Question

There are many methods available to mobilize patients and many options to assist with mobility. The primary point to remember is that patients need to get out of bed and get moving. Negative effects of immobility include pressure ulcers, pneumonia, urinary tract infection, and deep venous thrombosis, just to name a few. Yet the most common activity order for hospitalized patients continues to be bed rest. Patients with a bed rest order often don’t have the order changed simply because it isn’t a focus for healthcare providers. Research studies on mobility have demonstrated an improvement in outcomes by mobilizing ICU patients and found less than 1% of the patients experienced any untoward complications when mobilized out of bed. It’s clear that the benefits of mobility far outweigh the risks. Some facilities may rely on the physical therapy (PT) department to assist with mobilization, but the resources for PT are often inadequate to provide mobilization for all patients. However, patients who are unable to progress in their mobility or have sustained weakness may benefit from a PT consult. Currently, the most effective method of ensuring mobilization is to put it in the hands of the nurses who are with the patient at the bedside. The nurse is in the best position to assess the patient’s capabilities and progression of mobility. The use of a mobility protocol that allows the nurse to make autonomous decisions about the progression of mobility has been shown to be effective in mobilizing hospitalized patients and results in a decrease in functional declines among patients. Nurses need to understand the importance of mobility and prioritize this action in the care of their patients. A mobility protocol may begin with low levels of activity, such as range of motion exercises while in bed, progressing to cardiac chair positions in the bed or high head of bed elevation. This should be followed by sitting the patient at the edge of the bed with his feet and legs supported, allowing him to work on strength of muscles and balance. The next step is to have the patient stand at the side of the bed, perhaps stepping in place or getting into a chair. It’s important to assess the patient before progressing with activity because the patient must be able to support his own body weight and maintain balance. These steps can be followed by ambulation, within the room or in unit hallways. The next step may depend on the area; for example, ambulating ICU patients with multiple lines/tubes, ventilators, and other machines may not be as easily achieved as a patient on a medical-surgical floor. Regardless of the methods, devices, processes, or policies in place at individual institutions, it’s imperative to ensure that there’s an identified process for mobilizing patients in a progressive manner that increases activity. Other resources that may be helpful in mobilizing patients are appropriate lift equipment and other devices such as gait belts and walkers, as indicated. Lift equipment assists nurses in mobility options while also decreasing the potential risk of injury to the nurse and other healthcare providers.

1.) What GOLDEN RULE did you learn from the article? (What is the one item that you learned that you will be able to apply to your Nursing Practice?)

2. Give an example of how this information might apply to a patient you have had in Clinicals or elsewhere. (You can use family members, work experience or even Simulations.)

3. Discuss one Nursing Diagnosis and how it applies to this article.

Answer 1

ANSWERS:-

1) GOLDEN RULE that I learned from this article is - The nurse is in the best position to assess the patient's capabilities and progression on mobility ,because the nurse spend most of the time with the patient at bedside than any other health care provider.Using mobility protocol helps nurse to assess the patient's abilities and weakness and plan accordingly.The nurse who is at bedside can easily identify even the minute improvements , Example- a post operative patient gets up from bed by self , and plan the mobilization accordingly.

2) I had a patient (32yrs old male) with right femur fracture after a motor vehicle accident, he was on bed and after surgery patient had pain and was not willing even to change position , the patient was made to turn side to side with help first and then made to sit up on the bed with a cardiac table in front and coughing and deep breathing exercises were done,next day made to sit on the side of the bed with operated leg supported ,then standing with the help of a crutches, slowly walking around his bed and walking to corridor by 3rd day .This gradual increase in mobility helped the patient to improve fast without any complications like pneumonia,pressure ulcers, deep vein thrombosis etc.

3) One nursing diagnosis:-

* Impaired physical mobility related to bed rest/ underlying disease condition.

* The article tells how to improve patient's physical mobility and prevent complications and improve fast recovery.