We came across an interesting study recently titled “How Nurses Decide to Ambulate Hospitalized Older Adults: Development of a Conceptual Model.” Conducted in 2011 by Barbara Doherty-King, PhD, RN, and Barbara Bowers, PhD., FAAN, RN and published in The Gerontologist, it indicated that nurses mobilize their patients for three worthy reasons:
- To prevent complications
- To monitor progress and
- To comply with unit expectations
But it also revealed that decisions to ambulate were driven less by an understanding of the benefits of mobility and more by the nurses’ own risk/opportunity assessments – subjective evaluations of their patients, themselves and the dynamics of the unit.
Weighing risk and opportunity
These assessments included consideration of the patient’s physical and cognitive characteristics. Patients who were large, heavy, unsteady, unable to bear weight or unable to follow instructions were deemed to be at a high risk of injury to themselves and/or the nurse and were less likely to advance to ambulation.
Personal factors such as the nurse’s own abilities and experience also came into play. Self-perception of strength, experience and confidence and consideration of prior injury to oneself or others all contributed to the risk assessment. When nurses saw themselves as strong and confident, they were more inclined to ambulate their patients.
And nurses also took into account unit dynamics: the availability of resources, level of unit activity and unit expectations. Patients were more likely to ambulate if the nurse had the help of a CNA or other staff member and equipment was available. On the other hand, if the unit was particularly busy, low-opportunity assessments limited mobilization. As one nurse put it:
“…unfortunately, on days when it has been a bad day and you don’t have a lot of help… you are just turning them. Sometimes, yeah, you do leave them.”
The power of accountability
Expectations set and enforced by unit managers played an outsized role in the nurses’ decisions to ambulate. Interestingly, facility-wide and unit-based expectations, regardless of how clearly they were communicated, weren’t enough to achieve general mobilization alone. In units where the expectation to mobilize wasn’t clear or explicit, nurses noted that tracking was rarely used and there were no consequences for noncompliance.
But expectations paired with accountability proved to be a powerful motivator. When patient mobilization was visible to others through white boards and reporting and nurses faced consequences for failing to mobilize, units created an environment of accountability that had a significant impact on mobilization.
All of the nurses in the study agreed that patients should be mobilized to prevent complications. They were most concerned about deep vein thrombosis, pneumonia and pressure ulcers, with a secondary focus on functional decline. But knowing what should happen didn’t always lead to it happening.
The study indicated that education and protocols alone have little impact on ambulation rates. Instead, “decreasing nurses’ perceptions of risk, enhancing opportunities for ambulation, and increasing accountability for ambulating are more likely to have an impact.”
Time for a reality check?
We’ve had countless conversations with clinical leaders who assure us that their caregivers are ambulating to orders and then, upon closer examination, discover that in fact ambulation is frequently missed due to risk/opportunity factors. Yes, protocols are important, and accountability, as the study suggests, has a significant impact. But to truly drive improvement, you need the right tool – equipment designed to simultaneously reduce the risks of ambulation while creating more opportunities for ambulation.
Are perceptions of high risk and low opportunity lowering ambulation rates in your unit? Not sure? We can help you find out and put you on the path to reduced complications through improved ambulation.
Contact us today to schedule a complimentary consultation and IVEA demonstration.