Inhibiting Interference - a grounded theory of health professionals' pattern of behaviour related to the relatives of older patients in fast-track treatment programmes

AIM: To generate a grounded theory explaining health professionals' pattern of behaviour and experience related to the relatives of older patients in fast-track treatment programmes during total joint replacement.

BACKGROUND: Health professionals uphold standardised care for patients, and effect on quality is seen when relatives support patients during total joint replacement. Since health professionals often have problematic relationships with relatives, knowledge is needed of the health professionals' pattern of behaviour in relation to relatives of older patients in fast-track treatment programme.

DESIGN: Grounded theory according to Glaser's methodology was used to generate substantive theory of health professionals' pattern of behaviour.

METHODS: Data were collected from 2010 to 2011 by 44 health professionals in orthopaedic wards at two Danish hospitals. Data from nonparticipant observations, formal interviews, group interviews, informal interviews and written information material were collected, coded and analysed through the constant comparative method.

FINDINGS: Inhibiting Interference emerged as health professionals' pattern of behaviour through which they resolved their main concern, striving for maintenance of the fast-track treatment programme and principles. Their main concern was resolved by a main strategy: Focusing on Principles, by striving for patients' full compliance during the trajectory, followed by two strategies of social control: Accepting Compliant Motivators, by involving well-informed relatives, and Avoiding Disobedient Doubters, by excluding relatives who do not comply with programme principles.

CONCLUSION: In the health professionals' strive to maintain programme principles, relatives were perceived as interferences, if noncompliant with trajectory rules, resulting in exclusion with consequences for their potential of being resources for patients.