Title : Step forward: Promoting improved mobility in the acute care setting with evidence-based approaches
Abstract:
Background: Bedrest is bad! Prolonged immobility in hospitalized patients contributes to muscle atrophy and a decrease in muscle strength at a rate of up to 20% per week. Patients may suffer from preventable hospital-acquired immobility harm, such as thrombotic events, falls, and pressure injuries. Despite these potential negative patient outcomes, challenges and inconsistencies persist with mobilizing patients. Incorporating early and frequent mobility into daily activities is essential for promoting recovery.
Purpose: To promote improved patient recovery, this evidence-based practice (EBP) initiative implemented a standardized, system-wide early mobility program within the acute care setting of a Military Treatment Facility.
Methods: A pre- and post-intervention design was utilized to evaluate the impact of the Johns Hopkins Activity and Mobility Promotion (JH-AMP) program as a structured framework to enhance patient mobility and mitigate immobility-related harm. The initiative encompassed the identification of staff-related barriers, assessment of hospital mobility equipment, provision of staff education, and implementation of interprofessional assessment and communication tools. The Johns Hopkins Evidence-Based Practice (EBP) Model for Nurses and Healthcare Professionals was employed as the foundational framework to guide the implementation and long-term sustainability of evidence-based practices.
Findings: Within 11 months of implementation, the Activity Measure for Post-Acute Care (AM-PAC) tool was consistently used to assess patient mobility, achieving a compliance rate of 94%. Documentation of patients' actual mobility levels using the Johns Hopkins Highest Level of Mobility (JH-HLM) tool reached 76% across the participating units. Additionally, over 93% of nursing staff received training in safe patient handling through the "Move Safely with Patients" initiative, facilitated by Physical Therapy collaborators.
Relevance to military nursing and nursing science: Deployed Service Members who are injured need to mobilize to avoid preventable muscle loss and immobility issues. Activity and mobility reduces recovery time and returns Service Members back to duty. Although this project took place in a stateside Military Treatment Facility, nurses will be prepared to incorporate mobility into the combat setting, whether they are providing care in a field hospital, ship, or aircraft. Future threats from adversaries are anticipated to yield large scale combat operations with prolonged care of Service Members in the combat zone. The limited evacuation options make early mobility vital for quicker patient recovery and return to duty timeframes.
