clinical practice
What do you see as the role of the nurse in getting their patients up and moving ? It is important , and our research has shown that nurses think it ’ s really important , but they ’ re kind of frustrated because there are so many other things that they have to do in their busy days . And like many other industries , there ’ s a lot of specialisation that ’ s occurred : it used to be a regular role of nurses , but we do have more allied health professionals now , and physiotherapists particularly would be very much involved in getting people up and moving . So , there ’ s a demarcation that ’ s occurred around that as well .
You surveyed 138 nurses around Australia and conducted interviews with 11 of them , what was the general consensus ? I think nurses see it as their role , there ’ s absolutely no doubt about it . But their roles are complex too , there are many other things that they are required to do . And so it ’ s not always easy to facilitate that .
The other side of it is the expectations of families and patients themselves , that they ’ re in hospital to recuperate . The idea about resting and trying to recuperate slowly is quite ingrained , and maybe it ’ s something that ’ s embedded in media portrayals and memories of how it used to be a long time ago . But of course that ’ s not how it is , people do need to get up and get moving , and keep moving , to get better and to remain healthy . It ’ s good for their wellbeing , it ’ s good for their muscle strength . It ’ s a positive and important thing all around .
There ’ s also the resistance that nurses recognise from family and the patients themselves . Sometimes there ’ s issues around the worry about people falling . If they had the time or the personnel to be really careful about walking with people who were perhaps a little frail , or in danger of falling , they might be more inclined to get them up .
I think there ’ s a bit of an issue around the degree to which nurses are involved in decision making . It can be hard for them to be involved in discussions and decision making around patient care , so there ’ s a bit of a feedback loop that doesn ’ t get back to the treating physician and the nursing managers on the wards .
Another thing that quite a few nurses brought up was the increasing complexity of patient conditions . That could be around multiple chronic illnesses , it could be that a lot of people are coming in who are extremely overweight so they require a lot of special handling using machines and someone to get them up . It ’ s complex .
I think nurses really recognise this complexity , and I think in a way it worries them that they know what they ’ d like to do , but it ’ s really often hard to organise it .
What do the nurses say about how families and carers can better support them in promoting movement ? I think if patients and families have a particular expectation about what ’ s going to happen when they come into a hospital ward , then maybe we just need to try and change those perceptions . One of the things that really came out of this research was the realisation that there needs to be a lot more work around informing patients and families about the importance of being active and how they can really be engaged in helping that process along . I guess the nurse ’ s concerns are really around that kind of friction that may arise , because it ’ s quite a frequent thing .
One of the things our team is looking at now is the sorts of intervention that we might be able to introduce . We need to find a way to get the families involved in this whole process , and of course they need to know about it . So some of the answer to that problem may be early information , or information given on admission into the ward , so they can be informed that not only will their loved one have to get up and get moving , but that they ’ re going to be a part of that process as well .
It ’ s about involving everybody and seeing how we can develop that process , how we can design it to make it more transparent and get a more collaborative approach to solving this problem .
What did the nurses say about the ways the organisations and the people who are in decision making roles can better support them ? Part of it will be education and training , so more knowledge about physical activity and sedentary behaviour as it applies to their particular nursing context . And also the skills about how they might go about translating that knowledge into clinical practise : actually working out how to work with patients and families in a constructive way and a more effective way . It ’ s also about engaging the nursing staff in some more decision making .
It might be you set up little nooks for people to read , or to have visitors . Or create a space where you might have a centre of activity that would encourage people to get out of bed , or get off their chair , and to come together to do something enjoyable .
Nurses may be thinking about these things , but they might not get the opportunity to feed those suggestions through to the managers and leaders .
Did the findings of the study surprise you in any way ? Yes and no . I think from working both clinically and as a manager a lot of the information that has come from this study has reinforced some of the ideas or thoughts that I ’ ve already had . We talked to those who worked in subacute services and to managers , and there was a lot of crossover . So I think a lot of things were known , it ’ s just about getting that all together and making it clear so we can really see what are the important issues that need to be addressed .
Once we get that information , we can start thinking more clearly about how we might work towards improving the situation . That ’ s what ’ s important about doing research like this , to get much more clarity from the perspectives of the people that are directly affected by the concerns and the focus of the research .
Do you think nurses are being listened to in this context ? I think everybody knows it ’ s an issue . There often is a bit of a barrier to that free flow of information . Some of it ’ s got to do with the fact that it ’ s easier to just get on and do the work at hand . But sometimes you do need to sit down and ask what ’ s going on and where there might be some areas for improvement , or where you might do something differently in the way you work .
This is one of many really important issues , so certain things can be drowned out a bit by all of the other important issues which might be more pressing , or at least have more visibility . I think this is why this sort of research is good because it brings to light something that ’ s important but maybe gets pushed down a little bit amongst all of the noise and clamour of working in health care and providing patient care . ■
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