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    Careplan

    Mobility Impairment, Adult Inpatient

    Oct.01.2020

    Mobility Impairment (Adult Inpatient)

    Clinical Description

    • Care of the hospitalized patient experiencing limitation in ability to independently and safely move self from one position or place to another.

    Key Information

    • Mobility impairment may hinder the patient’s ability to perform daily activities and may lead to negative health outcomes and the need for greater physical assistance.

    Clinical Goals

    By transition of care

    A. The patient will achieve the following goals:

    • Optimal Mobility

    B. Patient, family or significant other will teach back or demonstrate education topics and points:
    • Education: Overview
    • Education: Self-Management
    • Education: When to Seek Medical Attention

    Correlate Health Status

    • Correlate health status to:

      • history, comorbidity
      • age, developmental level
      • sex, gender identity
      • baseline assessment data
      • physiologic status
      • response to medication and interventions
      • psychosocial status, social determinants of health
      • barriers to accessing care and services
      • health literacy
      • cultural and spiritual preferences
      • safety risks
      • family interaction
      • plan for transition of care

    Mobility Impairment

    Signs/Symptoms/Presentation

    • difficulty with transfers
    • motor skill limitation
    • muscle strength decreased
    • range of motion limitation
    • reluctance to attempt mobility
    • requires assistance with ambulation
    • shortness of breath during or after activity
    • unable to reposition self independently

    Problem Intervention

    Optimize Mobility

    • Assess mobility skills (e.g., bed, transfers, ambulation, gait, stair climbing, wheelchair) and factors influencing mobility, such as balance, safety, range of motion, strength, muscle tone, cognition and sensory processing.
    • Instruct in transfer and mobility techniques supporting highest level of independence while ensuring safety.
    • Consider any contraindications or precautions to individualize treatment plan (e.g., joint or ligament instability, weightbearing restrictions).
    • Encourage early mobilization and performance of daily activities, if able, while providing level of assistance needed for safety.
    • Schedule mobility activities when pain and fatigue are at a minimum to encourage optimal performance.
    • Pace activity; allow adequate time and rest periods to conserve energy.
    • Provide frequent encouragement, along with prompting and assistance as needed.
    • Individualize instructions and prompts to patient’s cognitive status to promote effective communication; simplify verbal directions, give encouragement and provide demonstrated cues as needed.
    • Design and implement therapeutic interventions to address impairments (e.g., functional mobility training, mat and standing balance activities, strengthening).
    • Train in and reinforce use of adaptive equipment and assistive devices, such as a walker or transfer board.
    • Utilize appropriate modalities, devices or techniques to facilitate mobility (e.g., ankle foot orthosis, electrical stimulation, sit-to-stand lift, treadmill-training).
    • Assess fall risk using standardized tool; implement appropriate interventions, such as behavioral or environmental modifications.
    • Use proper body mechanics and patient alignment during mobility to ensure safety.

    Associated Documentation

    • Activity Management
    • Assistive Device Utilized
    • Positioning/Transfer Devices

