Understanding patient and relative/carer experience of hip fracture in acute care: a qualitative study protocol.

Background: This paper presents a qualitative study protocol focusing on older peoples’ experience of recovery in acute care following hip fracture and also the experiences of their family or informal carers. There is limited evidence regarding older people and their relatives'/carers' experiences of recovery in acute care. Aim: The study had two research questions. First what is the experience of older people who have suffered a fractured hip and secondly what is the relatives'/carers' experience of being alongside a person who has suffered a fractured hip? Methods: The methodology chosen is phenomenology using the methods of interviewing and participant observation. It is planned to recruit a purposive sample of up to 40 patients including those with memory loss who have suffered a fractured hip, and up to 30 of their relative/carers, and up to 20 staff may choose to take part in the observation sessions. Analysis will be through drawing out units of meaning, bringing them together to form categories and themes of experience. Conclusion: This study will extend knowledge by exploring what is important to patients and their relatives/carers in the early phase of recovery. Practice based principles that can be integrated into the hip fracture pathway and enhance future care will be developed from the study findings.</p

Understanding informal carers’ experiences of caring for older people with a hip fracture: a systematic review of qualitative studies

Purpose: This systematic review aimed to reconceptualize experiences from a variety of papers to provide direction for research, policy and practice. Method: Meta-ethnography was used to inform the review, and 21 studies were included. Findings: The analysis identified a core theme of “engaging in care: struggling through”, as carers, who wanted to be involved in caring, learnt to live with the intense and stressful impact of caring and changes to their life. The core theme is represented through three themes (1) Helping another to live, (2) Adapting ways of living and (3) Negotiating the unknown. Conclusions: The discussion identified a focus on carers of people suffering from a hip fracture, the willingness of informal carers to engage in caring and the intense experience of adapting to changes in relationships and dependency alongside a steep experiential learning curve. Tensions exist in negotiations with complex health care systems as carers do not feel their expertise is valued and struggle to find and understand information. Implications for Rehabilitation Including relatives/carers in the umbrella of care within a family-centred approach. Involving relatives/carers within shared decision-making about care requirements and rehabilitation goals. Utilizing forms of experiential learning to help the development of relatives/carers skills in relation to their role as carer. Providing opportunities for carers to explore ways of sustaining their own health through self-compassion. </ul

Identifying patient-centred recommendations for improving patient safety in general practices in England: a qualitative content analysis of the free text responses in the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire

Background: There is a growing interest in identifying strategies to achieve safer primary healthcare provision. However most of the research conducted so far in this area relies on information supplied by healthcare providers, and limited attention has been paid to patients’ perspectives. Objective: To explore patients’ experiences and perceptions of patient safety in English general practices with the aim of eliciting patient-centred recommendations for improving patient safety. Methods: The Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire was sent to a random sample of 6,736 primary care users registered in 45 English practices. We conducted a qualitative content analysis of responses to seven open-ended items addressing patients’ experiences of safety problems, lessons learnt as a result of such experiences, and recommendations for safer healthcare. Results: 1,244 (18.4%) participants returned completed questionnaires. Of those, 678 (54.5%) responded to at least one open-ended question. Two main themes emerged: 1) experiences of safety problems, and 2) good practices and recommendations to improve patient safety in primary care. Most frequent experiences of safety problems were related to appointments, coordination between providers, tests, medication and diagnosis. Patients’ responses to these problems included increased patient activation (for example, speaking up about concerns with their healthcare) and avoidance of unnecessary healthcare. Recommendations for safer healthcare included improvements in patient-centred communication; continuity of care; timely appointments; technical quality of care; active monitoring; teamwork; health records; and practice environment. Conclusion: This study identified a number of patient-centred recommendations for improving patient safety in English general practices

Patient and informal carer experience of hip fracture: a qualitative study using interviews and observation in acute orthopaedic trauma

Objectives The time taken for older people to recover from hip fracture can be extensive. The aim of this study was to gain an understanding of patient and informal carer experience of recovery in the early stage, while in acute care. Design A phenomenological (lived experience) approach was used to guide the design of the study. Interviews and observation took place between March 2016 and December 2016 in acute care. Setting Trauma wards in a National Health Service Foundation Trust in the South West of England. Participants A purposive sample of 25 patients were interviewed and observation taking 52 hours was undertaken with 13 patients and 12 staff. 11 patients had memory loss, 2 patients chose to take part in an interview and observation. The age range was 63–91 years (median 83), 10 were men. A purposive sample of 25 informal carers were also interviewed, the age range was 42–95 years (mean 64), 11 were men. Results The results identified how participants moved forward together after injury by sharing the journey. This was conveyed through three themes: (1) sustaining relationships while experiencing strong emotions and actively helping, (2) becoming aware of uncertainty about the future and working through possible outcomes, (3) being changed, visibly looking different, not being able to walk, and enduring indignity and pain. Conclusion This study identified the experience of patients and informal carers as they shared the journey during a challenging life transition. Strategies that support well-being and enable successful negotiation of the emotional and practical challenges of acute care may help with longer term recovery. Research should focus on developing interventions that promote well-being during this transition to help provide the foundation for patients and carers to live fulfilled lives.</p