Quality of Care before, during, and after Casting: A Cross‑sectional Study

Document Type: Original Article

Authors

Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran

Abstract

Background: Casting is the most common treatment for managing limb fractures. Casts that are not properly provided or are not correctly cared for may hinder the healing of fractures. However, no study assessed the quality of care before, during, and after casting. Objectives: This study aimed to investigate the quality of nursing care before, during, and after casting. Methods: A cross‑sectional study was conducted on 188 patients with limb fractures referred to Shahid Beheshti Hospital in Kashan, Iran, from July to November 2018. The data collection instrument consisted of 57 items on the quality of care before, during, and after casting. Descriptive statistics and Fisher’s exact test were used to analyze the data. Results: A total of 188 patients were assessed, 94 cases regarding the quality of care before and during casting and 94 additional cases for the quality of care after casting. The quality of care before, during, and after casting was at a moderate level in 83%, 58.5%, and 63.8% of patients, respectively. A significant connection was found between the quality of care before casting and the type of damage (P = 0.002). Significant connections were also found between the quality of care after casting and the nurses’ work shift (P = 0.05) and gender (P = 0.05). Conclusion: The quality of care before, during, and after casting was mostly at a moderate level. Educational interventions are needed for nurses to improve the quality of cast care.

Keywords


1. Remizov V, Lungu E. Quality of life in patients with orthopedic trauma. J Prev Med 2008;16:3‑9.

2. Global Toll of Injuries Down by Almost a Third Since; 1990. Available from: http://www.healthdata.org/news‑release/ global‑toll‑injuries‑down‑almost‑third‑1990. [Last retrieved on 2018 Jan 26].

3. Wang H, Yu H, Zhou Y, Li C, Liu J, Ou L, et al. Traumatic fractures as a result of falls in children and adolescents: A retrospective observational study. Medicine (Baltimore) 2017;96:e7879.

4. Nguyen S, McDowellM, SchlechterJ. Casting: Pearls and pitfalls learned while caring for children’s fractures. World J Orthop 2016;7:539‑45.

5. Lankarani KB, Sarikhani Y, Heydari ST, Joulaie H, Maharlouei N, Peimani P, et al. Traffic accidents in Iran, a decade of progress but still challenges ahead. Med J Islam Repub Iran 2014;28:96.

6. EkwallA, Carlberg E, Palmberg G, Sloberg R. An audit of complications of fiberglass cast and hybrid cast for fractures of the foot, ankle and forearm in a Swedish emergency department. Int J Orthop Trauma Nurs 2018;31:32‑4.

7. Meling T, Harboe K, Søreide K. Incidence of traumatic long‑bone fractures requiring in‑hospital management: A prospective age‑ and gender‑specific analysis of 4890 fractures. Injury 2009;40:1212‑9.

8. Mamaril ME, Childs SG, Sortman S. Care of the orthopaedic trauma patient. J Perianesth Nurs 2007;22:184‑94.

9. Raoufi M, Abedtash H, Mohagheghzadeh A. The historical background of plaster cast. Arch Iran Med 2017;20:461‑4.

10. Bakody E. Orthopaedic plaster casting: Nurse and patient education. Nurs Stand 2009;23:49‑56.

11. Surrena H. Handbook for Brunner and Suddarth’s Textbook of Medical‑Surgical Nursing. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2010.

12. Hinkle JL, Cheever KH. Brunner & Suddarth’s Textbook of Medical‑Surgical Nursing. 13th ed. China: Lippincott Williams & Wilkins; 2014.

13. Nielsen DM, Ricketts DM. Where to split plaster casts. Injury 2005;36:588‑9.

14. Esoga PI, Seidl KL. Best practices in orthopaedic inpatient care. Orthop Nurs 2012;31:236‑40.

15. Cameron LE, de Araújo ST. Vision as an instrument of perception in trauma and orthopedic nursing care. Rev Esc Enferm USP 2011;45:95‑9. 16. Szostakowski B, Smitham P, Khan WS. Plaster of Paris‑short history of casting and injured limb immobilzation. Open Orthop J 2017;11:291‑6.

17. Adib Hajbaghery M, Moradi T. Quality of care for patients with traction in Shahid Beheshti hospital in 2012. Arch Trauma Res 2013;2:85‑90.

18. Delasobera BE, Place R, Howell J, Davis JE. Serious infectious complications related to extremity cast/splint placement in children. J Emerg Med 2011;41:47‑50.

