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R. Fallen-Bailey1, L. Robinson1
1Newcastle upon Tyne Hospitals NHS Foundation Trust, Rehabilitation Department, Newcastle upon Tyne, United Kingdom
Background: Interventions are needed to prevent functional decline in hospital and promote positive health behaviours to relieve pressures on health and social care. Patients in hospital are vulnerable to functional deterioration at a loss of 5% muscle strength per day, largely due to physical inactivity. It has been suggested that all clinical staff, regardless of professional discipline, should receive education and training to promote patient mobility. Adopting a co-ordinated and collaborative approach to promoting inpatient mobility could result in a reduction in functional deterioration in the region of 35% for individuals aged over 70 years, a decreased length-of-stay of up to two days and a reduced requirement for social support on discharge.
Purpose: To compare and contrast the views and opinions of clinical staff from different professional disciplines regarding patient mobility and physical activity in hospital.
Methods: A mixed-methods online survey was sent to all Agenda-for-Change Band 5 Nurses, Physiotherapists and Occupational Therapists (OTs), therapy-assistants and healthcare-assistants (HCAs) working in the emergency department, internal medicine and older people’s medicine directorate of an NHS hospital (n=680 participants). The survey remained open for a six-week period (November 2019–January 2020) and consisted of 13 demographic, closed-response and open-response questions.
Results: 115 responses were received (49 nurses, 13 physiotherapists, 10 OTs, 27 HCAs, and 16 therapy-assistants). Clear differences were observed between professional groups particularly the physiotherapists and nursing staff. Physiotherapists were primarily concerned with influencing health behaviours on the wards, whereas nursing staff saw their role as being to provide a holistic patient-centred experience. Participants’ knowledge of the effects of bed rest was limited to commonly-reported complications, such as pressure ulcers and chest infections. There was a lack of awareness amongst OTs, nurses and HCAs of the risk of hospital-associated deconditioning.
Although the physiotherapists suggested that promoting inpatient mobility was everybody’s responsibility, there was a perception amongst all staff groups that physiotherapists were the ‘experts’ in assessing movement. Respondents from all professional groups suggested that a detailed risk-assessment performed by a qualified physiotherapist was essential to ensure patient safety prior to promoting inpatient mobility. The majority of respondents believed that patients being more mobile during their hospital stay would ultimately result in less work for all professional disciplines. However, there were concerns amongst nurses and HCA's that promoting physical activity on the ward was not part of their job role and would result in a greater workload in the short-term.
Although the physiotherapists suggested that promoting inpatient mobility was everybody’s responsibility, there was a perception amongst all staff groups that physiotherapists were the ‘experts’ in assessing movement. Respondents from all professional groups suggested that a detailed risk-assessment performed by a qualified physiotherapist was essential to ensure patient safety prior to promoting inpatient mobility. The majority of respondents believed that patients being more mobile during their hospital stay would ultimately result in less work for all professional disciplines. However, there were concerns amongst nurses and HCA's that promoting physical activity on the ward was not part of their job role and would result in a greater workload in the short-term.
Conclusion(s): Promoting physical activity should become part of a focused care strategy that is incorporated into the patient’s daily routine and supported by all clinical disciplines. An enhanced understanding of established hospital culture is necessary to develop interventions with the potential to successfully challenge established professional role boundaries. Physiotherapists must relinquish their status as experts in ensuring patient safety without fear of professional dissolution, and move towards unified rehabilitation strategies that promote inpatient independence and wellbeing.
Implications: Organisational culture, human factors and traditionally-defined professional role boundaries need to be explored and understood in greater detail in order to successfully tackle functional decline in an inpatient setting.
Funding, acknowledgements: This work was undertaken during a Trust Internship, which funded 24-days of the presenter’s salary over six months.
Keywords: Inpatient activity, Mixed-methods survey, Professional cultures and behaviours
Topic: Health promotion & wellbeing/healthy ageing/physical activity
Did this work require ethics approval? No
Institution: Newcastle upon Tyne Hospitals NHS Foundation Trust Research and Development Department
Committee: N/A
Reason: This work was considered to be a service evaluation, meaning no Research Ethics Committee approvals were required.
All authors, affiliations and abstracts have been published as submitted.
