Comparison of Nursing Workload Between Direct Anterior Approach Versus Posterolateral Approach for Hip Arthroplasty in Femoral Neck Fractures: A Prospective Cohort Study
Pingping Xu, Fengli Gao, Huiyue Zhang, Baojing Zhao, Kai Yang, Jingqian Huang, Lu Chen, Yongwei Pan, Han CaoABSTRACT
Aims
To compare the perioperative nursing workload between the direct anterior approach and the posterolateral approach for hip arthroplasty in femoral neck fractures.
Design
A single‐centre, prospective observational cohort study.
Methods
The study population consisted of 27 orthopaedic nurses who provided perioperative care for patients who underwent a direct anterior approach or posterolateral approach. Perceived nursing workload was assessed using the NASA Task Load Index, while actual workload was evaluated using the Orthopaedic Nurse Work Responsibilities Scale, which quantified the cumulative time (in minutes) required to complete nursing tasks. The unit of analysis was each nurse–patient interaction, with assessments conducted at five time points: preoperative Day 1, postoperative Days 1–3 and discharge day. Data were analysed using linear mixed‐effects models with random intercepts for both nurse and patient to account for repeated measurements and clustering.
Results
Twenty‐seven orthopaedic nurses providing perioperative care for 65 patients completed the study. The two patient groups were comparable in baseline characteristics. The actual nursing workload was similar between the two groups. For perceived workload, the main effect of surgical approach was not statistically significant ( β = −0.59, 95% CI [−2.042, 0.862], p = 0.421). However, the group‐by‐time interaction was significant, and the perceived workload was significantly higher for nurses caring for PLA patients on postoperative Day 3 ( β = −1.364, 95% CI [−2.267, −0.461], Bonferroni‐corrected p = 0.003) and at discharge ( β = −1.406, 95% CI [−2.309, −0.503], Bonferroni‐corrected p = 0.002). Descriptive analyses suggested that nurses at higher competency levels tended to report lower perceived and actual workload than their less experienced counterparts, though this was not formally tested.
Conclusion
Surgical approach was not associated with actual nursing workload but appeared to be associated with higher perceived workload later in the recovery phase, which may reflect institution‐specific care pathways rather than the surgical approach alone. Nurse experience was inversely related to both perceived and actual workload. These hypothesis‐generating findings suggest that surgical approach and nurse experience may merit consideration when planning staffing and training to optimize workload and enhance patient care.
Implications for Nursing Practice
The findings suggest that nursing staffing and training programs could consider both the surgical approach and nurse experience levels to optimize workload management, support nurse well‐being and enhance the quality of perioperative patient care. Nurse managers could consider providing additional support to patients receiving PLA when they first get out of bed and upon discharge to alleviate the perceived workload of the nurse.
Patient or Public Contribution
Patients and members of the public were not involved in the design, conduct, reporting or dissemination plans of this research. They participated solely as study participants, providing data through workload assessments during their perioperative care. We sincerely thank both the patients and nurses for their participation in this study.
Trial Registration
This study was registered on the Chinese Clinical Trial Registry (ChiCTR2500100878)