Orthopaedic surgical procedures place substantial physical demands on operating room personnel and are associated with high rates of work-related musculoskeletal injury. These procedures frequently require prolonged standing, sustained static postures, repetitive forceful movements, and the use of heavy instruments, all of which increase injury risk to surgical team members. The purpose of this article is to provide a narrative review of current evidence regarding core ergonomic principles and body mechanics as they apply to the orthopaedic operating room, with emphasis on implications for orthopaedic nursing practice. Procedure-specific challenges across orthopaedic subspecialties are also examined. Practical, evidence-based strategies for risk mitigation are presented to support optimal operating room setup, promote neutral body positioning, and reduce physical strain. Emphasis is placed on the role of orthopaedic nurses in incorporating ergonomic best practices into daily routines to reduce injury risk among operating room personnel, support career longevity, and strengthen a culture of safety.
Objective: This systematic review and meta-analysis aimed to evaluate the effectiveness of interventions for preventing or managing frailty in adults aged 65 and over, based on evidence from randomized controlled trials. Methods: A systematic search was conducted using the modified keywords “frailty,” “older,” and “intervention” across multiple databases, without publication year restrictions, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 16 studies were included. The statistical analyses were performed using Comprehensive Meta-Analysis version 4 software. Heterogeneity was assessed using Cochran’s Q test and the I 2 statistic. Publication bias was examined using funnel plots and Egger’s regression test. Results: The meta-analysis yielded an overall effect size of −0.799 (Z = −2.524, SE = 0.32, 95% confidence interval [−1.420, 0.179]). Heterogeneity was high (Q = 561.205, p < .001, I 2 = 97.32%). In subgroup analyses, combined interventions (Hedges’ g = 2.843, SE = 1.651, 95% confidence interval [0.376, 6.062]) showed a larger effect size than other intervention types; however, subgroup analyses were not statistically significant ( p = .080). Conclusions: The effectiveness of exercise interventions to improve physical endurance depends on factors such as duration and frequency. Due to the multifactorial nature of frailty, additional approaches—including nutritional support, integrated care, and metformin treatment—also yielded beneficial outcomes.
Given that about two-thirds of adults in the United States have not completed any advance directive, and there are over five million inpatient and outpatient orthopedic surgeries each year, there are unparalleled opportunities to engage with patients in advance care planning (ACP) discussions. ACP is defined as an ongoing strategy to help adults across the lifespan identify and communicate their preferences for medical care, based on their individual values and life goals. To meet the call for more widespread ACP documentation, the first levels of the Patton, Zalon, and Ludwick Policy Assessment Framework© can be applied by orthopedic nurses to promote ACP for individual patients and advocate for associated policy changes. The three dimensions and their respective levels: engagement (literacy), partnership (single group, discipline, or organization), and reach (local/unit/organization) are described. Similarly, strategies are explored that the National Orthopaedic Nurses Association could use to set a well-defined ACP policy role for orthopedic nursing.
