Differences in Perceived Patient Mobility Barriers Among Nurses from Various Departments and Location Work Sites
Teresa Bigand, Danell Stengem, Crystal Billings, Jennifer Hoople, Tiffanie Rampley, Elena Crooks, Nathaniel Nickerson, and Brandon Clem
Background: Hospitalized patients suffer negative outcomes related to lack of mobilization activities such as falls with injury or infection. Mobility requires a multi-disciplinary team approach including Registered Nurses (RNs), Certified Nursing Assistants (NA-Cs), and Physical/Occupational Therapists (PT/OTs) to promote best patient outcomes. The Johns Hopkins Culture of Mobility toolkit provides evidence-based practices for integrating multi-disciplinary mobilization efforts for hospitalized patients. This toolkit had not been implemented on a busy orthopedic post-operative nursing unit in one large hospital.
Purpose/aims: To test the impact of the culture of mobility toolkit on caregiver perceptions of mobility barriers and evaluate the implementation of the toolkit on a surgical acute care unit.
Methods/Approach: This quality improvement project was implemented on an orthopedic post-surgery inpatient unit in a large medical center in the Pacific Northwest. A pre-survey was administered to RNs, NA-C's and PT/OTs prior to the implementation of this project, and those findings guided the development of an educational intervention. The education was a poster on the Johns Hopkins Culture of Mobility toolkit with focus on using the toolkit's mobility screening tool presented to RN's, NAC's and PT/OT's. Caregivers were also informed to complete a form each shift on the following: the patient's Highest Level of Mobility score, the patient's mobility goal for the shift, whether the patient met the personal goal, and barriers/facilitators to the patient's ability to meet personal goals. Staff were directed to complete tracking sheets each shift for each patient during a 6-week period. After the intervention, all staff were invited to complete the post-survey to re-assess perceived mobility barriers.
Results: More than 90 caregivers completed the pre-intervention perceived mobility barriers survey, which suggested that staff felt that patient mobilization efforts were time-intensive and posed an injury risk for caregivers. After the education was provided, over 240 mobility tracking sheet were submitted by mainly RN's working night shift, and 65% of caregivers reported that the patient's self-reported mobility goal was met by the end of the shift. Barriers to achieving patient-created mobility goals included inadequate symptom management, reduced patient-specific motivation to move, and lack of adequate resources to safely mobilize patients. A total of 32 caregivers responded to the post-project mobility survey, revealing a significant decrease in overall perceived mobility barriers from preintervention levels. PT/OTs reported significantly less barriers compared to nursing staff at both time points.
Conclusion: This project demonstrated that multi-disciplinary staff working on a busy orthopedic postsurgical floor can adopt evidence-based practice tools to promote mobility which may facilitate increased patient mobilization activities. Future projects may include greater adoption of the toolkit throughout the medical center.
Implications for practice: Hospital-based mobility programs such as the Johns Hopkins Culture of Mobility toolkit can mitigate functional decline of adults following hospitalization. Inpatient mobility activities may be enhanced by engaging patients to set and attain mobility goals each shift, partnering with PT/OTs, identifying patient motivation to mobilize, and optimizing symptom management.
Shelly Johnson and Alice E. Dupler
Background: In early 2020, the appearance of the novel COVID-19 virus became a global concern, infecting hundreds of thousands of people. To reduce the spread of the virus, the United States government instituted social distancing and required hospitals to take steps to create extra beds for patient with COVID. One method to increase hospital capacity was the cancellation of scheduled, elective surgeries. In one large pediatric hospital in the Pacific Northwest, there was no formal process in place for cancelling elective procedures or for prioritizing when or how to reschedule the case. Because nurses were being called on to provide direct patient care with increased volumes during the pandemic, non-licensed surgery schedulers were tasked with calling patients to cancel cases without ability to assess patient conditions or provide guidance on when the case might be rescheduled. As a consequence, children and their families who were impacted by cancellations experienced uncertainty and fear that, if left untreated and unevaluated, the underlying condition might worsen and lead to an emergency situation. Nurses in this pediatric surgery center therefore conducted a deep dive into the literature to identify best practices to inform when and how to resume elective surgeries in this vulnerable population.
