MOBILITY
ANSWER
1 INTRODUCTION
Most healthcare recipients are older (Canadian Institute for Health Information, 2011). (Canadian Institute for Health Information, 2011). This significantly impacts nursing care as older people often have multiple comorbidities, atypical presentation of acute illnesses, and are subject to functional decline when hospitalized (Fedarko & Fedarko, 2011). (Fedarko & Fedarko, 2011). Functional decline is defined as a reduction in the ability to perform self-care activities, which includes activities of daily living (ADL) or instrumental activities of daily living (IADL) (Padula, Hughes, & Baumhover, 2009). (Padula, Hughes, & Baumhover, 2009). ADLs are self-care tasks, including feeding, grooming, bathing, dressing, bowel and bladder care, toilet use, and mobility (ambulation, transfers, and stair climbing) (ambulation, transfers, and stair climbing). IADLs are life skills necessary to function independently, including managing finances, preparing meals, managing medications, and maintaining the household (Padula et al., 2009). (Padula et al., 2009). The functional decline associated with hospitalization is often the first sign of acute illness and, if prolonged, can negatively affect older people’s physiological and psychological status (Lyons, 2014). (Lyons, 2014). Approximately 50% of hospitalized older people experience a functional decline (Boltz, Resnick, Capezuti, Shuluk, & Secic, 2012). (Boltz, Resnick, Capezuti, Shuluk, & Secic, 2012).
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Ginsberg et al. (2011) assessed the relationship between hospitalized older persons’ mobility levels and the meaningful functional outcome. At discharge, 46% of patients experienced a functional decline in activities of daily living (ADLs), which increased to 49% at the follow-up one-month post-discharge. A decrease in mobility capacity during hospitalization is often not recovered after discharge (Brown, Roth, Peel, & Allman, 2006). (Brown, Roth, Peel, & Allman, 2006). Thus, decreases in mobility can have significant effects on the lives of older people.
Older people also risk experiencing adverse systemic health outcomes secondary to immobility associated with hospitalization (Kalisch, Lee, & Dabney, 2013). (Kalisch, Lee, & Dabney, 2013). Examples include decreases in the metabolism of carbohydrates, fats, and proteins; an increased risk of thrombus formation; musculoskeletal changes reflected in decreased muscle mass, strength, endurance, stability, and balance; integument changes, which may progress to pressure ulcers; psychosocial effects such as emotional instability, social isolation, loss of independence and adverse developmental changes, such as accelerated loss of total bone mass, muscle strength and aerobic capacity (Kalisch et al., 2013). (Kalisch et al., 2013). Mobility is critical to an individual’s health care due to the global and progressive negative effects on health status if mobility is decreased.
The impact of hospitalized older people’s decreased mobility is not only isolated to functional status; decreased mobility can increase inpatient length of stay and mortality rate. Fisher, Kuo, Graham, Ottenbacher, and Ostir (2010) found that patients who increased their daily step count from their baseline by 600 steps were discharged 1.7 days earlier than patients who did not. The association between ambulation and shortened length of stay was consistent across similar studies (Fisher et al., 2011; Pedersen et al., 2013; Zisberg et al., 2011). (Fisher et al., 2011; Pedersen et al., 2013; Zisberg et al., 2011). Furthermore, Ostir et al. (2013) suggest that mobility level can indicate survival in hospitalized older people. An increase of 100 steps between the first and last day of hospitalization can yield a 2% and 3% decreased mortality risk over the next two years. However, if an older patient’s mobility level at discharge has decreased since their admission rate, there is a greater than four times risk of death over the next two years following discharge. In another study, Brown, Redden, Flood, and Allman (2009) observed a cohort of hospitalized older people and evaluated how much time was spent on three levels of mobility: lying, sitting, and standing or walking. Eighty-three percent of patients’ hospital time was spent lying in bed. These findings were comparable to a similar study, which found patients lying in bed for 17 hr a day (Pedersen et al., 2013). (Pedersen et al., 2013). As nurses are responsible for the around-the-clock care of hospitalized older people, understanding their role and perceptions in promoting mobility is important.
A nurse-driven mobility assessment developed is the Banner Mobility Assessment (BMAT) (BMAT). BMAT identifies the patient’s mobility level and guides nurses to recommend safe patient handling and mobility (SPHM) technology appropriate for the specific patient (Boynton, Kelly, & Perez, 2014). (Boynton, Kelly, & Perez, 2014). Upon admission, the patient’s mobility level is assessed once per Registered Nurse (RN) shift and in response to patient status change. Scholars suggest that these types of nurse-initiated assessments empower nurses to work with patients and other professionals to progress a patient’s mobility level (Lyons, 2014; Padula et al., 2009). (Lyons, 2014; Padula et al., 2009). Benefits of attending to patients’ mobility include increased patient independence, shortened hospital stay lengths, and reduced 30-day readmission rates (Lyons, 2014; Padula et al., 2009). (Lyons, 2014; Padula et al., 2009).
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Although BMAT and nurse-initiated protocols demonstrate advantages in addressing older people’s mobility issues, little is known about how nurses mobilize older patients and their perspectives on the barriers and facilitators related to mobilizing hospitalized older people. Understanding factors that influence how nurses can restore and maintain the mobility needs of older people would assist leaders in creating patient-specific mobility protocols and supports.
QUESTION
Mobility can have either a positive or negative impact on our patients’ lives. You are the nurse of an older adult who is being discharged and need to provide education for the promotion of safe ambulation. How can mobility promote a healthy lifestyle?