Question about ambulation orders

jadelpn, LPN, EMT-B · Sep 26, 2009

When reviewing the plan of care with your patient after your shift assessment, you could tell the patient that the Dr's expectation is that they ambulate twice today. Then give a choice. "I can get you up now for breakfast, or I will be back at 10am and we will walk the hall, down to the nurse's station and back" That way the expectation is clear, and patient has a choice. Then document "reviewed plan of care with patient, including MD ambulation order". Then if they choose not to ambulate, or get up, you can document "patient declined". But always document patient teaching regarding skin integrity and patient changing position in bed should they decide they won't get out of it. Good luck!!

Callisonanne · Sep 26, 2009

I am not a nurse yet but I figured i'd at least offer an opinion. Maybe try to explain to them why they should ambulate. Such as the MD ordered this and I do understand that it may be painful but it will actually help you heal quicker. I dunno just an idea!

dishes, BSN, RN · Sep 26, 2009

I agree with ackteal and callisonanne, inform the patient the risks associated with inactivity include dvt and pe. Acknowledge that ambulating may be uncomfortable. If pain is the reason the patient does not want to walk, inform the patient that they can have pain medication prior to minimize this. Better a little pain than dead. Give the patient a couple of time options and give the analgesic 1/2 hr before ambulating.

If pain is not the reason, it may be depression, which will need more time and listening on your part. Keep trying, tell the patient you understand it is hard for them to feel like doing anything but that you are not going away until they walk with you.

regards

dishes

Tait, MSN, RN · Sep 26, 2009

I work a lot of GI post surgicals and I explain to them about ileus, pneumonia and healing time. I work nights so I am not necessarily the one getting them up, but I always discuss the importance of ambulation with them.

Tait

BabyLady, BSN, RN · Sep 26, 2009

Your patient has an order to ambulate BID or out of bed to chair BID or whatever specific order there is for activity. You let the patient know they need to do this. They say, not right now, I don't feel like it or I don't want to, I'm not up to it, etc. How far do you go trying to make them do it?
I will admit that sometimes it slips my mind to keep offerring to do it, but sometimes I just don't feel like spending 15 MORE minutes trying to convince someone to do something in their best interest. I'd rather just document that they said no and leave it be. I don't like the feeling of being a pushy person of sorts in this way. So what do you do? And if you don't succeed in getting a patient up, do other nurses on your unit make you feel like you failed or somehow are less of nurse because of it?
Just curious.

I would tell them that if they don't get up, they can get pneumonia and end up dead.

Sometimes, you cannot pull any punches with these people.

diane227, LPN, RN · Sep 26, 2009

As the charge nurse I tell the staff caring for the patient that the patient has to get up at least twice during the shift. If the patient does not want to get up, then I go in with them and talk to the patient and try to get them up myself. I am very direct. If they still don't want to get up, I give them the pneumonia, blood clot. longer recovery time lecture. If that does not work, then I chart the actions taken and their refusal in the physician progress notes so that the doctor knows when he/she makes rounds what we have done to try to get the patient up.

nursej22, MSN, RN · Sep 26, 2009

Our cardiothoracic surgeons are very clear with patients preoperatively that they will be out of bed for every meal and will walk at least 4 times a day so this helps some. And if pts refuse to walk right away then plan a time, say around a pain med, right after meal, whatever. Also foleys come out post-op day 1, and we avoid BSC if at all possible so people will at least walk to the BR, and "oh as long as your up let's go for a walk".

And yeah, discussing blood clots and pneumonia is totally appropriate, especially for families who think that laying is bed is more therapeutic than ambulation. I have a coworker who actually says "people die in bed. If you don't want to die, then get out of that bed."

litbitblack, ASN, RN · Sep 26, 2009

You can also play the strip the bed while they are in the bathroom so they have to go to the chair or take a walk if its a really difficult one. We do that in long term care for a resident that will get up to go to the bathroom and want to go back to bed. Strip it lol...of course you will always get the one that will climb back in that bed anyways.

RNKPCE · Sep 27, 2009

Agree with above postings. I also tell them that walking is as important as any medication they are taking. On my post op open hearts I tell them that DR. X has done his job and the ball is heavily in their court now to rehabilitate.

My other pet peeve is family member spoon feeding very capable patients. I say to the family " was your husband feeding himself before surgery? if so he needs to do this after surgery" Moving there arms to reach for food on their tray is very important.

JomoNurse · Sep 27, 2009

I tell them that the MD wants them up and walking. If they say not now, I leave it alone. I come back in a few hours and they say not now again, I leave it alone and go about my business. I don't have time or patience to act like mother and baby more than capable patients.