Hip fracture in the elderly is characterized by high incidence, high disability rate, and high mortality and has been recognized as a public health issue threatening their health. Surgery is the preferred choice for the treatment of elderly patients with hip fracture. However, lower extremity deep venous thrombosis (DVT) has an extremely high incidence rate during the perioperative period, and may significantly increase the risk of patients′ death once it progresses to pulmonary embolism. In response to this issue, the clinical guidelines and expert consensuses all emphasize active application of comprehensive preventive measures, including basic prevention, physical prevention, and pharmacological prevention. In this prevention system, basic prevention is the basis of physical and pharmacological prevention. However,there is a lack of unified and definite recommendations for basic preventive measures in clinical practice. To this end, the Orthopedic Nursing Professional Committee of the Chinese Nursing Association and Nursing Department of the Orthopedic Branch of the China International Exchange and Promotive Association for Medical and Health Care organized relevant nursing experts to formulate Expert consensus on perioperative basic prevention for lower extremity deep venous thrombosis in elderly patients with hip fracture ( version 2024) . A total of 10 recommendations were proposed, aiming to standardize the basic preventive measures for lower extremity DVT in elderly patients with hip fractures during the perioperative period and promote their subsequent rehabilitation.

Hip fracture is considered as the most severe osteoporotic fracture characterized by high disability and mortality in the elderly. Improved surgical techniques and multidisciplinary team play an active role in alleviating prognosis, which places higher demands on perioperative nursing. Dysfunction, complications, and secondary impact of anaesthesia and surgery add more difficulties to clinical nursing. Besides, there still lack clinical practices in perioperative nursing for elderly patients with hip fracture in China. In this context, led by the Orthopedic Nursing Committee of Chinese Nursing Association, the Expert consensus on clinical practice in perioperative nursing for elderly patients with hip fracture ( version 2023) is developed based on the evidence-based medicine. This consensus provides 11 recommendations on elderly patients with hip fracture from aspects of perioperative health education, condition monitoring and inspection, complication risk assessment and prevention, and rehabilitation, in order to provide guiding advices for clinical practice, improve the quality of nursing and ameliorate the prognosis of elderly patients with hip fracture.

[Objective]:To explore the effect evaluation of discharge preparation service on elderly patients with hip fractures.Methods:Totally 80 elderly patients with hip fractures admitted to Shanghai Sixth People′s Hospital from April 2019 to October 2019 were selected as the research objects, and they were divided into intervention group and control group according to admission time, 40 patients in each group. The control group was given routine nursing care, and the intervention group was given readiness service for hospital discharge.The application effect of the scheme was evaluated by the degree of readiness for discharge and the quality of discharge guidance, Barthel index score, Harris score and incidence of complications.Results:In the intervention group,the total score of readiness for hospital discharge of patients was 83.43±8.10,the total score of the quality of discharge guidance was 151.30±16.61,while those in the control group were 77.13 ± 9.30, 141.58 ± 18.34, the differences between the two groups were statistically significant( t=3.23, 2.49, both P<0.05).In terms of the follow-up after patients were discharged for 3 months, the Harris hip score and Barthel index scores for patients with hip fracture were 82.53 ± 7.83 and 88.13 ± 3.34,while those were 76.03 ± 12.15, 86.13 ± 2.65 in the control group,the differences between the two groups were statistically significant ( t=2.84, 2.97, both P<0.05). Conclusions:The discharge preparation service can effectively improve the readiness for hospital discharge and the quality of discharge guidance. It improves the hip joint function, the quality of life of patients, and the clinical outcome of patients effectively.

Objective:To explore the continuous nursing needs at discharge among geriatric hip fracture patients with hip arthroplasty.Methods:From January to March 2019, this study selected 15 geriatric hip fracture patients with hip arthroplasty by purposive sampling. Semi-structured interview was carried out for those patients at discharge. Colaizzi 7-step analysis was used to data analysis to understand the needs.Results:By analyzing, marshaling and extracting, there were three themes concerned by postoperative patients. Those themes included the needs for health education, improving unhealthy psychology and health services.Conclusions:Hip fracture patients with hip arthroplasty have many burdens and needs for physiology, psychology and society. Nurses should pay more attention to those patients, and provide targeted intervention as well as thorough health education for discharged patients to improve their self-care abilities.

