Hip fracture was costly in terms of money and loss of independence. The process of recovery continued at home. There were frustrations associated with not being able to do what you used to do; overcoming hurdles in the recovery process and adapting to new accommodation.
Vera experienced difficulties regaining full mobility. Despite continuing physiotherapy and attending an additional exercise class she had not gained full function of her leg. She got tired when walking and so spent more time sitting. Consequently, she felt she had gained weight since her accident.
And I went to that….what is it they call it, Pilates?.... I went for six weeks, I mean I didn’t begrudge the money if it was going to help me but I didn’t feel any better for it, you know. The girl was nice though…...the exercises she gave me, I still do them, you know…….If I could just lose some weight. [My sister] will say well stop eating; I mean I wouldn’t say I’m a big eater. But I like sweets and I mean when you’re sitting, you know, and my brother will say go out and walk and I says I go down to the bottom of the road and I’m exhausted because I’m walking to the side. I mean it’s alright for them saying but you’ve got your stick and that, but it’s so hard to do, it really is…………..Maybe if I was a bit thinner I’d maybe be able to get on a wee bit better you know (Vera 243) (Patient)
Trying every possible solution to the problem can be costly in time, money and effort. Vera took advice and tried different shoes but this was expensive and made no difference.
And it’s affected my foot now because I seem to be going to one side, so when I went to the GP he says to me get a good pair of shoes because the shoes you have on he says are too slack. So my son-in-law took me up and I got a pair of trainers, he says get a good pair of trainers, I’ve got the trainers and I can’t walk in them, I couldn’t lift my feet. So I bought these special shoes instead and it cost me a bomb and I’m not walking any better so…….. (Vera 39) (Patient)
In addition, to getting different shoes Vera did all the exercises she had been asked to do but this also had made little difference. Despite this, this older woman had managed to keep her sense of humour and determination to improve.
Oh aye, they’ll say to me do this and do that and I’ll say I’ll see if I can get a job in the hospital giving exercises to the people because I know every exercise. …It’s to try and strengthen this leg but it never helped. It’s my back that gets sore. It’s the way I’m walking, you know……I go from one side to the other…..My legs are the same length because I’ve been measured……It’s a muscle, it’s adductor.(Vera 217) (Patient)
It was interesting to note that not only the patient experience can have a poor outcome but the reality for the carers it can also be difficult in that they have to deal with the psychological trauma. Even with support it could be depressing and difficult to maintain a healthy life style and this was difficult for everyone involved.
He lives on his own, smokes too much and doesn't get enough fresh air, and doesn't do enough movement. So, the hip was a great excuse for doing even less moving. He's old and he's tired, and he's lost his partner, and he's lost the will to live to be honest with you, you know, to be absolutely honest, he would quite happily not being here, you know…he doesn't do enough exercise to get his lungs doing anything other than .smoking, you know (Kevin 78) (Carer)
For another carer it was not so much the issues of determination and psychological care but in terms of social issues. Jack’s wife had the additional problem of a stroke which made walking very difficult. Re-housing became essential.
……we had to get this house because we were staying in the top flat upstairs and that was quite an ordeal getting up and down there. It took us a year to get transferred to a house like this. (Jack 310) (Carer)
We don’t always know the person; going home is not always best and can be isolating. Carers can feel the burden (AR8 group reflection)
In summary, hip fracture was always unexpected, painful and resulted in immobility. These excerpts from the stories told by the patients and carers highlighted some of the difficulties experienced in the journey to recovery following hip fracture. Being unable to get help, care being impersonal and embarrassing, being ignored and not having enough information, lack of choice and finally loss of independence all increased the stress of the hip fracture experience.
4.4.5 Aha, everyone is different
By reflecting on all these experiences the silent voices had been heard and the team now realised that everyone was different. As a result the team awareness of the hip fracture experience was hightened. Working together in the action meetings had given the team an opportunity to acknowledge the complexity of the experience
I mean, there's a world of difference with the old lady who fell lying in her house or the one that tripped [whilst out shopping] and broke her hip aged fifty something, a world of difference. (4.88 Physio 2)
Following hip fracture there was a complex journey of care that took the patients to different health board divisions. This involved travelling to different locations.
It shows how complex a journey can be from place to place and you know, quite complex things might happen to the person (6.675 OT3). We have learned lots about the patient journey and now understand this better (AR8 Dietician).
It was unusual for the team to have time to see the whole picture. Seeing the whole picture acknowledged the diversity of experience and confirmed the perceptions of earlier meetings. They had increased their awareness of the patient journey from the patients’ and carers’ perspective and had learned what was important.
Increased awareness that patient may find things more important than I would; NHS targets are not concern to patients (AR8 Physio 2)
Patients did not know about NHS targets instead there were others things that were important to them. The team had been so involved in their own responsibilities that they had forgotten to consider issues that were important to others. In some ways it was a humbling experience.
Each person thinks that their contribution to the patient journey is the most important. It shows you what a small part of the patient experience you are (AR8 OT 3)
Once the team felt secure and able to accept their own feelings then they were able to acknowledge the feelings of others. The hidden caring could emerge and they began to acknowledge their own good work which earlier had been overwhelmed by the negatives. Through listening to each other and discussing difficult issues they could help each other move forward. Exploring the patients’ and carers’ experience finally transformed their perspective. The team felt comfortable, refreshed and enlightened. They had recognised the complexities of the journey following hip fracture. They could see the small things that they could change that would make a difference from the patients’ and carers’ point of view.
It is a magical stage when the design goes to plan and transformation occurs (Reflections). My theory is that shared understanding builds trust and respect and in turn enables the team to trust and respect others (AR8 reflective notes)