Older People’s Accounts of Pressure Ulcer Prevention Following Fractured Neck of Femur

Pressure ulcers are both distressing to patients who sustain them and costly to the National Health Service (NHS) and the healthcare economy. Despite advances in healthcare over the last 50 years, preventing pressure ulcers remains a challenge, both in the United Kingdom (UK) and worldwide. Sustaining a hip fracture dramatically increases the risk of pressure ulcers occurring and this is compounded if the person is older. Previous research has focused on patient knowledge, participation, and involvement in pressure ulcer prevention and patient experiences of hip fractures, but these bodies of literature exist in isolation. This research aims to understand older people’s experiences and participation in pressure ulcer prevention following hip fracture and explores the tension between empowerment and patient experience. The initial research question was focused on pressure ulcer prevention however, early in the data collection phase it became apparent that participants were not interested in pressure ulcer prevention especially in the early stages of their injury. Consequently, the emerging analysis and argument took a related yet different direction to that originally planned. Semi-structured interviews were conducted with 21 older adults who were recruited from a fractured neck of femur ward, between April 2017 and December 2019. The interviews were digitally recorded and transcribed by the researcher. Data was analysed using computer-assisted analysis software NVivo12 and thematic networks were developed from the emerging themes and codes. The thematic networks included: becoming an inpatient, dependency, recovery, and patient experience of pressure ulcer prevention. This study examines the utility of biographical disruption and its variants as the conceptual framework and lens to understand the experiences of hip fracture. The findings suggest that there is a need to reinstate the focus on care delivery, rather than engage older patients in education, and active involvement. In the initial phases of injury at a time when older patients are at the greatest risk of pressure ulceration, they are often clinically unwell and unable to participate in prevention strategies. These findings challenge policy and guidance around the concept of patient participation and involvement, in favour of a more individualised approach to care delivery in the acute phase of recovery. The contribution this research makes is to link the two bodies of literature on patient experience of pressure ulcer prevention and hip fracture, highlight the value of biographical disruption and its variants to understand the journey to recovery and inform the individualised approach to care delivery and pressure ulcer prevention, and suggests that finite NHS resources may be better used focusing on the care delivery of pressure ulcer prevention rather than the empowerment of patients following hip fracture.