Barriers and facilitators to an outreach rehabilitation program delivered in nursing homes after hip fracture surgical repair

Donna M. Wilson, Sandra L. Robertson, C. Allyson Jones, D. W. C. Johnston, Lauren A. Beaupre

Department of Physical Therapy, Faculty of Rehabilitative Medicine, University of Alberta, Edmonton, Canada.
Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
Faculty of Nursing, University of Alberta, Edmonton, Canada.

DOI: 10.4236/aar.2013.21006                

Abstract

Objective: To identify and understand facilitators and barriers to implementing an Outreach rehabilitation program designed to improve post-operative recovery following hip fracture in long-term care residents. Residents of nursing home facilities are at considerable risk of hip fracture and minimal recovery following a hip fracture. Methods: Data were gathered over June-August, 2012 through semi-structured interviews or focus groups. Fifteen persons (n = 15) who were members of the Outreach rehabilitation team (n = 8) or relevant nursing home staff (n = 7) were interviewed. Data analysis was guided by principles of grounded theory method. Findings: Three major themes that contributed to or hindered the Outreach rehabilitation program emerged, namely, 1) the division, the separate operation and delivery of rehabilitation services; 2) building bridges, or negotiating ways to communicate and work together, and 3) strength in the structure, the acceptance of the program and the perceived benefits of the program. One main challenge to program implementation con- cerned coordinating additional rehabilitation with the rehabilitation provided within the nursing homes. Facility staff was largely unaware of the program and were unprepared to work with Outreach team members. As the program progressed, the facility staff and Outreach team were able to collaborate to overcome resident health issues impeding recovery such as cognitive impairment, language barriers and post-surgical pain control needs. Facilitators included the consistency of Outreach team members and accessible facility staff, which contributed to effective communication and trust between the Outreach team and facility staff. Facilitators also included support for the program by the Outreach team and facility staff, as well as the potential benefits of improved mobility and functional status among some program recipients. Conclusion: Although planning, implementation, and delivery of an Outreach rehabilitation program present some challenges, this study suggests that it is possible to deliver rehabilitation to older residents who fracture their hips in nursing homes.

Keywords

Hip Fracture; Rehabilitation; Qualitative Research; Nursing Homes; Continuing Care

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Brennan, J., Johansen, A., Butler, J., Stone, M., Richmond, P., Jones, S., et al. (2003) Place of residence and risk of fracture in older people: A population-based study of over 65-year-old in cardiff. Osteoporosis International, 14, 515 519. doi:10.1007/s00198-003-1404-5
[2]	Norton, R., Campbell A.J., Reid, I.R., Butler, M., Currie, R., Robinson, E., et al. (1999) Residential status and risk of hip fracture. Age and Ageing, 28, 135-139. doi:10.1093/ageing/28.2.135
[3]	Ronald, L., McGregor, M., McGrail, K., Tate, R. and Broemling, A. (2008) Hospitalization rates of nursing home residents and community-dwelling seniors in british columbia. Canadian Journal of Aging, 27, 109-115. doi:10.3138/cja.27.1.109
[4]	Hirdes, J., Mitchell, L., Maxwell, C. and White, N. (2011) Beyond the “iron lungs of gerontology”: Using evidence to shape the future of nursing homes in Canada. Canadian Journal on Aging, 30, 371-390. doi:10.1017/S0714980811000304
[5]	Wilson, D.M. and Truman, C.D. (2003) Canada’s continuing care population: A description and discussion of information issues and health care concerns. Canadian Journal on Aging, 22, 127-131. doi:10.1017/S0714980800003780
[6]	Crotty, M., Miller, M., Whitehead, C., Krishnan, J. and Hearn, T. (2000) Hip fracture treatments—what happens to patients from residential care? Journal of Quality in Clinical Practice, 20, 167-170. doi:10.1046/j.1440-1762.2000.00385.x
[7]	Beaupre, L., Cinats, J., Jones, C.A., Scharfenberger, A., Johnston, W.C.D., Senthilselvan, A., et al. (2007) Does functional recovery in elderly hip fracture patients differ between patients admitted from long-term care and the community? Journal of Gerontology Series A-biological Sciences & Medical Sciences, 62, 1127-1133.
[8]	Beaupre, L., Jones, C., Majumdar, S., Johnston, D., Buck ingham, J. and Saunders, L. (2002) Hip fracture in the geriatric population. Alberta Heritage Foundation for Me dical Research.
[9]	Allen, J., Koziak, A., Buddingh, S., Liang, J., Buckingham, J. and Beaupre, L. (2012) Rehabilitation in patients with dementia following hip fracture: A systematic review. Physiotherapy Canada, 64, 190-201. doi:10.3138/ptc.2011-06BH
[10]	Sherrington, C. and Lord, S. (1997) Home exercise to improve strength and walking velocity after hip fracture: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 78 208-212. doi:10.1016/S0003-9993(97)90265-3
[11]	Stern, P. and Porr, C. (2011) Essentials of accessible ground ed theory. Left Coast Press, Inc., Walnut Creek.
[12]	Glaser, B. (1965) The constant comparative method of qualitative analysis. Social Problems, 12, 436-445. doi:10.2307/798843
[13]	Streubert Speziale, H. and Rinaldi Carpenter, D. (2007) Qualitative research in nursing: Advancing the humanistic imperative. 4th Edition, Lippincott Williams & Wilkins, Philadelphia.
[14]	Taylor, N., Barelli, C. and Harding, K. (2010) Community ambulation before and after hip fracture: A qualitative analysis. Disability and Rehabilitation, 32, 1281 1290. doi:10.3109/09638280903483869
[15]	Nahm, E., Resnick, B., Orwig, D., Magaziner, J. and De Grezia, M. (2010) Exploration of informal caregiving following hip fracture. Geriatric Nursing, 31, 254-262. doi:10.1016/j.gerinurse.2010.01.003
[16]	Barbour, R. (2007) Doing focus groups. SAGE Publications Ltd., Thousand Oaks.
[17]	Friese, S. (2012) Qualitative data analysis with ATLAS.ti. SAGE Publications Ltd., Thousand Oaks.
[18]	Beaupre, L.A., Jones, C.A., Johnson, D.W.C., Wilson, D.M., Majumdar, S.R. (2012) Recovery of function following a hip fracture in geriatric ambulatory persons living in nursing homes: REGAIN-I prospective cohort study. Journal of the American Geriatrics Society, 60, 1268 1273. doi:10.1111/j.1532-5415.2012.04033.x
[19]	Williams, P. (2002) The competent boundary spanner. Public Administration, 80, 103-124. http://onlinelibrary.wiley.com/doi/10.1111/1467-9299.00296/pdf doi:10.1111/1467-9299.00296