Using timed event sequential data in nursing research.

BACKGROUND: Measuring behavior is important in nursing research, and innovative technologies are needed to capture the "real-life" complexity of behaviors and events. PURPOSE: The purpose of this article is to describe the use of timed event sequential data in nursing research and to demonstrate the use of this data in a research study. DISCUSSION: Timed event sequencing allows the researcher to capture the frequency, duration, and sequence of behaviors as they occur in an observation period and to link the behaviors to contextual details. Timed event sequential data can easily be collected with handheld computers, loaded with a software program designed for capturing observations in real time. CONCLUSION: Timed event sequential data add considerable strength to analysis of any nursing behavior of interest, which can enhance understanding and lead to improvement in nursing practice.

Frequency and duration of nursing care related to older patient mobility.

PURPOSE: To evaluate the frequency and duration of nursing care activity related to mobilizing older patients in acute care settings and determining who initiates the mobility event (patient or nurse). METHODS: This was an observation study using time and motion. Observers shadowed 15 registered nurses (RNs) each for two to three 8-hr periods using hand-held computer tablets to collect data on frequency and duration of six mobility events (standing, transferring, walking to and from the patient bathroom, walking in the patient room, and walking in the hallway) that occurred in the nurse's presence. Chart reviews were conducted on 47 adult patients (> 65 years of age) who were cared for by the nurses during the observation periods. Descriptive statistics (mean, median, standard deviation, frequency, and proportion) were used to describe the occurrence of mobility events among all 47 patients and among a subgroup of 16 patients identified as dependent (needing human assistance of another to ambulate) at the time of admission. RESULTS: Thirty-two percent of older patients were not engaged by an RN in any mobility event during an 8-hr period. For all patients, standing and transferring were the most frequent mobility activity. Mean duration for ambulation was less than 2 min per observation period. Patients who were dependent had fewer mobility events with no events related to ambulation initiated by nurses. The majority of mobility events were initiated by patients. CONCLUSIONS: Nurses infrequently initiated mobility events for hospitalized older patients and most often engaged patients in low-level activity (standing and transferring). CLINICAL RELEVANCE: Limited mobility (standing and transferring only) is an independent predictor of negative outcomes for hospitalized older patients. Nurses are in a key position to improve outcomes for hospitalized older patients by engaging them in mobility activity, particularly ambulation, but further research is needed to determine how best to engage nurses in these activities.

Use of Simulation in Multimodal Researcher Training for Observational Studies.

STATEMENT: Researchers employing observational studies need to develop a coding scheme that is robust enough to measure behaviors of interest adequately. However, the more intricate the coding scheme, the more difficult it is for observers to code correctly and consistently. The purpose of this article is to describe the use of a simulation suite in a multimodal training approach to accommodate a complex coding structure and achieve observer agreement. The observer training included explanation of codes and technology, coding of simulation video, and observer-trainer hospital practice. The simulation video consisted of hypothetical nurse-patient scenarios filmed in a simulation suite that mimicked the hospital setting. Researchers should consider using simulation suites in their training programs to achieve observer agreement in observational studies of complex behaviors in the ever-changing clinical environment.

Attributing the responsibility for ambulating patients: a qualitative study.

BACKGROUND: Functional decline has been identified as a leading negative outcome of hospitalization for older person. Functional decline is defined as a loss in ability to perform activities of daily living including a loss of independent ambulation. In the hospital literature, a patient's loss in ability to independently ambulate during the hospital stay varies between 15 and 59%. Lack of ambulation and deconditioning effects of bed rest are one of the most predictable causes of loss of independent ambulation in hospitalized older persons. Nurses have been identified as the professional most capable of promoting walking independence in the hospital setting. However, nurses do not routinely walk patients. OBJECTIVE: The purpose of this study was to explore the relationship between nurses' attributions of responsibility for ambulating hospitalized patients and their decisions about whether to ambulate. METHODS: A descriptive, secondary analysis of data gathered for a parent study was conducted. Grounded dimensional analysis was used to analyze the data. Participants consisted of 25 registered nurses employed on medical or surgical units from two urban hospitals in the United States. RESULTS: Nurses fell into two groups: those who claimed ambulation of patients within their responsibility of practice and those who attributed the responsibility to another discipline. Nurses who claimed responsibility for ambulation focused on patient independence and psychosocial well-being. This resulted in actions related to collaborating with physical therapy, determining the appropriateness of activity orders, diminishing the risk and adjusting to resource availability. Nurses who attributed the responsibility deferred decisions about initiating ambulation to either physical therapy or medicine. This resulted in actions related to waiting, which involved, waiting for physical therapy clearance, physician orders, risks to decrease, and resources to improve before ambulating. CONCLUSIONS: Nurses who claimed responsibility for ambulating patients within their domain of practice described actions that promoted patient independent function and were more likely to get patient s up to ambulate.

How nurses decide to ambulate hospitalized older adults: development of a conceptual model.

Adults over the age of 65 years account for 60% of all hospital admissions and experience consequential negative outcomes directly related to hospitalization. Negative outcomes include falls, delirium, loss in ability to perform basic activities of daily living, and new walking dependence. New walking dependence, defined as the loss in ability to walk independently, occurs in 16%--59% of hospitalized older patients. Nurses are pivotal in promoting functional walking independence in hospitalized patients. However, little is known about how nurses make decisions about whether, when, and how to ambulate older patients. A qualitative study using grounded dimensional analysis was conducted to further explore how nurses make decisions about ambulating hospitalized older adults. Twenty-five registered nurses participated in in-depth interviews lasting 30--60 min. Open, axial, and selective coding was used during the analysis. A conceptual model, which is grounded in how nurses experience ambulating patients, was developed. Multiple categories and dimensions interact and produce an action by the nurse to either restrict mobilization to the level of the bed or progress the patient to ambulation in the hallway. Factors that seemed to have a greater impact on nurses' decisions on whether, when, and how to ambulate were the risk/opportunity assessment, preventing complications, and the presence of a unit expectation to ambulate patients.