Abstract:

Objective Based on the Common-Sense Model of Self-Regulation，this study explores the internal and external motivations of postoperative activity decision-making conflicts in elderly patients with hip fracture，to provide evidence for developing targeted interventions in clinical practice and improving postoperative activity compliance in elderly patients with hip fracture. Methods Using purposive sampling，13 elderly hospitalized patients who underwent hip fracture surgery at a tertiary hospital in Anhui Province from January to November 2025 were selected for semi-structured interviews. Traditional content analysis was employed to code the interview data and extract themes. Results A total of 3 primary themes and 17 secondary themes were extracted，including insufficient awareness of postoperative activities（misinterpretation of normal physiological responses，deviation in recovery time expectations，complete adherence to traditional beliefs，overestimation of activity risks，insufficient awareness of immobilization risks，insufficient awareness of activity benefits，lack of confidence in activity capabilities，over-identification with the patient role，and limited understanding of activity concept），impediments in self-regulation processes（dominance of negative emotions，inadequate planning ability，lack of execution skills，insufficient ability for dynamic adjustment，and inadequate evaluation ability），and limitations in support systems（inadequate family support，insufficient medical support，and lack of peer support）. Conclusion The decision-making conflict regarding postoperative activity in elderly patients with hip fractures stems from the interplay of insufficient awareness，impediments in self-regulation processes，and limitations in support systems. It is recommended that clinical practice adopts integrated intervention strategies，including correcting patients’ cognitive biases through individualized cognitive restructuring，providing patients with phased and structured guidance during the interpretation，coping，and evaluation stages，and promoting collaborative support from family，medical，and peer systems. This provides a basis for developing systematic intervention plans.

Key words: Aged, Hip Fracture, Postoperative Activity, Decision-Making Conflict, Qualitative Study

摘要：

目的 基于疾病自我调节常识模型，探究老年髋部骨折患者术后活动决策矛盾的内外部动因，为临床制订针对性干预措施、改善老年髋部骨折患者术后活动依从性提供依据。方法 采用目的抽样法，选取2025年1—11月在安徽省某三级甲等医院骨科住院的13例老年髋部骨折术后患者作为研究对象，进行半结构式访谈，运用传统内容分析法对访谈资料进行编码与主题提炼。结果 共提炼3个一级主题和17个二级主题，分别是对术后活动认知不足（错误解读正常生理反应，恢复时间预期偏差，完全遵从传统观念，过度夸大活动风险，制动风险认知不足，活动获益认知不足，对活动能力缺乏信心，患者角色过度认同，活动概念理解局限）；自我调节过程受阻（负性情绪主导，活动规划能力不足，执行技能缺乏，动态调节能力不足，评价能力不足）；支持系统局限（家庭系统支持不足，医疗系统支持不足，同伴系统支持不足）。结论 老年髋部骨折患者术后活动决策矛盾源于认知不足、自我调节过程受阻及支持系统局限三者的交互作用，建议临床采取整合干预策略，通过个体化认知重构矫正患者的认知偏差，在解释、应对与评估环节为患者提供分阶段的结构化指导，并推动家庭、医疗与同伴系统协同支持，从而为制订系统化干预方案提供依据。

关键词: 老年人, 髋部骨折, 术后活动, 决策矛盾, 质性研究