International Journal of Orthopaedic and Trauma Nursing (2015) 19, 119–120
International Journal of Orthopaedic and Trauma Nursing www.elsevier.com/locate/ijotn
EDITORIAL
Clinical assessment of the orthopaedic and trauma patient Clinical assessment and, specifically, physical examination and requesting of clinical investigations in trauma and orthopaedics have been traditionally seen as the role of medical staff or physiotherapists. Over the last decade, however, there have been a significant number of nurses working within the speciality who have been integrating the role of clinical assessment/examination into their practice on a regular basis. This has been synonymous with the proliferation of specialist and advanced nursing roles ranging from the Advanced Trauma Nurse Specialist conducting assessments of Airway, Breathing, Circulation, Disability & Exposure (A–E assessment) to quickly identify life threatening issues in emergency care through to working with patients with chronic orthopaedic problems that require a more staged approach to assessment, often building a picture over the course of several consultations in conjunction with results of clinical investigations. However, clinical assessment is not confined to specialist and advanced roles, but is an important skill set for every nurse working in any trauma and orthopaedic setting. In my own position as a part-time Advanced Nurse Practitioner working with patients who undergo hip and knee arthroplasty, a major part of my role is assessment of patients within the outpatient department. This includes history taking, physical examination of the patients’ hips and knees and joints below and above to check for referred symptoms. My role also involves requesting and interpreting clinical investigations such as x-rays, MRI scans, Metal Artefact Resonance Scans and blood investigations for metal ions (cobalt and chromium levels) and other blood tests to exclude either early superficial infection or late deep sepsis. I have also been involved, for many years, in the development and delivery of degree and postgraduate http://dx.doi.org/10.1016/j.ijotn.2015.02.002 1878-1241/© 2015 Elsevier Ltd. All rights reserved.
level modules and courses in advanced health and clinical assessment for nurses who are advancing their roles within trauma and orthopaedics. I have learnt from these experiences that nurses can develop these skills to a very high level and this is supported by a growing evidence base. I have also found that in the beginning nurses are quite reluctant to undertake physical examination procedures such as gait assessment, assessing range of movement (R.O.M.), palpation and special diagnostic examination procedures. This has always caused me both a degree of surprise and amusement because nurses in the role of caring for patients are always “examining patients” but we just do not use that language. We use the skills of observation and inspection all the time to detect changes and either deterioration or improvement in a patient’s condition. For example, we palpate or “feel” for changes in the shape and size of patients’ limbs if we suspect oedema or DVT. Nurses also tell me they have never taken a history! I can guarantee that every single nurse reading this editorial takes patient histories all the time as an integral part of their practice. Again, we do not use the terminology “history taking” or “consultation”. When your patient wakes in the night complaining of acute pain you inevitably “take a history”; When did it start? How severe is it? Is it localised or diffuse? and What may have exacerbated the pain? This is known as “eliciting the chief complaint” and you do it all the time. Based on this experience and in discussion with nursing colleagues in our speciality we thought our readership would find it very useful to have a dedicated series of papers within the journal focusing on clinical assessment of the orthopaedic and trauma patient. We also hope that it will give readers an evidence base and more confidence in structuring and conducting patient assessments and, ultimately, this will improve patient care.
120
Editorial
The series begins in this issue with the first paper written by Dr Sandra Flynn (Nurse Consultant Orthopaedics at the Countess of Chester NHS Foundation Trust, UK) and Hannah Pugh Advanced Nurse Practitioner in Trauma at University College Hospital (London, UK). This inaugural paper in the series sets out the key principles of clinical assessment and provides a very useful guide to history taking, systematic and structured approaches to assessment and the key principles of physical examination of the musculoskeletal system. Future papers in the series will focus on a particular area of the musculoskeletal system and consider in more detail specific clinical investigations and special physical examination tests.
