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The WAPEF is divided into seven dimensions of experiences, and these were used to identify gaps in the current literature on patient experiences of hip fracture. The first is the ‘patient as an active participant in their own health care’, which refers to the ‘importance of patient involvement in their health care, for example, through shared decision making and feeling in control of one’s own health care’ (p155) (Staniszewska et al., 2014). The literature on experiences of hip fracture suggests that hip fracture patients are not

encouraged to take an active part in their health care, and that they feel a loss of control over their lives (McMillan et al., 2011; Ziden and Kreuter, 2010; Wykes, Pryor and Jeeawody, 2009; Ziden, Wenestom and Scheman, 2008; Olsson et al., 2007; Archibald, 2003; Williams et al., 1994b; Borkan, Quirk and Sullivan, 1991; Luken, 1986; Furstenberg, 1986; Bowman, 1997; Robinson, 1999). These studies reported experiences of anxiety and a fear of dependency as a result not being an active participant in their own health care. However, the evidence lacked an exploration of how elderly people would like to be encouraged to be an active participant in their health care throughout their experience, from the acute ward to discharge home.

The second dimension of the WAPEF refers to how ‘receptive the health services are in tailoring the health services to disease group or the individual patient’ (p155) (Staniszewska et al., 2014). Thus defined, the literature again lacked evidence of patient centred or individualised health care services, highlighting another important gap in the research conducted in this area (Young and Resnick, 2009; Olsson et al., 2007; Powell, 2004).

The third dimension explores the ‘lived experience where individuals live with their condition and experience it in a unique way, hence family and broader life issues need to be taken into account’(p155) (Staniszewska et al., 2014). Some of these experiences originate ‘outside’ of the health care system but are brought with the patient into the health system; other experiences may be affected by attitudes and expectations of health professionals (Staniszewska, 2014). While the evidence around hip fracture focussed on specific aspects of the lived experience of hip fracture, such as stories of their injury, surgery, and pain felt (Olsson et al., 2007; Mauleon, 2007; Berge, Jakobsson and Sjostrom,

2005; Pownall, 2004; Archibald, 2003; Robinson, 1999; Borkan, Quirk and Sullivan, 1991; Furstenberg, 1986), together with their struggles to maintain independence while at hospital and immediately after discharge from hospital (Ziden, Wenestom and Scheman, 2008; Wykes, Pryor and Jeeawody, 2009, Archibald, 2003; Bowman, 1997; Borkan, Quirk and Sullivan, 1991;

Furstenberg, 1988), and their changed body image following hip fracture (Ziden and Kreuter, 2010; Ziden, Wenestom and Scheman, 2008). However, the evidence was weighted towards an exploration of the lived experience while in hospital and lacked a more complete insight into the lived experience of hip fracture along the care trajectory from injury to recovering at home. Furthermore, the evidence lacked vision in how the lived experience of hip fracture could inform care needs for this population.

The fourth dimension of the WAPEF explored the ‘continuity of care and relationships relating to the health care services received, from initiation of contact to discharge of care’ (p155) (Staniszewska, 2014). While studies have explored the continuity of care through to rehabilitation centres (Wykes, Pryor and Jeeawody 2009; Travis and McAuley, 1997), evidence exploring the continuity of care after discharge home was lacking. Some countries, such as the USA and Sweden, offer rehabilitation centres for hip fracture patients following their discharge from hospital, but this type of care is rarely available in England, and is certainly not part of standardised care for this population. The fifth dimension of the WAPEF explores ‘the skills and the style of how health professionals communicate with their patients’ (p155) (Staniszewska, 2014). One paper reported the importance of how health professionals communicated with hip fracture patients to improve motivation and morale

during recovery (Furstenberg, 1986). However, studies suggest that health professionals make decisions for patients in this elderly population rather than involving them in the decision making process, which leaves patients confused as to why certain procedures are conducted (Olsson et al., 2007; Pownall, 2004). Furthermore, the evidence around this dimension was focussed on communication while in the hospital or at a rehabilitation centre, but lacked evidence around communication at discharge and ongoing communication with patients after returning home.

The sixth dimension of the WAPEF explored the ‘importance of information provision’(p155) (Staniszewska, 2014). Studies reported a lack of information and knowledge provided to this population, particularly in relation to their injury and their rehabilitation (Ziden and Kreuter, 2010; Olsson et al., 2007). While studies reported a lack of information provision at these time points, the information patients wanted and how they wanted it, was not reported. Furthermore, as before, information needs after returning home were not examined.

The seventh dimension of the WAPEF explored the ‘need for support’ (p155) (Staniszewska, 2014). Studies have provided insight into the support needs of patients (Huang, 2009; Wykes, Pryor and Jeeawody, 2009; Ziden, Wenestom and Scheman, 2008; Olsson et al., 2007; Pownall, 2004; Archibald, 2003; Travis and McAuley, 1997; Furstenberg, 1986), and a lack of support has been noted as leading to social isolation and disappointments during recovery (Huang, 2009; Ziden, Wenestom and Scheman, 2008; Archibald, 2003; Borkan, 1991). Again, the evidence base lacked sufficient patient-focussed evidence to suggest support needs after hip fracture in England.