Challenges of self-care at home after orthopaedic implant surgery in Indonesia: A qualitative study
DOI:
https://doi.org/10.12923/pielxxiw-2026-0033Keywords:
vulnerable populations, orthopaedic procedures, postoperative care, caregivers, nursing ethicsAbstract
Aim. This study explored self-care challenges at home after orthopaedic implant surgery among Indonesian adults as expressions of patient vulnerability and examined the ethical implications for nursing responsibilities during the transition from hospital to home.
Material and methods. A qualitative descriptive phenomenological design was used, involving in-depth semi-structured interviews with 18 adults, conducted two to six weeks after open reduction and internal fixation for lower-extremity fractures at a public hospital in Jakarta. Data were analysed using reflexive thematic analysis.
Results. Participants described a fragile recovery space characterised by poorly controlled pain and sleep disturbance, movement-related anxiety and kinesiophobia, uncertainty about wound care and safe activity, and heavy reliance on unprepared family caregivers experiences that amounted to perceived ethical neglect. Participants also expressed a strong wish for simple digital tools that would sustain contact with nurses after discharge.
Conclusions. Current discharge practices risk ethical neglect of patients and their families by transferring complex care to the home without adequate preparation. Nurses should reconceptualise discharge as transitional protection, combining family-inclusive education with low-threshold digital support to deliver the “strong care” required by these vulnerable populations.
References
1. Yan J, Li F, Zhou J, et al. The global burden of fractures and its underlying etiologies: results from and further analysis of the Global Burden of Disease Study 2021. Arch. Osteoporos. 2025;20:111. https://doi.org/10.1007/s11657-025-01596-3
2. Firdaus MN, Pratista MB, Rahman A, et al. The Profile of Road Traffic Injury-Related Fracture Patient in the Emergency Department of H. Damanhuri Barabai General Hospital. (JOINTS) Journal Orthopaedi and Traumatology Surabaya. 2025;14:37-45. https://doi.org/10.20473/joints.v14i1.2025.37-45
3. Saunders R, Dineen D, Gullick K, et al. Exploring orthopaedic patients’ experiences of hospital discharge: Implications for nursing care. Collegian. 2022;29:78-83. https://doi.org/10.1016/j.colegn.2021.05.001
4. You S, Li N, Guo M, et al. Are patients ready for discharge from the hospital after fast-track total knee arthroplasty? A qualitative study. PLoS One. 2024;19(5):e0303935. https://doi.org/10.1371/journal.pone.0303935
5. Rahayu U, Ibrahim K, Herman H. Exploring the learning needs for discharge planning among postoperative orthopedic patients: A scoping review. Patient prefer adherence 2025;19:1881-1991. https://doi.org/10.2147/PPA.S529228
6. Gopinatth V, Mameri ES, Casanova FJ, et al. Systematic review and meta-analysis of clinical outcomes after management of posterior cruciate ligament tibial avulsion fractures. Orthop. J. Sports Med. 2023;11. https://doi.org/10.1177/23259671231188383
7. van Manen M. Phenomenology of Practice. New York: Routledge; 2023. https://doi.org/10.4324/9781003228073
8. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care. 2007;19:349-357. https://doi.org/10.1093/intqhc/mzm042
9. Hennink M, Kaiser BN. Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Soc. Sci. Med. 2022;292:114523. https://doi.org/10.1016/j.socscimed.2021.114523
10. Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual. Res. Sport Exerc. Health. 2019;11:589-597. https://doi.org/10.1080/2159676X.2019.1628806
11. Braun V, Clarke V. Toward good practice in thematic analysis: Avoiding common problems and be(com)ing a knowing researcher. Int. J. Transgend. Health. 2023;24:1-6. https://doi.org/10.1080/26895269.2022.2129597
12. Ahmed SK, Mohammed RA, Nashwan AJ, et al. Using thematic analysis in qualitative research. J. Med. Surg. Public Health. 2025;6:100198. https://doi.org/10.1016/j.glmedi.2025.100198
13. Byrne D. A worked example of Braun and Clarke’s approach to reflexive thematic analysis. Qual. Quant. 2022;56:1391-412. https://doi.org/10.1007/s11135-021-01182-y
14. Ahmed SK. The pillars of trustworthiness in qualitative research. J. Med. Surg. Public Health. 2024;2:100051. https://doi.org/10.1016/j.glmedi.2024.100051
15. Welsh A, Hanson S, Pfeiffer K, et al. Facilitating the transition from hospital to home after hip fracture surgery: a qualitative study from the HIP HELPER trial. BMC Geriatr. 2024;24:948. https://doi.org/10.1186/s12877-024-05390-7
16. Beer N, Riffat A, Volkmer B, et al. Patient perspectives of recovery after hip fracture: a systematic review and qualitative synthesis. Disabil. Rehabil. 2022;44:6194-209. https://doi.org/10.1080/09638288.2021.1965228
17. Longo UG, Matarese M, Arcangeli V, et al. Family caregiver strain and challenges when caring for orthopedic patients: A systematic review. J. Clin. Med. 2020;9:1497. https://doi.org/10.3390/jcm9051497
18. Sukchokpanich P, Anusitviwat C, Jarusriwanna A, et al. Quality of life and depression status of caregivers of patients with femoral neck or intertrochanteric femoral fractures during the first year after fracture treatment. Orthop. Surg 2023;15:1854-1861. https://doi.org/10.1111/os.13802
19. Di Nitto M, Durante A, Caggianelli G, et al. Effectiveness of transitional care interventions in patients with serious illness and their caregivers: a systematic review and metanalysis of randomized controlled trial. BMC Nurs. 2025;24:565. https://doi.org/10.1186/s12912-025-03189-4
20. Costa MFBNA da, Sichieri K, Poveda V de B, et al. Transitional care from hospital to home for older people: implementation of best practices. Rev. Bras. Enferm. 2020;73. https://doi.org/10.1590/0034-7167-2020-0187
21. Prieto-Moreno R, Mora-Traverso M, Estévez-López F, et al. Effects of the ActiveHip+ mHealth intervention on the recovery of older adults with hip fracture and their family caregivers: a multicentre open-label randomised controlled trial. EClinicalMedicine. 2024;73:102677. https://doi.org/10.1016/j.eclinm.2024.102677
22. Parmar J, L’Heureux T, Anderson S, et al. Bridging the care gap: integrating family caregiver partnerships into healthcare provider education. Healthcare. 2025;13:1899. https://doi.org/10.3390/healthcare13151899
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Authors

This work is licensed under a Creative Commons Attribution 4.0 International License.
