A systematic review of nursing contributions to mobility rehabilitation: examining the quality and content of the evidence

Sophomore nursing students' perception of their Professional Behavior toward Rehabilitation patients: a cross-sectional study

BACKGROUND

Rehabilitation is considered one of the elements of universal health coverage, emphasizing its importance for every person in need throughout the life course. Nurses play a pivotal role in the rehabilitation team as they possess the competencies to help individuals manage health problems and maximize potential well-being. Yet, little is known regarding knowledge of this subject among nursing students, as well as regarding their attitudes, thoughts, and professional behavior. This study aimed to explore: (a) Sophomore students' attitudes, feelings, thoughts, and professional behavior toward rehabilitation patients; and (b) Differences in the research variables as affected by students' previous exposure to rehabilitation patients.

METHODS

A cross-sectional survey design among sophomore nursing students. A questionnaire was distributed through a commercial internet survey provider (Qualtrics.com) before the beginning of a mandatory course on "nursing rehabilitation", introduced for the first time in 2022 in all Israeli universities. Students were divided into three groups according to their previous exposure to rehabilitation patients: no professional or personal previous exposure to rehabilitation patients; previous professional or personal exposure to rehabilitation patients; and previous exposure to rehabilitation patients both in one's professional and personal life. The study adhered to the STROBE guidelines.

RESULTS

The sample consisted of 122 participants. Significant differences were found between the groups by their previous exposure to rehabilitation patients. Participants with no previous exposure to rehabilitation patients were found to have lower self-perceived capability to care for rehabilitation patients and more negative professional behavior toward rehabilitation patients and their families compared to the other two groups (H = 22.06, p = 0.006, H = 23.86, p = 0.03, respectively). No other statistical differences were observed between the groups.

CONCLUSIONS

The findings emphasize the importance of exposing students to the field of nursing rehabilitation and to the care of rehabilitation patients. Exposure to nursing rehabilitation specifically during one's studies, through theoretical learning and clinical experience, can promote positive attitudes, professional values, and positive professional behavior toward these patients and their families.

Effective nursing interventions in ADL care affecting independence and comfort - a systematic review

Despite its frequent provision, evidence of nursing interventions in Activities of Daily Living (ADL) remains unclear. Hence, we addressed the research question: What are the effects of ADL nursing interventions on independence and comfort in adults across all care settings? We conducted a systematic review of randomized controlled trials and quasi-experimental studies described in systematic reviews. In three databases, we searched for systematic reviews that we used as a portal to select (quasi) experimental studies. After narratively summarizing the studies on characteristics, effects, and interventions, we assessed the risk of bias. Among the 31 included studies, 14 studies evaluated independence, 14 studies measured comfort, and three studies assessed both outcomes. Seven interventions significantly improved independence and seven interventions significantly improved comfort. The studies varied highly in intervention components, outcome measures, and quality. Evidence on ADL nursing interventions affecting independence and comfort remains fragmented and inconclusive, limiting guidance for nursing professionals.

What is the relationship between falls, functional limitations, and depressive symptoms among Chinese older adults? The role of living alone

OBJECTIVES

Although the association between falls and depressive symptoms is well documented, the mechanisms underlying this association remain largely unexplored. We investigated the mediation role of functional limitations in the association between falls and depressive symptoms among Chinese older adults and determined whether the living arrangement (living alone or not) is a significant moderator of the above-mentioned mediation pathway.

STUDY DESIGN

Cross-sectional study.

MAIN OUTCOME MEASURES

Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale short form (CESD-10), on which higher scores indicate higher levels of depressive symptoms.

RESULTS

We used the harmonized China Health and Retirement Longitudinal Study national baseline data (2011-2012 year) involving 7410 participants aged 60 years and over. After adjusting for covariates (e.g., age and sex), the effects of falls on depressive symptoms were seen to be mediated by functional limitations among Chinese older adults (β = 0.82, p < .001). The moderated mediation analysis, which assesses whether an indirect effect is conditional on values of a moderating variable, found that the mediation effect was contingent upon the living arrangement (β = -0.60, p = .029). Specifically, the levels of functional limitations and depressive symptoms were higher for people with falls who were living with others relative to those living alone.

