Can nursing students boost exercise therapy in a subacute ward? An implementation study

To determine the feasibility, uptake, safety, effectiveness and acceptability of nursing students and allied health assistants (AHAs) delivering additional exercise sessions during inpatient geriatric rehabilitation and to assess whether this model improved patient and health service outcomes compared with usual care.

Prospective pre-post implementation evaluation.

A single secondary-care geriatric subacute rehabilitation ward in metropolitan Australia.

All patients aged ≥65 years admitted with deconditioning, falls or hip fracture who were able to weight-bear were eligible. Exclusion criteria included inability to participate in exercise or medical instability. Sixty-four participants were included in the pre-implementation cohort and 115 in the implementation cohort (91% uptake).

Nursing students were supported to deliver up to two additional weekday exercise sessions alongside usual physiotherapy care and AHAs delivered one additional weekend exercise session. Implementation strategies were informed by the Consolidated Framework for Implementation Research and included staff orientation, training, supervision and structured verbal and written handovers. The intervention was delivered over a 6-month period.

Primary outcomes were feasibility and uptake. Secondary outcomes included safety (falls and medical emergency calls), effectiveness (functional independence, mobility, discharge destination and subacute length of stay) and acceptability.

Nursing students delivered 13 exercise sessions in total, indicating low feasibility, whereas AHA-led sessions were delivered consistently, with participants receiving one additional session during a mean 15-day admission. No statistically significant differences were observed in functional independence, mobility, discharge destination or length of stay (LOS) (implementation: mean 15.5 days, SD 11.2; pre-implementation: mean 16.4 days, SD 12.4). Falls incidence decreased from 52 events pre-implementation to 38 during implementation, although this did not reach statistical significance. The study was not powered to detect small differences, and CIs were not calculated.

Using nursing students to deliver additional therapy sessions was not feasible, whereas AHA-led sessions were easier to implement. The intervention was safe. The fidelity of the nursing student-led component was compromised by multiple personal, service and system-level factors.