Wednesday, May 02, 2007

Abstract and Commentary

Callen, B. L., Mahoney, J.E., Grieves, C.B., Wells, T.J., & Enloe, M. (2004). Frequency of hallway ambulation by hospitalized older adults on medical units of an academic hospital. Geriatric Nursing, 25, 212-217.

Authors’ Abstract
Lack of activity during hospitalization may contribute to functional decline. The purpose of this study was to determine the frequency of hallway walking by older adults hospitalized for medical illness. The study was an observational time-sampled study, which was conducted in the hallways of 3 medical units of a 485-bed academic health care center. Each unit was observed weekdays for eight 3-hour intervals covering 8 AM to 8 PM. Before each observation, nursing staff were questioned about walking abilities of patients aged > 55 years. During observation, frequency and minutes of patients’ hallway ambulation were recorded. Of 118 patients considered by nurses as able to walk in the hallways, 18.6% walked once, 5.1% twice, 3.4% more than twice, and 2.9% did not walk at all per 3-hour period. The median minutes for ambulation was 5.5. Frequency of ambulation was as low for patients independent in walking as for those dependent (28% vs. 26%, P=.507). Of the 32 patients who walked in the hallways, most did so alone (46.8%, n=15) or with therapy staff (41%, n=13); few walked with nursing staff (9.4%, n=3) or family (18.8%, n=6). In this setting, hallway walking was very low for hospitalized older patients. If this trend of limited walking is found to be prevalent across other settings, then both independent and dependent patients will require additional interventions to improve ambulation during hospitalization.

Commentary by Dana Rutledge, RN, PhD, Nursing Research Facilitator

This is one of few studies that document anything about ambulation in hospitalized patients. Its limitations include the fact that it was an observational study, that determination of patients’ ability to ambulate and need for assistance was based upon nursing judgment, that no data were collected on motivation to walk, and that the study only occurred on weekdays. Despite these limitations, study results point out that medical/surgical patients do not ambulate a lot, and that much ambulation may be driven by “therapy” goals rather than optimizing patient physical function (normal conditioning). This implies that patients who do not have ambulation “ordered” may lose function even if they entered the hospital fully functional. We are all aware of the “hazards of immobility” (Olson, 1967): pathology including cardiovascular, respiratory, gastrointestinal, musculoskeletal, urinary, metabolic, and psychosocial health changes.

When I read this abstract, I was surprised at the low proportion of walks where the patient was with nursing staff or family. So, in the article, I searched for how they measured this. Walking was observed by a non-staff observer who “sat in a corner of the middle section of the unit;” walking in the rooms was not observed. Each of 3 medical/surgical units were sampled during 3-hour intervals between 8 a.m. and 8 p.m. Each unit was observed for 24 hours. For patients who would be observed (> 55 years), the observer first gathered information about patient activity from the nursing staff. Per observation period and per patient, the observer noted time and duration, route taken, apparent purpose, and presence of human assistance or assistive device. The definition of the walk’s purpose was confusing to me:
· For therapy – patient walking with a nurse or off-unit health professional
· For a purpose other than therapy – walking with a definite goal (e.g., walking to elevator)
· For exercise – walking along or with family with no observable goal
I was unable to reconcile how the researchers differentiated walking with therapy staff or with nursing staff.

So, the actual percentages of walks per category may not make sense, but overall, patients did not walk much. I wonder how much patients at St. Joseph are walking.

Olson, E.V. (1967). The hazards of immobility. American Journal of Nursing, 67, 779–97.


Judy Rousch, RN, BSN said...

This article reminds me of my first e-journal article that discusses missed nursing care (see April 09,2007). We have a specific nursing ambulation program starting here at St. Joseph’s and I wonder what the input is from the time impact on the floor nurses?

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