What should be considered a positive benefit for frequently ambulating a resident when they are able to do so?

Table of Contents Show

Incidental activity
Retraining ADLs
Ensuring appropriate supervision during mobility and self-care tasks
Environmental modifications

We need to understand our patient’s prior level of mobility, independence in self-care and usual living situation if we are to implement appropriate and effective mobility and self-care interventions. For example, if a patient's mobility restrictions affected their ability to remain socially connected and manage their own affairs, we should develop a plan with them to rectify this.

Consider five areas of mobility and self-care interventions as part of an interdisciplinary strategy: incidental activity, exercise, retraining activities of daily living (ADLs), ensuring appropriate supervision, and environmental modifications.

Interventions should be discussed and implemented in partnership with the older person and their family and carer, as appropriate.

Incidental activity

Incidental activities are those where physical activity occurs as part of regular daily activities, for example, walking to the toilet, transferring and dressing. Performing regular daily activities, including self-care, is the easiest exercise for our patients to undertake in hospital. Self-care can be beneficial to your patient’s mobility.

Encourage your patients to:

dress (consider the possibility of wearing their normal day clothes and footwear)
get out of bed and move around the ward, with supervision or assistance and an appropriate gait aid if required
sit out of bed as soon as it is considered safe to do so, as much as possible as appropriate to their condition
walk to the toilet, with supervision or assistance if required
eat meals out of bed, preferably in a communal dining room where available and appropriate
undertake or participate in showering and other grooming and self-care activities.

As staff, we can:

supervise or assist older people during walking, transfers and ADLs if required
create a continence and mobility plan that fits with patients sitting out of bed for meals
adjust bed height to allow for safe, independent transfers
orient our patients to the ward, showing them where the toilet is
provide a culture that encourages incidental exercise
provide aids to assist with optimal transfers and mobility
avoid using bed rails, which may limit mobility and be a hazard
improve our understanding of the risks of restricting mobility and provide strategies to prevent de-conditioning.

Exercise

As part of an interdisciplinary intervention, an exercise program may benefit your patient.

Exercise programs can be administered in both individual and group settings and may include strength, balance, functional retraining and aerobic (or endurance) exercises. Group classes also provide an opportunity for social interaction and may help prevent loneliness.

We can refer older patients to physiotherapy for prescription of individual or group exercise.

Retraining ADLs

Our patients’ abilities to live independently may depend on retraining their skills in ADLs. We can:

provide the minimal amount of assistance required to encourage optimal participation; assistance should be reduced as the person’s condition improves
encourage and guide our patients to promote independence
assist with alternative strategies for self-care, as necessary
refer our patients to occupational therapy, as appropriate
make sure aids are available to assist with optimal independence
ensure bed and chair heights are optimal for independence
recommend patients for self-care programs, such as cooking groups and self-care education sessions, as appropriate
consider use of everyday clothes and footwear
clear any clutter
ensure obstacles to mobility or self-care are moved
ensure any tools or aids for mobility or self-care are clean and maintained
ensure bed and chair heights are optimal for independence
avoid using bed rails, which may limit mobility and be a hazard.

Ensuring appropriate supervision during mobility and self-care tasks

We can:

supervise patients who are acutely unwell during walking and transfers. It may be appropriate to reduce supervision as medical stabilisation occurs and familiarisation with the environment and equipment is achieved.
consult physiotherapy if we are in doubt about the supervision needs of our patients. Use strategies such as a traffic light colour coding system, a common way to inform all care staff of an individual's mobility supervision needs.

Environmental modifications

The hospital environment is important in promoting mobility and self-care for older people. We should:

clear any clutter
ensure obstacles to mobility or self-care are moved
ensure any tools or aids for mobility or self-care are clean and maintained
ensure bed and chair heights are optimal for independence
avoid using bed rails, which may limit mobility and be a hazard.

Reviewed 05 October 2015

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Phases of Inductive Content Analysis.29,56

Phase	Key Feature	Example
preparation (pre-data collection)	• select the unit of analysis• decide on sampling plan• decide on type of data to include • decide on format for collecting data	• the research team decided the unit of analysis would be a theme• purposive sampling plan selected• included manifest and latent data• selected focus group format to collect interview and observation data• selected number of focus group meetings • decided on number of participants/focus group meeting
organizing (data collection and analysis)	• gather data (conduct interviews, review literature, collect observations)• engage in open coding • develop preliminary subcategories	• conducted focus group interviews with 11 participant members who attended each focus group• observations of non-verbal behavior were made during each focus group• debriefed after each focus group to discuss observations and decide on action plan if needed to improve data collection• textual data transcribed verbatim• memos related to observations completed• data analysis occurred immediately after each focus group meeting• conducted line-by-line analysis assigning labels to data• labels conceptually similar were grouped into subcategories • started developing preliminary categories and linked subcategories to categories
Abstraction (Analysis)	Finalize identification of categories Identify main category	• Continued data reduction to identify categories and fill in subcategories• Used constant comparative analysis to determine accuracy of data classification in each category • Formulated a description of the phenomena linking categories to the main category