The importance of motivation in the care for patients after HIP

Abstract

Fear of complications, from the future, and many other concerns are normal by patients before and after a surgery. Support of the motivation can significantly streamline the nursing care. Research Questions: What are the specific concerns and fears of patients before the HIP, how do nurses use their skills in this area? Purpose of the Study: The aim of the survey is to identify as precisely as possible the concerns and fears of patients before and after the HIP. Furthermore, to determine how nurses use their skills in the context of the motivation of these patients.

Keywords: HIPNursedoubtfearmotivation

Introduction

Artificial hip joints have a wide range of benefits for patients. The most significant of these is

improvement of the quality of life of patients with advanced degenerative disease. However, this

procedure also has some negative points, including the risk of infection, excessive blood loss or some

restrictions if post-surgery care is not adhered to, etc. According to statistical data, over ten thousand hip

joint replacement surgeries are executed every year in the Czech Republic (uzis. cz, 2012). A gradual

increase in these types of operation can be expected due to rising average life expectancy.

One serious problem of old age is falling. Two different groups of patients suffer from fractured

femurs. The first, smaller group of patients consists of young people whose fracture is caused by a traffic

accident, sports accident, falling from a height, etc. The second, larger group of patients (65 – 70 %) is

made up of older people, mainly women. These fractures originate with minimum force when a patient

falls (Luckerová, 2014). Treatment of this situation depends on many factors: the type of fracture, the

patient’s age and overall state of health and his mobility before the accident.

As well as conservative treatment, both the aforementioned causes can lead to surgical treatment

of the patient’s situation. Surgery related hospitalisation places a lot of stress on the patient. This fact is

markedly expressed particularly as changes to a patient’s mental health. Within the terms of

hospitalisation the patient must adapt to a new environment, situation and to the new regime of the

treatment unit. This new situation frequently makes hospitalised patients concerned and afraid.

Problem Statement

Fear of complications, of the future and many other concerns, are normal in patients before and

after surgery. Support of motivation may significantly increase the effectiveness of nursing care.

Research Questions

What are the specific concerns and fears of patients before a total hip replacement?

What role does the patient’s family play in the patient’s motivation?

How can nurses use their skills and competence in this area?

Purpose of the Study

The purpose of research was to identify concerns, fear and motivation to restore mobility,

rehabilitation and self-sufficiency and a return to normal life in selected patients.

Research Methods

The executed research was qualitatively and quantitatively orientated. Two methods were chosen

to compile data and multiple research methods were used in order to assure the high quality of the

research

The method of individual semi-structured interviews was used to compile qualitative data. The

advantages of this technique include personal contact, the opportunity to ask additional questions and

greater flexibility. All these attributes are a great advantage with regard to the chosen group of

respondents. Thirteen hospitalised respondents (5 men and 8 women) were questioned. The common

attribute of these patients was their senior age, a pertochanteric fracture and these patients were

questioned on the 5th to 7th day post-surgery. The duration of each interview did not exceed 20 minutes.

The average age of respondents was 77 years.

In the subsequent the research the quantitative data will be expanded into a broader range of

respondents (patients) and it will be acquired by means of a questionnaire, which takes the answers of

respondents within the terms of qualitative research into consideration.

The cluster analysis technique was used in order to execute and evaluate qualitative data acquired

through interviews. The cluster analysis method is usually used to group and conceptualise specific

statements into groups. The basic principles of the cluster analysis method are based on comparison and

aggregation of data.

Findings

The executed questioning provided valuable data, which will be analysed further with regard to the

limited scope of paper.

Evaluation of the field of questions focusing on concerns and fears resulted in quite a surprise, we

identified very little or no fear of the future in the questioned patients and patients express the most

intensive concerns and fear of subsequent insufficient self-care. We can suppose that this low intensity of

concern and fear is related to the expected care when hospitalisation ends, in which family plays an

important role. This is also confirmed by the statements of all respondents, who say that they find the

separation from their family during hospitalisation difficult. It can therefore be concluded that fear of the

future and of other medical complications is significantly or may be significantly influenced by family.

During communication with the patient, which is the most important means of motivation, the

presence of pain and discomfort, which all respondents stated (with the exception of one female patient),

must also be taken into consideration. The medical professional must accept concerns about pain as a

possible obstacle to the patient’s motivation. However, he must also use the possibility of the reduction of

pain as a goal for rehabilitation when motivating the patient. It is therefore essential that medical

professionals (not only rehabilitation workers) are capable of working with a patient’s pain.

Over half of respondents stated that they have sufficient information about rehabilitation and

subsequent treatment. All respondents stated that their efforts to make progress are sufficiently

appreciated by medical professionals The respondents’ willing attitude to hospitalisation, their perception

and appreciation of the care provided by medical professionals and their knowledge about rehabilitation,

are conditions for successful cooperation between patients and medical professionals and also for

motivation of the patients.

Respondents considered the fact that they are motivated to rehabilitate by medical professionals

very positive, and they consider this motivation to be very beneficial and inspiring. All respondents agree

that the medical professionals help them.

Answers to questions focusing on care after being discharged from hospital demonstrate the

interest expressed by families of these patients. The patients state that they will be cared for after they are

discharged from hospital. Care by families and life partners predominates. However, it is disputable

whether this is a truly objective finding or whether some respondents may have answered more on the

basis of their expectations and their wishes.

From our own experience we can state that partners and families are an important factor, which

influences the motivation of patients towards rehabilitation for example. On the basis of their answers the

addressed patients clearly indicated the significance of their family. Medical professionals should reflect

this fact. Cooperation with the family of, not just, geriatric patients should be a basis for motivation by

medical professionals, whether this means motivation for rehabilitation or the patient’s return to his

previous manner of life. It is not enough to inform the family of the state of health of their family member

and rely on work by physiotherapists, nurses and doctors. It is necessary to communicate with the family

and unify procedures, which have a motivating effect on the patient.

We consider it important that patients consider support from their family and care by their family

to be fundamental. They believe that their families will take care of them, they have positive expectations

of their families. This faith in family care also eliminates concerns about medical complications in the

future and fear of pain. The finding that geriatric patients are most motivated to rehabilitate and return to

their normal lives by their families and medical professionals is a very important finding for medical

professionals. Research clearly indicates that the influence families and medical professionals have on

motivation is considered decisive by these patients.

Conclusion

Motivation of patients (not only geriatric patients) with a pertochanteric fracture to renew their

mobility by rehabilitation, self-sufficiency and the return to their normal life is of fundamental importance

for the success of treatment. The current results of research demonstrate the influence of the patient’s

current state of health on his motivation. If the patient has positive expectations, self-confidence and the

desire to achieve progress, the patient’s assumption of successful rehabilitation increases, fear of medical

complications in the future lessens and concerns about pain also lessen. This positive expectation was

confirmed by the respondents. It is linked to good tolerance of hospitalisation, faith in progress and

management of rehabilitation, as well as faith in support and help from medical professionals.

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