TITLE:
Barriers and facilitators to an outreach rehabilitation program delivered in nursing homes after hip fracture surgical repair
AUTHORS:
Donna M. Wilson, Sandra L. Robertson, C. Allyson Jones, D. W. C. Johnston, Lauren A. Beaupre
KEYWORDS:
Hip Fracture; Rehabilitation; Qualitative Research; Nursing Homes; Continuing Care
JOURNAL NAME:
Advances in Aging Research,
Vol.2 No.1,
February
28,
2013
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.