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Hip-fracture patients’ experience of involvement in their care: A qualitative study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. (Vårdvetenskap)
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Little is known about how hip-fracture patients experience involvement in their own nursing care. Yet understanding this is essential in order to both meet patient expectations and ensure delivery of high-quality nursing care. The aim of the study was to describe how elderly hip-fracture patients experienced their involvement in the nursing care they received while in the orthopaedics ward. A descriptive design with a qualitative interview approach was used.

Semi-structured interviews were conducted with16 hip-fracture patients, 14 days postoperative in 2012. Systematic Text Condensation was used to analyse the data collected. The findings reveal six themes: 1) experiencing severe pain, 2) feeling dependent on the nurses, 3) feeling they were not valued, 4) poor organisation, 5) positives and negatives of sharing a room with fellow patients, and 6) positive interactions with nurses that encouraged the patient. Hip-fracture patients reported experiencing very little involvement in their nursing care, to the extent that fundamental aspects of nursing care went unfulfilled. Patients did not feel valued by the nurses. Most patients described experiencing unbearable pain during their stay in the orthopaedics ward despite the existence of evidence-based and established guidelines for pain management. The result of this study indicates that there is much to do on a number of levels in the health care system to improve patient involvement in nursing care.

Keyword [en]
patient involvement, hip fracture, nursing care, elderly, geriatric, qualitative, interview.
National Category
Nursing
Identifiers
URN: urn:nbn:se:uu:diva-232823OAI: oai:DiVA.org:uu-232823DiVA: diva2:751463
Available from: 2014-10-01 Created: 2014-09-25 Last updated: 2015-12-13
In thesis
1. Patients with Hip Fracture: Various aspects of patient safety
Open this publication in new window or tab >>Patients with Hip Fracture: Various aspects of patient safety
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the thesis was to investigate whether patient safety can be improved for patients with hip fracture by nutritional intervention and by pharmacological treatment with cranberry concentrate. Another aim was to describe the patients’ experience of involvement in their care. The thesis includes results from four studies that include both quantitative and qualitative design. Studies I and II were intervention studies with a quasi-experimental design, with intervention and comparison groups. Study III was a randomised, double-blind, placebo-controlled trial with intervention and control groups. Study IV took a qualitative approach.

Study I showed that when patients with hip fracture received nutritional supplementation according to nutritional guidelines, from admission until five days postoperatively, fewer patients developed pressure ulcers. Study II showed that it is possible to objectively evaluate a short-term nutritional intervention through the nutritional biochemical marker IGF-1, as it was affected by a five-day high-energy regimen. The randomised controlled trial, Study III, showed that a short-term treatment from admission until five days postoperatively with cranberry as capsules does not seem to be useful in preventing positive urine cultures in female patients with hip fracture and a urinary catheter. Finally, Study IV showed that patients with hip fracture reported experiencing very little involvement in their nursing care, to the extent that fundamental aspects of nursing care went unfulfilled. Patients did not feel valued by the nurses and unbearable pain that affected rehabilitation was reported. Positive interactions with nurses, however, did encourage patients to be more active.

It is possible for every nurse to improve patient safety at bedside when caring for patients with hip fracture. Simply by increasing caloric/energy intake, it is possible to prevent pressure ulcers. It is also important to involve patients in nursing care, since the patients have experienced low or almost no involvement in care. Nurses need to see each patient as a whole person with different wishes and needs. However, certain prerequisites have to be in place to give nurses the opportunity to increase patient safety at bedside for patients with hip fracture.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. 68 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1035
Keyword
Hip fracture, patient safety, nutrition, cranberry, patient involvement, adverse event, elderly
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-232825 (URN)978-91-554-9053-9 (ISBN)
Public defence
2014-11-14, Grönwallsalen, Akademiska sjukhuset, ing 70, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2014-10-24 Created: 2014-09-25 Last updated: 2015-01-23

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Gunnarsson, Anna-KarinGunningberg, Lena

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