Perceived Barriers to Patient Mobilization Among Therapy and Nursing Acute Care Staff: A Multi-Site Survey Study.

OBJECTIVE: To identify differences in perceived barriers to patient mobilization in acute care among therapy and nursing clinicians, and among hospitals of different sizes and types. DESIGN: Cross-sectional survey study. SETTING: Eight hospitals of various sizes and types (teaching vs non-teaching; urban vs rural), from 2 different states in the Western region of the United States. PARTICIPANTS: A nonprobability sample of 568 acute care clinicians (N=586) involved in direct patient care were surveyed. Clinicians indicated a clinical role within the branch of therapy (physical therapy or occupational therapy) or nursing (registered nurse or nurse assistant). MAIN OUTCOME MEASURES: The Patient Mobilization Attitudes and Beliefs Survey (PMABS) was used to assess perceived barriers to early patient mobilization among therapy and nursing staff. A PMABS total score and 3 subscale scores (knowledge, attitudes, or behaviors associated with barriers to mobilization) were calculated, with higher scores indicative of greater mobilization barriers. RESULTS: Mean PMABS total scores were significantly lower (better) for therapy providers (24.63±6.67) than nursing providers (38.12±10.95), P<.001. Additionally, therapy providers had significantly lower scores than nursing providers on all 3 subscales (all P<.001). Item-specific analyses revealed significant differences in responses between therapy and nursing staff on 22 of 25 items, with nursing staff indicating greater perceptions of barriers than therapy staff on 20 of the 22 items. The top 5 items with the largest response differences between therapy and nursing clinicians included adequate time to mobilize patients, understanding appropriate referral to therapy staff, knowledge on when it is safe to mobilize patients, confidence in the ability to mobilize patients, and receiving training on methods of safe mobilization. While hospital type did not affect perceived barriers to early mobilization, PMABS scores were significantly higher for large and small hospitals when compared to medium-sized hospitals. CONCLUSION: Perceived barriers to patient mobilization exist among therapy and nursing acute care clinicians, with greater barriers noted among nursing staff for knowledge, attitudes, and behaviors associated with patient mobility practices. Findings suggest future work is warranted, with opportunities for therapy providers to collaborate with nursing providers to address barriers to implementing patient mobility.

An Experience Sampling Analysis of the Impact of Video Monitoring Technology and In-Person Sitters on Nurse Burnout: The Moderating Effect of Nurse Commitment and Mediating Effect of Emotional Labor.

BACKGROUND: While it is established that video monitoring technology (compared with the use of in-person sitters) is a safe and cost-effective solution for hospitals, little is known about the impact of these approaches on nurses' stress and well-being. PURPOSE: To compare the use of video monitoring technology and in-person sitters (likely a resource reallocated from nurses) for monitoring patients on nurses' emotional labor and burnout. METHOD: An experience sampling method was conducted by surveying nurses twice a day for 3 weeks, resulting in 524 survey administrations provided by 74 nurses. The surveys included measures of daily video monitoring technology and in-person sitter use, emotional labor, emotional exhaustion, and nurse career commitment. FINDINGS: There were positive effects from video monitoring technology and negative effects of in-person sitters on emotional labor and emotional exhaustion, particularly for nurses lower in commitment. DISCUSSION: Hospital adoption of video monitoring technology has a positive impact on nurses compared with in-person sitter use.