A collaborative and integrated approach to resident mobility

Some of society’s most frail and vulnerable older people live in nursing homes. As a result of physical and cognitive impairment many residents experience mobility loss resulting in the need for staff to assist them to move and perform activities of daily living. This thesis proposes that residents are often at risk of losing mobility, autonomy and control during mobility care. It also suggests that care staff will be safer and gain greater job satisfaction when they use mobility enhancing strategies that support residents’ mobility and autonomy. Extensive literature has explored the impact of safe manual handling on staff outcomes. However, there is a dearth of literature investigating the impact of staff manual handling or assistance on resident mobility outcomes. The overarching aim of this research was to gain a deeper understanding of factors influencing the quality and safety of mobility care for residents and staff. I also aimed to determine an approach for safe and person-centred mobility care and directions for practice improvement. The program of research is best described as a focused ethnography that explores various stakeholder perspectives. Methods employed included: interviews with 11 senior staff and 15 residents; focus groups with 18 direct care workers; and almost twenty hours of observations of interactions between residents and staff during mobility care. In the tradition of critical ethnography I conducted an analysis of discourses that may conflict or compete with resident mobility optimization. Through auto ethnography I reflected on my contribution to the research project as both a researcher and clinician. I explored person- and relationship-centred frameworks that provided a theoretical framework to the research. Finally, I used crystallization, a postmodern form of triangulation, to draw the various stakeholder perspectives together. The main theme that emerged from resident interviews was residents’ acceptance of mobility loss. This led to development of a model of residents’ positive adaptation to mobility loss. However, findings indicated that residents may not adapt positively if staff impose dependence on them. This finding highlighted that staff should support residents’ autonomy during mobility care by using person-centred approaches. An important theme, decision-making, emerged from focus groups with care staff. This theme was explored in detail because care staff’s decisions and behaviour are a critical determinant of whether care is person-centred or task-oriented. Using Cognitive Continuum Theory, I examined staff’s modes of decision-making practice and concluded that peer-aided judgements, reflective practice and situation awareness may support improved mobility care. Finally, a collaborative and integrated approach to mobility care that focuses on quality care, safety and residents’ quality of life is proposed. By drawing on perspectives of all stakeholders I developed a comprehensive model of moderating and mediating factors that can act as barriers or facilitators of mobility care. Suggested mobility care improvements focus on staff’s assistive performance, but also development of a facility culture that will sustain practice improvement. Thus the health, well-being and safety of residents and staff will be enhanced and improved staff job satisfaction may contribute to sustainability of the aged care workforce