Objectives: Hospital Acquired Deconditioning is increasingly recognized as a major cause of functional decline, falls, frailty, institutionalisation and mortality. Immobility due to illness can be exacerbated due to practices and structures within hospitals. Physiotherapists often play a key role in addressing the problem of deconditioning in hospitals. The aim of this study was to explore the barriers to walking, as perceived by patients, nursing and Health Care Assistant (HCA) staff on acute medical wards.
Methods: Semi-Structured questionnaire based interviews, each lasting approximately 15 minutes, were carried out by 4 physiotherapists with 20 current medical inpatients, 20 former medical inpatients and 20 staff members, to gain a subjective account of perceived barriers to walking during a medical admission. Purposeful sampling was undertaken, with patients selected based on eligibility criteria (age, length of stay and cognition level). Nurses and HCA’s who were available on the days of interview were asked to participate. Rich data was obtained by allowing open questions and offering participants the opportunity to expand on their views where appropriate. Thematic analysis of the data was undertaken. Emerging themes were identified and coded.
Results: Post-analysis the following themes emerged:
All staff identified falls risk as a barrier to patients walking; they expressed concern regarding the consequences of falling for both the patient and staff. Consequences for staff included possible legal implications, increased paperwork and poor reflection on the individual staff member. In contrast, only a quarter of the patients expressed concern regarding falling.
Clinical factors or medical symptoms were observed as a barrier by all groups.
Time constraints was a dominant theme across all groups. Staff reported that they were too busy but perceived a role for family involvement. Patients were reluctant to ask busy staff to help them to walk and were unsure whose role it was. Patients also expressed a reluctance to ask family for help; “wouldn’t want to be putting that on them – I couldn’t expect it”. Busy mornings were noted to be specifically unsuitable for mobilising while afternoons were deemed more conducive to ambulation.
Environmental factors were seen as a deterrent among all groups. These included cluttered and crowded wards and corridors, shiny floors and unsuitable toilet areas.
Most patients expressed that they were motivated to walk but they reported a lack of encouragement from staff. Only 25% of patients reported that their doctors encouraged or instructed them to walk. Some patients also expressed the need/wish to conform to expected behaviours while in hospital and were therefore unsure if they were allowed to walk; “always feel you’re in the way or doing something you shouldn’t be doing”.
Conclusion: This study identified that patients and staff perceive some common barriers to walking while in hospital. However the conflicting perspectives on falls risk, the lack of clarity on roles and lack of guidance and encouragement from staff highlight areas where current practice may be contributing to deconditioning. It provides valuable insight from the perspectives of patients and staff to inform how the problem of deconditioning may be addressed.
Ethical Approval
Ethical approval was granted by the ethics committee at Mayo University Hospital.
