Health Promotion

1

Mobility

Jane Doe

Benjamin Leon School of Nursing, Miami Dade College

NUR1025L: Fundamentals of Nursing Clinical Lab

Professor Name

April 15, 2020

2

Mobility

Mobility involves physical movement of the body, and its existence dictates the level of

independence and freedom a person holds. Mobility is a spectrum, with full mobility lying on

one end, immobility on the other, and varying degrees of mobility lying somewhere in between.

Mobility “requires sufficient muscle strength and energy, along with adequate skeletal stability,

joint function, and neuromuscular synchronization” (Crawford & Harris, 2016. p. 40). Disturbances in

mobility are caused by postural and muscular abnormalities, central nervous system damage, and

trauma to the musculoskeletal and nervous system (Potter et al., 2017). Acute or chronic pain are

also deterrents. Additionally, long periods of immobility can negatively affect the body systems

and may cause impaired tissue perfusion, deconditioning of the muscles, orthostatic hypotension,

thrombus formation, pneumonia, pressure ulcers, contractures, constipation, and psychosocial

complications amongst other health issues (Crawford & Harris, 2016). To this end, improving

and preserving the degree of mobility that a person possesses is essential to their well-being. This

fact especially rings true in the nursing home setting where the preservation of mobility can have

a huge impact on a patient’s quality of life and autonomy. Therefore, to prevent decline,

evidence-based practice and interventions must be used to resolve the causative factors of the

patient’s mobility impairment.

Patient Description

F.G. is an 82-year-old woman residing in the long-term care of a nursing home. She has

been a resident there for 10 months. Her current medical diagnoses include Parkinson’s disease,

scoliosis, anxiety, major depressive disorder, arthritis, ischemic stroke, and dementia. These

disease processes cause her to experience dysphagia, bradykinesia, muscle weakness, fatigue,

3

pain, mental decline, and tremors. She exhibits great difficulty ambulating and is mostly

wheelchair bound.

Patient Care

F.G. requires full assistance with basic Activities of Daily Living (ADLs) and needs help

with grooming, bathing, and toileting. She also needs help with ambulation and moving from her

bed to her wheelchair. Moreover, the nursing staff encourages her to participate in her self-care

as much as possible. She can brush her teeth on her own and feeds herself without help. F.G.

only requires the help of one nurse at a time, because she has retained a great deal of

independence despite exhibiting major difficulties with movement. These interventions aid in

maintaining the patient’s independence and level of mobility. The more the patient can continue

to do without assistance, the better her quality of life. Getting the patient out of bed and into the

wheelchair, while allowing the patient to help, permits her to retain as much muscle strength and

stability as possible.

Analysis

While the care the nursing staff provided to F.G. aligns with evidence-based practice,

there are more interventions that can be implemented to improve her mobility impairment issues.

Types of “interventions depend on the patient’s unique circumstances during hospitalization,

such as the illness/disease process, procedures performed, and surgery type” (Crawford & Harris,

2016, p. 39). For these reasons, assessing the patient and identifying immobilization factors is crucial

to initiating care. Initially, assessing the patient’s pain prior to beginning movement can broaden

the patient’s abilities. Pain can limit movement and worsen if not treated beforehand. Therefore,

providing pain-reducing measures before ambulation or exercise can make the process more

comfortable for the patient. Also, assessing the patient’s level of mobility, range of motion

4

(ROM), and strength will allow the nurse to gauge what exercises are suitable for that patient to

perform. Once assessed, range of motion exercises should be added to the patient’s activity

regimen. ROM exercises reduce risks for muscle atrophy and prevent formation of contractures.

A patient who is wheelchair-bound but can initiate movement can participate in active ROM by

flexing and extending at the knees, elbows, and ankles. They can also perform strengthening

exercises, such as gluteal and quadriceps sitting. Another cause for concern when addressing

mobility impairment is safety. Consequently, using a gait belt when ambulating the patient can

alleviate fears of falling, improve mobility, and preserve safety (Ackley et al., 2017; Wintersgill,

2019).

Summary

Preservation of mobility is essential to sustaining the quality of life and independence of

patients. Assessing the patient, performing ROM exercises, and using a gait belt for ambulation

are all forms of evidenced-based practices that benefit patients with mobility impairments and

prevent associated complications. In short, individualizing care and using evidence-based

practice to implement interventions are essential in producing optimal outcomes regarding

mobility.

Reflection

My experience with F.G. allowed me to thoroughly understand mobility impairment. I

had previous knowledge about issues with mobility but researching it deeply and relating it to the

care of an actual patient allowed me to see mobility from a different perspective. Understanding

this topic verbally and visually allowed me to personalize this issue and create my own

experience with it. The most important thing I learned through my clinical experience with F.G.,

in terms of her mobility impairment, was to help as little as safely as possible when assisting her

5

with movement and activities of daily life. This idea seemed to contradict the nursing profession,

and it went against my instincts as a highly empathetic and caring person. However, I came to

realize that by providing unnecessary help I would be stripping her of what mobility she had left

and would be encouraging dependence. This realization shifted my thought process from trying

to help her with everything to using my words to encourage her to embrace and save her

independence; I only offered help when I was truly needed. This experience taught me that there

are different ways to show caring in the nursing profession.

6

References

Ackley, B. J., Ladwig, G. B., & Makic, M. B. F. (2017). Nursing diagnosis handbook (11th ed.).

Elsevier.

Crawford, A., & Harris, H. (2016). Caring for adults with impaired physical mobility. Nursing,

46(12), 36–41. https://doi.org/10.1097/01.nurse.0000504674.19099.1d

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2017). Fundamentals of nursing (9th

ed.). Elsevier.

Wintersgill, W. (2019). Gait belts 101: A tool for patient and nurse safety. American Nurse

Today, 14(5), 31–34. https://www.myamericannurse.com/gait-belts-101-a-tool-for-

patient-and-nurse-safety/