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Nursing Made Incredibly Easy!:
doi: 10.1097/01.NME.0000396000.08762.68
Department: Ask an Expert

How to promote progressive mobility

Powers, Jan PhD, RN, CCRN, CCNS, CNRN, FCCM

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Director of Clinical Nurse Specialists and Nursing Research • St. Vincent Hospital • Indianapolis, Ind.

Editorial Advisory Board Member • Nursing made Incredibly Easy!

A: There are many methods available to mobilize patients and many options to assist with mobility. The primary point to remember is that patients need to get out of bed and get moving. Negative effects of immobility include pressure ulcers, pneumonia, urinary tract infection, and deep venous thrombosis, just to name a few. Yet the most common activity order for hospitalized patients continues to be bed rest. Patients with a bed rest order often don't have the order changed simply because it isn't a focus for healthcare providers. Research studies on mobility have demonstrated an improvement in outcomes by mobilizing ICU patients and found less than 1% of the patients experienced any untoward complications when mobilized out of bed. It's clear that the benefits of mobility far outweigh the risks.

Some facilities may rely on the physical therapy (PT) department to assist with mobilization, but the resources for PT are often inadequate to provide mobilization for all patients. However, patients who are unable to progress in their mobility or have sustained weakness may benefit from a PT consult. Currently, the most effective method of ensuring mobilization is to put it in the hands of the nurses who are with the patient at the bedside. The nurse is in the best position to assess the patient's capabilities and progression of mobility. The use of a mobility protocol that allows the nurse to make autonomous decisions about the progression of mobility has been shown to be effective in mobilizing hospitalized patients and results in a decrease in functional declines among patients. Nurses need to understand the importance of mobility and prioritize this action in the care of their patients.

Figure. Q: Whats the...
Figure. Q: Whats the...
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A mobility protocol may begin with low levels of activity, such as range of motion exercises while in bed, progressing to cardiac chair positions in the bed or high head of bed elevation. This should be followed by sitting the patient at the edge of the bed with his feet and legs supported, allowing him to work on strength of muscles and balance. The next step is to have the patient stand at the side of the bed, perhaps stepping in place or getting into a chair. It's important to assess the patient before progressing with activity because the patient must be able to support his own body weight and maintain balance.

These steps can be followed by ambulation, within the room or in unit hallways. The next step may depend on the area; for example, ambulating ICU patients with multiple lines/tubes, ventilators, and other machines may not be as easily achieved as a patient on a medical-surgical floor. Regardless of the methods, devices, processes, or policies in place at individual institutions, it's imperative to ensure that there's an identified process for mobilizing patients in a progressive manner that increases activity.

Other resources that may be helpful in mobilizing patients are appropriate lift equipment and other devices such as gait belts and walkers, as indicated. Lift equipment assists nurses in mobility options while also decreasing the potential risk of injury to the nurse and other healthcare providers.

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Bailey P, Thomsen GE, Spuhler VJ, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007;35(1):139–145.

Morris PE. Moving our critically ill patients: mobility barriers and benefits. Crit Care Clin. 2007;23(1):1–20

Padula CA, Hughes C, Baumhover L. Impact of a nurse-driven mobility protocol on functional decline in hospitalized older adults. J Nurs Care Qual. 2009;24(4):325–331.

© 2011 Lippincott Williams & Wilkins, Inc.

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