Frequency and duration of nursing care related to older patient mobility

To evaluate the frequency and duration of nursing care activity related to mobilizing older patients in acute care settings and determining who initiates the mobility event (patient or nurse).

This was an observation study using time and motion. Observers shadowed 15 registered nurses (RNs) each for two to three 8-hr periods using hand-held computer tablets to collect data on frequency and duration of six mobility events (standing, transferring, walking to and from the patient bathroom, walking in the patient room, and walking in the hallway) that occurred in the nurse's presence. Chart reviews were conducted on 47 adult patients (> 65 years of age) who were cared for by the nurses during the observation periods. Descriptive statistics (mean, median, standard deviation, frequency, and proportion) were used to describe the occurrence of mobility events among all 47 patients and among a subgroup of 16 patients identified as dependent (needing human assistance of another to ambulate) at the time of admission.

Thirty-two percent of older patients were not engaged by an RN in any mobility event during an 8-hr period. For all patients, standing and transferring were the most frequent mobility activity. Mean duration for ambulation was less than 2 min per observation period. Patients who were dependent had fewer mobility events with no events related to ambulation initiated by nurses. The majority of mobility events were initiated by patients.

Nurses infrequently initiated mobility events for hospitalized older patients and most often engaged patients in low-level activity (standing and transferring).

Limited mobility (standing and transferring only) is an independent predictor of negative outcomes for hospitalized older patients. Nurses are in a key position to improve outcomes for hospitalized older patients by engaging them in mobility activity, particularly ambulation, but further research is needed to determine how best to engage nurses in these activities.