NSG/501 Week 6: Education Intervention for the Population, sample paper

Your Wrist Broke for a Reason: A Two-Visit Education Intervention to Close the Treatment Gap for Women Over 65 After a First Fragility Fracture

[Student Name]

University of Phoenix

NSG/501: Pathophysiology, Assessment Variables and Pharmacology I

Week 6 Assignment

[Instructor Name]

[Date]

The clinic, its data and the intervention are a composite written for a model paper.

For six weeks, this course has followed one group of patients: women past 65 whose first low-trauma fracture was a broken wrist. Week 1 showed that the broken wrist is often the first visible sign of osteoporosis, that it predicts a hip or spine fracture to come and that treatment after fracture is rare: in a national study of patients hospitalized for hip fracture, only about 28.5% received osteoporosis medication within a year (Solomon et al., 2014). Week 2 found that the first education priority for Mrs. D. was understanding what her fracture meant. This paper designs an education intervention for every woman in this group who comes through our orthopedic clinic, aimed at the gap between fracture and treatment.

The Problem the Intervention Addresses

In a review of our clinic's records for the past year, 142 women aged 65 or older were seen for a low-trauma wrist fracture. Only 31, or 22%, had a bone density scan ordered within six months, and 14, or 10%, started osteoporosis medication. Women who were asked why they had not pursued testing most often said their doctor had not mentioned it or that they believed the fracture was simply bad luck. The women in this population are not refusing treatment; most were never told there was anything to treat.

Target Population and Setting

The intervention is for women aged 65 and older seen in the clinic for a low-trauma distal radius fracture, delivered at two routine visits they already attend: the cast check at about two weeks and the cast removal at about six weeks. Building the intervention into existing visits avoids asking patients who may depend on family for rides to make extra trips.

Objectives

By the end of the second visit, each participant will be able to:

1. Explain in her own words what her broken wrist says about the strength of her bones and what it means for her future fracture risk.

2. State that effective treatment exists and that it lowers the risk of new fractures.

3. Name two food sources of calcium she will eat and state her vitamin D dose.

4. Identify two changes she will make at home to prevent falls.

5. Describe her next step, a bone density scan, and when it is scheduled.

Program objectives, measured at six months: at least 70% of participants complete a bone density scan, and at least 40% of those diagnosed with osteoporosis start treatment.

Content and Methods

Visit 1, at the cast check, about 15 minutes with the fracture liaison nurse. The nurse opens with a question rather than a lecture: "What do you think caused your wrist to break?" Most women answer that they fell hard. The nurse then explains, using a simple picture of healthy and osteoporotic bone, that a healthy bone would usually bend rather than break in such a fall, and that the break is a sign the bone may be weak. The nurse explains that one fracture raises the chance of another, possibly in the spine or hip, and that treatment can lower that chance. The nurse orders or arranges the bone density scan under the clinic's protocol and uses teach-back: "So that I know I explained it clearly, can you tell me why we are checking your bones?"

Visit 2, at cast removal, about 20 minutes. The nurse reviews the scan results if available, reinforces the meaning of the fracture and covers three topics in plain language: how treatment helps, with the drug options explained briefly and evidence stated simply, for example that a yearly infusion lowered new spine fractures by about 70% in a large trial (Black et al., 2007); calcium and vitamin D, using a one-page food list with portion sizes; and fall prevention, using a home checklist. Teach-back follows each topic. The nurse confirms the referral to the prescriber for a treatment decision and books follow-up.

Materials

Materials are written at a sixth-grade reading level in large print, reviewed by two women from the population before use: a one-page picture of healthy and weak bone with the message "Your wrist broke for a reason"; a calcium food list with portion sizes, including options for women who avoid milk; a home safety checklist; and a card with the date of the bone density scan and the fracture liaison nurse's phone number.

Teaching Principles

The intervention follows principles of adult learning: it starts from the learner's own explanation of her fracture, connects each topic to a decision she can make and limits each visit to a few messages. Teach-back is used because older adults often nod in agreement without understanding, and because repeating information in her own words helps her remember it. Family members are invited to attend, since many women in this age group rely on daughters or sons for rides and medication help.

Staff Preparation and Clinic Workflow

An intervention delivered by one enthusiastic nurse disappears when she goes on vacation, so the design includes the clinic's workflow. The scheduling system flags every woman aged 65 or older with a wrist fracture code at check-in, so the fracture liaison nurse knows whom to see. The two other clinic nurses complete a one-hour session on the key messages and teach-back, with a short script they can follow when the liaison nurse is away. The clinic's physicians and nurse practitioners agree in advance to a standing order for bone density testing in this group, so ordering the scan does not depend on catching a provider between patients. Finally, the liaison nurse keeps a simple log of each participant's scan and treatment status, which also supplies the data for the evaluation.

Evaluation

The intervention is evaluated at three levels. Learning: before visit 1 and after visit 2, each participant answers five short questions matching the objectives. Behavior: at six months, the fracture liaison nurse records whether each participant completed a bone density scan and whether those with osteoporosis started treatment, compared with the 22% and 10% baseline. Outcome: at two years, the clinic compares the rate of second fragility fractures with the prior two years. Evidence from fracture liaison programs suggests that coordinated follow-up of this kind can raise testing and treatment rates and lower refracture rates (Wu et al., 2018), which gives a realistic benchmark.

Cultural and Health Literacy Considerations

About a fifth of the women in last year's group spoke Spanish as their first language, and several had limited reading skills. All materials are therefore produced in English and Spanish and reviewed by bilingual staff, and a trained interpreter, not a family member, is used for visits when requested. Pictures carry the key message so that understanding does not depend on reading. The nurse also asks about beliefs that may shape decisions, such as a view that bones naturally weaken with age and nothing can be done, and addresses them respectfully with the same central message.

Conclusion

The central problem in this population is not that treatment fails but that it never begins, because women are not told what their fracture means. A short, nurse-led intervention built into two visits they already attend, focused on one message and confirmed with teach-back, can change that. Its success will be measured by scans ordered, treatments started and, in time, fractures prevented.

References

Black, D. M., Delmas, P. D., Eastell, R., Reid, I. R., Boonen, S., Cauley, J. A., Cosman, F., Lakatos, P., Leung, P. C., Man, Z., Mautalen, C., Mesenbrink, P., Hu, H., Caminis, J., Tong, K., Rosario-Jansen, T., Krasnow, J., Hue, T. F., Sellmeyer, D., ... Cummings, S. R. (2007). Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. New England Journal of Medicine, 356(18), 1809-1822. https://doi.org/10.1056/NEJMoa067312

Solomon, D. H., Johnston, S. S., Boytsov, N. N., McMorrow, D., Lane, J. M., & Krohn, K. D. (2014). Osteoporosis medication use after hip fracture in U.S. patients between 2002 and 2011. Journal of Bone and Mineral Research, 29(9), 1929-1937. https://doi.org/10.1002/jbmr.2202

Wu, C.-H., Tu, S.-T., Chang, Y.-F., Chan, D.-C., Chien, J.-T., Lin, C.-H., Singh, S., Dasari, M., Chen, J.-F., & Tsai, K.-S. (2018). Fracture liaison services improve outcomes of patients with osteoporosis-related fractures: A systematic literature review and meta-analysis. Bone, 111, 92-100. https://doi.org/10.1016/j.bone.2018.03.018