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2021 prov rn wa; 2021 prov rn poster; 2021 prov rn mt; montana; phfmc prmccentralia; everett; spokane; missoula; sph; psph
Background: Hospitalized patients suffer negative outcomes related to lack of mobilization activities such as falls with injury or infection. Mobility requires a multi-disciplinary team approach including Registered Nurses (RNs), Certified Nursing Assistants (NA-Cs), and Physical/Occupational Therapists (PT/OTs) to promote best patient outcomes. The Johns Hopkins Culture of Mobility toolkit provides evidence-based practices for integrating multi-disciplinary mobilization efforts for hospitalized patients. This toolkit had not been implemented on a busy orthopedic post-operative nursing unit in one large hospital.
Purpose/aims: To test the impact of the culture of mobility toolkit on caregiver perceptions of mobility barriers and evaluate the implementation of the toolkit on a surgical acute care unit.
Methods/Approach: This quality improvement project was implemented on an orthopedic post-surgery inpatient unit in a large medical center in the Pacific Northwest. A pre-survey was administered to RNs, NA-C's and PT/OTs prior to the implementation of this project, and those findings guided the development of an educational intervention. The education was a poster on the Johns Hopkins Culture of Mobility toolkit with focus on using the toolkit's mobility screening tool presented to RN's, NAC's and PT/OT's. Caregivers were also informed to complete a form each shift on the following: the patient's Highest Level of Mobility score, the patient's mobility goal for the shift, whether the patient met the personal goal, and barriers/facilitators to the patient's ability to meet personal goals. Staff were directed to complete tracking sheets each shift for each patient during a 6-week period. After the intervention, all staff were invited to complete the post-survey to re-assess perceived mobility barriers.
Results: More than 90 caregivers completed the pre-intervention perceived mobility barriers survey, which suggested that staff felt that patient mobilization efforts were time-intensive and posed an injury risk for caregivers. After the education was provided, over 240 mobility tracking sheet were submitted by mainly RN's working night shift, and 65% of caregivers reported that the patient's self-reported mobility goal was met by the end of the shift. Barriers to achieving patient-created mobility goals included inadequate symptom management, reduced patient-specific motivation to move, and lack of adequate resources to safely mobilize patients. A total of 32 caregivers responded to the post-project mobility survey, revealing a significant decrease in overall perceived mobility barriers from preintervention levels. PT/OTs reported significantly less barriers compared to nursing staff at both time points.
Conclusion: This project demonstrated that multi-disciplinary staff working on a busy orthopedic postsurgical floor can adopt evidence-based practice tools to promote mobility which may facilitate increased patient mobilization activities. Future projects may include greater adoption of the toolkit throughout the medical center.
Implications for practice: Hospital-based mobility programs such as the Johns Hopkins Culture of Mobility toolkit can mitigate functional decline of adults following hospitalization. Inpatient mobility activities may be enhanced by engaging patients to set and attain mobility goals each shift, partnering with PT/OTs, identifying patient motivation to mobilize, and optimizing symptom management.
Conference / Event Name
2021 Providence RN Conference
Bigand, Teresa; Stengem, Danell; Billings, Crystal; Hoople, Jennifer; Rampley, Tiffanie; Crooks, Elena; Nickerson, Nathaniel; and Clem, Brandon, "Differences in Perceived Patient Mobility Barriers Among Nurses from Various Departments and Location Work Sites" (2021). 2021 Providence Nurse Research Conference. 37.