Continuity of care and general wellbeing of patients with comorbidities requiring joint replacement

Williams, Allison, Dunning, Trisha and Manias, Elizabeth 2007, Continuity of care and general wellbeing of patients with comorbidities requiring joint replacement, Journal of advanced nursing, vol. 57, no. 3, pp. 244-256, doi: 10.1111/j.1365-2648.2006.04093.x.

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Title Continuity of care and general wellbeing of patients with comorbidities requiring joint replacement
Author(s) Williams, Allison
Dunning, TrishaORCID iD for Dunning, Trisha
Manias, ElizabethORCID iD for Manias, Elizabeth
Journal name Journal of advanced nursing
Volume number 57
Issue number 3
Start page 244
End page 256
Publisher Blackwell Publishing Ltd
Place of publication Oxford, England
Publication date 2007-01-12
ISSN 0309-2402
Keyword(s) comorbidities
joint replacements
record audit
Summary Aim. The aim of this paper is to examine the continuity of care and general wellbeing of patients with comorbidities undergoing elective total hip or knee joint replacement.
Background. Advances in medical science and improved lifestyles have reduced mortality rates in most Western countries. As a result, there is an ageing population with a concomitant growth in the number of people who are living with multiple chronic illnesses, commonly referred to as comorbidities. These patients often require acute care services, creating a blend of acute and chronic illness needs. For example, joint replacement surgery is frequently performed to improve impaired mobility associated with osteoarthritis.
Method. A purposive sample of twenty participants with multiple comorbidities who required joint replacement surgery was recruited to obtain survey, interview and medical record audit data. Data were collected during 2004 and 2005.
Findings. Comorbidity care was poorly co-ordinated prior to having surgery, during the acute care stay and following surgery and primarily entailed prescribed medicines. The main focus in acute care was patient throughput following joint replacement surgery according to a prescribed clinical pathway. General wellbeing was less than optimal: participants reported pain, fatigue, insomnia and alterations in urinary elimination as the chief sources of discomfort during the course of the study.
Conclusion. Continuity of care of comorbidities was lacking. Comorbidities affected patient general wellbeing and delayed recovery from surgery. Acute care, clinical pathways and the specialisation of medicine and nursing subordinated the general problem of patients with comorbidities. Systems designed to integrate and co-ordinate chronic illness care had limited application in the acute care setting. A multidisciplinary, holistic approach is required. Recommendations for further research conclude this paper.
Language eng
DOI 10.1111/j.1365-2648.2006.04093.x
Field of Research 111799 Public Health and Health Services not elsewhere classified
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2008, Blackwell Publishing Ltd
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