Orthopaedic Essentials: Research Update
Delores C. Schoen, PhD, RN,C, FAAN, Adjunct Professor, The Pennsylvania State University School of Nursing, University Park, PA.
To provide the best outcomes for patients and their families, nurses must rely on the implementation of clinical practice guidelines that are based on research evidence. Evidence-based practice is the integration of clinical practice, research evidence, clinical expertise, and patient and family expectations. It ensures that the nursing care provided will be scientifically based while maximizing quality outcomes in a cost-effective manner. Despite the importance of evidence-based practice to nursing, only a small percentage of nurses actually practice evidence-based care. Typical barriers are a lack of time, difficulty interpreting the research literature, and a lack of administrative support. Facilitating evidence-based practice is now an active area of study, and several promising theoretical models about research use have been published within the last few years. The purpose of this column is to assist with the transition to evidence-based care by providing a brief review of individual research articles and discussing the nursing interventions they imply.
The articles reviewed are from several different journals and reflect the diversity of patients and care settings within orthopaedic nursing. Here I review articles that discuss (1) issues related to patients who are Islamic, (2) comparisons of patient with osteoarthritis who are African American and White, (3) managing chronic pain in patients with arthritis, (4) comparisons of pain measures in patients with fibromyalgia, and (5) the effect of osteoporosis on quality of life.
Variation in perceptions of treatment and self-care practices in elderly with osteoarthritis: A comparison between African American and White patients.
Ibrahim, S. A., Siminoff, L. A., Burant, C. J., & Kwoh, C. K. (2001). Arthritis Care & Research, 45(4), 340–345.
Arthritis is a leading cause of disability in the elderly, and it is estimated that by 2050 it will affect 60 million Americans and cost $65 billion in medical care and lost productivity. In the older population, osteoarthritis of the knee or hip is the most common type of arthritis and is equally prevalent in all ethnic groups. However, there is ethnic disparity in the use of total joint replacements as an end-stage treatment of osteoarthritis. White men are 3 to 5 times more likely than African American men to have a total knee replacement and are more likely to have a total hip replacement as well. The object of the study was to compare elderly male patients (593 patients–44% African American and 56% white) with osteoarthritis of the knee or hip with respect to their perceptions of the efficacy of medical treatments and self-care practices. The two groups were comparable with respect to age, disease severity or functional status, and comorbidities. All were patients in a Veterans Administration hospital.
The two races differ in their perceptions of the efficacy of standard medical treatments for arthritis, as well as in their reliance on self-care measures. African Americans are more likely to believe in the value of prayer and other forms of “complementary care,” make greater use of over-the-counter medications such as Tylenol, consult chiropractors, and have less faith in the results of a total joint replacement. Cultural and social factors thus affect how different groups of patients perceive and deal with this chronic disease.
© 2003 National Association of Orthopaedic Nurses
