Date of Award

Spring 5-26-2018

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Eileen Fry-Bowers, PhD, JD, RN, CPNP

Abstract

Problem: Functional decline is the leading complication of hospitalization in the elderly. Loss of functional independence during hospitalization results from the inability to maintain function during hospitalization compounded by acute illness. Potential negative outcomes from decreased function include increased length of stay (LOS), morbidity, and added discharges to a skilled nursing facilities (SNF).

Introduction: A mobility-based protocol created by an interdisciplinary team was implemented for three months on an 8 to 12-bed specialized Acute Care Elderly (ACE) medical-surgical floor. The purpose of the project was to evaluate if an evidence-based practice (EBP) mobility protocol can decrease discharges to SNFs, falls, length of stay, and maintain activities of daily living and walking function. Baseline data was collected 10 days prior to the initiation of staff education.

Methods: One-on-one staff education on the mobility protocol was given to 17 registered nurses (RNs) and 10 certified nursing assistants (CNAs). The protocol included ambulating the patient at minimum twice a day, placing the patient in a chair three times a day for meals, and educating the patient and family about the hazards of immobility through an educational handout. Two outcome indicators for patients included Katz Index of Independence in Activities of Daily Living and mobility level of function before admission, on admission, and on discharge.

Results: Sixty-six patients met inclusion criteria for the project. Input from the staff, several committees with varying disciplines, including one with patients, were utilized for the success of the project. Weekly data was collected and analyzed to demonstrate progress and areas of improvement. Based on the project, implementing a mobility protocol based on EBP may decrease LOS, improve or maintain level of function of the patient on discharge, and decrease discharges to SNFs. No patients in the project experienced a fall. Staff were engaged and the main project interventions are still being sustained on the hospital unit.

Discussion: Ambulation and maintaining ADLs in the geriatric population benefits include a reduction in cardiovascular disease, weight loss, reduced osteoporosis, enhanced sleep, ability to perform ADLs, and improved mood and general health. The benefits may be underestimated since the indirect costs of disability, reduced quality of life, and dependence on others are not known and readily calculated. Maintaining or improving ADLs and level of function during hospitalization is well documented in the literature and should be duplicated by other medical-surgical units.

Available for download on Tuesday, May 12, 2020

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