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Systems Approach Is Needed for In-Hospital Mobility: A Qualitative Metasynthesis of Patient and Clinician Perspectives.

Authors
  • Stutzbach, Julie1
  • Jones, Jacqueline2
  • Taber, Anna3
  • Recicar, John4
  • Burke, Robert E5
  • Stevens-Lapsley, Jennifer6
  • 1 Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado. Electronic address: [email protected]
  • 2 College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.
  • 3 College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, Colorado; College of Nursing, Nevada State College, Henderson, Nevada.
  • 4 College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, Colorado; Trauma and Burn Program, Children's Hospital Colorado, Aurora, Colorado.
  • 5 Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, Pennsylvania; Hospital Medicine Section, Division of General Internal Medicine, Department of Medicine, University of Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
  • 6 Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado; Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, Colorado.
Type
Published Article
Journal
Archives of physical medicine and rehabilitation
Publication Date
May 01, 2021
Volume
102
Issue
5
Pages
984–998
Identifiers
DOI: 10.1016/j.apmr.2020.09.370
PMID: 32966808
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To describe how different key stakeholders (ie, interprofessional clinical care team and patients) perceive their role in promoting in-hospital mobility by systematically synthesizing qualitative literature. PubMed, Ovid MEDLINE, Ovid PsychInfo, and Cumulative Index to Nursing and Allied Health were searched using terms relevant to mobility, hospitalization, and qualitative research. A total of 510 unique articles were retrieved and screened for eligibility. Eligible qualitative studies included stakeholder perspectives on in-hospital mobility, including patients, nursing staff, rehabilitation staff, and physicians. Eleven articles remained after inclusion/exclusion criteria were applied. At least 2 authors independently read, coded, and derived themes from each study. We used a team-based inductive approach to thematic synthesis informed by critical realism and the socioecological model. Reciprocal translation unified convergent and divergent constructs across primary studies. Investigator triangulation enhanced interpretation. Three primary themes emerged: (1) patient, family, and clinician expectations shape roles in in-hospital mobility; (2) stakeholders' role in mobility depends on hospital environment, infrastructure, culture, and resources; and (3) teamwork creates successful in-hospital mobility, but lack of coordination and cooperation leads to delay in mobilizing. Studies suggested that while mobility is an essential construct in the professional role of clinicians and in the personal identity of patients, the ability of stakeholders to realize their role in mobility is highly dependent on the hospital physical and cultural environment, administrative support, clarity in professional roles, and teamwork. Interventions designed to address the problem of low hospital mobility should take a systems approach and consider allocation of resources, clarity around professional responsibilities, and elevation of patient and clinician expectations surrounding mobility. Copyright © 2020 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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