Communicating during care transitions for older hip fracture patients: family caregiver and health care provider's perspectives

Abstract

IntroductionOlder hip fracture patients frequently require care across a variety of settings, from multiple individuals, including their family caregivers. We explored issues related to information sharing during transitional care for older hip fracture patients through the perspectives of both health care providers and family caregivers.MethodsThirty-five semi-structured interviews were conducted with family caregivers (n = 9) and health care providers (n = 26) of six hip fracture patients to gather perspectives on information sharing at each care transition, beginning with post-surgical discharge from acute care. Data were analysed using conventional qualitative content analysis methods using NVivo8 software.ResultsBoth family caregivers and health care providers recognise that family caregivers' involvement has important benefits for patients, but this involvement is frequently limited by poor information sharing. Barriers include limited staff time, patient privacy regulations and lack of a clear structure to guide information sharing. Receiving, not offering, information was the focus of information sharing by both family caregivers and health care providers.ConclusionsSpecific barriers that lead to poor information sharing between family caregivers and health care providers have been identified in this study. Possible interventions to improve information sharing include encouraging communication with family caregivers as standard care practice, educational strategies and more effective use of health information systems and technologies.

Understanding informal carers’ experiences of caring for older people with a hip fracture: a systematic review of qualitative studies

“…You know, work, making sure things were taken care of with his household, my household, visiting him every day…so, trying to juggle everything was probably the most difficult thing" [36 p.5]. Additional stress and complication were sorting out and co-ordinating the roles of other family members involved in providing care [32,40,41,[43][44][45]; or living a significant distance away [41,45].…”

“…The strategies reviewed were intrinsic, interpersonal and environmental. Intrinsic strategies included self-confidence [37,43], being positive, being patient [37,46], relaxation techniques [38], life philosophies or religious beliefs [37]; and being persistent and proactive to obtain information from healthcare providers [33,37,40,43,44]: "I just put my foot down and said I need this, this, this" [44 p.6]. Some carers with health professional backgrounds used it to navigate the health system and it helped them to cope with the stress linked to their lack of knowledge as a carer: "because I have medical knowledge and experience, I could fill in the gaps and ask the questions for answers I needed to know" [43 p.143].…”

“…For carers of patients with cognitive impairment this was a particular problem [39,42]. Being involved and being aware of what was happening with their relative/friend in the hospital was extremely important especially in the discharge planning [41,43,44]. However studies showed that carers were not included in discharge planning [41][42][43][44]: "The hospital sent him back to the nursing home on Friday instead of Tuesday the week after" [42 p.454].…”

“…Being involved and being aware of what was happening with their relative/friend in the hospital was extremely important especially in the discharge planning [41,43,44]. However studies showed that carers were not included in discharge planning [41][42][43][44]: "The hospital sent him back to the nursing home on Friday instead of Tuesday the week after" [42 p.454]. Providing carers with opportunities to express preferences and expectations in healthcare and strengthen information sharing could ensure that the needs of everyone involved in care are met [41,46].…”

“…Providing carers with opportunities to express preferences and expectations in healthcare and strengthen information sharing could ensure that the needs of everyone involved in care are met [41,46]. This was described as being part of a patient's circle of care [40,41,[43][44][45]48].…”