Restoring: a grounded theory of recovery
Healee, David John
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In this thesis, the theory of restoring is presented. Restoring explains how older adults recover following a health event such as hip fracture. Understanding how the older age group manages recovery is important with ageing populations occurring around the world. Age-related health events impact at individual, community, and national levels. To date, research has tended to examine age-related recovery from perspectives that focus on factors relevant for professionally based care. Recovery though, does not just stop at discharge from those settings. It is an ongoing process. Yet, little exploration of recovery following the completion of interventional healthcare has taken place. Shorter healthcare episodes and longer lifespan mean older adults are returning to community settings to recover in their own way. It is important to understand what happens as older adults continue to recover after discharge from hospital. A Glaserian grounded theory study has been undertaken. Twenty-one individual interviews were conducted. Data collection, analysis and theory generation follow the classical grounded theory methodological approach. The hallmarks of the methodology include constant comparative analysis, theoretical sampling, theoretical coding, and theoretical sensitivity. It is evident that the main concern was normalisation, which participants resolved using the process of restoring. Restoring consists of regaining and reasserting, which are continuously being balanced depending on the context and situation. Regaining is about pacing, spacing, and relying relative to the physical and social aspects of recovery. Reasserting is the permissioning, connecting, and reconciling that focuses on the psychological factors influencing recovery. This research shows that older adults manage recovery according to their social memory, whilst adhering to professional regimes that are interpreted in terms of individual self-governance. It will be shown that individual social responsibility for managing recovery is continuously balanced against the social collective responsibility for the professional management of recovery in hospital and the community. Thus, individual-collective social responsibility determines the governance of restoration and the return to normality. Therefore, I argue that restoring is contextual and also influenced by social memory that is about people restoring normal patterns of behaviours to manage their recovery. Clearly, though, there is more to restoring normal than simply managing the physical aspects of regaining function. While there are multiple ways to view normal, four contextual perspectives were evident from the data. These perspectives frame participants’ interpretations of normal. They include a societal view, a physiological viewpoint, and an everyday perspective, all of which influence the fourth point of view, which is the individual perspective. The four views demonstrate how a collective social context influences recovery at an individual level. The theory of restoring has implications for practice. Current practice reflects generalised recovery programmes that sit alongside medicalised processes of care managed by professionals. How the person manages recovery and restoring their normal once they return home, needs to be factored into care delivery. This research shows that people will manage their recovery irrespective of what clinicians say. Understanding this will have implications for how information is imparted to patients during recovery and at discharge. This will influence how people understand and adhere to the generalised recovery information that is provided when a person leaves hospital.