Health Care Professionals' Decision Making Related to Mobility and Safety for People in the Hospital: A Scoping Review

OBJECTIVE

Mobility dysfunction can have an impact on safety, and this fact is particularly relevant to hospital settings. There are no clear standards for how health care professionals should approach the aim to encourage mobility without compromising safety. The objective of this scoping review was to identify factors that shape health care professionals' decision making for people in hospitals, in situations in which mobility and safety are taken into consideration.

METHODS

For this scoping review, 4 databases (Medline, CINAHL, PubMed, and Scopus) were searched. Terms previously agreed upon were used to identify peer-reviewed articles related to decision making by health care professionals in hospital settings (acute and rehabilitation), in which safety and mobility were factors for consideration. An initial screening of titles and abstracts was conducted by a single reviewer. Two reviewers independently screened the full texts of the remaining articles. The key findings of the articles were synthesized to determine common themes.

RESULTS

After 10,717 articles were screened, 28 met the inclusion criteria. Ten themes influencing decision making were identified: Clinical factors assessed; health care professional experience; limited use of standardized tests; impact of institutional governance; risk/benefit trade-off; capacity for decision making; role of the multidisciplinary team; families and others; communication; and fear of negative outcomes.

CONCLUSION

A wide range of factors influence health care professionals' decision making. The decisions can be complex, and individual priorities may vary in the balancing of safety with promotion of independence. Health care professionals rely on experience, clinical judgment, and shared decision making.

IMPACT

This review brings attention to many factors that contribute to decision making when mobility and safety are the factors. Health care professionals should include patients' values and monitor the impact of their personal preferences on this process.

Occupational therapy practice in acute physical hospital settings: Evidence from a scoping review

BACKGROUND/AIM

Increased accountability and growing fiscal limitations in global health care continue to challenge how occupational therapy practices are undertaken. Little is known about how these changes affect current practice in acute hospital settings. This article reviews the relevant literature to further understanding of occupational therapy practice in acute physical hospital settings.

METHOD

A scoping review of five electronic databases was completed using the keywords Occupational therapy, acute hospital settings/acute physical hospital settings, acute care setting/acute care hospital setting, general medicine/general medical wards, occupational therapy service provision/teaching hospitals/tertiary care hospitals. Criteria were applied to determine suitability for inclusion and the articles were analysed to uncover key themes.

RESULTS

In total 34 publications were included in the review. Analysis of the publications revealed four themes: (1) Comparisons between the practice of novice and experienced occupational therapists in acute care (2) Occupational therapists and the discharge planning process (3) Role of occupation in the acute care setting and (4) Personal skills needed and organisation factors affecting acute care practice.

CONCLUSION

The current literature has highlighted the challenges occupational therapists face in practicing within an acute setting. Findings from this review enhance understanding of how occupational therapy department managers and educators can best support staff that practise in acute hospital settings.

Enacting Fall Prevention in Community Outreach Care

Despite increased international concern about fall prevention throughout the past 20 years, only limited attention has been paid to the experiences and perspectives of health care providers who deliver fall prevention programs. The purpose of this interpretive phenomenological study was to explore the meaning of the experience of enacting fall prevention, through individual semistructured interviews, among 6 members of an interprofessional geriatric outreach team in Ontario, Canada. Findings suggest that enacting careful practice was essential to the experience of enacting fall prevention, represented by four interrelated phenomenological themes: caring fully for older clients, carefully seeing older clients in their life contexts, enacting therapeutic relationships, and experiential learning in interprofessional teams. We discuss findings in relation to literature on emotional labor, leading to suggestions for the policy and practice of fall prevention.

Risk Assessment: Enabler or Barrier?

Are occupational therapists using risk assessment to its fullest potential? Taking part in activities of daily living can introduce significant risk for someone overcoming disabilities and risk assessment is regularly utilised to confirm where harm is liable to occur. In this opinion piece, risk assessment is promoted as a valuable addition to the therapist's ‘toolbox’ — allowing, rather than hindering, occupational therapy practice. In offering therapists the opportunity to engage creatively in finding novel solutions to problems, risk assessment can, in fact, avoid a focus on what cannot be done in favour of what can be done with greater certainty, accountability and transparency.