Maintaining Unity – relatives in older patients' fast-track treatment programmes. A grounded theory study


  • Connie Bøttcher Berthelsen MScN RN,

    Clinical Nurse Specialist, PhD Student, Corresponding author
    1. Department of Elective Orthopaedic Surgery, Copenhagen University Hospital, Hellerup, Denmark
    2. Department of Nursing Science, Aarhus University, Denmark
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  • Tove Lindhardt MScN PhD RN,

    Senior Researcher
    1. Research Unit, Department of Internal Medicine, Copenhagen University Hospital, Herlev, Denmark
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  • Kirsten Frederiksen MEd PhD RN

    Associate Professor, Study Director
    1. Department of Nursing Science, Institute of Public Health, Faculty of Health Science, University of Aarhus, Denmark
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To generate a substantive grounded theory of relatives' pattern of behaviour in older patients' fast-track treatment programmes during total hip or knee replacement.


Fast-track treatment programmes are designed to make total hip and knee replacements more efficient through recovery improvements. The support of relatives during older patients' trajectory is important. However, knowledge is needed on the relatives' pattern of behaviour to strengthen their involvement in fast-track treatment programmes.


We used a Glaserian grounded theory approach based on a systematic generation of theory from data to explain the latent pattern of behaviour of relatives.


Data were collected from 2010–2011 in orthopaedic wards at two Danish university hospitals and consisted of 14 non-participant observations, 14 postobservational interviews and five interviews. Seven relatives of patients over 70 years of age participated. The constant comparative method was the guiding principle for simultaneous data collection, data analysis and coding, while theoretically sampling and writing memos.


Maintaining Unity emerged as the relatives' pattern of behaviour through which they resolved their main concern: preventing the patients from feeling alone. The relatives resolved their main concern through three interchangeable behavioural modes: Protecting Mode, by providing loving and respectful support; Substituting Mode, with practical and cognitive support; and an Adapting Mode, by trying to fit in with the patients' and health professionals' requirements.


The substantive theory of Maintaining Unity offers knowledge of relatives' strong desire to provide compassionate and loving support for the older patients during fast-track treatment programmes.