Page 397 - Encyclopedia of Nursing Research

364 n OSTeOPOROSIS

nurse staffing and leadership positions were
frequently eliminated, unskilled workers OsteOpOrOsis
O were introduced, and nursing services were
shifted from acute to community care, result-
ing in intensified nursing workloads across Osteoporosis is defined as a systemic skel-
all sectors. Health care studies during this etal disease characterized by a decrease in
period were mostly retrospective, focusing bone mass and microarchitectural deteri-
on the immediate aftereffects of redesign oration of bone tissue with a consequent
on outcomes for care recipients, employees, increase in bone fragility and susceptibility
and organizations. A largely negative pic- to fracture (Waugh et al., 2009). Bone qual-
ture of the impact of restructuring on clinical, ity, a poorly understood factor, is thought
human resource, and organizational out- to result from the bone’s micro- and macro-
comes emerged, and prospective research on structure, biochemical composition, distri-
change interventions was minimal. In health bution and integrity of material components
care, concerns related to emergency prepared- within the bone, turnover, and micro-
ness and to clinical integration across settings damage accumulation. That a 50-year-old
and episodes of care to seamlessly manage woman with low bone density has a much
chronic illness have also generated signifi- lower risk of fracture than an 80-year-old
cant planning and coordination work across woman with the same bone density speaks
organizational and jurisdictional boundaries. to changes in bone quality (Kolata, 2003).
In 2000, the landmark book To Err Is Human Although there is no way to clinically mea-
(Institute of Medicine, 2000) documented sure bone strength, the most reliable test for
safety issues in the health care industry and diagnosis of osteoporosis is a bone mineral
spurred research on the basis of the science of density (BMD) test (National Institutes of
human factors engineering to identify orga- Health [NIH], 2010). BMD accounts for 70%
nizational structures (e.g., clinical pathways) of bone strength and is measured as grams
and coordination mechanisms (e.g., team- of mineral per area. It is reflective of both
work) that prevent critical incidents. More peak bone mass and the amount of bone
recently, the Institute of Medicine (2010) pub- loss (NIH, 2001). BMD can decline slowly
lished a report on the future of nursing that with age, making osteoporosis an insidious
provides a framework for examining nurs- disease, often going undiagnosed until a
ing care at the work unit level to identify the fracture occurs.
mechanisms that improve care and to reorga- Investigation by nursing related to oste-
nize nursing services to specific patient popu- oporosis is appropriate across the life span.
lations; from prospective intervention studies Osteoporosis not only is the result of accel-
to systematically evaluate planned changes erated bone loss during aging but also devel-
to nursing service delivery; and from longi- ops because of suboptimal bone growth in
tudinal research designs to identify the tem- childhood and adolescence. “Osteoporosis
poral ordering of relationships (i.e., cause and is a pediatric disease with geriatric conse-
effect) and long-term outcomes related to the quences” (Drugay, 1997, as cited in Gueldner,
sustainability of organizational design initia- Burke, and Smiciklas-Wright, 2000).
tives. Future investigations of organizational Prevention of osteoporosis, early detection,
design would benefit from standardized use of pharmaceutical management, and res-
instruments, indicators, and benchmarks to toration or maintenance of function in those
enable cross comparisons. who have the disease are all consistent with
nursing’s focus on the human response to
Sean P. Clarke disease as well as the meta-paradigm: per-
Raquel M. Meyer son, environment, health, and nursing. There