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.
Highlights
Hip fractures are common among residents of nursing homes [1]
Conclusion: 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
Three themes emerged to highlight barriers and facilitators to implementing the Outreach rehabilitation program in nursing homes for residents following hip fracture surgery: 1) the division, or the separate operations and delivery of the two distinct rehabilitation services; 2) building bridges, or negotiating ways to communicate and work together; and 3) strength in the structure, or the acceptance of the program which was based in part on the perceived benefits of the program
Summary
Hip fractures are common among residents of nursing homes [1]. Nursing home residents are twice as likely to suffer a hip fracture as older community-dwelling persons [2]. This rate is not surprising, as the risk of hip fractures increases with age [3] and with disability [4]. Previous studies have shown residents of nursing homes experience lower recovery after hip fracture surgery than their community-dwelling counterparts [6]. One study revealed only 22% of nursing home residents recovered to their pre-fracture functional levels as compared to 71% of their community-dwelling counterparts [7]
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