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Falls are one of the most common causes of hip fracture that required hospitalization and it is one of the leading causes of death in older people. Hip arthroplasty will help the patient move their body faster and helps to reduce complications from being bedridden. The majority of older people who have fallen will have a fear of repeated falls and avoid practicing daily activities. This fear of falling results in the inability to perform simple activities, decreases their quality of life and makes them more dependent upon others to perform simple tasks. In order to prevent complications and follow the guidance of the nursing care, nurses play an important role in caring for patients, both before and after surgery. The objective of this case study is to reduce the fear of falling by implementing the self-efficacy promotion program on older people who have a fear of falling after hip replacement surgery. The results showed older people with postoperative total hip replacement and after participating in the self-efficacy promoting program, had a lower fear of falling compared to high to mild to moderate fear of falling. The people who followed the self-efficacy program were able to walk with a supportive device and had no complications after surgery.
Keywords: Fear of falling, Hip replacement surgery, Self-efficacy, Older persons, People
- Session 1: Day 3 after surgery. Assessing fear of falling with the Thai Falls Efficacy Scale-international (Thai FES-I)  before starting activities. Step 1, verbal persuasion for relationship building, giving health education about hip arthroplasty and postoperative rehabilitation and illustrative examples of patients who have had hip replacement surgery and being able to perform activities on their own. Step 2, organized activities to see the post-operative symbolic model, such as demonstration with muscle exercise, sitting, standing, and walking with a support device.
- Session 2: Day 5 after surgery. Step 3: Enactive mastery experience by organizing a self- practice activity after watching a video of the symbolic - modeling demonstration with muscle exercise, sitting, standing, and walking. Then process to Step 4, stimulate physical aspects and emotions that affect the efficacy of the patient by asking for symptoms and assess the vital signs and pain before starting each activity. The pain relievers will be given according to the treatment plan.
- Sessions 3-4: Day 9-12 after surgery. The activities were performed according to the same procedures as the 1st and 2nd sessions starting from Step 2 to Step
- Session 5-6: After being discharged to home, giving a phone call to motivate the patient to continue activities at home, discussing problems and obstacles, asking for symptoms and received inquiry, including prompt correct behavior. This state took 10 - 15 min at a time.
- Session 7: Stimulating the physical and emotional aspects at home. Followed up patient's physical and emotional condition on the phone to discuss problems and obstacles to do activity, giving question and answer, including prompt correct behavior. This state took 10 - 15 min at a time.
- Session 8: Day 28 after surgery, on the appointment date with the surgeon at the Orthopedic OPD for the postoperative examination and evaluation of fear of falls (Thai FES-I).
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