What is the nursing team involvement in maintaining and promoting the mobility of older adults in hospital? A grounded theory study

AIMS OF THE PAPER: To present a grounded theory of the nursing team involvement in the process of maintaining and promoting the mobility of hospitalised older adults.

BACKGROUND: Being able to mobilise is an important determinant of quality of life in late adulthood. However, advancing age is often accompanied by worsening mobility, which may deteriorate further as a result of illness and particularly hospitalisation. Targeted in-patient rehabilitation interventions may have the capacity to maintain and promote older adults' mobility. Some authors suggest that the nursing team may have a central role in such activities.

OBJECTIVES: The study set out to describe the involvement of the nursing team in the process of maintaining and promoting the mobility of hospitalised older adults. It also sought to understand how members of the nursing team viewed their work in relation to physiotherapists and in relation to hospital policy on patient handling.

DESIGN: Grounded theory provided the philosophical and structural underpinning to the study.

SETTINGS: Data collection centred on three clinical settings which included a general rehabilitation ward, a regional spinal injuries unit and stroke rehabilitation ward.

PARTICIPANTS: Semi-structured interviews with 39 rehabilitation staff and 61h of non-participant observation comprised the data set.

FINDINGS: The nursing team involvement in patients' mobility maintenance and rehabilitation was explained by the core category 'care to keep safe.' This category identified how the nursing team focused primarily on preventing patient problems rather than focusing on rehabilitation goals. A number of contextual factors in the workplace meant that the nursing team found it difficult to engage in activities to support mobility maintenance and rehabilitation.

CONCLUSIONS: Significant changes in the micro and macro context for rehabilitation practice are needed to enable the nursing team to engage more fully in the processes of mobility rehabilitation. Nurse-led initiatives which allow the nursing team to take an active role in implementing intentional strategies to maintain and promote mobility should be implemented and trialled for effectiveness.