Moving the Bar: Part 2: Initiating Mobility: Introduction

Introduction

For the minimally mobile patient, the clinician’s actions play a particularly important role. While accomplishing the task at hand, be it draping, positioning, assessing vital signs, or transferring a dependent patient, even the seemingly small aspects of the clinician’s activities can have large effects on the patient’s potential for mobility. The clinician’s abilities to establish rapport with the patient and engage the patient in the task, to create an environment conducive to mobility, and to establish baselines and monitor responses to activities can be powerful influences on the patient’s capacity for mobility.

Attending to the Person: Establishing Rapport

A patient’s behaviors are a function of both the person and the surroundings.¹ As a clinician, you become part of the patient’s environment, and the nature of your interactions has a strong influence on the patient’s behaviors and thus the clinical outcome. Being attentive to and respectful of a patient helps reduce the patient’s anxiety and allows the patient to focus more fully on the mobility task. Consider this: A cold, uncomfortable, or otherwise unpleasant environment is much easier to tolerate if you feel safe and are in the company of kind and respectful people. A beautiful setting, on the other hand, can seem intolerable if you are surrounded by powerful people you feel you cannot trust. It is the clinician’s obligation to create an optimal psychosocial environment for the patient.

When interacting with a patient:

• Listen to the patient’s information, questions, and concerns. Take time to respond, and respond genuinely.

• Be clear about the patient’s goals and how your planned activities fit into those goals.

• Maintain patient confidentiality. Speak about patients respectfully in their presence and absence.

• Be aware of power differentials, intended or otherwise, between you and your patient. Minimize the perceived power differences when possible. Sit down to be at eye level with the patient, use language that is familiar to your patient, avoid patronizing comments or gestures, and so on.

• Implement a caring touch, but respect the patient’s cultural preferences and personal boundaries.

• Explain all procedures to patients before initiating them, even if you think your patient is not cognitively aware enough to understand.

When the clinician makes physical contact—to position the patient or to assist in a dependent lift, for example—the rapport that has been established can determine whether that contact is effective or is resisted by the patient.

Matching your expectations to your patient’s true capabilities also tends to yield better mobility outcomes.² Clinicians must guard against the natural tendency to make assumptions about a patient based on age, education level, or other factors. When your expectations are too high, the patient can become frustrated and give up. Inappropriately low expectations are associated with overprotective behaviors,³ which foster continued or increased dependence.⁴ When patients’ capabilities are congruent with the support ...