title: Restoring integrity--A grounded theory of coping with a fast track surgery programme.
abstract: OBJECTIVE
  The aim of this study was to generate a theory conceptualizing and explaining behavioural processes involved in coping in order to identify the predominant coping types and coping type-specific features.
  
  
  BACKGROUND
  Patients undergoing fast track procedures do not experience a higher risk of complications, readmission, or mortality. However, such programmes presuppose an increasing degree of patient involvement, placing high educational, physical, and mental demands on the patients. There is a lack of knowledge about how patients understand and cope with fast track programmes.
  
  
  METHODS
  The study design used classical grounded theory.
  
  
  METHODS
  The study used a multimodal approach with qualitative and quantitative data sets from 14 patients.
  
  
  RESULTS
  Four predominant types of coping, with distinct physiological, cognitive, affective, and psychosocial features, existed among patients going through a fast track total hip replacement programme. These patients' main concern was to restore their physical and psychosocial integrity, which had been compromised by reduced function and mobility in daily life. To restore integrity they economized their mental resources, while striving to fulfil the expectations of the fast track programme. This goal was achieved by being mentally proactive and physically active. Three out of the four predominant types of coping matched the expectations expressed in the fast track programme. The non-matching behaviour was seen among the most nervous patients, who claimed the right to diverge from the programme.
  
  
  CONCLUSIONS
  In theory, four predominant types of coping with distinct physiological, cognitive, affective, and psychosocial features occur among patients going through a fast track total hip arthroplasty programme.
authors.affiliation: Centre of Elective Surgery, Aarhus University, Aarhus C, Denmark.|Interdisciplinary Research Unit, Regional Hospital Silkeborg, Silkeborg, Denmark; lenejoer@rm.dk.
authors.forename: Lene Bastrup
authors.initials: LB
authors.lastname: Jørgensen
authors.affiliation: School of Health Sciences, Jönköping University, Jönköping, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Fridlund
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D005260:Female; D066296:Grounded Theory; D006801:Humans; D008297:Male; D008875:Middle Aged; D013514:Surgical Procedures, Operative / Q000523:psychology*
keywords: Coping preferences; education level; fast track programme; grounded theory; integrity; orthopaedic surgery; self-management; self-reported health status