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Physical Therapy vs. What Is Outpatient Physical Therapy? A qualitative study using grounded dimensional analysis was conducted to further explore how nurses make decisions about ambulating hospitalized older adults. Twenty-five registered nurses participated in in-depth interviews lasting min. Open, axial, and selective coding was used during the analysis.
A conceptual model, which is grounded in how nurses experience ambulating patients, was developed. Multiple categories and dimensions interact and produce an action by the nurse to either restrict mobilization to the level of the bed or progress the patient to ambulation in the hallway. For many older adults, hospitalization can be a catastrophic event. Negative effects of hospitalization include delirium Inouye et al.
Decline in walking ability begins within 2 days of hospitalization Hirsch et al. Callen, Mahoney, Grieves, Wells, and Enloe found that Only one intervention study was found. Killey and Watt conducted a study to test whether a twice-daily walking program would enhance mobility.
Results from the study found that patients in the intervention group increased walking distance from However, only two studies explored how nurses view ambulation of hospitalized patients. Kalisch conducted a qualitative study and found that ambulation was regularly missed in the provision of nursing care.
Reasons given by nurses were related to time required to carry out ambulation, ease of omitting ambulation, and believing that ambulation was the job of physical therapists.
Brown, Williams, Woodby, Davis, and Allman found that barriers to ambulation most frequently cited by nurses were related to a patient physical symptoms such as weakness, pain, and fatigue; b presence of devices such as intravenous lines and urinary catheters; and c lack of staff to assist patients with out-of-bed activity.
Yet, little is known about how nurses make decisions about whether to ambulate, how they ambulate, and when they ambulate older patients. The purpose of this qualitative study was to explore how nurses make decisions about ambulating hospitalized older adults. The study was initiated in and completed in This methodology is particularly well suited to discovery in areas about which little is known and where understanding and perception are the focus.
It is, like grounded theory, informed by symbolic interaction. There are specific differences in sequencing of analytic procedures that distinguish dimensional analysis from more traditional grounded theory; specifically, open coding tends to continue longer during analysis, avoiding early narrowing of focus.
In this study, open coding continued through the fifth interview. Data were collected at two hospitals located in urban areas in southern Wisconsin. The study sites differed in the number of patient days used by people older than 65 years.
However, the units where nurses were recruited for the study were included based on their high census of people older than 65 years. Both hospitals were designated teaching hospitals and had bed capacities of greater than The patient to nurse ratio, or , was similar in both institutions. The sample consisted of a total of 25 registered nurses RNs who were employed on either an adult medical or surgical unit and cared for patients older than 65 years.
In the early phase of the study, recruitment was open and included any nurse on a medical or surgical unit who worked with adults older than 65 years. In later phases, as categories were constructed, recruitment shifted to include those nurses who were more likely and less likely to mobilize patients.
In a grounded dimensional analysis study, data collection and analysis occur simultaneously. Consistent with the grounded theory method, data collection and analysis for this study can be described in three phases. In all phases, data were collected using in-depth interviews, and were tape recorded and transcribed. Each interview was conducted in a private space away from the patient care unit, lasting 30—60 min. An example of questions used in each phase of data collection and analysis are provided in Table 1.
Each phase included recruitment, sampling, data collection, and analysis, building on prior phases. Data were analyzed using a research team of 10 individuals, nurses from a variety of settings, and non-nurses. The primary purpose of Phase I was to explore how nurses think about caring for hospitalized older adults and how they think about ambulating hospitalized older adults.
Nurses were recruited by placing flyers describing the study in the mailboxes of all RNs working on either the adult medical or the surgical unit in the first hospital. Ten RNs, five from each unit, responded to the initial recruitment. Seeing ambulation as only one of the types of mobilizing helps to explain how nurses make decisions about ambulating patients. The primary purpose of Phase II was to identify dimensions within the categories that had been discovered in Phase I.
Recruiting was guided by theoretical sampling based on categories types of mobilizing or reasons for not walking patients identified in Phase I. Specifically, three nurse managers were asked to identify nurses who routinely walked patients and those who did not and invite them to participate in the study, facilitating the comparative analysis.
Ten additional nurses including three nurse managers were recruited for this phase, three nurses who routinely walked patients and four who did not, according to the nurse managers. Nurses were not told they had been selected this way. Data collection was designed to further open coding and to provide greater depth in categories identified.
In Phase II, data were analyzed using axial coding. This analysis revealed three main types of mobilizing moving in bed, up to chair, and ambulating and many reasons for not walking patients characteristics about the patient, nurse, and organization. The primary purpose of Phase III was integration of categories. Theoretical sampling guided recruitment of five additional nurses who were either highly unlikely or highly likely to walk patients during hospitalization.
Interview questions were altered to facilitate an exploration of how characteristics of patient, nurse, and organization interacted to influence whether a patient is walked and what influenced the type of mobilization selected. At the same time, focused interview questions were added to generate data for selective coding, thereby maximizing both depth and integration of categories. Data analysis focused on integrating categories and exploring how patient, nurse, and organizational characteristics interacted with the type of mobilization chosen by the nurse.
The outcome of this analysis was the development of a model to help explain how nurses make decisions about mobilizing hospitalized older adults. All nurses identified preventing complications as the reason for mobilizing.
