I recently visited a hospitalized family member. Although quite ill, he was cognitively intact and permitted to walk with assistance. He gained a measure of comfort from sitting on the side of the bed with his feet on the floor during meals. Just as he accessed his dinner tray on the bedside table, a nurse entered and sternly told him that patients on her unit were not allowed to sit on the side of the bed because of the fall risk. Stunned, I politely said that I am also an RN and would not leave him unattended. She conveyed her disapproval and began to troubleshoot the bed exit alarm.
Although I fully support the healthcare imperative to keep patients safe and prevent falls, the pendulum may have swung so far toward highly restrictive practices in many organizations that we are likely inflicting a different kind of harm: forced immobility. I have heard perfectly functional individuals (including young adults) complain that they have had bed alarms imposed due to broad-based hospital policies that mandate their use. Walking for the sake of staying mobile was a luxury that many never experienced.
Historically, nurses promoted patient mobility to prevent physical decline and complications associated with immobility. However, the prevailing logic seems to hold that if patients are made to stay in bed, they cannot fall, be harmed, and increase liability risk; nor can they jeopardize a unit's safety record, blemish reportable metrics, or threaten reimbursement. But how many more patients will develop deep vein thrombosis or pulmonary emboli from lack of mobility? How many will fall at home after discharge from avoidable weakness? How many will no longer be able to live at home? These forms of harm are also real.
Intended or not, current healthcare system incentives are perfectly aligned to keep patients in bed despite individual patient needs or condition. Staffing can also contribute—there may be a will, but not a way, when safe patient movement requires several staff members but too few are available to help.
When it comes to mobility, we must reengage in critical thinking and patient advocacy. Who are the patients with significant fall risk? What innovative strategies can we implement to keep patients safe but mobile? Consider the bigger picture—a one-size-fits-all restrictive approach is dangerous. Mobility is a care priority worth defending.
Until next time,
LINDA LASKOWSKI-JONES, MS, APRN, ACNS-BC, CEN, NEA-BC, FAWM, FAAN