CONCLUSIONS

These results suggest that functional limitations are an important intervening variable that links falls to depressive symptoms among Chinese older adults. Interventions to promote older adults' physical function and prevent falls are recommended to decrease the risk of depressive symptoms. These interventions can particularly benefit those who live with others.

Mobility care in nursing homes: development and psychometric evaluation of the kinaesthetics competence self-evaluation (KCSE) scale

BACKGROUND

Impaired mobility is a prevalent condition among care-dependent persons living in nursing homes. Therefore, competence development of nursing staff in mobility care is important. This study aimed to develop and initially test the Kinaesthetics Competence Self-Evaluation (KCSE) scale for assessing nursing staff's competence in mobility care.

METHODS

The KCSE scale was developed based on an analysis of the concept of nurses' competence in kinaesthetics. Kinaesthetics is a training concept that provides theory and practice about movement foundations that comprise activities of daily living. The scale contains 28 items and four subscales (attitude, dynamic state, knowledge and skills). Content validity was assessed by determining the content validity index within two expert panels. Internal consistency and construct validity were tested within a cross-sectional study in three nursing homes in the German-speaking region of Switzerland between September and November 2015.

RESULTS

The content validity index for the entire scale was good (0.93). Based on a sample of nursing staff (n = 180) the internal consistency results were good for the whole scale (Cronbach's alpha = 0.91) and for the subscales knowledge and skills (α = 0.91, 0.86), acceptable for the subscale attitude (α = 0.63) and weak for the subscale dynamic state (α = 0.54). Most items showed acceptable inter-item and item-total correlations. Based on the exploratory factor analysis, four factors explaining 52% of the variance were extracted.

CONCLUSION

The newly developed KCSE scale is a promising instrument for measuring nursing staff's attitude, dynamic state, knowledge, and skills in mobility care based on kinaesthetics. Despite the need for further psychometric evaluation, the KCSE scale can be used in clinical practice to evaluate competence in mobility care based on kinaesthetics and to identify educational needs for nursing staff.

Nurses' competence in kinaesthetics : A concept development

AIM

This study was carried out to systematically describe nurses' competence in kinaesthetics.

BACKGROUND

In elderly care the kinaesthetics program for nurses has been taught for over 25 years; however, the competence that nurses should gain through kinaesthetics training from a theoretical perspective has not yet been systematically described.

MATERIAL AND METHODS

The method was modelled after the three phases of the hybrid model of concept development by Schwartz-Barcott and Kim (2000). In the theoretical phase a working definition was established and a literature review conducted. We searched the online databases PubMed and CINAHL and the reference lists up to February 2016. In the empirical phase experts defined the attributes during a workshop in October 2013. In the analytical phase the results from the theoretical and empirical phase were combined in order to define antecedents, attributes and consequences of the concept.

RESULTS

The concept of nurses' competence in kinaesthetics includes two antecedents: (1) nurses' kinaesthetics training and (2) care recipients' need for mobility support in activities of daily living. This concept includes a set of attributes in the areas of knowledge, skills, attitudes and dynamic state. It contributes towards (1) movement competence and (2) physical and psychological well-being of both care recipients and nurses.

CONCLUSION

The concept of nurses' competence in kinaesthetics might support awareness and communication about mobility-enhancing gerontological care. Based on the attributes of nurse' competence in kinaesthetics an assessment instrument will be developed that can be used to evaluate nurses' competence in kinaesthetics in clinical practice. Further research is needed to evaluate the consequences of the developed concept.

A systematic review of observational instruments used to assess nurses' skills in patient mobilisation

AIMS AND OBJECTIVES

The aim of this study was to identify and describe the existing observation instruments that are used to assess nurses' skills in patient mobilisation and to evaluate the psychometric properties of the included instruments.

