A Grounded Theory of 'Taking Control' After Surgery for Fall-Induced Hip Fracture

  • Laura McMillan

Student thesis: Doctoral ThesisDoctor of Philosophy (PhD)


Hip fracture is a significant cause of mortality and morbidity in older people, and is commonly experienced as a result of a fall. The majority of the literature details hip fracture from a medical perspective, highlighting functional recovery and rehabilitation outcomes. This leaves a gap in knowledge and understanding of hip fracture from the perspective of older people who experience this traumatic injury. The specific concerns of older people and the strategies they use to resolve these concerns after hip fracture are unknown. This study sought to redress this gap using grounded theory. The application of Glaser’s (1978) approach to the method, blended with the constructivist epistemology of Charmaz (2006), guided the systematic generation of this grounded theory.

Semi-structured interviews were carried out with 19 older people who had returned to their homes after surgical intervention for a fall-induced, traumatic hip fracture. Using the constant comparative method, the core category of ‘taking control’ emerged. Conceptually, taking control is about ‘balancing’ and is both a process and a range of strategies. The three stages that people move through in taking control are going under (where they initially lose control as a consequence of the fall), keeping afloat (where they struggle to manage in the acute post operative and post discharge context) and gaining ground (where people start to make progress and take control over their lives again). These stages represent a dynamic process; however, not everyone reaches the third stage. Nautical metaphors emphasise the precarious and unstable conditions of the post operative context, as well as conceptualising the physical and emotional struggles people face in balancing help and balancing risk as they attempt to resolve their main concern of ‘going under anew’, by taking control. ‘Going under anew’ conceptualises concerns about losing control and independence in the future.

This study has generated a substantive grounded theory of ‘taking control’ after fall- induced hip fracture. This theory adds a new dimension to current understanding of older people’s recovery following traumatic hip fracture, drawing on the theoretical literature around control and stress and coping theory and highlighting the significance of the concept of self efficacy. Older people are vulnerable to losing a sense of control after a health trauma and healthcare professionals have a vital role to provide information to patients and their families, helping to restore control and increase self efficacy. Therefore, it is anticipated that this theory will enable healthcare professionals to understand the patient’s perspective of hip fracture and thus enhance their care of older people, ensuring that people take control safely and appropriately after hip fracture. Keywords are: hip fracture, older people, falls, taking control, balancing, self efficacy, and grounded theory.
Date of Award2010
Original languageEnglish
Awarding Institution
  • Glasgow Caledonian University
SupervisorJo Booth (Supervisor), Kay Currie (Supervisor) & Tracey Howe (Supervisor)

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