An Observational Study of Nursing Delivery of Mobility Assistance in Acute Care

Abstract

Objectives: Early and frequent mobility is a recommended best practice in the hospital setting based on evidence of benefits to patients.

Design: This was an observational study.

Setting and participants: Nursing staff and patients across 9 hospital units within one academically affiliated medical center.

Methods: Research personnel conducted 845 standardized observation hours of registered nurse and nursing assistant staff to document time spent on mobility care, including repositioning in bed, bed-to-chair transfer, and walking assistance. On observation days, research personnel abstracted nurse ratings for mobility assistance from the electronic health record using the following categories: independent, 1-person or stand-by assistance, 2-person assistance, and repositioning for bedbound patients.

Results: Observations included 1677 patients across 9 units, and 75.5% were rated by nurses as requiring 1 or 2 staff for mobility assistance. An additional 4.4% required repositioning because of being bedbound. Among 375 patients with observed mobility care, 59.7% received repositioning, 26.9% received bed-to-chair transfer, and 13.3% received walking assistance. Nearly all (90.7%) mobility care episodes were provided by RNs and/or NAs, with RNs helping during 63% of observed episodes. Repositioning in bed required the least staff time, and walking assistance required the most time (8.51 vs 1.46 minutes per patient episode, respectively).

Conclusions and implications: Most patients across 9 hospital units needed mobility assistance, and 90% of mobility care episodes relied on nursing staff. Although less than 5% of patients were rated by nurses as bedbound, the most common type of assistance was repositioning in bed, which also required the least staff time. Hospital nursing staff may be challenged to provide daily mobility care because of prevalent care needs among patients. Support from nonprofessional staff may be necessary for hospitals to implement effective mobility programs that benefit patients.

Keywords: Geriatrics; acute care; age-friendly care; mobility; nurse staffing.