Cognitive impairment, which occurs in 31-88% of postoperative elderly persons with hip fracture, found to predict poor functional recovery and to increase risk of mortality. However, a lack of study was found on post-operative processes and experiences for these patients and families. This information will increase the understanding of the health professions of the conditions of these patients and families and provide a base for development of appropriate and effective interventions. Therefore, the purposes of this study are to explore the post-operative recovery and family caregiving processes for hip-fractured older persons with cognitive impairment, and to understand how it is different or similar to those without cognitive impairment, in order to develop a theory to explain the variations in this phenomenon.

 

Grounded theory method is selected to develop the conceptual framework of the phenomena. Approval of Institutional Review Board (IRB) of CGMH will be obtained before the study starts. Family caregivers of hip fractured older persons with and also without cognitive impairment will be recruited to receive in-depth interviews. The family caregiver-hip fracture older persons dyad will be obtained at the trauma wards or emergency rooms of a medical center in Northern Taiwan. Interviews and participant observations will be used to collect the data. Face-to-face interviews using an open-ended interview guide will be conducted. The family caregivers will received 6 times of interview (before surgery, before discharge and at 1st, 3rd, 6th, 12th months after discharge) and the hip fractured older person will received cognitive and physical functioning assessments at the same time point as the interviews take place. Initially, 30 dyad of family caregivers and patients (15 with and 15 without cognitive impairment) will be collected. Actual sample size will be determined by theoretical sampling which refers to sampling based on concepts and incidents that are relevant to the evolving theory. The comparison of the experiences of family caregivers of patients with and without cognitive impairment will enhance the researcher’s theoretical sensitivity of the concepts that unique to family caregivers of the patients with cognitive impairment. Theoretical sampling will cease when the concept categories reach theoretical saturation. Constant comparative analysis will be used to analyze the data. Specifically, Glaser’s approach will be selected and implemented to allow more flexibility. We will conduct audit trails, peer debriefing, triangulation of data from different collection methods, obtaining rich descriptions of the contextual conditions, administering prolonged engagement with extended visits, conducting theoretical sampling and member checks to increase the overall trustworthiness of the study. The developed conceptual framework can provide a culturally relevant perspective to the post-operative recovery and family caregiving processes for hip-fractured older persons with cognitive impairment in Taiwan and increase our knowledge base of gerontological nursing. Findings of this study can provide a reference for clinical decisions and offer suggestions to better care for hip fractured older persons with cognitive impairment and their family caregivers.