Communication for Early Mobilisation of People Living With Dementia Following Surgery for Hip Fracture

Communication Practices to Achieve Early Mobilisation of People Living With Dementia Following Surgery for Hip Fracture: a Conversation Analytical Study ('VideOing to Improve Communication Through Education - Hip Fracture', VOICE-HF)

This goal of this study is to identify ways that healthcare professionals communicate that are effective in helping a person living with dementia to stand or walk after surgery for a broken hip (hip fracture). We aim to identify 'what works' in successfully helping people with dementia to mobilise early, and share this in practice. The main question the research aims to answer is:

What healthcare professional communication practices are effective in achieving early and continued mobilisation among people living with dementia following hip fracture surgery?

We will use a research method called 'Conversation Analysis', to look at the fine detail of the language healthcare professionals use and responses to it. We will make video recordings of real-life ward care, when healthcare staff are trying to help a person with dementia get up early after hip fracture surgery. We will involve people with dementia in decisions to take part and get agreement from their families before we record anything. We have done this successfully in two previous studies. We will record up to 50 episodes of care on three trauma orthopaedic wards. We will identify specific, practical recommendations and 'teachable' approaches: ways of speaking, or sequences of requests or instructions. We will work with people with dementia, family carers, educators and clinicians to do this. We will use clips of videos in future communication training.

Research question: What healthcare professional (HCP) communication practices are effective in achieving early and continued mobilisation among people living with dementia (PLWD) following hip fracture surgery?

Background: 75,000 people are admitted to hospital with a hip fracture each year, half of whom have dementia. Outcomes are worse for PLWD. Fewer than half regain their pre-fracture mobility and a third die within a year. Best practice is for rapid fracture surgery, and early mobilisation - getting out of bed, standing or walking, by the day after surgery. This is associated with better outcomes, fewer complications and shorter hospital stay. PLWD are less likely to mobilise early. Dementia affects communication, judgement and reasoning. PLWD may be less able to communicate pain, anxiety, understand and follow HCP instructions, and see the benefits of mobilising early. Practitioners vary in how they communicate. Identifying HCP communication practices that are effective in achieving early mobilisation ('what works') will allow the description and dissemination of best practice.

Methods: 'Conversation analysis' (CA), is a socio-linguistic research method, which looks at the fine detail of the language we use and responses to it. We will use CA to identify specific and teachable communication practices that HCPs use. We will recruit up to 100 healthcare professionals, up to 50 people with dementia and up to 50 family members or friends who may be present during the video recording. We will recruit HCPs in advance, and PLWD, if possible, before their surgery. We will video record up to 50 interactions on 3 trauma orthopaedic wards when HCPs are supporting PLWD to mobilise. CA will be used to reveal systematic patterns in interactions, and successful practices. We have experience in conducting video research with PLWD on acute wards. We will use an established protocol for recruitment, consent and data collection, developed with user input and acceptable to ethics committees.

Findings: Findings will inform practical communication guidelines for HCPs, which will be immediately useable by staff on wards.

Inclusion Criteria:

Patient participants will:

• have a documented diagnosis of dementia
• be either waiting for hip fracture surgery or have had hip fracture surgery within the previous 7 days
• have someone who can act as their personal consultee, in case they are assessed as lacking capacity during the study.

HCP participants will:

• be registered, student or assistant healthcare practitioners
• be involved in assessing, supporting or encouraging PLWD to mobilise post-hip fracture surgery
• work on the relevant wards

Relative and friend participants will:

• Be visiting a consented patient at a time when an appropriate recording with consented HCPs will take place
• Be a relative or friend of the consented patient who might normally be present during attempts to mobilise the patient after surgery

Exclusion Criteria:

• Patients will be excluded if we are unable to gain informed consent or consultee agreement, or if they are expected to die within 7 days.