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Towards an Integrated Person‐Centred Care Pathway to Support the Recovery Journey Post Hip Fracture: A Qualitative Study

ABSTRACT

Aim

To explore the pathway of care for people post hip fracture and define what is important for person-centred recovery.

Design

Qualitative design using interpretive descriptive methodology, guided by the Health Empowerment theoretical framework.

Methods

Semi–structured interviews were conducted from March to October 2021, focussed on the lived experience of recovery post hip fracture. Thirteen participants were interviewed. Five people post hip fracture; four advanced practice nurses and four practice nurses. Data were analysed using thematic analysis.

Results

Fragments of hip fracture care was a major theme describing a disconnected pathway following discharge from hospital, and exposed the gap between recommendations for follow up and implementation. Gaps highlighted the need for a key contact clinician to support care coordination, use of individualised care plans, clinical pathways for practice nurses, and follow up post hip fracture.

Conclusion

A disconnected recovery pathway was found from the lived experience of hip fracture. Findings highlight opportunities to develop integrated person-centred models of care that empower patients to self-manage their recovery. Implementation of an empowered coordinated pathway with a shared care approach integrates consistent care across the whole patient journey.

Implications for the Profession and/or Patient Care

Identified gaps from a fractured recovery formed key components to support a connected care pathway post hip fracture. Linked by the overarching construct of Health Empowerment, policy and practice development embedding a connected pathway within nurse-led models of care should be considered.

Reporting Method

Consolidated Criteria for Reporting Qualitative Research.

Patient or Public Contribution

No Patient or Public Involvement.

Impact

This study explored what was important for recovery post-hip fracture. A fragmented recovery pathway was identified that highlighted key components for improvement. Research supports policy and practice development for nurse-led models of care with an empowered approach post hip fracture.

PREPARE—Empowering People Post Hip Fracture: A Conceptual Framework for a Nurse‐Led Model of Care. Results of a Modified e‐Delphi Study

ABSTRACT

Aim

To develop a person-centred nurse-led model of care framework to empower people post hip fracture.

Design

Modified e-Delphi study.

Methods

A Modified e-Delphi study seeking expert opinion from people with the lived experience of hip fracture and clinicians was implemented. Content experts consisted of 17 nursing and medical clinicians and four people with the experience of hip fracture.

Results

Study found > 70% consensus on all 20 statements rating the importance and feasibility of care components in the Modified e-Delphi survey. Themes developed from content analysis of expert free text responses comprised: Relationships support person-centred care; Value of a Specialist Hip Fracture Nurse; Prioritising is key to positive outcomes. PREPARE—Empowering People Post Hip Fracture: A Conceptual Framework for a nurse-led model of care was developed from study findings, highlighting key principles: person-centred care; evidence-informed practice; Health Empowerment; organisational governance; follow-up and evaluation, constituting this framework.

Conclusion

This study presents PREPARE—Empowering People Post Hip Fracture: A Conceptual Framework for a nurse-led model of care. PREPARE presents a structured approach to empowering people post hip fracture, outlining the aim and context in which the model of care is intended. It highlights an integrated, shared, coordinated approach to the care of people post hip fracture. Shared care empowers people and their support person to effectively manage their recovery journey and safely remain supported in the community.

Implications for Practice

PREPARE outlines a structured framework to support nurse leaders in implementing nurse-led models of care for people post hip fracture. There is an opportunity to empower nurse leaders and patients to support the recovery journey through education encompassing this person-centred holistic framework.

Impact

To our knowledge this is the first study to develop a conceptual framework for a nurse-led model of care to empower people post hip fracture. This model highlights opportunities for an integrated shared, coordinated approach to the care of people post hip fracture. PREPARE—Empowering People Post Hip Fracture: A Conceptual Framework for a nurse-led model of care, offers a structured approach for localised health service development of person-centred nurse-led empowerment models of care.

Reporting Method

DELPHISTAR—Delphi studies in social and health sciences—Recommendations for an interdisciplinary standardised reporting.

Patient or Public Contribution

The experiences of people post-hip fracture, and clinicians were elicited to inform the PREPARE Conceptual Framework.

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