings. Delayed transition from acute orthopedic hospitalization to postacute rehabilitation is independently associated with increased risk of healthcare-acquired infection and higher hospitalization costs. Reducing avoidable acute care days through improved coordination may enhance patient safety and system efficiency.
Rising health care costs necessitate value-based health care (VBHC) initiatives. Large hospital systems offer a platform for surgeon collaboration in developing standardized, interdisciplinary orthopedic care. This study evaluates the formation, implementation, and outcomes of the Musculoskeletal Quality Collaborative (MSKQC) across a hospital system. Established in 2019, the MSKQC comprises physician, quality, and nursing leaders from 14 hospitals. Using the Delphi method, surgeons identified VBHC interventions, leading to protocols for antibiotic-infused bone cement (AIBC), povidone-iodine irrigation, and negative pressure wound therapy (NPWT) dressings, implemented in May 2023. Usage was tracked across hospitals and reviewed quarterly from June 2023 to June 2024. Total hip arthroplasty and total knee arthroplasty (TKA) standardized infection ratios (SIRs) were calculated using National Healthcare Safety Network (NHSN) baselines. Surgeons performing more than 30 cases annually with more than 30% utilization of a target consumable were deemed high utilizers. The systemwide savings opportunity exceeded $800,000 annually. AIBC use dropped from 19.6% to 5.5%. Two high-use hospitals showed gradual improvement, and 7 high-use surgeons were identified. NPWT usage remained stable at less than 5%. Sterile iodine irrigation decreased by 51.6% to less than 10%. TKA infections occurred in 18 of 6592 (0.27%) surgeries in 2023, compared with 14 of 5955 (0.24%) in 2022. The NHSN SIR was 0.906. The MSKQC successfully reduced high-cost consumable use while maintaining low infection rates. Regular protocol distribution and surgeon-specific feedback proved effective in advancing VBHC initiatives. This model offers a scalable approach for orthopedic VBHC implementation in the absence of national guidelines.