Objective:To investigate knowledge, attitude and practice status of transitional care in orthopedic nurses in Shanghai and their advice on transitional care for hip fractures.Methods:From January to March 2019, the questionnaire star was used to send "nurse transitional care knowledge attitude practice scale" and "self-made opinion questionnaire on postoperative transitional care for patients with hip fractures" to orthopedic nurses in 18 public secondary and tertiary hospitals in Shanghai by link through WeChat platform to conduct a questionnaire survey. A total of 423 valid questionnaires were collected.Results:The total scores of knowledge, attitude and practice dimensions of transitional care in orthopedic nurses were respectively (39.60±8.72) , (60.43±9.52) and (29.03±8.43) , which were at the medium level. Position and education background were the influencing factors of the total score of knowledge, attitude and practice of transitional care in orthopedic nurses ( P<0.05) . Hospital level, professional title, educational background and position were the influencing factors of knowledge score of transitional care in orthopedic nurses ( P<0.05) . Position, education background and hospital level were the influencing factors of the attitude score of transitional care in orthopedic nurses ( P<0.05) . Professional title was the influencing factor of the practice score of transitional care in orthopedic nurses ( P<0.05) . Orthopedic nurses believed that the best way to realize transitional care needs was WeChat official account, the most important dimension was rehabilitation exercise, the best practitioner was the rehabilitation therapist and the most appropriate frequency was once every two weeks. Conclusions:The level of knowledge, attitude and practice of transitional care in clinical nurses in Shanghai needs to be further improved. To carry out transitional care for hip fractures, it is necessary to strengthen information exchange between medical institutions, establish and improve the nurses' transitional care training system, establish a new transitional care service system based on information technology and centered on patients and promote the orderly development of transitional care work.

Objective:To understand the current status of discharge readiness for elderly patients with hip fractures and analyze its influencing factors.Methods:The convenient sampling method was used to select 180 elderly patients with hip fractures who were to be discharged from the hospital after surgery in the Orthopedic Department of a Class Ⅲ Grade A hospital in Shanghai from October 2018 to June 2019. General information questionnaire, Readiness for Hospital Discharge Scale (RHDS) and Quality of Discharge Teaching Scale (QDTS) were used for the questionnaire survey. Pearson correlation analysis was used to analyze the correlation between discharge guidance quality and discharge readiness, and multiple linear regression analysis was used to analyze the influencing factors of discharge readiness.Results:The standardized score of discharge readiness of elderly patients with hip fracture was (6.37±1.26) points, which was in the middle level. Multiple linear regression analysis showed that fracture location, education level, caregiver, age, chronic disease and complications were the influencing factors of the readiness for discharge of elderly patients with hip fractures ( P<0.05) . The total score of QDTS for elderly patients with hip fractures was (140.52±17.27) points, which was in the upper middle level. There was a statistically significant difference between the total scores of the required and obtained discharge guidance ( P<0.05) . The total scores of discharge readiness and discharge guidance quality were positively correlated ( P<0.05) . Conclusions:The discharge readiness of elderly patients with hip fracture is affected by many factors and positively correlated with the quality of discharge guidance. According to the current status of discharge readiness and discharge guidance quality of elderly patients with hip fractures, weak links should be identified, and various forms of transitional discharge preparation services should be carried out with the help of information technology.