    Education

    CPG-Specific Education Topics

    Overview

    • risk factors

    • signs/symptoms

    Self-Management

    • assistive/adaptive devices

    • energy conservation

    • home safety

    • joint mobility/strength

    When to Seek Medical Attention

    • unresolved/worsening symptoms

    General Education Topics

    General Education

    • admission, transition of care

    • orientation to care setting, routine

    • advance care planning

    • diagnostic tests/procedures

    • diet modification

    • opioid medication management

    • oral health

    • medication management

    • pain assessment process

    • safe medication disposal

    • tobacco use, smoke exposure

    • treatment plan

    Safety Education

    • call light use

    • equipment/home supplies

    • fall prevention

    • harm prevention

    • infection prevention

    • MDRO (multidrug-resistant organism) care

    • personal health information

    • resources for support

    References

    • (2018). Butcher, H. K.; Bulecheck, G. M.; Dochterman, J. M.; Wagner, C. M. (Eds.), Nursing interventions classifications (NIC). St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • (2019). Lazaro, R. T.; Reina-Guerra, S. G.; Quiben, M (Eds.), Umphred's Neurological Rehabilitation. St. Louis: Elsevier. [Expert/Committee Opinion]
    • (2020). Paz, J. C.; West, M. P.; Panasci, K.; Greenwood, K. C (Eds.), Acute care handbook for physical therapists. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Corregidor-Sánchez, A. I.; Segura-Fragoso, A.; Rodríguez-Hernández, M.; Criado-Alvarez, J. J.; Jaime, G. G.; Polonio-López, B. Can Exergames contribute to improving walking capacity in older adults? A systematic review and meta-analysis. Maturitas. 2020;132, 40-48. doi:10.1016/j.maturitas.2019.12.006 [Meta-analysis,Systematic Review]
    • Cortes, O. L.; Delgado, S.; Esparza, M. Systematic review and meta‐analysis of experimental studies: In‐hospital mobilization for patients admitted for medical treatment. Journal of Advanced Nursing. 2019;75(9), 1823-1837. doi:10.1111/jan.13958 [Meta-analysis,Systematic Review]
    • Doiron, K. A.; Hoffmann, T. C.; Beller, E. M. Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit. Cochrane Database of Systematic Reviews. 2018;(3) doi:10.1002/14651858.CD010754.pub2 [Metasynthesis,Meta-analysis,Systematic Review]
    • Fazio, S.; Stocking, J.; Kuhn, B.; Doroy, A.; Blackmon, E.; Young, H. M.; Adams, J. Y. How much do hospitalized adults move? A systematic review and meta-analysis. Applied Nursing Research. 2020;51, 1-10. doi:10.1016/j.apnr.2019.151189 Source[Meta-analysis,Systematic Review]
    • Gray-Miceli, D. Impaired mobility and functional decline in older adults: Evidence to facilitate a practice change. Nursing Clinics. 2017;52(3), 469-487. doi:10.1016/j.cnur.2017.05.002 [Expert/Committee Opinion]
    • Haugen, N.; Galura, S. (2020). Ulrich and Canale's Nursing Care Planning Resource-E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health. St. Louis: Saunders, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Hopkins, R. O.; Mitchell, L. Implementing a mobility program to minimize post–intensive care syndrome. AACN Advanced Critical Care. 2018;27(2), 187-203. doi:10.4037/aacnacc2016244 Source[Expert/Committee Opinion]
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    • Lehman, C. (2015). The specialty practice of rehabilitation nursing: A core curriculum. Chicago: Association of Rehabilitation Nurses. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Lin, T. C.; Yen, M.; Liao, Y. C. Hearing loss is a risk factor of disability in older adults: A systematic review. Archives of Gerontology and Geriatrics. 2019;85, 1-9. doi:10.1016/j.archger.2019.103907. [Systematic Review]
    • Martínez-Velilla, N.; Cadore, E. L.; Casas-Herrero, Á.; Idoate-Saralegui, F.; Izquierdo, M. Physical activity and early rehabilitation in hospitalized elderly medical patients:  Systematic review of randomized clinical trials. Journal of Nutrition, Health and Aging. 2016;20(7), 738-751. doi:10.1007/s12603-016-0683-4 [Metasynthesis,Meta-analysis,Systematic Review]
    • Menezes, K. V. R. S.; Auger, C.; de Souza Menezes, W. R.; Guerra, R. O. Instruments to evaluate mobility capacity of older adults during hospitalization: A systematic review. Archives of Gerontology and Geriatrics. 2017;72, 67-79. doi:10.1016/j.archger.2017.05.009. Source[Systematic Review]
    • Papa, E. V.; Dong, X.; Hassan, M. Resistance training for activity limitations in older adults with skeletal muscle function deficits. Clinical Interventions in Aging. 2017;12, 955-961. doi:10.2147/CIA.S104674 [Systematic Review]
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    • Porras, D. C., Siemonsma, P., Inzelberg, R., Zellig, G., Plotnik, M. Advantages of virtual reality in the rehabilitation of balance and gait: Systematic review. Neurology. 2018;90(22), 1017-1025. [Metasynthesis,Meta-analysis,Systematic Review]
    • Registered Nurses' Association of Ontario. (2017). Preventing falls and reducing injury from falls. Source[Quality Measures,Clinical Practice Guidelines]
    • Youkhana, S.; Dean, C. M.; Wolff, M.; Sherrington, C.; Tiedemann, A. Yoga-based exercise improves balance and mobility in people aged 60 and over: A systematic review and meta-analysis. Age and Ageing. 2015;45(1), 21-29. doi:10.1093/ageing/afv175 [Metasynthesis,Meta-analysis,Systematic Review]
    • Zhang, L.; Hu, W.; Cai, Z.; Liu, J.; Wu, J.; Deng, Y.; Yu, K.; Chen, X.; Zhu, L.; Ma, J.; Qin, Y. Early mobilization of critically ill patients in the intensive care unit: A systematic review and meta-analysis. PLOS ONE. 2019;14(10), 1-16. doi:10.1371/journal.pone.0223185 [Meta-analysis,Systematic Review]

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    Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.

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