Purpose/aims: To investigate the role of pediatric nurses following unexpected surgery cancellation for at-risk children.
Methods/Approach: An integrative literature review was conducted. The Cochrane Library, the Cumulative Index of Nursing and Allied Health Literature (CINAHL), and OVID databases were searched using the key words “pediatric surgeries”, “delayed”, “COVID-19”, and “nursing assessment”. Retrieved evidence was limited to peer-reviewed publications, government websites and reputable healthcare organizations published between January 2018 and September 2020. Results: A total of 25 articles and government-sponsored websites met search criteria. Evidence supported that the following criteria merit high priority for rescheduling surgeries for patients: risk for loss of life, limb, organ function, delayed breastfeeding, and developmental delay. Furthermore, nurses are uniquely trained to prevent illness, facilitate healing, and alleviate suffering, and are recommended to assess ongoing individualized care needs that could drive prioritization of surgery rescheduling following unexpected cancellation.
Conclusion: In pediatric patients awaiting non-emergent, elective surgery during the COVID-19 pandemic, literature supports that pediatric surgery nurses must provide ongoing assessment and care of each child affected by cancellation of an elective surgery. Appropriate and timely assessment of evolving family and child needs related to the cancelled surgery can reduce the likelihood of harm during the pre- and post-operative periods.
Implications for practice: Pediatric surgery nurses are uniquely positioned to minimize the impact of cancelled elective surgeries by advocating for rescheduling procedures based on assessment of evolving pediatric patients’ need for care. Moving forward, pediatric surgery nurses should collaborate with interdisciplinary teams to write specific institutional policies to guide decisions regarding how and when to resume and prioritize pediatric surgeries if elective procedures need to be delayed.
Shelly Johnson, Alice E. Dupler, and Deanna J. Koepke
Background: Relationships exist between improved patient outcomes and Registered Nurse (RN) caregivers with an earned Bachelor’s degree or higher compared to those with an associate’s or diploma in nursing. However, nurses who are working and attending a bridge program to obtain a Bachelor of Science in Nursing (BSN) report high levels of stress which may increase risk for withdrawing from the program or quitting work. Furthermore, providing direct patient care during the COVID-19 pandemic may significantly increase stress among those who are concurrently finishing a nursing advanced degree. Little is known about how front-line caregivers perceive the experience of working at least three days per week during a pandemic such as COVID while also completing a full-time RN-BSN program.
Purpose/aims: To explore the lived experience of final-semester RN-BSN students working at least 0.6 full-time-equivalent in the healthcare setting during a global pandemic. Methods/Approach: A qualitative study using thematic content analysis was conducted to explore perceptions of working and going to school during the COVID-19 pandemic among graduating RN to BSN students working between 0.6-1.0 FTE concurrently during the program. Two weeks prior to graduation from the program, students from one cohort were required to write and submit a reflection with the following prompt, “Tell your story about working and going to school during the COVID-19 pandemic”. Analysis of the narratives was undertaken with automated content and thematic analysis by Leximancer software, an automated textual analysis technology, to identify and characterize emerging themes and concepts described in the narratives. The software produces a visual representation of the frequency of concepts reported in qualitative data, and draws lines to demonstrate how often certain terms are used in conjunction with others. The study received IRB approval from the primary investigator’s institution.
Results: A total of 42 students were part of the cohort and 35 submitted a reflection. All 35 were analyzed by the software with names and identifiers were removed. Based on the qualitative software output and validation of generated themes by two independent nurse scholars, three separate concepts arose: COVID-19, time, and family. Many students reported COVID being a major disruptor to all aspects of life during their experience in the program. For instance one student said, “It is like, sucking the life out of me.”
Conclusion: Participants in the study made distinctions between COVID-19, time and family in written assignments discussing their lived experiences of working and going to school during the pandemic. For our participants, work and social environments may play an important role in stress levels for working RN-BSN students which is intensified in the context of the pandemic.
Implications for Practice: College and healthcare leaders should partner to support the RN to BSN workforce to reduce stress and optimize individual capacity to provide effective care to patients and family. Nurses who are working full-time during the current pandemic should carefully consider the pros and cons to returning to school and create a plan for self-care to enhance success and maintain a worklife balance.