Fear of complications, from the future, and many other concerns are normal by patients before and after a surgery. Support of the motivation can significantly streamline the nursing care. Research Questions: What are the specific concerns and fears of patients before the HIP, how do nurses use their skills in this area? Purpose of the Study: The aim of the survey is to identify as precisely as possible the concerns and fears of patients before and after the HIP. Furthermore, to determine how nurses use their skills in the context of the motivation of these patients.
Artificial hip joints have a wide range of benefits for patients. The most significant of these is
improvement of the quality of life of patients with advanced degenerative disease. However, this
procedure also has some negative points, including the risk of infection, excessive blood loss or some
restrictions if post-surgery care is not adhered to, etc. According to statistical data, over ten thousand hip
joint replacement surgeries are executed every year in the Czech Republic (uzis. cz, 2012). A gradual
increase in these types of operation can be expected due to rising average life expectancy.
One serious problem of old age is falling. Two different groups of patients suffer from fractured
femurs. The first, smaller group of patients consists of young people whose fracture is caused by a traffic
accident, sports accident, falling from a height, etc. The second, larger group of patients (65 – 70 %) is
made up of older people, mainly women. These fractures originate with minimum force when a patient
falls (Luckerová, 2014). Treatment of this situation depends on many factors: the type of fracture, the
patient’s age and overall state of health and his mobility before the accident.
As well as conservative treatment, both the aforementioned causes can lead to surgical treatment
of the patient’s situation. Surgery related hospitalisation places a lot of stress on the patient. This fact is
markedly expressed particularly as changes to a patient’s mental health. Within the terms of
hospitalisation the patient must adapt to a new environment, situation and to the new regime of the
treatment unit. This new situation frequently makes hospitalised patients concerned and afraid.
Nakonečný (2014) states that the concept of motivation endeavours to explain the direction,
duration and intensity of behaviour in psychology: “to be highly motivated to do something” may mean
that “someone mobilises all their strength to achieve something specific and does not allow himself to be
distracted from this gaol, he has one goal before him, is fixated only on this goal and will not rest until he
achieves this goal“. It is therefore a process, which determines the direction, strength and duration of
specific behaviour and actions. We understand the reason for specific actions to be the fact that human
behaviour is not random, but is based on specific current needs (Trachtová, 2001). According to Vymětal
(2003), in psychological terminology motivation is “a process, which evokes specific, possibly
complicated behaviour by a person, maintains this behaviour and subsequently, after the need for this
behaviour has been satisfied, ends this behaviour“. Any new need initiates the process of motivation. This
need is therefore basically the motive for specific behaviour and actions. Motivation of patients and
people close to them depends mainly on the psychological approach of medical professionals. In this
situation, patients and people close to them expect medical professionals to satisfy their needs and
motivate them. Motives originate on the basis of motivation. These are personal reasons for specific
behaviour, psychological causes for a person’s reactions and activities. Situational motives lead
individuals to resolve specific situations in which an individual has found himself (Šamánková et al.,
2011). Motivation of patients and people close to them is an integral element of the medical profession.
Seeking and finding motivation for cooperation and recovery is very difficult for some groups of
patients in specific situations and requires a very professional and psychological approach by the medical
Fears and concerns during hospitalisation
Fear and concerns about the surgery itself, about possible complications, about the future and
many other concerns are a normal mental phenomena. Expressions of concern in patients may include
irritability, behavioural changes, imbalance of vegetative activity and also, for example, disinterest or
unreasonable calmness. Uncertainty, which frequently originates on the basis of insufficient information
about actual treatment or nursing care, is a main reason for fear and its intensity. The concerns and fears
of patients, particularly geriatric patients, must be identified in good time and chiefly eliminated so that
they do not exceed a tolerable limit, in order for treatment and nursing care to be successful.
Working with these aforementioned facts and finding an effective method to help the patient with
adaption is unavoidable, particularly for improving the effect of the surgery or treatment. Motivation
plays a crucial role in coming to terms with the mental situation of hospitalised patients. The task of
health care professionals and people caring for the patient is to direct the senior patients towards
achieving self-sufficiency by utilising his own abilities and compensatory equipment (Klevetová, 2008).
This is why medical processionals and the patients must work together, practical examples of practicing
self-care must be provided in a benevolent and supportive environment, without a lack of humour and
willingness, as well as a clear and specific system and rules (Klevetová, 2008). The medical professional
may have significant influence over the hospitalised patient’s experience. He should support the patient’s
efforts to retrain his motoric skills, appreciate partial success, explain potential failure and endeavour to
support the patient in his efforts. The medical professional should help geriatric patients create positive
expectations – that everything will end well, that the patient will manage rehabilitation, that he will return
to the life he was used to.
Factors influencing the patient’s motivation
Factors influencing the motivation of patients, not only geriatric patients, include their current
mental health, a safe environment, a feeling of certainty, the presence or absence of fear of pain, concerns
about failure, about the future, support by the family or partner, the medical personnel’s attitude,
communication, creation of realistic expectations, appreciation of partial success – progress, creation of
positive expectations, reinforcement of self-confidence, cooperation between medical professionals and
cooperation with the family – coordination of the patient’s motivation (Nakonečný, 2014).
Fear of complications, of the future and many other concerns, are normal in patients before and
after surgery. Support of motivation may significantly increase the effectiveness of nursing care.
What are the specific concerns and fears of patients before a total hip replacement?
