Rest is Not Always Best: Why Nurses Encourage Patient Activity, Mobility Work

• Rest is a vital part of the healing process, but mobility work is also key to proper recovery. 
• Learn what avenues to take if your patient is resistant to movement or mobility work. 
• Sometimes a lack of knowledge about the importance of movement can be a barrier to patient motivation. 

I don’t know if you have ever been a patient before, but when someone is not feeling well, sometimes it feels better to lay in bed. I know that whether I am a patient in the hospital or sick at home, I don’t particularly like the thought of moving to do anything. Our compassion and empathy as nurses, among other factors, may sometimes lead us to come into an unspoken agreement with our patients. In some ways, coddling them and allowing them to rest for longer than we should. Before I get judged as unempathetic, please hear me out as I explain the importance of activity and mobility during a hospital stay.  

Rest is not always best. 

Why Isn’t Rest Always the Best?

Let’s be clear. Rest is certainly a vital part of the healing process. I will never disagree with that. However, as my grandmother used to say, “Everything in moderation.” A little too much of a good thing is not always the best thing. Studies have shown that immobility has a negative impact on every system of our bodies, which means immobility can lead to psychological, cardiovascular, respiratory, integumentary, musculoskeletal, gastrointestinal, and genitourinary issues. If we think about it, mobility is movement.  

Movement MOVES things: blood, air, bowels, muscles, fluid, etc. Immobile patients are at higher risk for delirium, depression, anxiety, fatigue, urinary discomfort, urinary tract infection, challenges with urinating, deep vein thrombosis, pneumonia, skin breakdown, and more. Other issues include, but are not limited to, what is listed in the table outlined by open evidence-based textbook resources.   

What if My Patient Doesn’t Want to do Mobility Work?

There are several avenues to take when a patient does not want to move. Whatever avenue you take depends on the barrier or root cause of why they do not want to move. Nurses certainly have the option to document “patient refused” for various types of refusals. Depending on how overwhelmed we feel during our shifts, this option seems like the easiest way out. However, before you make that notation, ask the question, “Did I try?”  

I do not like to use the words “persuade” or “convince,” as those words connotate a level of pressuring patients to do something that they may not want to do. So, my other question would be, “How did you encourage your patient to mobilize?” 

One of the keys to encouraging anybody to do anything is to engage with them, give them a sense of regaining control, and bring attention to how it would benefit them. The question with most things in life is, “What’s in it for me?”  

When engaging with the patient, we shouldn’t be the only person in the conversation dictating the plan for the day. Let’s face it. Unless you are someone without a home or have a dangerous living situation, not many people enjoy being in the hospital. They want to go home. Many times, the road toward discharge is the incentive for mobility. But we shouldn’t get in the habit of suggestion. It almost places us in a dictator role and removes some control from our patients, who already might feel out of control. So, instead of saying “Don’t you want to get out of here? If you move, you can get out of here,” you can try, “What are some things you were doing at home that you’re excited to get back to once you leave here?” This can open communication that will potentially encourage the patient to mobilize. 

Sometimes the barrier is lack of knowledge. Among the many roles nurses have, one is the role of teacher. Patient and family teaching is of the utmost importance when encouraging activity and mobility.  

While it’s true that nurses have areas where we document patient and family education in the electronic medical record, how do we know that patients truly understand what we teach them? When patients are ill, it may sometimes feel like nurses just want them to move  a task box can be checked.  

How do we know that patients truly understand the benefits of mobilizing while in the hospital? One way to determine if your patient understands the benefits is to have a moment of teach-back. According to the Agency for Healthcare Research and Quality, the teach-back method is a way of checking understanding by asking patients to state in their own words what they need to know or do about their health. This is not meant to test memory or verbatim regurgitation of what the nurse said. It really is a way to clarify anything that may have been misunderstood. Because the common thought can be that they need rest to heal. Patient teaching with teach-back can provide the opportunity to clarify misconceptions.  

