We need to understand our patient’s prior level of mobility, independence in self-care and usual living situation if we are to implement appropriate and effective mobility and self-care interventions. For example, if a patient's mobility restrictions affected their ability to remain socially connected and manage their own affairs, we should develop a plan with them to rectify this.
Consider five areas of mobility and self-care interventions as part of an interdisciplinary strategy: incidental activity, exercise, retraining activities of daily living (ADLs), ensuring appropriate supervision, and environmental modifications.
Interventions should be discussed and implemented in partnership with the older person and their family and carer, as appropriate.
Incidental activity
Incidental activities are those where physical activity occurs as part of regular daily activities, for example, walking to the toilet, transferring and dressing. Performing regular daily activities, including self-care, is the easiest exercise for our patients to undertake in hospital. Self-care can be beneficial to your patient’s mobility.
Encourage your patients to:
- dress (consider the possibility of wearing their normal day clothes and footwear)
- get out of bed and move around the ward, with supervision or assistance and an appropriate gait aid if required
- sit out of bed as soon as it is considered safe to do so, as much as possible as appropriate to their condition
- walk to the toilet, with supervision or assistance if required
- eat meals out of bed, preferably in a communal dining room where available and appropriate
- undertake or participate in showering and other grooming and self-care activities.
As staff, we can:
- supervise or assist older people during walking, transfers and ADLs if required
- create a continence and mobility plan that fits with patients sitting out of bed for meals
- adjust bed height to allow for safe, independent transfers
- orient our patients to the ward, showing them where the toilet is
- provide a culture that encourages incidental exercise
- provide aids to assist with optimal transfers and mobility
- avoid using bed rails, which may limit mobility and be a hazard
- improve our understanding of the risks of restricting mobility and provide strategies to prevent de-conditioning.
Exercise
As part of an interdisciplinary intervention, an exercise program may benefit your patient.
Exercise programs can be administered in both individual and group settings and may include strength, balance, functional retraining and aerobic (or endurance) exercises. Group classes also provide an opportunity for social interaction and may help prevent loneliness.
We can refer older patients to physiotherapy for prescription of individual or group exercise.
Retraining ADLs
Our patients’ abilities to live independently may depend on retraining their skills in ADLs. We can:
- provide the minimal amount of assistance required to encourage optimal participation; assistance should be reduced as the person’s condition improves
- encourage and guide our patients to promote independence
- assist with alternative strategies for self-care, as necessary
- refer our patients to occupational therapy, as appropriate
- make sure aids are available to assist with optimal independence
- ensure bed and chair heights are optimal for independence
- recommend patients for self-care programs, such as cooking groups and self-care education sessions, as appropriate
- consider use of everyday clothes and footwear
- clear any clutter
- ensure obstacles to mobility or self-care are moved
- ensure any tools or aids for mobility or self-care are clean and maintained
- ensure bed and chair heights are optimal for independence
- avoid using bed rails, which may limit mobility and be a hazard.
Ensuring appropriate supervision during mobility and self-care tasks
We can:
- supervise patients who are acutely unwell during walking and transfers. It may be appropriate to reduce supervision as medical stabilisation occurs and familiarisation with the environment and equipment is achieved.
- consult physiotherapy if we are in doubt about the supervision needs of our patients. Use strategies such as a traffic light colour coding system, a common way to inform all care staff of an individual's mobility supervision needs.
Environmental modifications
The hospital environment is important in promoting mobility and self-care for older people. We should:
- clear any clutter
- ensure obstacles to mobility or self-care are moved
- ensure any tools or aids for mobility or self-care are clean and maintained
- ensure bed and chair heights are optimal for independence
- avoid using bed rails, which may limit mobility and be a hazard.
Reviewed 05 October 2015