Date of Award

2002-12-01

Degree Name

PhD Nursing

Dissertation Committee

Patricia A. Roth, EdD RN, Chairperson; Jane M. Georges, PhD, RN; Mary Woods Scherr, PhD

Keywords

elderly, Hip fracture, morbidity & mortality, nursing, rehabilitation

Abstract

Fracturing a hip is a devastating experience for the older adult, and mortality and morbidity following a hip fracture are high among this vulnerable population. Mortality rates from 12 to 37 percent have been reported within one year after a hip fracture. It is estimated that 50 percent of individuals who experience hip fractures become partially dependent in activities of daily living, and 33 percent become totally dependent in activities of daily living. Reducing morbidity by improving rehabilitation outcomes is an important healthcare goal for older adults. Motivating participation in rehabilitation activities poses a challenge for professional caregivers. The purpose of this study was to explore motivation for successful rehabilitation. The study focused on discovering what the experience of fracturing a hip and recovering from this life-altering event was like for the older adult. Dimensional analysis was used to develop an explanatory model of successful rehabilitation following a hip fracture. In-depth interviews were conducted with eighteen older adults between 72 and 92 years of age. Analysis of the data yielded an explanatory model of successful rehabilitation grounded in the experiences of the participants. Life stops as you know it emerged as the context of the study that described the sudden dependence experienced by older adults following a hip fracture. The central dimension, Getting Back, represented intrinsic motivation to return to independent functioning that served as the primary motivator for participation in rehabilitation. Self-directed actions used by participants included having a vision of returning to independent functioning, taking responsibility for participating in rehabilitation activities, and monitoring their rehabilitation progress. Participants identified many conditions that facilitated and hindered their participation in rehabilitation. A lack of social support, limited resources, pain, depression, alterations in mental status, and medical or surgical complications were barriers to participation in rehabilitation. Support provided by professional and informal caregivers was important in facilitating rehabilitation. Resuming a reasonable life was the consequence of successful rehabilitation after a hip fracture. These findings have important implications for clinical practice and future research.

Document Type

Dissertation: Open Access

Department

Nursing

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