Safeguarding Self-Governance: A Grounded Theory of Older Patients’ Pattern of Behavior in Relation to their Relatives in Fast-track Programs

Abstract
The aim of this study was to generate a grounded theory of older patients’ pattern of behavior in relation to their relatives’ involvement in fast-track programs during total joint replacement. Sixteen patients were recruited in orthopedic wards. Data collection included 11 interviews with patients and 15 non-participant observations of interactions between patients, relatives, and health professionals during scheduled meetings throughout the fast-track program. The constant comparative method was used for simultaneous data collection, data analysis, and coding. Safeguarding self-governance emerged in the analysis as the core category of our theory and pattern of behavior of the older patients in relation to their relatives. The older patients’ main concern was to complete the fast-track program while maintaining autonomy, which they resolved through four strategies of actions: embracing, shielding, distancing, and masking.
Keywords: Fast-track program, grounded theory, older patients, relatives, total joint replacement.