19. Neumann M. Knowledge and attitudes of orthopedic nurses regarding pain management. Scholarly project submitted to the faculty of Liberty University. In: Partial Fulfillment of The Requirements for the Degree of Doctor of Nursing Practice. Liberty University; 2017. Available from: https://www.digitalcommons.liberty.edu/cgi/viewcontent. cgi?referer=https://www.google.com/&httpsredir=1&article=1009 &context=nurse_grad_proj_schol. [Last accessed on 2018 Dec 04].

20. You J, Zheng G. Nursing interventions in improving the postoperative recovery of patients with orthopedic hip and knee surgery: A descriptive literature review. Thesis for the Fulfillment of Bachelor Degree in Nursing, University of Gavle; 2018. Available from: http://www. diva‑portal.org/smash/get/diva2:1223156/FULLTEXT01.pdf. [Last accessed on 2018 Dec 04].

21. Williams M. The patient’s experience in a plaster cast. Int J Orthop Trauma Nurs 2010;14:132‑41.

22. Williams JT, Kedrzycki M, Shenava Y. Multidisciplinary approach to improve the quality of below‑knee plaster casting. BMJ Open Qual 2018;7:e000284.

23. Kelly AM, Miljesic S, Mant P, Ashton W. Plaster checks by nurses: Safe and efficient? Accid Emerg Nurs 1996;4:76‑7.

24. Hall G, Gregory J. The assessment and management of pain in an orthopaedic out‑patient setting: A case study. Int J Orthop Trauma Nurs 2016;22:24‑8.

25. Ahmed AM, Hussein HA. Nurses knowledge toward cast complications in orthopedic ward at Al‑Najaf AL‑Ashraf hospitals. Int J Sci Res Publ 2016;6:94‑100.

26. Black J, Hawks J. Medical Surgical Nursing: Clinical Management for Positive Outcomes. 8th ed. Philadelphia; Elsevier’s Health Sciences Right Department; 2009.

27. Polaski AL, Tatro SE. Luckmann’s Core Principle and Practice of Medical‑Surgical Nursing. 1st ed. Philadelphia: W.B. Saunders; 1997.

28. Adib‑Hajbaghery M, Zehtabchi S. Developing and validating an instrument to assess the nurses’ professional competence in spiritual care. J Nurs Meas 2016;24:15‑27.

29. Polit DF, Beck CT. Nursing Research, Generating and Assessing Evidence for Nursing Practice. Philadelphia: Wolters Kluwer; 2017.

30. Baheiraei A, Khoori E, Ahmadi F, Foroushani AR, Ghofranipour F, Weiler RM, et al. Psychometric properties of the adolescent health concern inventory: The Persian version. Iran J Psychiatry 2013;8:28‑36.

31. Rose MS, Koshman ML, Spreng S, Sheldon R. Statistical issues encountered in the comparison of health‑related quality of life in diseased patients to published general population norms: Problems and solutions. J Clin Epidemiol 1999;52:405‑12.

32. Hamblen DL, Simpson AH. Adams’s Outline of Fractures, Including Joint Injuries. 12th ed, Edinburgh: Elsevier Health Sciences; 2007.

33. Monahan FD, Sands JK, Neighbors M, Marek JF, Green CJ. Phipps’ Medical‑Surgical Nursing: Health and Illness Perspectives: Europe, Middle East and African Edition. China: Elsevier Mosby; 2007.

34. Halanski M, Noonan KJ. Cast and splint immobilization: Complications. J Am Acad Orthop Surg 2008;16:30‑40.

35. Guillen PT, Fuller CB, Riedel BB, Wongworawat MD. A prospective randomized crossover study on the comparison of cotton versus waterproof cast liners. Hand (N Y) 2016;11:50‑3.

36. DiPaola MJ, Abzug JM, Pizzutillo PD, Herman MJ. Incidence and etiology of unplanned cast changes for fractures in the pediatric population. J Pediatr Orthop 2014;34:643‑6.

37. Cronenwett L, Sherwood G, Barnsteiner J, Disch J, Johnson J, Mitchell P, et al. Quality and safety education for nurses. Nurs Outlook 2007;55:122‑31.

38. Choo J, Hutchinson A, Bucknall T. Nurses’ role in medication safety. J Nurs Manag 2010;18:853‑61.

39. Al‑Barwari RH. Evaluation of nursing knowledge and practices concerning nursing care of patient with skin traction in orthopedic units in Kurdistan region. Nurs Natl Iraqi Spec 2006;19:1‑10