An ethnographic study of mobilization, basic mobility, physical activity, and exercise during acute hospitalization in patients following hip fracture surgery

ABSTRACT Introduction Existing evidence highlight the need for a standardized approach in treating patients hospitalized following a hip fracture surgery. Clinical guidelines highlight rapid recovery of basic mobility post-surgery and the importance of frequent mobilization, physical activity, and exercise in rehabilitation. However, findings from the first HIP-ME-UP study show increasing physical inactivity among these patients, indicating issues with guideline implementation in clinical practice. Therefore, this study investigated clinical practice in relation to mobilization, basic mobility, physical activity and exercise during acute hospitalization in patients following hip fracture surgery. Methods An ethnographic field study was conducted at the orthopedic ward of a publicly funded hospital in the Capital Region of Denmark. Researchers carried out 22 observations from November 2023 to February 2024. A total of 230 pages of field notes were produced. An initial inductive qualitative content analysis was applied to find preliminary themes and subthemes. To nuance and validate these findings, 23 interviews with healthcare professionals and management were conducted and analyzed deductively. This deductive analysis was guided by the preliminary themes and subthemes that were revised in the final analysis if data provided nuances and new insights to the observations. Result Three themes emerged from the final analysis: (1) Different cultural models; (2) Organizational factors shaping mobilization practice; and (3) Mediating artefacts. Professional groups differ in their understanding of patient mobilization, leading to unclear responsibilities and inconsistent practices. A lack of interprofessional communication, resource constraints and challenging procedures for pain management aggravate these issues and hinder effective patient mobility. Moreover, the physical spaces and environments at the hospital contribute to patients staying in bed. Discussion Achieving recovery basic mobility and promoting mobilization, physical activity and exercise during hospitalization for patients following a hip fracture is complex and hindered by unclear definitions and responsibilities. The findings suggest a need for clear communication and consistent practices across professional and cultural boundaries to improve patient outcomes. Conclusion Our study contributes to an understanding of why mobilization remains inconsistently practiced despite guidelines that stress frequent mobilization as being important. These inconsistencies are deeply rooted in different cultural models regarding professional responsibility and practices, organizational priorities, and the hospital environment. HIGHLIGHTS Cultural models shape how mobilization is defined, prioritized, and delegated in clinical orthopedic practice. Professional roles and responsibilities around mobilization are negotiated through implicit routines and interactions. Lack of a shared terminology regarding mobility limits interprofessional collaboration and contributes to fragmented mobilization practices. Mediating artefacts like the Sara Stedy reflect and reinforce shifting norms about mobility in hospital care. Organizational structures and staffing patterns influence how and when mobilization is implemented in daily routines.