1. Getting Patients Walking: A Pilot Study of Mobilizing Older Adult Patients Via a Nurse Driven Intervention
Barbara King, PhD, APRN-BC, FAAN

2. What Happens to Older Adult Patients During Their Hospital Stay?
Up to 65% of hospitalized older adults will lose their ability to independently ambulate
Loss of functional status now identified as a Hospital Acquired Disability
Impact
$26 billion/annually
55% of persons are still disabled at five years
Limited ambulation or bed rest has been identified as the most predictable and preventable cause for loss of independent ambulation

3. How Often do Older Adult Patients Walk during Hospital Stay?
Accelerometer Studies
96% of patients not engaged in any ambulation
Fisher et al., 2011
83% of time patients spend lying in bed
Brown et al., 2009
Observation Studies
Nurses only walk with patients 9% of time
Callen et al, 2004
Nurses generally engage patients in low mobility activity
King et al, 2014
Survey
80% of nurses report patient ambulation as most frequently missed nursing care activity
Kalisch et al., 2011

4. But is Older Adult Patient Ambulation Safe?
Early Mobility literature
ICU studies of mechanically ventilated patients
<1% activity related adverse events
Hip Fracture Patients, Kamel et al., 2003
Improved outcomes
No adverse events
General Medical Patients, Mundy et al., 2003; Brown et al 2016

5. What is Getting in the Way?
System barriers that prevent nurses from ambulating patients
System barriers that limit patient engagement in initiating ambulation
Personal barriers that prevent nurses from initiating patient ambulation

6. MOVIN Theoretical Framework
Systems Engineering Initiative for Patient Safety (What)
Social Cognitive Theory (How)
Change culture
Increase nurse self-efficacy
Improve communication

7. Engage Stakeholders

8. MOVIN Pilot Timeline

9. MOVIN Components

10. Feasibility of Recruitment
Psychomotor Training
20 nurses expressed interest
18 completed training
Reschedule 4 training sessions
Patient recruitment
32 patients consented
6 patients refused

11. Quantitative Results

12. Qualitative Results

13. Qualitative Results

14. Qualitative Results

15. Patient Feedback
Patient 1: “That board (My Activity Board) lets me see whether or not I have walked. I think it is important”
Patient 2: “It’s easy to vegetate in this place so anything you can do to get people moving is important”
Patient 3: “I could only walk 50 feet when I got here. Now I can walk 200 feet. That’s amazing”
Patient 4: “I wouldn’t walk if nurses didn’t get me up. That would be bad for me”
Patient 5: “The pictures are beautiful. I go for walks just to look at them”

16. Sustainability

17. Lessons Learned
Early Planning- consider and plan for sustainability early on, what are your outcomes, can you get data, who are the stakeholders?
Alignment- is mobility important in your organization?
Good Communication- researchers and knowledge users work together
Support- buy-in critical for systems based intervention

18. Acknowledgments Our Clinical Partner University of Wisconsin- Madison
Our MOVIN Research Team

19. Questions?
Contact Information
Barbara King, PhD, APRN-BC, FAAN