BACKGROUND

Structured knowledge about instruments for assessing nurses' skills in patient mobilisation is limited.

DESIGN

Systematic review.

METHODS

Studies were identified via electronic database searches and reference lists and were included based on the eligibility criteria. Data regarding the type of instrument, the number of items/domains and the psychometric properties of the instruments were extracted, and the quality of the instruments were appraised according to Zwakhalen et al.'s (BMC Geriatrics, 2006) proposed criteria.

RESULTS

A total of 26 studies, reporting on 16 instruments, were included in this review. The instruments differed in terms of: (1) type of patient-mobilisation task, (2) focus of the instrument, (3) level of structure and (4) use by the observer. Most of the instruments were developed and used in evaluation studies that measured nurses' mobilisation techniques as an outcome of an educational intervention. The total quality score of the included instruments varied between 6-11 points out of a maximum quality score of 19.

CONCLUSION

Although patient mobilisation is part of nurses' everyday work, we suggest from the results of this review that no common consensus exists about the best way to perform patient-mobilisation tasks. The results from this study further show that no instrument measured all of the important aspects of effective patient mobilisation.

RELEVANCE FOR CLINICAL PRACTICE

Most of the instruments that were reviewed were able to detect differences in patient-mobilisation techniques. However, convincing evidence is lacking with regard to the content, psychometric properties and practicability of these instruments for use in clinical practice. We suggest the development and validation of a new comprehensive instrument.

Adverse risk: a 'dynamic interaction model of patient moving and handling'

AIM

The aim of the present study was to examine patient adverse events associated with sub-optimal patient moving and handling.

BACKGROUND

Few studies have examined the patient's perspective on adverse risk during manual handling episodes.

EVALUATION

A narrative review was undertaken to develop the 'Dynamic Interaction Model of Patient Moving and Handling' in an orthopaedic rehabilitation setting, using peer-reviewed publications published in English between 1992 and 2010.

KEY ISSUES

Five predominant themes emerged from the narrative review: 'patient's need to know about analgesics prior to movement/ambulation'; 'comfort care'; 'mastery of and acceptance of mobility aids/equipment'; 'psychological adjustment to fear of falling'; and 'the need for movement to prevent tissue pressure damage'.

CONCLUSION

Prevalence of discomfort, pain, falls, pressure sores together with a specific Direct Instrument Nursing Observation (DINO) tool enable back care advisers to measure quality of patient manual handling. Evaluation of patients' use of mobility aids together with fear of falling may be important in determining patients' recovery trajectory.

IMPLICATIONS FOR NURSING MANAGEMENT

Clinical governance places a responsibility on nurse managers to consider quality of care for their service users. 'Dynamic Interaction Model of Nurse-Patient Moving and Handling' provides back care advisers, clinical risk managers and occupational health managers with an alternative perspective to clinical risk and occupational risk.

Nursing staff's communication modes in patient transfer before and after an educational intervention

The objective was to explore and describe nursing staff's body awareness and communication in patient transfers and evaluate any changes made after an educational intervention to promote staff competence in guiding patients to move independently. In total, 63 nursing staff from two hospitals wrote weekly notes before and after the intervention. The topics were: A) reflect on a transfer during the last week that you consider was good and one that was poor; B) reflect on how your body felt during a good and a poor transfer. The notes were analysed with content analysis. The results showed five different communication modes connected with nursing staff's physical and verbal communication. These communication modes changed after 1 year to a more verbal communication, focusing on the patient's mobility. The use of instructions indicated a new or different understanding of patient transfer, which may contribute to a development of nursing staff's competence. STATEMENT OF RELEVANCE: The present findings indicate that patient transfer consists of communication. Therefore, verbal and bodily communication can have an integral part of training in patient transfer; furthermore, the educational design of such programmes is important to reach the goal of developing new understanding and enhancing nursing staff's competence in patient transfer.