No one size fits all—the development of a theory-driven intervention to increase in-hospital mobility: the “WALK-FOR” study

Abstract

BackgroundThere is growing evidence that mobility interventions can increase in-hospital mobility and prevent hospitalization-associated functional decline among older adults. However, implementing such interventions is challenging, mainly due to site-specific constraints and limited resources. The Systems Engineering Initiative for Patient Safety (SEIPS 2.0) model has the potential to guide a sustainable, site-tailored mobility intervention. Thus, the aim of the current study is to demonstrate an adaptation process guided by the SEIPS 2.0 model to articulate site-specific, culturally based interventions to improve in-hospital mobility among older adults.MethodsSix consecutive phases addressed each of the model’s elements in the research setting. Phase-1 aimed to determine a measurable outcome: steps/d, measured with accelerometers, associated with functional decline. Phase-2 included interviews with key persons in leadership positions in the hospital to explore organizational factors affecting in-hospital mobility. Phases-3 and 4 aimed to identify attitudes, knowledge, barriers, and current behaviors of medical staff (n = 116) and patients (n = 203) related to patient mobility. Phase-5 included four focus-groups with unit staff aimed at developing an action plan while adapting existing intervention strategies to site needs. Phase-6 relied on a steering committee that developed intervention-adaptation and implementation plans.ResultsNine hundred steps/d was defined as the intervention outcome. 40% of patients walked fewer than 900 steps/d regardless of capability. Assessing or promoting mobility did not exist as a separate task and thus was routinely overlooked. Several barriers to patients’ mobility were identified, specifically limited knowledge of practical aspects of mobility. Consequently, staff adopted practical steps to address them. Nurses were designated to assess mobility, and nursing assistants to support mobility. Mobility was defined as a quality indicator to be documented in electronic medical records and closely supervised by hospital and unit management. Preliminary analyses of the “Walk FOR” protocol demonstrates its’ ability to reduce barriers, to re-shape staff attitudes and knowledge, and to increase in-hospital mobility of older adults.ConclusionsThe SEIPS-2.0 model can serve as a useful guide for implementing a site-tailored comprehensive mobility intervention. This process, which relies on local resources, may promise sustainable practice change that may support early effective rehabilitation and recovery.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0778-3) contains supplementary material, which is available to authorized users.

‘I will walk out of here’: Qualitative analysis of older rehabilitation patients' perceptions of mobility

“…Successful multicomponent programs in acute care have often invested in careful identification of local barriers and enablers to shape interventions. 11,12 In acute care, these have generally focused on staff knowledge, patient and family awareness, and clearer communication of goals within teams and with patients. Our findings in the rehabilitation setting suggest that positive and consistent communication about mobility expectations within teams and with patients and families are also essential and that effective symptom management, flexible routines, meaningful activities and active engagement of families may be important additional strategies to consider.…”

“…Patient, staff and organisational barriers to greater mobilisation have been explored within acute hospital settings. [9][10][11][12][13] However, these barriers may be different in rehabilitation settings where case-mix, staff training, patient and staff expectations, routines and resourcing may differ from acute care wards. We therefore undertook a mixed methods observational study to describe and understand mobility in rehabilitation patients, to inform local improvement strategies.…”

Staff knowledge, attitudes and behaviours related to mobilisation in a rehabilitation setting: Short report of a multidisciplinary survey

“…Existing perceptions of patient and family resistance need to be clarified by engaging patients and families and seeking their perspectives on barriers and opportunities for improving mobility, to develop patient-centred solutions. Overall barriers 35 (11) 34 (9) 33 (12) .77 33 (9) 35 (12) .39 Knowledge 25 (17) 23 (20) 22 (13) .86 19 (15) 28 (20) .04…”

“…Distributing surveys through staff meetings meant not all eligible staff may have received a survey (eg staff on leave or night shift) and the true denominator is uncertain. The survey only considers staff perceptions and should be considered in the context of measures of actual mobility performance and patient perceptions 9,10,13 ; our findings from these linked studies are reported elsewhere in this journal.…”

Tasks and responsibilities in physical activity promotion of older patients during hospitalization: A nurse perspective

“…Implementation of interventions in clinical practice is challenging since it is affected by factors on organizational, professional, intervention and patient level (Chaudoir, Dugan, & Barr, 2013). Previous studies have developed mapping guides addressing factors for implementing in hospital physical activity interventions including knowledge, attitudes and barriers as perceived by various healthcare providers and patients (Moore et al, 2014;Zisberg et al, 2018). Moore et al (2014) concentrated on barriers to behaviour change using the "capability, opportunity, motivationbehaviour (COM-B) system."…”