A Collaborative and integrated approach to mobility care in nursing homes

Abstract

Objectives: Staff assistance during residents' mobility should be safe, meet residents' needs and provide residents with a positive experience that contributes to their quality of life [1, 2]. This project aimed to determine directions to integrate quality and safety within mobility care. Methodology: A critical, focused ethnography [3, 4], conducted in four nursing homes in Melbourne, Australia, included interviews with fifteen residents and eleven senior staff, twenty hours of observations of resident transfers in public areas, and three focus groups with eighteen care and lifestyle staff. A relationship-centred framework [5] was applied to two hypothetical cases. Discourses related to mobility care were analysed. Results: Residents valued independence and safety. Themes of residents' positive adaptation to mobility loss through motivation to remain mobile and acceptance of staff assistance emerged. Another theme was residents' acquiescence to loss of autonomy and control during mobility. Staff decision-making emerged as a theme from focus groups. Cognitive Continuum Theory (CCT) [6] was applied to these findings. Analysis of discourse highlighted conflicting messages regarding safety versus quality during mobility care. Conclusion: The Senses Framework and CCT provided directions for collaborative and integrated approaches to mobility care focused on shared decision-making, leadership and culture change.