Greetings! I am a returning member, last here in 9/14/02, according to the little thingee that popped up when I logged back in!!
I am now the nurse manager on a 46-bed LTC unit. I am also a returning nursing student. I am in the midst of getting my BS and will be finished in May. The big project that I have been working on is to initiate an ambulation program on my unit. We seem to have a real problem getting residents ambulated as often as they should be. Therefore, their transfer and ambulation status declines more quickly (among other things!!).
What I am wondering is this: what things have you tried in your facilities to get your CNAs and/or nurses to complete the required ambulation? I know it seems like a simple thing, but there are all kinds of obstacles that seem to get in the way.......not enough staff, too busy, etc.
Does anyone have any words of wisdom for a tired old nurse manager and nursing student?!!
Pt/OT....if the patient has a medical reason for ambulation problem, such as post fx hip...ect...pt/ot can be ordered by physician , and a qualifying home health company can come in to retrain ambulation...as far as staff having time to ambulate ppl around, i know its needed, but usually they understaffed, poorly staffed for the job....
I'm not saying we didn't ambulate and we always restrained. We all had one to walk to dining, Restorative had ones to do q day. They were all taken out q2 hours to reposition during turn and change. We had CNA's that was all they did. We had 4 that done turn and change and reposition and the other 4 done AM care. That is what we did on 7-3. Not sure what they did on other shifts because there were only 4 on the shift but all the baths were on 7-3.
I was so excited to see this as a topic! Speaking as a frustrated PT working in a 240 bed LTC facility, I can tell you from experience that not having formal nursing rehab aides leaves the staff CNAs to do all the floor ambulation (yeah ok); since they are already overworked, of course it never gets done. We have an accountability sheet that the CNA must initial daily the distance the pt walks. Its so easy and convenient to put down "R" for refused because they dont have the time or dont want to do it.
The problem for us in rehab is that after we d/c the pt to the unit, and they aren't ambulated for months, I get a call from nursing saying (guess what)" the pt cant walk please re-evaluate." Of course the pt cant ambulate! They've been sitting on their butt for months! So the moral of the story is: the best solution to the problem (but not the most cost-effective) is to have a Nursing Rehab department with aides specifically designated to do all the floor ambulation.
I do not necessarily agree. We had dedicated restorative staff in the past and had problems arise from that system. Now we have the NA caring for the resident doing their restorative programs and ambulation. To decrease their workload, we have "spa techs" who do the bathing and assist as needed. I like the idea and it seems to be working.:)
Carla Graf, MS, RN, of Univ of Cal-SF has written on this topic in the Jan 2006 issue of AJN, "Functional Decline in Hospitalized Older Adults," which you probably all have rec'd thru ANA membership. She is a clinical leader on a geri ward there. I wrote to her on this issue and I suggest you do, too, after reading her article. Her e-mail address, as published in AJN, is [email protected]
It is a great article and I enourage you all to read it. Some of her ideas, in addition to those expressed in the article:
- question bedrest orders
- teach patients and families about the importance of walking in the hospital
- work with and recognize the nursing assistants who do a good job with mobilization
- coach your patients and let them do for themselves what they can, motivating them and telling them they are doing a good job, rather than just doing it for them
- keep a clear path to the bathroom and encourage continence and rather than using a bedpan or urinal, walk the patient to the toilet
- find a PT or OT that is willing to work with you on a mobilization program pilot of some sort for your unit. You might talk with your hospital's volunteer program to see if it is possible that volunteers can be trained to work on your unit
- make up unit schedules for spending time with and mobilizing patiients so it is not all just left up to one person (the patient's nurse) or one discipline (PT or the CNA) to do it
stbernardclub
305 Posts
Pt/OT....if the patient has a medical reason for ambulation problem, such as post fx hip...ect...pt/ot can be ordered by physician , and a qualifying home health company can come in to retrain ambulation...as far as staff having time to ambulate ppl around, i know its needed, but usually they understaffed, poorly staffed for the job....