The levels of mobilizing were consistent among nurses. Influence of others, patient label, and organizational characteristics were not saturated. Several strategies were used to ensure rigor of the study. First, a large and diverse research group participated in data analysis, making it less likely that preconceived assumptions would be imposed on data.
Member checking was also used throughout data collection. In Phase II, participants were asked to respond to categories and dimensions that had been generated by preceding participants. In Phase III, participants were asked to comment on the developing matrix. They were asked to identify missing dimensions, to suggest any alternate explanations or relationships, and to elaborate on any section of the matrix. Finally, each dimension and relationship included in the conceptual model was tested by locating supporting quotes and searching for negative cases within the data set.
When nurses talked about providing care, they talked about ambulation and other forms of mobility; however, mobility was used primarily as a means to another end, not as an end in itself. Nurses talked about mobilizing patients or getting patients moving.
These terms were used to designate actions ranging from rolling over in bed or getting up to a chair to ambulating which generally meant walking in the hall.
When nurses cross the realm of thinking about moving patients to the action of moving the patient is the point of decision making. The decision-making process is highly sensitive and affected by many factors. Mobilizing older adult patients occurred throughout hospitalization but varied in terms of how patients were mobilized and the reasons for mobilizing. Nurses described patients as being in one of three phases: acutely ill, recovering, and getting-ready-for-discharge. The acutely ill phase is marked by physiological instability and is often relatively short.
Reasons for mobilizing patients were consistent throughout the course of hospitalization preventing complications. However, strategies used to mobilize patients differed depending on the phase of hospitalization.
When they start to feel better, they are able to get up. Interview 2, Site 1. For all nurses, acutely ill patients are limited to bed mobility. Once physiologically stable, getting up to a chair or ambulation can be considered. The recovering phase occurs when patients become physiologically stable and seems to comprise a significant portion of the hospitalization.
The recovery phase is generally the longest phase and where there is the most variation in terms of how nurses mobilize patients. Interview 5, Site 1. The getting-ready-for-discharge phase often occurs when discharge is anticipated within the next day.
The phase is also generally short and often unexpected by the nurse. Interview 3, Site 1. Although ambulation is sometimes pursued during the recovering phase, it often does not begin until the patient is getting ready for discharge.
This is generally the shortest phase, with little time to get the patient up and walking successfully.
Regardless of the phase, patients were mobilized for three purposes: to prevent complications, monitor progress, or compliance. Preventing complications was described as the most consistent and significant reason for mobilizing patients.
The complications of greatest concern were deep venous thrombosis DVT , pneumonia, pressure ulcers and, secondarily, functional decline. Of these, DVT was by far the most feared complication. In addition, the complication nurses were most concerned about preventing seemed to correlate with the phase of the hospital trajectory the nurse placed the patient in.
For example, in the acutely ill phase, nurses were primarily concerned about preventing pressure ulcers and pneumonia. This could be achieved by rolling the patient from side to side in bed. Once patients entered the recovering phase, the primary concern was the prevention of DVTs, with pressure ulcers and pneumonia becoming secondary. Although acknowledging that ambulation was the preferred method for preventing DVTs, nurses indicated that there were other options for preventing these complications.
As DVTs, and secondarily pneumonia, were seen as the most important complication to prevent, ambulation was seen as ideal but not necessary. Nurses indicated that other strategies could be used almost as effectively. Significantly, only one nurse interviewed indicated that functional decline was an important complication to prevent during hospitalization, suggesting that it must be addressed during the recovering phase.
Although others acknowledged that it was important when specifically asked, only one identified this spontaneously as a complication that nurses considered or that determined how patients were mobilized during the first two phases of hospitalization.
For most nurses, preventing functional decline was not considered until patients moved into the getting-ready-for-discharge phase; however, most patients have already lost function by this phase. There were no differences between the nurses on medical and surgical units. They become de-conditioned. General progress was determined by amount of assistance needed. Ambulating a Patient. Ambulation is defined as moving a patient from one place to another Potter et al. Once a patient is assessed as safe to ambulate , determine if assistance from additional health care providers or assistive devices is required.
To ambulate is simply to move, especially by walking. The Latin root of ambulate is ambulare, "to walk. Benefits of early ambulation after surgery: Ambulation stimulates circulation which can help stop the development of stroke-causing blood clots. Walking improves blood flow which aids in quicker wound healing. The gastrointestinal, genitourinary, pulmonary and urinary tract functions are all improved by walking. Mobility aids help you walk or move from place to place if you are disabled, aged, or have an injury.
Mobility aids include items such as walkers, canes, crutches, manual and electric wheelchairs and motorized scooters. Walking aids are tools designed to assist walking or enable mobility. Astrue, U. When a Patient Is Ambulatory This means the patient is able to walk around. After surgery or medical treatment, a patient may be unable to walk unassisted. Once the patient is able to do so, he is noted to be ambulatory.
ObjectiveTo investigate the effect of early balance training ambulation after stroke. Early ambulation of the patients could be permitted at two hours after operation.
The ambulation of the direction key control person. Time to achieve hemostasis and crura ambulation, vascular complications were compared. Transfer can also be a noun that means the act of moving something from one form or location to another, so that money that was shifted from one account to another is considered a transfer.
If you change something from one form to another, you can say that you transferred it.
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