Date of Award

Summer 2024

Project Type

Thesis

College or School

UNHM

Department

Nursing

Departments (Collect)

Graduate Nursing

Program or Major

Nursing: Clinical Nurse Leader

Degree Name

Master of Science

First Advisor

Deborah Simonton

Second Advisor

Pamela Kallmerten

Abstract

Background: Although beneficial to patient outcomes, inpatient ambulation is not a prioritized care intervention, and a task often deferred to physical therapy. Patient immobility is a complex problem that requires a multifaceted approach.

Local Problem: In a rural, critical access hospital, on an 18-bed medical surgical unit, nursing staff lacked ownership of patient mobility. There was no standardized process to document ambulation and mobility tasks were not scheduled, falling to the end of the nursing work list. Many patients did not have activity orders upon admission and nurses lacked resources for ambulation assessment and daily goal setting. There was no policy in place outlining expected mobility promotion tasks.

Methods: A multi-faceted approach was taken to shift ownership of patient mobility back to the nursing staff through changes to workflow in the electronic health record and implementing the Johns Hopkins Activity and Mobility Promotion program.

Interventions: Supported by the literature, the Activity Measure for Post-Acute Care (AM-PAC) "6 Clicks" mobility assessment tool and John Hopkins Highest Level of Mobility Scale (JH-HLM) were implemented and added to the nursing work list, required once per 12-hour shift, with guidance for appropriate referral to physical therapy. Nursing staff were trained in the proper use of the assessment tools. Inpatient ambulation was termed ‘mobility promotion’ and scheduled three times daily, with standardized activity orders for all admitted patients. Visuals were posted in the patient room to list options for in-room activities and a guide for setting daily mobility goals. A patient engagement poster was displayed in a high traffic area encouraging patients to track their ambulation distance to summit Mount Washington. The fall risk reduction policy was edited to include mobility promotion tasks.

Results: The completion rate of the AM-PAC mobility assessment and scheduled mobility promotions was 100%, exceeding the specific aim of this project. Although there were no statistically significant findings, patient survey nursing courtesy scores increased, and no falls occurred during the month of data collection. There was no significant change in the patient length of stay or 30-day readmission rate.

Conclusion: This mobility promotion project was successful in exceeding its aim of assessment and promotion documentation, an effective gauge of overall patient mobility. Nursing courtesy scores increased and there were no falls during the month of data collection. More data is needed on the impact to length of stay and 30-day readmission rates. This low cost, sustainable, multifaceted approach to immobility had a large and timely impact on mobility culture and is applicable to other patient care contexts.

Key Words: mobility promotion, mobility assessment, nurse-led mobility, medical surgical patients, ambulation, physical therapy

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