Outcome evaluation has received considerable attention recently as the most appropriate way to approach the concept of quality. The study was designed to answer the following research questions: (a) What are the client-focused outcomes of rehabilitative care for hip fracture clients in the nursing home that are valued by clients and family; and (b) how do the valued outcomes identified by clients compare with the outcomes identified by family?.

A qualitative study was conducted to answer the research questions. Semi-structured interviews were conducted with clients (n = 8) over the age of 65 and associated family members (n = 6). Data were analyzed using constant comparative analysis to identify and define the concepts and relationships central to the research questions.

Competencies are the most explicit outcomes valued by clients and their respective family members. At the aggregate level, ambulation and self care are of primary concern and instrumental activities of daily living, hobby or work activities, and social activities are secondary in importance. At the individual level, however, the importance of one set of competencies over another depends on previous functional status and the importance of those competencies in self definition. The importance to family members of one set of competencies over another is related to the perceived role that each family member plays in the respective client's life.

All clients and family members value going home as an outcome. While the importance of "going home" is clear from the data, the meaning that it holds for each client varies. Continuity of self emerged as the core category of the study. Most clients value, as an outcome of care, a return to being the person they were before the fracture; that is, they wish to maintain the continuity of self.

Not all outcomes are equally important to hip fracture clients in nursing homes. It is important for staff to acknowledge the outcomes that are valued by each client and to have some understanding of the significance of those outcomes for the client. Staff can then assist the client and family in achieving the client valued outcomes.