Free Nursing Dissertations - This Report Is A Research Proposal That Will Investigate The Association
This report is a research proposal that will investigate the association between perceptions of pain and anxiety by patients undergoing pin-site nursing care, using a combination of qualitative and quantitative research methods. It will explore the relationship between incidence of and severity of infection at external pin site locations, with compliance with treatment, anxiety/ depression symptoms, and post-operative adjustment to trauma incidents amongst patients. Metal pins are sometimes used in the treatment of patients with orthopaedic fractures to hold the bone in place while healing. The pins are held together with an external frame, and offer an alternative to plastering, traction or permanent internal fixation for patients with serious bone injury. The particular advantages of external pins include earlier mobilisation for the patient, early discharge, self-care by the patient, access to the skin for wound care and ease of observation and clinical monitoring of the injured limb (Behrens, 1988). Furthermore, they provide stability in severe fracture injuries, and reduce the risk of devitalisation of the bone and contamination of the bone (Sims and Saleh, 2000). External fixation also allows the position of the bone to be manipulated to correct deformities in the bones and soft tissues (Sims and Saleh, 2000).
The percutaneous pins extend through the skin, and there is a risk of skin infection and long term scarring of the associated area. Infection can also lead to failure of fixation, osteomyelitis and loss of alignment of the fracture. It can also lead to teomyelitis and systemic infections. Many of these complications such as osteomyelitis are difficult to treat and surgery may cause further chronic pain, discomfort and disability for the patient. In view of the number of drug-resistant micro-organisms, effective pinsite care through nursing practice is of paramount importance (Lee-Smith, Santy, Davis, Jester and Kneale, 2001). Infection rates of 1% for major infection and 80% for minor infection have been reported in the literature (Green, 1983). Others have reported infection rates of up to 50% (Lee-Smith et al, 2001). The mortality rate varies from 8% to 42% for pelvic ring injuries, depending on the severity of the injury (Mason, Khan, James, Chesser and Ward (2005)). Mason et al (2005) have reported the infection rate in definitive external fixation to be 62% and the infection rate in temporary external fixation prior to internal fixation to be 21%. In their study, six of the definitive fixators required premature removal for treatment of the infection. In four of the patients, the fracture was stable but two patients required internal fixation due to loss of fracture reduction. In one patient, internal fixation was not possible due to extensive soft tissue damage. Nine of the definitive fixators required revision, which included adding or replacing pins at the time of surgery.
Dissertations - Free Nursing Dissertations
