Background: It is well-known that hospitalized older adults do not receive the mobility they need (Barber et al., 2015; Fisher, Graham, Ottenbacher, Deer, & Ostir, 2016). Due to musculoskeletal changes that accompany aging, this population is at increased risk for accelerated muscle loss and weakness which contributes to functional decline, and other adverse health outcomes (Cruz-Jentoft et al., 2010). Studies conducted in a variety of developed countries, including Australia, Canada, England, Ireland, Israel and the United States, show that concerns about the insufficient promotion of mobility in hospitalized older adults exist on an international scale. The urgency to address the mobility needs of older adults is heightened by the demographic shift that is occurring due to our aging population. A recent international research study reported that the growth of older adults 65 years and older is accelerating in multiple developed as well as developing nations (He, Goodkind, & Kowal, 2016).
Busy inpatient units have been described as chaotic settings (Catchpole, 2013). In addition, within this environment, nurses encounter a variety of barriers to promoting mobility in older adults (Hoyer, Brotman, Chan, & Needham, 2015). The literature suggests that there is a convergence of knowledge, attitude and external barriers that contributes to the vexing problem of insufficient mobility (Hoyer et al., 2015). While the incongruence between mobility needed and the mobility promoted in hospitalized older adults has been studied for decades—and literature has pointed a critical finger at nurses for failing to promote mobility—little is known about whether the barriers that nurses encounter could explain nurses’ mobility-promoting behavior. The accelerated rise in the number of older adults necessitates that clinical and academic nurses work collaboratively to take the lead to overcome potential barriers to nurse-promoted mobility for this vulnerable population by becoming involved in the design and conduct clinical research.
Two key principles to participatory research are to engage partners in all phases of research and to build on existing goals of the clinical setting (Schmittdiel, Brumbach & Selby, 2010). The initial project stemmed from a staff identified need, which was substantiated by the Nurse Manager as a priority and then the study was designed and conducted by the nurse researcher with the participation of bedside nurses. Subsequent projects were based on findings from the initial study and designed collaboratively with the staff and the nurse researcher.
Methods: A participatory approach was used to engage nursing staff in the research process. A team of hospital nurses were involved in discussions addressing all phases of research including data collection methods. To recruit nurse participants for the initial study, informational group discussion sessions were conducted which served to foster an awareness and enthusiasm among the nursing staff. Several additional strategies were employed to nurture and sustain engagement of the nursing staff (Roll et al, 2013). Regular communications were maintained with the nursing staff through informal (i.e., being present on the unit) and formal methods (i.e., unit-based newsletter or email, unit-based council meetings). Study procedures were integrated into daily patient care such as using the informational patient “white board” for communicating mobility goal setting. Nursing staff co-investigators were encouraged and supported to submit abstracts at local, regional and national professional meetings to disseminate findings.
Results: Numerous research-based activities have been generated stemming from the original study purpose to identify and then minimize barriers, and increase nurse-led patient mobilization. Between June 2015 and December of 2016 three research projects were conducted, and two other studies are currently in progress. In addition, 3 manuscripts are under review. Furthermore, findings have been disseminated though posters and podium presentations in a variety of venues including hospital-based symposia, national research conferences and professional nursing organizations. Contributing authors of these research activities are interdisciplinary and include bedside nurses, nurse mangers, physical therapists, volunteers, nurse-researchers, and data analysts. Using a participatory approach is useful to build capacity for nurses and other disciplines to collaboratively address clinical issues and to facilitate nurse-led research at the bedside. In addition, using this approach has stimulated an ongoing dialogue about research findings and has fostered a curiosity about next steps. This has served as a springboard for future nurse-led research to overcome insufficient older adult mobilization.
Conclusion: A participatory approach to clinical research capitalizes on the strengths and knowledge of the bedside nurse and the researcher to design and conduct clinically relevant research. This partnership fosters a culture of curiosity and serves as a springboard to generate additional researchable clinical questions. In addition, this approach provides numerous opportunities for the nursing staff to develop their presentation skills.
References:
Barber, E. A., Everard, T., Holland, A. E., Tipping, C., Bradley, S. J., & Hodgson, C. L. (2015). Barriers and facilitators to early mobilisation in Intensive Care: a qualitative study. Aust Crit Care, 28(4), 177-182; quiz 183. doi:10.1016/j.aucc.2014.11.001
Catchpole, K. (2013). Spreading human factors expertise in healthcare: untangling the knots in people and systems. BMJ Qual Saf, 22(10), 793-797. doi:10.1136/bmjqs-2013-002036
Cruz-Jentoft, A. J., Baeyens, J. P., Bauer, J. M., Boirie, Y., Cederholm, T., Landi, F., . . . Zamboni, M. (2010). Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing, 39(4), 412-423. doi:10.1093/ageing/afq034
Fisher, S. R., Graham, J. E., Ottenbacher, K. J., Deer, R., & Ostir, G. V. (2016). Inpatient Walking Activity to Predict Readmission in Older Adults. Arch Phys Med Rehabil, 97(9 Suppl), S226-231. doi:10.1016/j.apmr.2015.09.029
He, W., Goodkind, D., & Kowal, P. (2016). An Aging World: 2015. Retrieved from Washington, DC:https://www.census.gov/content/dam/Census/library/publications/2016/demo/p95-16-1.pdf
Hoyer, E. H., Brotman, D. J., Chan, K. S., & Needham, D. M. (2015). Barriers to early mobility of hospitalized general medicine patients: survey development and results. Am J Phys Med Rehabil, 94(4), 304-312. doi:10.1097/phm.0000000000000185
Roll, L., Stegenga, K., Hendricks-Ferguson, V., Barnes, Y., J., Cherven, B., Docherty, S. L., Robb, S. L. & Haase, J. E. (2013). Engaging nurses in research for a randomized clinical trial of a behavioral helath intervention. Nursing Research and Practice,vol. 2013, Article ID 183984, 6 pages. doi:10.1155/2013/183984
Schmittdiel, J. A., Grumbach, K., & Selby, J. V. (2010). System-based participatory research in health care: An approach for sustainable translational research and quality improvement. Annals of Family Medicine 8(3):256-259. doi:10.1370/afm.1117
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