title: Pendulating-A grounded theory explaining patients' behavior shortly after having a leg amputated due to vascular disease.
abstract: BACKGROUND
  Although the group of vascular leg amputated patients constitutes some of the most vulnerable and frail on the orthopedic wards, previous research of amputated patients has focused on patients attending gait training in rehabilitation facilities leaving the patient experience shortly after surgery unexplored. Understanding patients' behavior shortly after amputation could inform health professionals in regard to how these vulnerable patients' needs at hospital can be met as well as how to plan for care post-discharge.
  
  
  OBJECTIVE
  To construct a grounded theory (GT) explaining patients' behavior shortly after having a leg amputated as a result of vascular disease.
  
  
  METHODS
  In line with constructivist GT methodology, data from ethnographic observations and interviews were simultaneously collected and analyzed using the constant comparative method covering the patients' experiences during the first 4 weeks post-surgery. Data collection was guided by theoretical sampling and comprised 11 patients. A GT was constructed.
  
  
  RESULTS
  Patients went through a three-phased process as they realized they were experiencing a life-changing event. The first phase was "Losing control" and comprised the sub-categories "Being overwhelmed" and "Facing dependency." The second phase was "Digesting the shock" and comprised the sub-categories "Swallowing the life-changing decision," "Detecting the amputated body" and "Struggling dualism." The third phase was "Regaining control" and comprised the sub-categories "Managing consequences" and "Building-up hope and self-motivation." "Pendulating" was identified as the core category describing the general pattern of behavior and illustrated how patients were swinging both cognitively and emotionally throughout the process.
  
  
  CONCLUSIONS
  The theory of "Pendulating" offers a tool to understand the amputated patients' behavior and underlying concerns and to recognize where they are in the process. Concepts from the theory could be used by health professionals who support patients coping with the situation by offering terms to express and recognize patients' reactions.
authors.affiliation: Department of Orthopedic Surgery, Slagelse & Holbæk Hospital, Region Sjaelland, Denmark; urm@regionsjaelland.dk.
authors.forename: Ulla Riis
authors.initials: UR
authors.lastname: Madsen
authors.affiliation: Faculty of Health, Department of Health Sciences, Lund University, Lund, Sweden.
authors.forename: Ami
authors.initials: A
authors.lastname: Hommel
authors.affiliation: Faculty of Health, Department of Health Sciences, Karlstad University, Karlstad, Sweden.
authors.forename: Carina
authors.initials: C
authors.lastname: Bååth
authors.affiliation: Institute of Health, Section of Nursing, Aarhus University, Aarhus, Denmark.
authors.forename: Connie Bøttcher
authors.initials: CB
authors.lastname: Berthelsen
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000523:psychology*; D000884:Anthropology, Cultural; D003071:Cognition; D004644:Emotions; D005260:Female; D066296:Grounded Theory; D006801:Humans; D007866:Leg / Q000601:surgery*; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological; D014652:Vascular Diseases / Q000601:surgery
keywords: Adaption; coping; dysvascular amputees; grounded theory; life situation; orthopedic nursing; pendulating; post-operative care; psycho-social needs; quality of life