Attributing the responsibility for ambulating patients: A qualitative study

Background: Functional decline has been identified as a leading negative outcome of hospitalization for older person. Functional decline is defined as a loss in ability to perform activities of daily living including a loss of independent ambulation. In the hospital literature, a patient's loss in ability to independently ambulate during the hospital stay varies between 15 and 59%. Lack of ambulation and deconditioning effects of bed rest are one of the most predictable causes of loss of independent ambulation in hospitalized older persons. Nurses have been identified as the professional most capable of promoting walking independence in the hospital setting. However, nurses do not routinely walk patients. Objective: The purpose of this study was to explore the relationship between nurses' attributions of responsibility for ambulating hospitalized patients and their decisions about whether to ambulate. Methods: A descriptive, secondary analysis of data gathered for a parent study was conducted. Grounded dimensional analysis was used to analyze the data. Participants consisted of 25 registered nurses employed on medical or surgical units from two urban hospitals in the United States. Results: Nurses fell into two groups: those who claimed ambulation of patients within their responsibility of practice and those who attributed the responsibility to another discipline. Nurses who claimed responsibility for ambulation focused on patient independence and psychosocial well-being. This resulted in actions related to collaborating with physical therapy, determining the appropriateness of activity orders, diminishing the risk and adjusting to resource availability. Nurses who attributed the responsibility deferred decisions about initiating ambulation to either physical therapy or medicine. This resulted in actions related to waiting, which involved, waiting for physical therapy clearance, physician orders, risks to decrease, and resources to improve before ambulating. Conclusions: Nurses who claimed responsibility for ambulating patients within their domain of practice described actions that promoted patient independent function and were more likely to get patient s up to ambulate. (C) 2013 Elsevier Ltd. All rights reserved.