The series aims to reflect the wide range of settings in which our readers work such as emergency trauma, elective orthopaedics, rehabilitation and community. I do hope you enjoy the series and gain new knowledge and a thirst to further develop your own clinical assessment skills either to use within your current practice or to develop more specialist or advanced roles. Rebecca Jester School of Health & Social Care, London South Bank University, Borough Road, SE1 0AA, London E-mail address: [email protected]
Available online at www.sciencedirect.com
ScienceDirect
International Journal of Orthopaedic and Trauma Nursing www.elsevier.com/locate/ijotn
EDITORIAL
Clinical assessment of the orthopaedic and trauma patient Clinical assessment and, specifically, physical examination and requesting of clinical investigations in trauma and orthopaedics have been traditionally seen as the role of medical staff or physiotherapists. Over the last decade, however, there have been a significant number of nurses working within the speciality who have been integrating the role of clinical assessment/examination into their practice on a regular basis. This has been synonymous with the proliferation of specialist and advanced nursing roles ranging from the Advanced Trauma Nurse Specialist conducting assessments of Airway, Breathing, Circulation, Disability & Exposure (A–E assessment) to quickly identify life threatening issues in emergency care through to working with patients with chronic orthopaedic problems that require a more staged approach to assessment, often building a picture over the course of several consultations in conjunction with results of clinical investigations. However, clinical assessment is not confined to specialist and advanced roles, but is an important skill set for every nurse working in any trauma and orthopaedic setting. In my own position as a part-time Advanced Nurse Practitioner working with patients who undergo hip and knee arthroplasty, a major part of my role is assessment of patients within the outpatient department. This includes history taking, physical examination of the patients’ hips and knees and joints below and above to check for referred symptoms. My role also involves requesting and interpreting clinical investigations such as x-rays, MRI scans, Metal Artefact Resonance Scans and blood investigations for metal ions (cobalt and chromium levels) and other blood tests to exclude either early superficial infection or late deep sepsis. I have also been involved, for many years, in the development and delivery of degree and postgraduate http://dx.doi.org/10.1016/j.ijotn.2015.02.002 1878-1241/© 2015 Elsevier Ltd. All rights reserved.
level modules and courses in advanced health and clinical assessment for nurses who are advancing their roles within trauma and orthopaedics. I have learnt from these experiences that nurses can develop these skills to a very high level and this is supported by a growing evidence base. I have also found that in the beginning nurses are quite reluctant to undertake physical examination procedures such as gait assessment, assessing range of movement (R.O.M.), palpation and special diagnostic examination procedures. This has always caused me both a degree of surprise and amusement because nurses in the role of caring for patients are always “examining patients” but we just do not use that language. We use the skills of observation and inspection all the time to detect changes and either deterioration or improvement in a patient’s condition. For example, we palpate or “feel” for changes in the shape and size of patients’ limbs if we suspect oedema or DVT. Nurses also tell me they have never taken a history! I can guarantee that every single nurse reading this editorial takes patient histories all the time as an integral part of their practice. Again, we do not use the terminology “history taking” or “consultation”. When your patient wakes in the night complaining of acute pain you inevitably “take a history”; When did it start? How severe is it? Is it localised or diffuse? and What may have exacerbated the pain? This is known as “eliciting the chief complaint” and you do it all the time. Based on this experience and in discussion with nursing colleagues in our speciality we thought our readership would find it very useful to have a dedicated series of papers within the journal focusing on clinical assessment of the orthopaedic and trauma patient. We also hope that it will give readers an evidence base and more confidence in structuring and conducting patient assessments and, ultimately, this will improve patient care.
120
Editorial
The series begins in this issue with the first paper written by Dr Sandra Flynn (Nurse Consultant Orthopaedics at the Countess of Chester NHS Foundation Trust, UK) and Hannah Pugh Advanced Nurse Practitioner in Trauma at University College Hospital (London, UK). This inaugural paper in the series sets out the key principles of clinical assessment and provides a very useful guide to history taking, systematic and structured approaches to assessment and the key principles of physical examination of the musculoskeletal system. Future papers in the series will focus on a particular area of the musculoskeletal system and consider in more detail specific clinical investigations and special physical examination tests.
The series aims to reflect the wide range of settings in which our readers work such as emergency trauma, elective orthopaedics, rehabilitation and community. I do hope you enjoy the series and gain new knowledge and a thirst to further develop your own clinical assessment skills either to use within your current practice or to develop more specialist or advanced roles. Rebecca Jester School of Health & Social Care, London South Bank University, Borough Road, SE1 0AA, London E-mail address: [email protected]
Available online at www.sciencedirect.com
ScienceDirect