Consider asking this open-ended question during patient teaching: “We’ve gone over a lot of information, and I want to make sure I explained things clearly. So tell me, what do you think are the benefits of activity and mobility during your stay with us?” Once a plan about getting the patient moving is discussed and agreed upon, it is important to follow up. Even if means starting with, “I’ll be back at 9 a.m. to assist you with sitting on the edge of the bed to eat as discussed.” 

What if I Don’t Have Time for Mobility Work With my Patient?

One area where nurses feel the most pressure is getting the patient out of the bed and finding time to ambulate the patient. The first thought is to delegate to the patient care technician, leave the task to the rounding physical therapist, or leave it for the next shift. What if I told you activity and mobility are not always synonymous with ambulation?   

Integrating activity and mobility into your shift is not as regimented as you may think. There really is no need to hurt your head if you cannot schedule time to ambulate your patient or complete active and passive range of motion as we have learned before. When you realize that mobility really is already incorporated in our everyday shift and activities of daily living, it will help you become more intentional about encouraging those activities. Let’s explore what you already do! 

Repositioning 

We know our patients will not always be able to move with full range of motion and may need total assistance. We know that regularly repositioning a sedentary patient in bed can reduce the incidence of pressure injuries. So, I will not preach to the choir. How about elevating legs? Remember that mobility improves circulation in more ways than one. While repositioning can improve blood flow and prevent skin from breaking down, moving other parts of the body can do the same. A lot of times, we think of elevating heels to offload them and prevent heel ulcers. However, are we intentional about elevating lower limbs above the heart when tolerated? Elevating above the level of the heart can improve circulation of blood flow back to the heart, alleviating some stress on the heart. It can also alleviate pooling of blood in the lower limbs that may lead to clots. 

Toileting 

Your patient may request a bedpan. Bedpans are fine for patients who are unable to tolerate sitting up or pivoting with assistance to get to the commode. However, if you assess that the patient is indeed able to sit up and pivot grab a commode. You may think this is no big deal, but consider this. Sitting up leads to better breathing and air exchange. Moving around gets the circulation going which can prevent blood clots. While they are valuable tools for wellness, let’s not solely rely on heparin and compression boots. Aside from the obvious movement of pivoting to a commode, it takes some time to stand and allow the caregiver to help with wiping. The patient may not have walked around the unit today, but they moved! 

Eating a Good Meal 

Again, the way we encourage mobility should always depend on the assessment of our patient’s ability. So, do not get discouraged if the patient is not able to ambulate. If your patient is able to tolerate sitting up in the bed with support of the back of the bed, you can count that as mobility when you prepare them to eat their meals. Even better, if the patient is unable to walk, but can tolerate sitting at the edge of the bed to eat meals or in a chair, that is also mobility.   

Basic Hygiene 

A walk to the bathroom for a shower or even to stand in the mirror to brush teeth is mobility. No worries if your patient is unable to walk. Just swing those legs over and sit the patient on the side of the bed to brush teeth at the bedside table with a basin. Aside from passive range of motion in bed, you can encourage the patient to hold the washcloth and assist with wiping the front of their body, arms and underarms. Get those arms moving! 

Vital Signs 

Instead of pushing your hand between the bed and the back of the patient, you can encourage the patient to sit up while you auscultate the lungs and heart. 

An “Unplanned” Stroll 

Sure, your patient may not have walked around the unit today, but does your patient have to leave the unit for imaging or a quick procedure? Stop the escort at the door and encourage the patient to walk to the stretcher instead of scooting from the bed to the stretcher.   

That is mobility! Do your patients need daily weigh ins? Let’s try encouraging them to walk to the scale instead of using the bed scale.   

The Bottom Line

While rest is certainly healing, balancing it with mobility is critical to positive patient outcomes. It may not always be easy to encourage mobility with your patients, or even to encourage your fellow coworkers to continue to try to mobilize patients. But remember that mobility is already weaved into what you do as a nurse. I wish you all the best! 

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