Mid Sweden University

When an older person suffers an acute event, such as a hip fracture, it influences the whole family. Research shows that while close relatives want to be a part of the older person’s life during recovery it is associated with a high perceived level of stress and burden. To provide in-depth knowledge of close relatives’ experiences in this situation, the aim of this study was to elucidate meanings of being a close relative to an older person recovering from hip fracture surgery. This study has a qualitative descriptive phenomenological hermeneutical design. Narrative interviews were conducted with ten close relatives. Analysis was conducted using phenomenological hermeneutical interpretation which provided a deeper understanding of the close relatives’ lived experiences of their older person’s recovery from hip fracture surgery. The structural analysis revealed two themes; “Participating in the illness journey”, which was constructed of the subthemes of facing the unimaginable yet expected, encountering healthcare personnel, and noticing recovery and “Putting oneself aside”, which was constructed of the subthemes of placing daily life on hold, giving support, and feeling concern and fear.

Purpose The aim of this study was to elucidate meanings of participation in care for older people after hip fracture surgery and nurses working in an orthopaedic ward. Methods A qualitative phenomenological hermeneutical design was used. We conducted personal interviews with a narrative approach with 11 older people recovering from hip fracture surgery and 12 nurses working in an orthopaedic ward. Results The results show that for older people, participation meant being a co-creator in their own care, founded on being met with sensitivity and support, being told what is going to happen, taking responsibility and asking questions and being able to influence care. For nurses, patient participation meant meeting the patients' needs and requests by being open and allowing them to influence care while at the same time recognizing that the patients' possibility to influence care was limited. Conclusion The study shows that for older people and nurses, the phenomenon of participation has similar meanings but also differences. When older people participate in their care, they become a co-creator in care and confirmed as a person. This highlights the importance of a nurse-patient relationship built on trust, connectedness and communication based on a shared understanding.

This thesis falls within the field of nursing and focuses on older people’s recovery after hip fracture surgery in a rural context. A fall-related hipfracture is a common and severe health issue that affects older people, leaving them vulnerable and in need of support from close relatives and healthcare personnel during recovery. The overall aim of this doctoral thesis was to explore and describe the recovery of older people after hip fracture surgery from the perspectives of older people, close relatives, and nurses. Data were collected through qualitative individual interviews (I), focus group interviews (II), and narrative interviews (III, IV). The interviews were analyzed using qualitative content analysis (I, II) and phenomenological hermeneutics (III,IV).

The findings show that older people found themselves in a new and vulnerable situation in which they were dependent on others for everyday activities they used to take for granted prior to the hip fracture. They were grateful to be able to return home after discharge from the hospital, although being at home would not have been possible without support from close relatives (I). For nurses, preparing patients for a life at home was vital, as they recognized the amount of support that was needed after hip fracture surgery. Nurses shared that certain aspects of discharge planning did not benefit the patient, but the nurses could not influence these (II). Furthermore, this study shows that for older people, participation in care means being a co-creator in care that is founded on being met with sensitivity and support, being told what is going to happen, taking responsibility, and asking questions and being able to influence care. For nurses, participation in care meant meeting the patients’ needs and requests by being open and allowing them to influence their care while also recognizing that the patients’ ability to influence care was limited. For older people and nurses, participation in care had somewhat different meanings, but it was associated with managing better at home (III). Being a close relative to an older person recovering from hip fracture surgery meant being a helper and involved facing the unimaginable yet expected, putting oneself aside, encountering the healthcare personnel, giving support, feeling concern and fear, and noticing recovery (IV). 

In conclusion, the findings of this thesis show that being affected by an acute, life-altering event such as a hip fracture greatly impacts the older person’s life. However, it seems that older people are given rather small opportunities to participate in and influence decisions about their care and discharge planning. Recovery after hip fracture surgery and the transition in daily life toward health seems to be influenced by the older person possessing selfdetermination and expectations of recovery, being a co-creator in care, and having supportive close relatives.

BACKGROUND: A hip fracture is an unexpected, subjective, traumatic experience that affects the person in both physical and emotional ways.

PURPOSE: The purpose of this study was to describe rural older people's experiences of recovering after hip fracture surgery.

METHODS: Thirteen individual interviews were conducted with older people. The interview texts were analyzed with qualitative content analysis.

RESULTS: Patients described finding themselves in a new and vulnerable situation, dependent on others for simple everyday chores. They struggled to regain independence while staying positive, convinced that they would recover. Fear of another fall, as well as lack of information, made recovery at home difficult.

CONCLUSION: Older people who experience hip fractures need support during the recovery process. Because recovery begins at the hospital, this study highlight patients' need to participate in recovery planning, as well as the need to have information about what it means to be affected by a hip fracture and how to prevent it from happening again. This study emphasizes that nurses' awareness of patients' need to participate in planning the recovery process is crucial for enabling patients' return to a daily life that is similar to their prefracture life.

Introduction: The in-hospital rehabilitation of patients who have undergone surgery for hip fracture requires a team-based effort, in which nurses play an all-embracing role throughout the patients’ hospital stays. Although discharge planning has been widely studied, little is known about discharge planning from hospitals to homes in rural settings. Aim: To describe nurses’ views on discharge planning for older patients after hip fracture surgery who live in their own homes in rural areas. Methods: A qualitative method was used. Four focus group interviews were conducted with 18 nurses who work at an orthopaedic clinic. The interview texts were analysed with qualitative content analysis. Findings: Nurses expressed that patients needed support from healthcare personnel as well as relatives in order to prepare for life at home. They also expressed that patients were not supported in all aspects of discharge planning because they faced difficulties in having their voices heard. Nurses described that many of those aspects were beyond their own control, which had left them with little to non-ability to influence discharge planning. Findings additionally indicate that discharge planning seems not affected by occurring in rural settings. Conclusions: Although discharge planning is intended to meet the unique wishes and needs of each patient given the realities of existing resources, nurses’ responsibilities in discharge planning are unclear. This study shows an organisation in which healthcare personnel continue to make decisions for patients. Significance for nurses to perform a discharge planning that support patients’ participation seems to be a communication based on shared understanding.

BACKGROUND: One strategy to develop nursing students’ clinical judgment are the use of high-fidelity patient simulation (HFS). The aim of the study was twofold. Firstly, the aim of this study was to describe the nursing students’ experiences while participating in HFS, and secondly to describe faculty teachers’ reflections about nursing students’ need in HFS and the related teaching challenges.

METHOD: Data was collected in focus group discussions and individual interviews, analyzed using thematic qualitative content analysis.

FINDINGS: The nursing students’ experienced HFS as being thrown into an uncertain, exposure situation. This were for some, reason for reluctance. The teachers challenge was motivating and coaching the students throughout a demanding teaching situation.

DISCUSSION: Students’ ability to perform in HFS is influenced by self-perceived efficacy, own attitudes and responsibility for one’s learning, which are a challenge for the teachers.

CONCLUSION: HFS methodology can be useful to identify gaps and strengths in students’ professional transition towards becoming registered nurses. Overcoming reluctance towards HFS is a mutual challenge for faculty teachers and nursing students. By entering the scenario with a positive mindset, nursing students can improve their ability to perform clinical judgments.