What role does the patient’s family play in the patient’s motivation?
How can nurses use their skills and competence in this area?
Purpose of the Study
The purpose of research was to identify concerns, fear and motivation to restore mobility,
rehabilitation and self-sufficiency and a return to normal life in selected patients.
The executed research was qualitatively and quantitatively orientated. Two methods were chosen
to compile data and multiple research methods were used in order to assure the high quality of the
The method of individual semi-structured interviews was used to compile qualitative data. The
advantages of this technique include personal contact, the opportunity to ask additional questions and
greater flexibility. All these attributes are a great advantage with regard to the chosen group of
respondents. Thirteen hospitalised respondents (5 men and 8 women) were questioned. The common
attribute of these patients was their senior age, a pertochanteric fracture and these patients were
questioned on the 5th to 7th day post-surgery. The duration of each interview did not exceed 20 minutes.
The average age of respondents was 77 years.
In the subsequent the research the quantitative data will be expanded into a broader range of
respondents (patients) and it will be acquired by means of a questionnaire, which takes the answers of
respondents within the terms of qualitative research into consideration.
The cluster analysis technique was used in order to execute and evaluate qualitative data acquired
through interviews. The cluster analysis method is usually used to group and conceptualise specific
statements into groups. The basic principles of the cluster analysis method are based on comparison and
aggregation of data.
The executed questioning provided valuable data, which will be analysed further with regard to the
limited scope of paper.
Evaluation of the field of questions focusing on concerns and fears resulted in quite a surprise, we
identified very little or no fear of the future in the questioned patients and patients express the most
intensive concerns and fear of subsequent insufficient self-care. We can suppose that this low intensity of
concern and fear is related to the expected care when hospitalisation ends, in which family plays an
important role. This is also confirmed by the statements of all respondents, who say that they find the
separation from their family during hospitalisation difficult. It can therefore be concluded that fear of the
future and of other medical complications is significantly or may be significantly influenced by family.
During communication with the patient, which is the most important means of motivation, the
presence of pain and discomfort, which all respondents stated (with the exception of one female patient),
must also be taken into consideration. The medical professional must accept concerns about pain as a
possible obstacle to the patient’s motivation. However, he must also use the possibility of the reduction of
pain as a goal for rehabilitation when motivating the patient. It is therefore essential that medical
professionals (not only rehabilitation workers) are capable of working with a patient’s pain.
Over half of respondents stated that they have sufficient information about rehabilitation and
subsequent treatment. All respondents stated that their efforts to make progress are sufficiently
appreciated by medical professionals The respondents’ willing attitude to hospitalisation, their perception
and appreciation of the care provided by medical professionals and their knowledge about rehabilitation,
are conditions for successful cooperation between patients and medical professionals and also for
motivation of the patients.
Respondents considered the fact that they are motivated to rehabilitate by medical professionals
very positive, and they consider this motivation to be very beneficial and inspiring. All respondents agree
that the medical professionals help them.
Answers to questions focusing on care after being discharged from hospital demonstrate the
interest expressed by families of these patients. The patients state that they will be cared for after they are
discharged from hospital. Care by families and life partners predominates. However, it is disputable
whether this is a truly objective finding or whether some respondents may have answered more on the
basis of their expectations and their wishes.
From our own experience we can state that partners and families are an important factor, which
influences the motivation of patients towards rehabilitation for example. On the basis of their answers the
addressed patients clearly indicated the significance of their family. Medical professionals should reflect
this fact. Cooperation with the family of, not just, geriatric patients should be a basis for motivation by
medical professionals, whether this means motivation for rehabilitation or the patient’s return to his
previous manner of life. It is not enough to inform the family of the state of health of their family member
and rely on work by physiotherapists, nurses and doctors. It is necessary to communicate with the family
and unify procedures, which have a motivating effect on the patient.
We consider it important that patients consider support from their family and care by their family
to be fundamental. They believe that their families will take care of them, they have positive expectations
of their families. This faith in family care also eliminates concerns about medical complications in the
future and fear of pain. The finding that geriatric patients are most motivated to rehabilitate and return to
their normal lives by their families and medical professionals is a very important finding for medical
professionals. Research clearly indicates that the influence families and medical professionals have on
motivation is considered decisive by these patients.
Motivation of patients (not only geriatric patients) with a pertochanteric fracture to renew their
mobility by rehabilitation, self-sufficiency and the return to their normal life is of fundamental importance
for the success of treatment. The current results of research demonstrate the influence of the patient’s
current state of health on his motivation. If the patient has positive expectations, self-confidence and the
desire to achieve progress, the patient’s assumption of successful rehabilitation increases, fear of medical
complications in the future lessens and concerns about pain also lessen. This positive expectation was
confirmed by the respondents. It is linked to good tolerance of hospitalisation, faith in progress and
management of rehabilitation, as well as faith in support and help from medical professionals.
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27 January 2017
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Child psychology, developmental psychology, occupational psychology, industrial psychology, ethical issues
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Snopek, . (2017). The importance of motivation in the care for patients after HIP. In Z. Bekirogullari, M. Y. Minas, & R. X. Thambusamy (Eds.), Cognitive - Social, and Behavioural Sciences - icCSBs 2017, January, vol 20. European Proceedings of Social and Behavioural Sciences (pp. 97-102). Future Academy. https://doi.org/10.15405/epsbs.2017.01.02.11