Purpose of arthritis care rounds

The core purpose of arthritis nursing rounds is essentially to break away from the "one size fits all" requirements of paper nursing specifications, dynamically adjust the nursing plan around the patient's individualized disease course, living habits, and treatment compliance, and ultimately achieve the goals of alleviating symptoms, delaying joint degeneration, and reducing the risk of disability, while simultaneously completing the practical teaching and nursing quality verification of front-line nursing staff.

Last week, when our orthopedic nursing team inspected Aunt Zhang Guilan's room with three beds, we encountered a typical problem of "it is difficult to implement the paper plan". My aunt is 62 years old. Rheumatoid arthritis affects both knee joints. The care plan she was given when she was discharged from the hospital clearly stated that she should perform passive knee flexion and extension exercises twice a day for 15 minutes each time. When we asked her, she hesitated and took a long time to explain that her son and daughter-in-law were at work.

In the past few years, there has been a lot of discussion in the industry about the positioning of this type of nursing rounds. One group is more oriented toward quality inspection and believes that ward rounds focus on the completion rate of nursing measures: Have patients been given infrared physiotherapy according to the frequency? Are pain scores assessed on time? Have functional exercises been taught properly? The essence is to put quality control first and avoid medical accidents due to carelessness. The other group is more patient-centered and feels that there is no point in just checking the boxes in the nursing records. They have to dig out the hidden secrets of the patients that have not been revealed. For example, some patients from rural areas feel that the prescribed topical NSAIDs are expensive and secretly stop using them and replace them with home remedies. ； Some elderly people believe that "if you have joint pain, you have to stay still". After lying down for half a month, the muscles atrophy faster than the joints degenerate. You can ask these questions to the care sheet a hundred times and still not be able to answer them.

I have been practicing orthopedic care for almost 9 years. The most regrettable case I have ever encountered is that of 58-year-old Chen. His osteoarthritis has just reached stage II. Before he was discharged from the hospital, he was told repeatedly that he could not do weight-bearing exercises such as climbing stairs and squatting. Every time he followed up with a regular phone call, he said he did as required. The result was that Three months later, I came back for another film and found that the joint space had narrowed by almost a third. It was so painful that I had to go downstairs to buy groceries. After repeated questioning, I told him that he had heard an old man in the community say "climbing stairs to exercise your knees" and climbed 12 floors every morning, noon and evening, which dragged the mild degeneration to the point of requiring arthroscopic cleaning. Now every time I do rounds on the ward, I have to ask a few questions, "What do you like to do when you have nothing to do?" and "Is there anything difficult to do with the precautions I told you?" for fear that I will miss this kind of problem hidden under the water.

Of course, this does not mean that quality control is not important. During the ward rounds last month, I encountered a young nurse who had just joined the job and was giving cold therapy to a patient with acute gout. The time was set to 30 minutes. Fortunately, we stopped her on the spot - cold therapy for more than 20 minutes will stimulate excessive local vasoconstriction, aggravate the inflammatory reaction, and may even lead to frostbite. This kind of detailed problem in the practice of a newbie cannot be found by looking at the nursing records. One round of ward can help her remember this pitfall and will not do it again in the future.

There are also many patients with misunderstandings that need to be solved through ward rounds. For example, many patients with arthritis regard "keeping warm" as an ironclad rule. They wear thick knee pads and dare not use the air conditioner in the dog days of summer. The 28-year-old gouty man admitted last week had a left knee that was so red, swollen and painful that he could not touch it. He was also wrapped in two thick knee pads. During the ward rounds, we asked him to protect the knee pads. After the knee was removed, the air conditioner was turned on at 26 degrees, not blowing directly on the knee, and combined with oral anti-inflammatory drugs, he said that the pain was less severe and he could turn over on his own that afternoon - lowering the local temperature during the acute stage of redness, swelling, heat and pain can reduce inflammatory infiltration. If you read this to the education manual ten times, it is better to adjust the air conditioner for him on the spot during ward rounds, and the effect will be faster.

In fact, after all is said and done, the purpose of arthritis care ward rounds is not so vain. It is nothing more than to turn those cold standards written in the guide into care methods that are truly suitable for each living patient and have their own lives, so that the patients can suffer less, delay the course of the disease, and the nursing team can also accumulate some practical experience, which is better than anything else.