Objective To explore the clinical effects of traumatic orthopedics nursing skills homogenization training in our partner hospitals. Methods Totally 97 orthopedics nurses from 8 partner hospitals of the Sixth People's Hospital Affiliated to Shanghai Jiaotong University were selected to attend the traumatic orthopedics skills homogenization training in four batches between March and June 2018. Training contents included theories and performance standards, clinical practice and examination of nursing skills. Training methods included intensive classroom teaching, group discussion and operation practice. The managers and trainees were investigated with the self-designed questionnaire after the training, which concerned training models, training contents, curriculum, teaching quality and teaching ability of the trainers. Results The satisfaction with the nursing skills homogenization training in the nursing mangers and 97 trainees from the 8 hospitals was 100%;and the 97 trainees' satisfaction with curriculum, training contents and the trainers' teaching ability was (4.88±0.361), (4.93±0.260) and (4.94±0.282), respectively. The nurses' satisfaction with the training scored higher than 4.70 in all dimensions;and the total score of training management was (4.88±0.331). Conclusions The intensive training of traumatic orthopedics nursing skills improves the specialized skills and service abilities of the orthopedics nurses in the hospitals, enable patients to receive homogeneous nursing, and accelerate patients' healing, which is worth promoting in clinical practice.

Objective To deeply know the psychological experience and coping style of patients with osteonecrosis of the femeral head (ONFH) in the process of free vascularized fibular graft transplantation, and provide basis for the development of targeted interventions.Methods Semi-structured in-depth interviews were used to investigate 10 cases of patients undergoing free vascularized fibular graft transplantation for femoral head necrosis by phenomenology method. Colaizzi data analysis principles were used to analyze and refine topic. Results Three themes were extracted: patients with insufficient understanding of disease and treatment; patients under high pressure; change of self-consciousness.Conclusions In the process of free vascularized fibular graft transplannation for ONFH, medical staff should have much more communication with patients, and provide more support and help for patients and their families. Through the psychological support, effective rehabilitation guidance and correction of bad habits the treatment effect and patients' coping capabilities would be improved.

Objective To investigate the anxiety level, caregivers' burden level and its influence factors of patients undergoing conservative treatment with osteonecrosis of the femoral head(ONFH). Methods A total of 90 hospitalized patients undergoing ONFH in orthopedics in Shanghai Sixth People's Hospital were included using convenient sampling from January 2016 to July 2016. Zung self-rating anxiety scale (SAS), visual analogue scale (VAS), Chinese version of Zarit Burden Interview(ZBI) and Simplified Coping Style Questionnaire were used for the questionnaire.Results The incidence rate of anxiety was 32.2%, whereas statistically significant differences were observed between male and female patients(P<0.05). The score of ZBl was (48.88±11.59) and 75.6% of caregivers showed moderate to high level of burden. There were statistically significant differences in the levels of caregiver burden among patients with different genders, educational levels and family caregivers (P<0.05). Caregivers with different characters had different coping styles. The coping style scores of caregivers with different genders, educational levels and family roles caregivers were statistically significant different (P<0.05).Conclusions Patients undergoing ONFH have anxiety. The caregivers also suffer from different levels of burden. Nurses should provide services for patients, pay attention to the physical and mental health of patients and caregivers and reduce their care burden so as to improve their quality of life.

Objective To explore the effect of multimodal analgesia methods on postoperative pain in patients with calcaneal fracture. Methods Totally 96 cases of the patients with calcaneal fracture were divided into the control group and the observation group, there were 48 cases in each group. The control group was treated with conventional methods of postoperative analgesia, the observation group was given with the multimodal analgesia method. The VAS scores,functional exercises compliance and the incidence of adverse reaction for patients between the two group were observed and compared. Results The scores of pain at different time points in the observation group was 3.40 ± 0.41, 2.50 ± 0.75, 2.10 ± 0.84, 2.00 ± 0.52 respectively, while in the control group was 5.50 ± 0.35, 4.50 ± 0.55, 3.60 ± 0.62, 3.10 ± 0.45 respectively, the difference between the two groups was significant, t=6.85-11.62, P < 0.01. The good functional exercises compliance in the observation group was 87.5%(42/48), which was higher than the 68.8%(33/48) in the control group, the difference between the two groups was significant (χ2=7.571, P<0.05). The occurrence of nausea and vomiting was lower than the control group (χ2=4.800 and 4.360, P<0.05). Conclusion Multimodal analgesia method can improve analgesia effect obviously, improve functional exercises compliance, reduce the incidence of adverse reaction.